What's happening
This bill prohibits insurers from charging higher copayments or coinsurance for physical or occupational therapy than for primary care visits.
Why it matters
Reduces financial barriers for patients needing physical or occupational therapy. by ensuring that their out-of-pocket costs are no greater than those for primary care, making these therapies more accessible for people with injuries, chronic conditions, or disabilities.
Addresses insurance plan disparities. where patients currently may face higher copays or coinsurance for therapy services than for primary care, potentially discouraging necessary rehabilitation or maintenance therapy.
May improve health outcomes and rehabilitation adherence. since patients are less likely to skip or delay therapy sessions due to cost, leading to better recovery and management of long-term conditions.
Creates parity between different types of essential healthcare services. , signaling that physical and occupational therapy are as vital to overall health as primary care, and could influence broader insurance practices regarding specialty care coverage.
Albany, before your first meeting.
Every bill that moved yesterday, summarized in a sentence and ranked by impact. The Albany Scorecard follows on Sundays.
Free. Unsubscribe in one click. Want alerts on specific bills? Create an account.
Who cares
Headline styles
Limit Therapy Copays
Plain English, a few words. Used as the page title.
Sponsors
17 Co-sponsors
42 Multi-sponsors
- Peter Abbate
- Thomas Abinanti
- Carmen E. Arroyo
- Michael Benedetto
- Edward Braunstein
- 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
- Ellen C. Jaffee
- Joseph Lentol
- Barbara Lifton
- Donna Lupardo
- William Magnarelli
- 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
- Jo Anne Simon
- Dan Stec
- Albert A. Stirpe
- Fred Thiele
- Carrie Woerner
- Kenneth Zebrowski
History
- Referred 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.
Limit Therapy Copays
In Senate Committee · Insurance · Sponsor Neil D. Breslin
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
405
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. CAHILL, BARRETT, BLANKENBUSH, DiPIETRO, FAHY, HUNTER, MALLIOTAKIS, B. MILLER, RIVERA, SANTABARBARA, STECK, WEPRIN -- Multi-Sponsored by -- M. of A. ABBATE, ABINANTI, ARROYO, BENEDETTO, BRAUNSTEIN, COLTON, CRESPO, CROUCH, CUSICK,… Show allHide
Introduced by M. of A. CAHILL, BARRETT, BLANKENBUSH, DiPIETRO, FAHY, HUNTER, MALLIOTAKIS, B. MILLER, RIVERA, SANTABARBARA, STECK, WEPRIN -- Multi-Sponsored by -- M. of A. ABBATE, ABINANTI, ARROYO, BENEDETTO, BRAUNSTEIN, COLTON, CRESPO, CROUCH, CUSICK, CYMBROWITZ, DINOWITZ, ENGLEBRIGHT, GALEF, GARBARINO, GIGLIO, GOTTFRIED, GUNTHER, HAWLEY, HEVESI, JAFFEE, LENTOL, LIFTON, LUPARDO, MAGNARELLI, McDONOUGH, MOSLEY, OTIS, PALMESANO, PAULIN, PEOPLES-STOKES, PERRY, PRETLOW, QUART, RAIA, RAMOS, L. ROSENTHAL, SIMON, STEC, STIRPE, THIELE, WOER- NER, ZEBROWSKI -- read once and referred to the Committee on Insurance
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 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01964-01-9
A. 405 2
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,
§ 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
A. 405 3
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.