Bill Text: NY A06211 | 2019-2020 | General Assembly | Amended

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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: Moderate Partisan Bill (Democrat 35-6)

Status: (Introduced - Dead) 2020-01-08 - referred to codes [A06211 Detail]

Download: New_York-2019-A06211-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         6211--B

                               2019-2020 Regular Sessions

                   IN ASSEMBLY

                                      March 4, 2019
                                       ___________

        Introduced  by  M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED,
          WOERNER,  FAHY,  MOSLEY,  FINCH,   MONTESANO,   SANTABARBARA,   BLAKE,
          PEOPLES-STOKES,  GALEF,  COLTON, GUNTHER, OTIS, BRONSON, RAIA, HUNTER,
          JAFFEE -- Multi-Sponsored by -- M. of A. ARROYO, CROUCH, GANTT,  HEVE-
          SI,  JOHNS,  KOLB, PERRY -- read once and referred to the Committee on
          Insurance -- committee discharged, bill amended, ordered reprinted  as
          amended  and recommitted to said committee -- reported and referred to
          the Committee on Rules -- Rules Committee  discharged,  bill  amended,
          ordered reprinted as amended and recommitted to the Committee on Rules

        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 (k) to read as follows:
     3    (k) 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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00646-04-9
        A. 6211--B                          2

     1  forty-one of this article, which shall not be excessive or unreasonable,
     2  when  the  provider  has  rendered  such  services,  has  on file a duly
     3  executed assignment of benefits, and has caused notice of  such  assign-
     4  ment  to  be given to the insurer, organization, or corporation licensed
     5  or certified pursuant to article  forty-three  or  forty-seven  of  this
     6  chapter  or  article  forty-four  of the public health law or jointly to
     7  such nonparticipating or  nonpreferred  provider  and  to  the  insured,
     8  subscriber,  or  other covered person; provided, however, that in either
     9  case the insurer, organization, or  corporation  licensed  or  certified
    10  pursuant  to article forty-three or forty-seven of this chapter or arti-
    11  cle forty-four of the public health law shall be required to  send  such
    12  benefit  payments  directly  to  the  provider who has the assignment on
    13  file. When payment is made directly to a provider of ambulance  services
    14  as authorized by this section, the insurer, organization, or corporation
    15  licensed  or certified pursuant to article forty-three or forty-seven of
    16  this chapter or article forty-four of the public health law  shall  give
    17  written  notice  of  such  payment  to the insured, subscriber, or other
    18  covered person.
    19    (2)  An  insurer  shall  provide  reimbursement  for  those   services
    20  prescribed  by  this section at rates negotiated between the insurer and
    21  the provider of such services. In the absence of agreed upon  rates,  an
    22  insurer shall pay for such services at the usual and customary charge as
    23  defined under section three thousand two hundred forty-one of this arti-
    24  cle, which shall not be excessive or unreasonable.
    25    (3)  An  insurer,  organization,  or corporation licensed or certified
    26  pursuant to article forty-three or forty-seven of this chapter or  arti-
    27  cle  forty-four  of the public health law shall ensure that the insured,
    28  subscriber, or other covered person shall incur no greater out-of-pocket
    29  costs for ambulance services provided by a nonparticipating  or  nonpre-
    30  ferred  provider  than  the insured, subscriber, or other covered person
    31  would have incurred with a participating or preferred provider  of  such
    32  services.
    33    (4)  Nothing contained in this section shall be deemed to prohibit the
    34  payment of different levels of benefits or from  having  differences  in
    35  coinsurance  percentages  applicable  to  benefit  levels  for  services
    36  provided by participating or preferred providers and nonparticipating or
    37  nonpreferred providers.
    38    The provisions of this subsection shall not apply to policies that  do
    39  not include coverage for ambulance services.
    40    §  2.  Subparagraphs  (C) and (D) of paragraph 24 of subsection (i) of
    41  section 3216 of the insurance law, as added by chapter 506 of  the  laws
    42  of 2001, are amended to read as follows:
    43    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    44  prescribed by this section at rates negotiated between the  insurer  and
    45  the  provider  of such services. In the absence of agreed upon rates, an
    46  insurer shall pay for such services at the usual and  customary  charge,
    47  which  shall  not be excessive or unreasonable.  Except in a city with a
    48  population of one million or more persons, the insurer shall  send  such
    49  payments  directly  to  the  provider of such ambulance services, if the
    50  ambulance service has on file an executed assignment  of  benefits  form
    51  with the claim.
    52    (D)  The  provisions  of  this  paragraph shall have no application to
    53  transfers of patients between hospitals or health care facilities by  an
    54  ambulance  service  as  described  in subparagraph (A) of this paragraph
    55  unless such services are covered under the policy.
        A. 6211--B                          3

     1    § 3. Subparagraphs (C) and (D) of paragraph 15 of  subsection  (l)  of
     2  section  3221  of the insurance law, as added by chapter 506 of the laws
     3  of 2001, are amended to read as follows:
     4    (C)   An  insurer  shall  provide  reimbursement  for  those  services
     5  prescribed by this section at rates negotiated between the  insurer  and
     6  the  provider  of such services. In the absence of agreed upon rates, an
     7  insurer shall pay for such services at the usual and  customary  charge,
     8  which  shall  not be excessive or unreasonable.  Except in a city with a
     9  population of one million or more persons, the insurer shall  send  such
    10  payments  directly  to  the  provider of such ambulance services, if the
    11  ambulance service has on file an executed assignment  of  benefits  form
    12  with the claim.
    13    (D)  The  provisions  of  this  paragraph shall have no application to
    14  transfers of patients between hospitals or health care facilities by  an
    15  ambulance  service  as  described  in subparagraph (A) of this paragraph
    16  unless such services are covered under the policy.
    17    § 4. Paragraphs 3 and 4 of subsection (aa)  of  section  4303  of  the
    18  insurance  law, as added by chapter 506 of the laws of 2001, are amended
    19  to read as follows:
    20    (3)  An  insurer  shall  provide  reimbursement  for  those   services
    21  prescribed  by  this section at rates negotiated between the insurer and
    22  the provider of such services. In the absence of agreed upon  rates,  an
    23  insurer  shall  pay for such services at the usual and customary charge,
    24  which shall not be excessive or unreasonable.  Except in a city  with  a
    25  population  of  one million or more persons, the insurer shall send such
    26  payments directly to the provider of such  ambulance  services,  if  the
    27  ambulance  service  has  on file an executed assignment of benefits form
    28  with the claim.
    29    (4) The provisions of this subsection shall  have  no  application  to
    30  transfers  of patients between hospitals or health care facilities by an
    31  ambulance service as described  in  paragraph  one  of  this  subsection
    32  unless such services are covered under the policy.
    33    §  5.  This  act  shall take effect January 1, 2021 and shall apply to
    34  health care claims submitted for payment after such date.