What's happening
This bill requires health insurance policies to provide equal coverage and reimbursement for podiatric care as for other medical professionals.
Why it matters
Ensures insurance equality for podiatric care. , meaning that patients who need foot and ankle treatment from a licensed podiatrist will have the same insurance coverage and reimbursement as if they had seen other medical professionals for the same condition. This could reduce out-of-pocket costs and barriers to accessing podiatric care.
Prevents insurance plans from imposing stricter or discriminatory limits. (such as higher co-pays, lower benefit caps, or more restrictive utilization reviews) on podiatric services compared to similar services by other healthcare providers. This directly addresses potential insurance practices that single out podiatry for less favorable treatment.
Clarifies that podiatrists must be recognized for hospital-based care. under insurance policies, supporting their ability to work as staff or employees in hospital settings and ensuring their services are covered in the same way as those of other licensed doctors.
Could affect premiums and provider networks. by potentially increasing utilization of podiatric services, but also has the potential to improve health outcomes by making specialized foot and ankle care more accessible and affordable for patients.
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Who cares
Licensed podiatrists
The bill would require equal reimbursement for covered services performed by physicians or podiatrists and bar discriminatory coverage restrictions on podiatric care.
Patients with podiatric coverage
The bill would require deductibles, copayments, coinsurance, benefit limits and utilization review for podiatric care to match those for other professionals treating the same or similar conditions.
Accident and health insurers and health service corporations
The bill would require covered policies and contracts to apply nondiscriminatory cost-sharing, limits and review standards to podiatric care.
Hospitals employing podiatrists
The bill would specify that the new provisions do not impede podiatrists from providing covered care within their lawful scope in hospitals as staff or employees.
Headline styles
Expand Podiatry Insurance Coverage
Plain English, a few words. Used as the page title.
Sponsors
4 Multi-sponsors
History
- Referred to insurance
- Referred to insurance
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3997
2019-2020 Regular Sessions
IN ASSEMBLY
January 31, 2019
Introduced by M. of A. WEPRIN -- Multi-Sponsored by -- M. of A. COLTON, GALEF, GUNTHER, PERRY -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to coverage and benefits of accident and health insurance policies for podiatric care
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph 2 of subsection (i) of section 3216 of the insurance law is amended to read as follows:
(2) If a policy provides for reimbursement for any podiatrical service within the lawful scope of practice of a licensed podiatrist, the insured shall be entitled to the same reimbursement for such service whether it is performed by a physician or licensed podiatrist.
§ 2. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 22 to read as follows:
(22) Every policy which provides coverage for podiatric care, as defined in section seven thousand one of the education law, provided by a doctor of podiatry licensed pursuant to article one hundred forty-one of the education law, may be subject to reasonable deductible, co-payment and co-insurance amounts, reasonable fee or benefit limits and reasonable utilization review, provided that any such amounts, limits and review: (A) shall not function to direct treatment in a manner discriminative against podiatric care; and (B) individually and collectively shall be no different than those applicable under that same policy to care or services provided by other health professionals in the diagnosis, treatment and management of the same or similar conditions, disorders or injuries. Nothing in this paragraph shall be construed as impeding or preventing either the provision or coverage of podiatric care and services by duly licensed doctors of podiatry within the lawful scope of podiatric care in hospital facilities on a staff or employee basis.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07388-01-9
A. 3997 2
§ 3. Section 4303 of the insurance law is amended by adding a new subsection (ss) to read as follows:
(ss) Every contract issued by a health service corporation or a medical expense indemnity corporation that includes coverage for physician services in a physician's office, that provides major medical or similar comprehensive-type coverage, and coverage for podiatric care as defined in section seven thousand one of the education law, provided by a doctor of podiatry licensed pursuant to article one hundred forty-one of the education law, may be subject to reasonable deductible, co-payment and co-insurance amounts, reasonable fee or benefit limits and reasonable utilization review, provided that any such amounts, limits and review: (1) shall not function to direct treatment in a manner discriminative against podiatric care; and (2) individually and collectively shall be no different than those applicable under the same policy to care or services provided by other health professionals in the diagnosis, treatment and management of the same or similar conditions, disorders or injuries. Nothing in this subsection shall be construed as impeding or preventing either the provisions or coverage of podiatric care and services by duly licensed doctors of podiatry within the lawful scope of podiatric care in hospital facilities on a staff or employee basis.
§ 4. This act shall take effect on the first of January next succeeding the date on which it shall have become a law and shall apply to policies and contracts issued, renewed, modified, altered or amended on or after such effective date.
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.