Bill Text: NY S01793 | 2019-2020 | General Assembly | Introduced

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

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Bill Title: Relates to services rendered by a non-participating provider; relates to hospital statements of rights and responsibilities of patients; relates to insurance coverage of ambulance and emergency medical services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-01-08 - REFERRED TO HEALTH [S01793 Detail]

Download: New_York-2019-S01793-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          1793
                               2019-2020 Regular Sessions
                    IN SENATE
                                    January 16, 2019
                                       ___________
        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health
        AN ACT to amend the public health law, in relation  to  hospital  state-
          ments of rights and responsibilities of patients; to amend the general
          municipal  law,  in  relation  to  insurance coverage of ambulance and
          emergency medical services; to amend the financial  services  law,  in
          relation  to  dispute  resolution for emergency services; and to amend
          the financial services law and  the  insurance  law,  in  relation  to
          assignment of health insurance benefits
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
     1    Section 1. Paragraph (k) of subdivision  1  of  section  2803  of  the
     2  public  health  law,  as  added  by  chapter 241 of the laws of 2016, is
     3  amended to read as follows:
     4    (k) The  statement  regarding  patient  rights  and  responsibilities,
     5  required  pursuant  to  paragraph (g) of this subdivision, shall include
     6  provisions informing the patient of his or her right to [choose] be held
     7  harmless from certain bills for emergency services and  surprise  bills,
     8  and  to  submit  surprise  bills  or bills for emergency services to the
     9  independent dispute process established in article six of the  financial
    10  services  law,  and  informing the patient of his or her right to view a
    11  list of the hospital's standard charges and the health plans the  hospi-
    12  tal  participates with consistent with section twenty-four of this chap-
    13  ter.
    14    § 2.  Subdivision 2 of section 122-b of the general municipal law,  as
    15  amended  by  chapter  303  of  the  laws  of 1980, is amended to read as
    16  follows:
    17    2. Such municipality shall formulate rules and regulations relating to
    18  the use of such apparatus and equipment in the  provision  of  emergency
    19  medical  services or ambulance service and may fix a schedule of fees or
    20  charges to be paid by persons requesting the  use  of  such  facilities.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07755-01-9
        S. 1793                             2
     1  Such  rules  and regulations shall ensure that insured individuals incur
     2  no out-of-pocket costs for  use  of  such  services  and/or  facilities,
     3  except  any applicable co-payment, coinsurance or deductible. Such muni-
     4  cipalities  may  provide  for the collection of such fees and charges or
     5  may formulate rules and regulations for the collection  thereof  by  the
     6  individuals,  municipal  corporations,  associations, or other organiza-
     7  tions furnishing service under contract as provided in paragraph (c)  of
     8  subdivision one of this section.
     9    §  3.  Subsection (b) of section 603 of the financial services law, as
    10  added by section 26 of part H of chapter 60 of  the  laws  of  2014,  is
    11  amended to read as follows:
    12    (b) "Emergency services" means ambulance services as defined in subdi-
    13  vision  one  of section three thousand one of the public health law and,
    14  with respect to an emergency condition:  (1) a medical  screening  exam-
    15  ination  as  required  under section 1867 of the social security act, 42
    16  U.S.C. § 1395dd, which is within the capability of the emergency depart-
    17  ment of a hospital, including ancillary services routinely available  to
    18  the  emergency  department to evaluate such emergency medical condition;
    19  and (2) within the capabilities of the staff and facilities available at
    20  the hospital, such further medical  examination  and  treatment  as  are
    21  required  under  section  1867  of  the social security act, 42 U.S.C. §
    22  1395dd, to stabilize the patient.
