STATE OF NEW YORK ________________________________________________________________________ 6484 2025-2026 Regular Sessions IN ASSEMBLY March 5, 2025 ___________ Introduced by M. of A. WEPRIN -- 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 Assem- bly, do enact as follows: 1 Section 1. Paragraph 23 of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 593 of the laws of 2000, is amended 3 to read as follows: 4 (23) If a policy provides for reimbursement for physical and occupa- 5 tional therapy service which is within the lawful scope of practice of a 6 duly licensed physical or occupational therapist, an insured shall be 7 entitled to reimbursement for such service whether the said service is 8 performed by a physician or through a duly licensed physical or occupa- 9 tional therapist, provided however, that nothing contained herein shall 10 be construed to impair any terms of such policy including appropriate 11 utilization review and the requirement that said service be performed 12 pursuant to a medical order, or a similar or related service of a physi- 13 cian. An insurer shall not impose a copayment or coinsurance amount 14 charged to the insured for services rendered for each date of service by 15 a physical therapist licensed under article one hundred thirty-six of 16 the education law or an occupational therapist licensed under article 17 one hundred fifty-six of the education law that is greater than the 18 copayment or coinsurance amount imposed on the insured for services 19 provided to the insured for an office visit for the service of a 20 licensed primary care physician or osteopath for the same or a similar 21 diagnosed condition even if a different nomenclature is used to describe 22 the condition for which the services are provided. 23 § 2. Subparagraph (A) of paragraph 1 of subsection (f) of section 4235 24 of the insurance law is amended by adding a new clause (iii) to read as 25 follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09380-01-5
A. 6484 2 1 (iii) a policy shall not impose a copayment or coinsurance amount 2 charged to the insured for services rendered for each date of service by 3 a physical therapist licensed under article one hundred thirty-six of 4 the education law or an occupational therapist licensed under article 5 one hundred fifty-six of the education law that is greater than the 6 copayment or coinsurance amount imposed on the insured for services 7 provided to the insured for an office visit for the service of a 8 licensed primary care physician or osteopath for the same or a similar 9 diagnosed condition even if a different nomenclature is used to describe 10 the condition for which the services are provided. 11 § 3. Subparagraph (A) of paragraph 4 of subsection (f) of section 4235 12 of the insurance law, as amended by chapter 593 of the laws of 2000, is 13 amended to read as follows: 14 (A) any physical and occupational therapy service which is within the 15 lawful scope of practice of a licensed physical and occupational thera- 16 pist, a subscriber to such policy shall be entitled to reimbursement for 17 such service, whether the said service is performed by a physician or 18 licensed physical and occupational therapist pursuant to prescription or 19 referral by a physician. A policy shall not impose a copayment or coin- 20 surance amount charged to the insured for services rendered for each 21 date of service by a physical therapist licensed under article one 22 hundred thirty-six of the education law or an occupational therapist 23 licensed under article one hundred fifty-six of the education law that 24 is greater than the copayment or coinsurance amount imposed on the 25 insured for services provided to the insured for an office visit for the 26 service of a licensed primary care physician or osteopath for the same 27 or a similar diagnosed condition even if a different nomenclature is 28 used to describe the condition for which the services are provided; 29 § 4. Subparagraph (G) of paragraph 1 of subsection (b) of section 4301 30 of the insurance law, as amended by chapter 593 of the laws of 2000, is 31 amended to read as follows: 32 (G) physical and occupational therapy care provided through licensed 33 physical and occupational therapists upon the prescription of a physi- 34 cian, provided, however, that no copayment or coinsurance amount charged 35 to the insured for services rendered for each date of service by a phys- 36 ical therapist licensed under article one hundred thirty-six of the 37 education law or an occupational therapist licensed under article one 38 hundred fifty-six of the education law is greater than the copayment or 39 coinsurance amount imposed on the insured for services provided to the 40 insured for an office visit for the service of a licensed primary care 41 physician or osteopath for the same or a similar diagnosed condition 42 even if a different nomenclature is used to describe the condition for 43 which the services are provided, 44 § 5. Paragraph 13 of subsection (b) of section 4322 of the insurance 45 law, as added by chapter 504 of the laws of 1995, is amended to read as 46 follows: 47 (13) Outpatient physical therapy up to ninety visits per condition per 48 calendar year, provided, however, that no copayment or coinsurance 49 amount charged to the insured for services rendered for each date of 50 service by a physical therapist licensed under article one hundred thir- 51 ty-six of the education law or an occupational therapist licensed under 52 article one hundred fifty-six of the education law is greater than the 53 copayment or coinsurance amount imposed on the insured for services 54 provided to the insured for an office visit for the service of a 55 licensed primary care physician or osteopath for the same or a similar
A. 6484 3 1 diagnosed condition even if a different nomenclature is used to describe 2 the condition for which the services are provided. 3 § 6. This act shall take effect on the one hundred eightieth day after 4 it shall have become a law.