Limits co-payments for physical and occupational therapy services.
Summary
S01198 would amend several provisions of New York insurance law to cap co-payments for physical therapy and occupational therapy services. Across individual, group, and certain health insurance policies, the bill requires that when a plan covers these services, any co-payment charged to the insured may not exceed 20 percent of the total reimbursement to the provider of care. The bill applies to services within the lawful scope of practice of licensed physical and occupational therapists and preserves existing policy conditions such as utilization review, physician orders, and referral requirements.
The bill also updates related insurance provisions governing coverage for dependents and outpatient therapy benefits. It preserves existing rules requiring coverage for children up to age 26 and for certain disabled adult children, while adding the same 20 percent co-payment cap to group policies and to outpatient physical therapy coverage under the specified insurance sections. The act would take effect 180 days after becoming law.
Impact
The bill would amend multiple sections of the Insurance Law, including sections 3216, 4235, 4301, and 4322, to standardize cost-sharing limits for physical and occupational therapy across different types of health insurance policies. Insurers offering covered therapy benefits would need to ensure co-payments do not exceed 20 percent of the provider reimbursement, which could reduce out-of-pocket costs for insured patients receiving rehabilitative care and may require plan design or claims-processing changes for insurers and health plans.
Sentiment
The available context suggests generally favorable treatment of the bill, with no recorded committee debate or votes indicating opposition. The measure’s stated purpose is consumer-facing and cost-limiting, which typically aligns with support for improved access to therapy services. Because there are no transcripts or vote records provided, there is no evidence of formal controversy in the available materials.
Contention
The main policy issue is the mandated cap on co-payments for physical and occupational therapy, which benefits patients but may be viewed by insurers or plan sponsors as a restriction on benefit design and cost-sharing flexibility. Another possible point of concern is that the bill preserves utilization review and physician-order requirements, so it does not eliminate administrative controls even as it limits patient cost-sharing. No specific opponents or competing viewpoints are identified in the provided record.