An Act to amend the insurance law, in relation to physical therapy services [S28-A (Defrancisco) / A1063-A(Cahill)]
Assembly Cosponsors (73): Skoufis, Blankenbush, Schimel, Rivera, Fahy, Barrett, Weprin, Titone, Brabenec, Murray, Tedisco, Abbate, Abinanti, Arroyo, Benedetto, Braunstein, Brennan, Brindisi, Ceretto, Colton, Corwin, Crespo, Crouch, Cusick, Cymbrowitz, Dinowitz, Englebright, Farrell, Galef, Garbarino, Giglio, Gottfried, Graf, Gunther, Hawley, Hevesi, Hooper, Jaffee, Kavanagh, Lavine, Lawrence, Lentol, Lifton, Lupardo, Lupinacci, Magee, Magnarelli, Markey, McDonald, McDonough, McKevitt, McLaughlin, Mosley, Otis, Paulin, Peoples-Stokes, Perry, Pretlow, Quart, Raia, Ramos, Rosenthal, Russell, Saladino, Simanowitz, Stec, Steck, Stirpe, Tenney, Thiele, Woerner, Wright, Zebrowski
Senate Cosponsors (19):ADDABBO, AMEDORE, AVELLA, BONACIC, BOYLE, BRESLIN, CARLUCCI, ESPAILLAT, GOLDEN, LATIMER, MARCHIONE, MARTINS, NOZZOLIO, PANEPINTO, PARKER, RANZENHOFER, RITCHIE, VALESKY, YOUNG
-Physical therapy is an integral part of health care and an essential health benefit under the Affordable Care Act.
-Health insurance imposed co-pays are currently unlimited, often equal to or exceedingthe actual cost of the treatment, and have put necessary physician-prescribed treatment out of the reach of many New Yorkers already paying ever-increasing insurance premiums.
-Health plans have shifted the vast majority of the cost of physical therapy services by imposing high “specialist” copayments on consumers. This category is generally reserved for higher-cost services such as care by neurologists, cardiologists, and neurosurgeons.
-This is particularly misleading to the patient who expects that the physical therapist is being reimbursed by the insurance company in addition to their copayment.
-The real problem is high co-pays are limiting access to necessary physical therapy care, resulting in unnecessary surgery, epidural injections and expensive imaging studies.
-A 2012 study demonstrated that earlier physical therapy leads to better outcomes. In 32,070 patients who were newly consulting a primary care physician for low back pain found that those who were referred to a physical therapist early (within 14 days of consultation) showed a reduced risk of subsequent health care utilization including decreased utilization of advanced imaging, surgery, additional physician visits, injections and opioid medications and lower overall health care costs than did those patients with delayed treatment by a physical therapist.[1] According to the study, total health care costs for patients receiving early care from a physical therapist were on average $2,736.23 lower per episode of care.
-New studies are proving that physical therapy is equally or more effective than surgery for managing certain conditions including knee pain and back pain.
-An NYPTA poll conducted in 2010, found that 71% of New Yorkers would be more likely to receive all necessary physical therapy care if insurance co-pays were lower. As a result, many patients forego treatment as they cannot afford it. They may then need higher more expensive levels of care for something that could have been managed conservatively for a fraction of the cost. In some situations such as back surgeries, joint replacements or other orthopedic, patients can’t afford the physical therapy co-pays after their procedures and choose to forego care, which then delays recovery or results in failure to benefit from the surgical intervention.
-Purpose: S.28/A.1063 Limits co-payments for physical therapy to no more than 20% of the reimbursement to the provider of care. (i.e. $50 visit = $10 copay). The 20% limitation will still allow insurance companies to impose co-pays to decrease overutilization but will protect patients from these cost shifting practices. 20% is also consistent with Medicare coverage.
The Bill has been referred to Senate and Assembly Insurance Committees
ASSEMBLY Insurance Committee (Kevin Cahill is the Chair and is the sponsor of the bill).
Check to see if your assemblyperson is a member of the Insurance committee.
-If they are a member please ask them to co-sponsor
-If they are a member and are already co-sponsoring please urge them to help the bill get to a vote within the committee
SENATE Insurance Committee(Senator James Seward is the Chair).
Check to see if your senator is a member of the insurance committee
-If they are a member please ask them to co-sponsor
-If they are a member and are already co-sponsoring please urge them to help the bill get to a vote within the committee
[1] Fritz et. al. Primary Care Referral of Patients with Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and CostsSpine Dec. 1, 2012, 37(25), 2114-21.