What's happening
This bill prohibits insurers from charging higher copays or coinsurance for physical or occupational therapy than for primary care office visits for similar conditions.
Why it matters
Reduces out-of-pocket costs for patients. By limiting copays and coinsurance for physical and occupational therapy to the same amounts charged for primary care visits, this bill directly lowers financial barriers that might prevent people from accessing necessary rehabilitation services.
Promotes equal access to therapy services. The bill addresses a common insurance practice where physical and occupational therapies are subject to higher cost-sharing than comparable medical services, which can discourage ongoing care and lead to poorer health outcomes.
Helps patients with chronic or recurring conditions. Many people need repeated therapy visits for injuries or long-term conditions. Equalizing copays makes it more feasible for patients to complete their prescribed course of therapy, potentially speeding recovery and preventing complications.
Encourages treatment decisions based on medical need, not cost. By removing the financial incentive to choose primary care over therapy (or to skip therapy altogether), the bill supports clinical decision-making that prioritizes what is best for the patient’s health.
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Who cares
Headline styles
Limit Therapy Copays
Plain English, a few words. Used as the page title.
Sponsors
18 Co-sponsors
48 Multi-sponsors
- Peter Abbate
- Thomas Abinanti
- Carmen E. Arroyo
- Michael Benedetto
- Edward Braunstein
- Anthony Brindisi
- William Colton
- Marcos Crespo
- Clifford Crouch
- Michael Cusick
- Steven Cymbrowitz
- Jeffrey Dinowitz
- Steven Englebright
- Sandy Galef
- Andrew R. Garbarino
- Joseph Giglio
- Richard Gottfried
- Aileen Gunther
- Stephen Hawley
- Andrew Hevesi
- Earlene Hooper
- Ellen C. Jaffee
- Joseph Lentol
- Barbara Lifton
- Donna Lupardo
- William Magee
- William Magnarelli
- John T. McDonald III
- David McDonough
- Walter T. Mosley
- Steven Otis
- Philip Palmesano
- Amy Paulin
- Crystal Peoples-Stokes
- N. Nick Perry
- J. Gary Pretlow
- Dan Quart
- Andrew Raia
- Philip Ramos
- Linda Rosenthal
- Luis R. Sepúlveda
- Jo Anne Simon
- Dan Stec
- Albert A. Stirpe
- Fred Thiele
- Raymond Walter
- Carrie Woerner
- Kenneth Zebrowski
History
- Referred to insurance
- Print number 569a
- Amend and recommit to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Cap Copays for Therapy
In Senate Committee · Insurance · Sponsor John A. DeFrancisco
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
569--A
2017-2018 Regular Sessions
IN ASSEMBLY
January 9, 2017
Introduced by M. of A. CAHILL, SKOUFIS, BLANKENBUSH, RIVERA, FAHY, BARRETT, WEPRIN, TITONE, BRABENEC, MURRAY, SANTABARBARA, LALOR, MOYA, HUNTER, CASTORINA, MALLIOTAKIS -- Multi-Sponsored by -- M. of A. ABBATE, ABINANTI, ARROYO, BENEDETTO, BRAUNSTEIN,… Show allHide
Introduced by M. of A. CAHILL, SKOUFIS, BLANKENBUSH, RIVERA, FAHY, BARRETT, WEPRIN, TITONE, BRABENEC, MURRAY, SANTABARBARA, LALOR, MOYA, HUNTER, CASTORINA, MALLIOTAKIS -- Multi-Sponsored by -- M. of A. ABBATE, ABINANTI, ARROYO, BENEDETTO, BRAUNSTEIN, BRINDISI, COLTON, CRESPO, CROUCH, CUSICK, CYMBROWITZ, DINOWITZ, ENGLEBRIGHT, FARRELL, GALEF, GARBARINO, GIGLIO, GOTTFRIED, GRAF, GUNTHER, HAWLEY, HEVESI, HOOPER, JAFFEE, JENNE, KAVANAGH, LENTOL, LIFTON, LOPEZ, LUPARDO, LUPI- NACCI, MAGEE, MAGNARELLI, McDONALD, McDONOUGH, McKEVITT, McLAUGHLIN, MOSLEY, OTIS, PAULIN, PEOPLES-STOKES, PERRY, PRETLOW, QUART, RAIA, RAMOS, ROSENTHAL, SEPULVEDA, SIMANOWITZ, SIMON, STEC, STECK, STIRPE, THIELE, WALTER, WOERNER, ZEBROWSKI -- read once and referred to the Committee on Insurance -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to physical therapy services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 23 of subsection (i) of section 3216 of the insurance law, as added by chapter 593 of the laws of 2000, is amended to read as follows:
(23) If a policy provides for reimbursement for physical and occupational therapy service which is within the lawful scope of practice of a duly licensed physical or occupational therapist, an insured shall be entitled to reimbursement for such service whether the said service is performed by a physician or through a duly licensed physical or occupational therapist, provided however, that nothing contained herein shall be construed to impair any terms of such policy including appropriate utilization review and the requirement that said service be performed pursuant to a medical order, or a similar or related service of a physician. An insurer shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01314-03-7
A. 569--A 2
a physical therapist licensed under article one hundred thirty-six of the education law or an occupational therapist licensed under article one hundred fifty-six of the education law that is greater than the copayment or coinsurance amount imposed on the insured for services provided to the insured for an office visit for the service of a licensed primary care physician or osteopath for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
§ 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235 of the insurance law is amended by adding a new clause (iii) to read as follows:
(iii) a policy shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by a physical therapist licensed under article one hundred thirty-six of the education law or an occupational therapist licensed under article one hundred fifty-six of the education law that is greater than the copayment or coinsurance amount imposed on the insured for services provided to the insured for an office visit for the service of a licensed primary care physician or osteopath for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
§ 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235 of the insurance law, as amended by chapter 593 of the laws of 2000, is amended to read as follows:
(A) any physical and occupational therapy service which is within the lawful scope of practice of a licensed physical and occupational therapist, a subscriber to such policy shall be entitled to reimbursement for such service, whether the said service is performed by a physician or licensed physical and occupational therapist pursuant to prescription or referral by a physician. A policy shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by a physical therapist licensed under article one hundred thirty-six of the education law or an occupational therapist licensed under article one hundred fifty-six of the education law that is greater than the copayment or coinsurance amount imposed on the insured for services provided to the insured for an office visit for the service of a licensed primary care physician or osteopath for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided;
§ 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301 of the insurance law, as amended by chapter 593 of the laws of 2000, is amended to read as follows:
(G) physical and occupational therapy care provided through licensed physical and occupational therapists upon the prescription of a physician, provided, however, that no copayment or coinsurance amount charged to the insured for services rendered for each date of service by a physical therapist licensed under article one hundred thirty-six of the education law or an occupational therapist licensed under article one hundred fifty-six of the education law is greater than the copayment or coinsurance amount imposed on the insured for services provided to the insured for an office visit for the service of a licensed primary care physician or osteopath for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided,
A. 569--A 3
§ 5. Paragraph 13 of subsection (b) of section 4322 of the insurance law, as added by chapter 504 of the laws of 1995, is amended to read as follows:
(13) Outpatient physical therapy up to ninety visits per condition per calendar year, provided, however, that no copayment or coinsurance amount charged to the insured for services rendered for each date of service by a physical therapist licensed under article one hundred thirty-six of the education law or an occupational therapist licensed under article one hundred fifty-six of the education law is greater than the copayment or coinsurance amount imposed on the insured for services provided to the insured for an office visit for the service of a licensed primary care physician or osteopath for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
§ 6. This act shall take effect on the one hundred eightieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.