Assembly caps co‑payments for physical and occupational therapy to improve access

The Assembly passed legislation on March 24 to amend the insurance law and cap co‑payments for physical and occupational therapy at the primary‑care copay rate plus 25%, aiming to reduce the out‑of‑pocket burden for patients who require frequent visits.

Sponsor Rep. Weprin said physical and occupational therapy often requires repeated visits over weeks or months and that specialty cost‑sharing currently can make necessary care unaffordable. He framed the change as a way to improve outcomes and reduce downstream spending by avoiding surgery and prolonged disability.

Opponents noted that existing Affordable Care Act and state rules cap out‑of‑pocket costs and that mandating lower cost sharing for specific services could shift costs into premiums paid by all insureds. Assemblymember Gandolfo questioned whether DFS oversight of cost‑sharing arrangements could address these concerns without a statutory cap.

The Assembly voted Ayes 135, Nays 7; the measure will take effect January 1, 2027, allowing time for insurers and regulators to adjust.