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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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--A

                               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

        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, which shall not be excessive or unreasonable, when the
    19  provider has rendered such services, has on file a duly executed assign-
    20  ment of benefits, and has caused notice of such assignment to  be  given

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00646-02-9
        A. 6211--A                          2

     1  to  the  insurer,  organization,  or  corporation  licensed or certified
     2  pursuant to article forty-three or forty-seven of this chapter or  arti-
     3  cle  forty-four  of  the public health law or jointly to such nonpartic-
     4  ipating  or  nonpreferred  provider  and  to the insured, subscriber, or
     5  other covered person; provided, however, that in either case the  insur-
     6  er, organization, or corporation licensed or certified pursuant to arti-
     7  cle  forty-three or forty-seven of this chapter or article forty-four of
     8  the public health law shall be required to send  such  benefit  payments
     9  directly to the provider who has the assignment on file. When payment is
    10  made  directly to a provider of ambulance services as authorized by this
    11  section, the insurer, organization, or corporation licensed or certified
    12  pursuant to article forty-three or forty-seven of this chapter or  arti-
    13  cle  forty-four  of  the  public health law shall give written notice of
    14  such payment to the insured, subscriber, or other covered person.
    15    (2)  An  insurer  shall  provide  reimbursement  for  those   services
    16  prescribed  by  this section at rates negotiated between the insurer and
    17  the provider of such services. In the absence of agreed upon  rates,  an
    18  insurer  shall  pay for such services at the usual and customary charge,
    19  which shall not be excessive or unreasonable.
    20    (3) Nothing contained in this section shall be deemed to prohibit  the
    21  payment  of  different  levels of benefits or from having differences in
    22  coinsurance  percentages  applicable  to  benefit  levels  for  services
    23  provided by participating or preferred providers and nonparticipating or
    24  nonpreferred providers.
    25    The provisions of this section shall not apply to policies that do not
    26  include coverage for ambulance services.
    27    §  2.  Subparagraphs  (C) and (D) of paragraph 24 of subsection (i) of
    28  section 3216 of the insurance law, as added by chapter 506 of  the  laws
    29  of 2001, are amended to read as follows:
    30    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    31  prescribed by this section at rates negotiated between the  insurer  and
    32  the  provider  of such services. In the absence of agreed upon rates, an
    33  insurer shall pay for such services at the usual and  customary  charge,
    34  which  shall  not be excessive or unreasonable.  Except in a city with a
    35  population of one million or more persons, the insurer shall  send  such
    36  payments  directly  to  the  provider of such ambulance services, if the
    37  ambulance service has on file an executed assignment  of  benefits  form
    38  with the claim.
    39    (D)  The  provisions  of  this  paragraph shall have no application to
    40  transfers of patients between hospitals or health care facilities by  an
    41  ambulance  service  as  described  in subparagraph (A) of this paragraph
    42  unless such services are covered under the policy.
    43    § 3. Subparagraphs (C) and (D) of paragraph 15 of  subsection  (l)  of
    44  section  3221  of the insurance law, as added by chapter 506 of the laws
    45  of 2001, are amended to read as follows:
    46    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    47  prescribed  by  this section at rates negotiated between the insurer and
    48  the provider of such services. In the absence of agreed upon  rates,  an
    49  insurer  shall  pay for such services at the usual and customary charge,
    50  which shall not be excessive or unreasonable.  Except in a city  with  a
    51  population  of  one million or more persons, the insurer shall send such
    52  payments directly to the provider of such  ambulance  services,  if  the
    53  ambulance  service  has  on file an executed assignment of benefits form
    54  with the claim.
    55    (D) The provisions of this paragraph  shall  have  no  application  to
    56  transfers  of patients between hospitals or health care facilities by an
        A. 6211--A                          3

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