    23    § 4.  Sections 605, 606 and 608 of  the  financial  services  law,  as
    24  added  by  section  26  of part H of chapter 60 of the laws of 2014, are
    25  amended to read as follows:
    26    § 605.  Dispute  resolution  for  emergency  services.  (a)  Emergency
    27  services for an insured. (1) When a health care plan receives a bill for
    28  emergency services from a non-participating physician, hospital or ambu-
    29  lance  provider, the health care plan shall pay an amount that it deter-
    30  mines is reasonable for the emergency services rendered by the  non-par-
    31  ticipating physician, hospital or ambulance provider, in accordance with
    32  section  three  thousand two hundred twenty-four-a of the insurance law,
    33  except for the insured's co-payment, coinsurance or deductible, if  any,
    34  and  shall  ensure that the insured shall incur no greater out-of-pocket
    35  costs for the emergency services than the insured  would  have  incurred
    36  with  a  participating  physician  pursuant to subsection (c) of section
    37  three thousand two hundred forty-one of the insurance law. If an insured
    38  assigns benefits to a non-participating physician, hospital or ambulance
    39  provider, such payment shall be made directly to the assignee.
    40    (2) A non-participating physician, hospital or ambulance provider,  or
    41  a  health  care plan may submit a dispute regarding a fee or payment for
    42  emergency services for review to an independent dispute resolution enti-
    43  ty.
    44    (3) The independent dispute resolution entity shall  make  a  determi-
    45  nation within thirty days of receipt of the dispute for review.
    46    (4)  In  determining  a  reasonable  fee for the services rendered, an
    47  independent dispute resolution entity shall  select  either  the  health
    48  care  plan's payment or the non-participating physician's, hospital's or
    49  ambulance provider's fee.  The  independent  dispute  resolution  entity
    50  shall  determine  which  amount  to select based upon the conditions and
    51  factors set forth in section six hundred four of  this  article.  If  an
    52  independent  dispute  resolution  entity determines, based on the health
    53  care plan's payment and the non-participating physician's, hospital's or
    54  ambulance provider's fee, that a settlement between the health care plan
    55  and non-participating  physician,  hospital  or  ambulance  provider  is
    56  reasonably  likely,  or that both the health care plan's payment and the
        S. 1793                             3
     1  non-participating physician's, hospital's or  ambulance  provider's  fee
     2  represent unreasonable extremes, then the independent dispute resolution
     3  entity  may  direct both parties to attempt a good faith negotiation for
     4  settlement. The health care plan and non-participating physician, hospi-
     5  tal  or  ambulance  provider  may be granted up to ten business days for
     6  this negotiation, which shall run concurrently with the thirty day peri-
     7  od for dispute resolution.
     8    (b) Emergency services for a patient that is not  an  insured.  (1)  A
     9  patient  that  is not an insured or the patient's physician may submit a
    10  dispute regarding a fee for emergency services for review  to  an  inde-
    11  pendent dispute resolution entity upon approval of the superintendent.
    12    (2) An independent dispute resolution entity shall determine a reason-
    13  able fee for the services based upon the same conditions and factors set
    14  forth in section six hundred four of this article.
    15    (3)  A patient that is not an insured shall not be required to pay the
    16  physician's, hospital's or ambulance  provider's  fee  in  order  to  be
    17  eligible  to  submit  the  dispute  for review to an independent dispute
    18  resolution entity.
    19    (c) The determination of  an  independent  dispute  resolution  entity
    20  shall  be  binding  on  the health care plan, physician and patient, and
    21  shall be admissible in any court  proceeding  between  the  health  care
    22  plan,  physician or patient, or in any administrative proceeding between
    23  this state and the physician.
    24    § 606. Hold harmless and assignment of benefits for emergency services
    25  and surprise bills for insureds. When an insured assigns benefits for an
    26  emergency service or a surprise bill in writing to  a  non-participating
    27  physician,  hospital  or  ambulance  provider  that knows the insured is
    28  insured under a  health  care  plan,  the  non-participating  physician,
    29  hospital or ambulance provider shall not bill the insured except for any
    30  applicable  copayment,  coinsurance  or deductible that would be owed if
    31  the insured utilized a participating physician.
