| For Immediate Release: May 24, 2021 Re: A.3202-C (McDonald)/S.5663-A (Kennedy) – An act to amend the education law, in relation to allowing patients to receive certain treatment by an occupational therapist without a referral from a physician or nurse practitioner; and to amend the insurance law, in relation to eliminating the need for referrals for certain treatment This legislation, A.3202-C/S.5663-A, would mandate health plans provide coverage of ten visits with an occupational therapist without referral from a physician, registered physician assistant, or registered nurse practitioner. The New York Health Plan Association (HPA) opposes this legislation because, similar to other health insurance mandates, it will result in increased costs and increased premiums for individuals and employers in New York at a time we are seeking to make coverage more affordable. Health plans have long provided comprehensive services that focus on preventive and primary care, including coverage of occupational therapies. This bill amends current law, which already ensures coverage of these services, to remove any requirement that patients have a referral to receive these services. As this benefit is currently offered and encouraged by plans, we feel this proposal to remove the referral requirement is unnecessary. In general, HPA opposes mandates because they increase the cost of coverage for consumers and employers, ultimately undermining affordability and leading to some people becoming uninsured. The cost of new mandates disproportionately falls on small businesses, as expanding existing mandated benefits exacerbates the challenge they face to find affordable health care options. Mandated benefit bills pertain only to fully-insured policies, which are purchased either by individuals who purchase coverage on their own or receive it through a small or medium-sized business. Large companies typically “self-insure,” providing employee health benefits by directly paying health care claims to providers. They are governed by the Federal Employee Retirement Income Security Act (ERISA) and are not subject to state mandated benefits. This exemption from state mandated benefits is a key reason that large employers typically self-insure. Today, roughly 50 percent of the commercial market in New York is covered under a self-insured plan. As more employers self-insure, state laws mandating specific types of benefits and services, or expanding existing mandates as this bill would, affect an increasingly smaller portion of the privately insured marketplace and fall largely on small and medium-sized employers. For all the reasons stated above, we urge you to say no to A.3202-C/S.5663-A. |
