Relates to copayment and coinsurance charged for physical and occupational therapy services

Showing the cosponsors who are on Agora, A to Z. The official record may list more.

• Democratic14
• Republican6

This bill has cosponsors from more than one party.

Shown in neutral colors by design; Agora is non-partisan.

◆ The sponsor's argument

Why Jamaal Bailey says this is needed

This bill will protect consumers by prohibiting plans from inappropri- ately shifting the cost of physical therapy care to consumers by limit- ing copayments to no more than 20 percent of the total reimbursement to the provider of care. Under existing law, health plans must cover phys- ical therapy services. Despite that requirement, health plans have shifted the vast majority of the cost of physical therapy services by imposing increasingly high co-payments on consumers. Under certain health plans, co-payments for physical therapy services have exceeded the reimbursement paid by the plan to the provider of care. This cost shift has imposed a financial burden on consumers, and it has restricted access to physical therapy services. Consumers frequently cannot afford the cost imposed by these copayments for medically necessary physical therapy care. physical therapy services generally require multiple visits over the healing process. A co-payment of $50 for a physical therapy plan of care of 3 times a week for a month will cost the consum- er $600 in out-of-pocket expenses which is beyond the means of many consumers. As a result, New Yorkers are forgoing medically necessary care running the risk of worsening the underlying condition or risking re-injury. This bill would reestablish the obligation of health plans to cover the expense of physical therapy services by limiting co-payments to no more than 20 percent of the total reimbursement to the provider of care. The 20 percent limitation will allow plans to require co-payments that discourage inappropriate care but will prohibit plans from inappropri- ately splitting the cost of physical therapy care to consumers.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.