    32    § 608. Payment for independent  dispute  resolution  entity.  (a)  For
    33  disputes  involving  an insured, when the independent dispute resolution
    34  entity determines the health care plan's payment is reasonable,  payment
    35  for  the  dispute  resolution process shall be the responsibility of the
    36  non-participating physician, hospital or ambulance  provider.  When  the
    37  independent  dispute  resolution entity determines the non-participating
    38  physician's, hospital's  or  ambulance  provider's  fee  is  reasonable,
    39  payment  for  the dispute resolution process shall be the responsibility
    40  of the health care plan. When a good faith negotiation directed  by  the
    41  independent  dispute  resolution  entity  pursuant  to paragraph four of
    42  subsection (a) of section six hundred five of this article, or paragraph
    43  six of subsection (a) of section  six  hundred  seven  of  this  article
    44  results in a settlement between the health care plan and non-participat-
    45  ing  physician, hospital or ambulance provider, the health care plan and
    46  the non-participating physician, hospital or  ambulance  provider  shall
    47  evenly divide and share the prorated cost for dispute resolution.
    48    (b)  For disputes involving a patient that is not an insured, when the
    49  independent dispute resolution entity determines the physician's fee  is
    50  reasonable,  payment  for  the  dispute  resolution process shall be the
    51  responsibility of the patient unless payment for the dispute  resolution
    52  process  would  pose a hardship to the patient. The superintendent shall
    53  promulgate a regulation to determine payment for the dispute  resolution
    54  process  in  cases  of hardship. When the independent dispute resolution
    55  entity determines the physician's fee is unreasonable, payment  for  the
    56  dispute resolution process shall be the responsibility of the physician.
        S. 1793                             4
     1    § 5.  Subsection (c) of section 3241 of the insurance law, as added by
     2  section  6  of  part  H of chapter 60 of the laws of 2014, is amended to
     3  read as follows:
     4    (c)  (1)  When  an insured or enrollee under a contract or policy that
     5  provides coverage for emergency services receives the  services  from  a
     6  health  care  provider that does not participate in the provider network
     7  of an insurer, a corporation organized pursuant to  article  forty-three
     8  of  this  chapter, a municipal cooperative health benefit plan certified
     9  pursuant to article forty-seven of this chapter,  a  health  maintenance
    10  organization  certified  pursuant  to  article  forty-four of the public
    11  health law, or a student health plan established or maintained  pursuant
    12  to section one thousand one hundred twenty-four of this chapter ("health
    13  care  plan"),  the  health  care  plan  shall ensure that the insured or
    14  enrollee shall (A) incur no greater out-of-pocket costs for the emergen-
    15  cy services than the insured or enrollee  would  have  incurred  with  a
    16  health care provider that participates in the health care plan's provid-
    17  er network and (B) provide the insured or enrollee the option of assign-
    18  ing  the  payment  of  any  benefits  due  under such contract or policy
    19  directly to the health care provider. Whenever, in any health  insurance
    20  claim  form,  an insured or enrollee specifically authorizes the payment
    21  of benefits directly to a health care provider,  the  health  care  plan
    22  shall  make  such  payment  to  the  health care provider.   (2) For the
    23  purpose of this section, "emergency services" shall have the meaning set
    24  forth in [subparagraph (D)  of  paragraph  nine  of  subsection  (i)  of
    25  section three thousand two hundred sixteen of this article, subparagraph
    26  (D)  of  paragraph  four of subsection (k) of section three thousand two
    27  hundred twenty-one of this article, and subparagraph  (D)  of  paragraph
    28  two  of  subsection  (a) of section four thousand three hundred three of
    29  this chapter] subsection (b) of section six hundred three of the  finan-
    30  cial services law.
    31    §  6.  This  act shall take effect on the ninetieth day after it shall
    32  have become a law.