Bill Text: NY A01309 | 2021-2022 | General Assembly | Introduced

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Bill Title: Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law; exempts a city with a population of one million or more persons.

Spectrum: Partisan Bill (Democrat 34-1)

Status: (Introduced - Dead) 2022-05-11 - reported referred to rules [A01309 Detail]

Download: New_York-2021-A01309-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          1309

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                     January 8, 2021
                                       ___________

        Introduced  by  M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED,
          WOERNER, FAHY, MONTESANO, SANTABARBARA, PEOPLES-STOKES, GALEF, COLTON,
          GUNTHER, OTIS, BRONSON, HUNTER, ABINANTI, BUTTENSCHON, McMAHON,  CRUZ,
          JOYNER, SAYEGH -- read once and referred to the Committee on Insurance

        AN  ACT to amend the insurance law, in relation to payments to prehospi-
          tal emergency medical services providers

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1. Section 3224-a of the insurance law is amended by adding a
     2  new subsection (l) to read as follows:
     3    (l) Payments to nonparticipating or nonpreferred  providers  of  ambu-
     4  lance  services  licensed under article thirty of the public health law.
     5  (1) Except in a city with a population of one million or  more  persons,
     6  whenever  an  insurer  or  an  organization,  or corporation licensed or
     7  certified pursuant to article forty-three or forty-seven of this chapter
     8  or article forty-four of the public health law provides that any  health
     9  care  claims  submitted  under contracts or agreements issued or entered
    10  into pursuant to this  article  or  article  forty-two,  forty-three  or
    11  forty-seven  of this chapter and article forty-four of the public health
    12  law are payable to a participating or preferred  provider  of  ambulance
    13  services  for  services  rendered,  the insurer, organization, or corpo-
    14  ration licensed or certified pursuant to article forty-three  or  forty-
    15  seven  of  this  chapter  or article forty-four of the public health law
    16  shall be required to pay such benefits either directly to any  similarly
    17  licensed  nonparticipating  or  nonpreferred  provider  at the usual and
    18  customary charge as defined under section  three  thousand  two  hundred
    19  forty-one of this article, which shall not be excessive or unreasonable,
    20  when  the  provider  has  rendered  such  services,  has  on file a duly
    21  executed assignment of benefits, and has caused notice of  such  assign-
    22  ment  to  be given to the insurer, organization, or corporation licensed
    23  or certified pursuant to article  forty-three  or  forty-seven  of  this

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01780-01-1
        A. 1309                             2

     1  chapter  or  article  forty-four  of the public health law or jointly to
     2  such nonparticipating or  nonpreferred  provider  and  to  the  insured,
     3  subscriber,  or  other covered person; provided, however, that in either
     4  case  the  insurer,  organization,  or corporation licensed or certified
     5  pursuant to article forty-three or forty-seven of this chapter or  arti-
     6  cle  forty-four  of the public health law shall be required to send such
     7  benefit payments directly to the provider  who  has  the  assignment  on
     8  file.  When payment is made directly to a provider of ambulance services
     9  as authorized by this section, the insurer, organization, or corporation
    10  licensed or certified pursuant to article forty-three or forty-seven  of
    11  this  chapter  or article forty-four of the public health law shall give
    12  written notice of such payment to  the  insured,  subscriber,  or  other
    13  covered person.
    14    (2)   An  insurer  shall  provide  reimbursement  for  those  services
    15  prescribed by this section at rates negotiated between the  insurer  and
    16  the  provider  of such services. In the absence of agreed upon rates, an
    17  insurer shall pay for such services at the usual and customary charge as
    18  defined under section three thousand two hundred forty-one of this arti-
    19  cle, which shall not be excessive or unreasonable.
    20    (3) An insurer, organization, or  corporation  licensed  or  certified
    21  pursuant  to article forty-three or forty-seven of this chapter or arti-
    22  cle forty-four of the public health law shall ensure that  the  insured,
    23  subscriber, or other covered person shall incur no greater out-of-pocket
    24  costs  for  ambulance services provided by a nonparticipating or nonpre-
    25  ferred provider than the insured, subscriber, or  other  covered  person
    26  would  have  incurred with a participating or preferred provider of such
    27  services.
    28    (4) Nothing contained in this section shall be deemed to prohibit  the
    29  payment  of  different  levels of benefits or from having differences in
    30  coinsurance  percentages  applicable  to  benefit  levels  for  services
    31  provided by participating or preferred providers and nonparticipating or
    32  nonpreferred providers.
    33    The  provisions of this subsection shall not apply to policies that do
    34  not include coverage for ambulance services.
    35    § 2. Subparagraphs (C) and (D) of paragraph 24 of  subsection  (i)  of
    36  section  3216  of the insurance law, as added by chapter 506 of the laws
    37  of 2001, are amended to read as follows:
    38    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    39  prescribed  by  this section at rates negotiated between the insurer and
    40  the provider of such services. In the absence of agreed upon  rates,  an
    41  insurer  shall  pay for such services at the usual and customary charge,
    42  which shall not be excessive or unreasonable.  Except in a city  with  a
    43  population  of  one million or more persons, the insurer shall send such
    44  payments directly to the provider of such  ambulance  services,  if  the
    45  ambulance  service  has  on file an executed assignment of benefits form
    46  with the claim.
    47    (D) The provisions of this paragraph  shall  have  no  application  to
    48  transfers  of patients between hospitals or health care facilities by an
    49  ambulance service as described in subparagraph  (A)  of  this  paragraph
    50  unless such services are covered under the policy.
    51    §  3.  Subparagraphs  (C) and (D) of paragraph 15 of subsection (l) of
    52  section 3221 of the insurance law, as added by chapter 506 of  the  laws
    53  of 2001, are amended to read as follows:
    54    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    55  prescribed by this section at rates negotiated between the  insurer  and
    56  the  provider  of such services. In the absence of agreed upon rates, an
        A. 1309                             3

     1  insurer shall pay for such services at the usual and  customary  charge,
     2  which  shall  not be excessive or unreasonable.  Except in a city with a
     3  population of one million or more persons, the insurer shall  send  such
     4  payments  directly  to  the  provider of such ambulance services, if the
     5  ambulance service has on file an executed assignment  of  benefits  form
     6  with the claim.
     7    (D)  The  provisions  of  this  paragraph shall have no application to
     8  transfers of patients between hospitals or health care facilities by  an
     9  ambulance  service  as  described  in subparagraph (A) of this paragraph
    10  unless such services are covered under the policy.
    11    § 4. Paragraphs 3 and 4 of subsection (aa)  of  section  4303  of  the
    12  insurance  law, as added by chapter 506 of the laws of 2001, are amended
    13  to read as follows:
    14    (3)  An  insurer  shall  provide  reimbursement  for  those   services
    15  prescribed  by  this section at rates negotiated between the insurer and
    16  the provider of such services. In the absence of agreed upon  rates,  an
    17  insurer  shall  pay for such services at the usual and customary charge,
    18  which shall not be excessive or unreasonable.  Except in a city  with  a
    19  population  of  one million or more persons, the insurer shall send such
    20  payments directly to the provider of such  ambulance  services,  if  the
    21  ambulance  service  has  on file an executed assignment of benefits form
    22  with the claim.
    23    (4) The provisions of this subsection shall  have  no  application  to
    24  transfers  of patients between hospitals or health care facilities by an
    25  ambulance service as described  in  paragraph  one  of  this  subsection
    26  unless such services are covered under the policy.
    27    §  5.  This  act  shall take effect January 1, 2023 and shall apply to
    28  health care claims submitted for payment after such date.