Bill Text: NY S03526 | 2019-2020 | General Assembly | Introduced


Bill Title: Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

Spectrum: Bipartisan Bill

Status: (Introduced) 2019-06-20 - COMMITTED TO RULES [S03526 Detail]

Download: New_York-2019-S03526-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          3526
                               2019-2020 Regular Sessions
                    IN SENATE
                                    February 8, 2019
                                       ___________
        Introduced  by  Sens.  BRESLIN,  SEWARD,  ADDABBO, AKSHAR, BOYLE, FUNKE,
          GALLIVAN, HELMING, SEPULVEDA -- read twice and  ordered  printed,  and
          when printed to be committed 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 (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) Whenever an insurer or an organization, or corporation  licensed  or
     6  certified pursuant to article forty-three or forty-seven of this chapter
     7  or  article forty-four of the public health law provides that any health
     8  care claims submitted under contracts or agreements  issued  or  entered
     9  into  pursuant  to  this  article  or  article forty-two, forty-three or
    10  forty-seven of this chapter and article forty-four of the public  health
    11  law  are  payable  to a participating or preferred provider of ambulance
    12  services for services rendered, the  insurer,  organization,  or  corpo-
    13  ration  licensed  or certified pursuant to article forty-three or forty-
    14  seven of this chapter or article forty-four of  the  public  health  law
    15  shall  be required to pay such benefits either directly to any similarly
    16  licensed nonparticipating or nonpreferred  provider  at  the  usual  and
    17  customary charge, which shall not be excessive or unreasonable, when the
    18  provider has rendered such services, has on file a duly executed assign-
    19  ment  of  benefits, and has caused notice of such assignment to be given
    20  to the 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 or jointly  to  such  nonpartic-
    23  ipating  or  nonpreferred  provider  and  to the insured, subscriber, or
    24  other covered person; provided, however, that in either case the  insur-
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00646-01-9

        S. 3526                             2
     1  er, organization, or corporation licensed or certified pursuant to arti-
     2  cle  forty-three or forty-seven of this chapter or article forty-four of
     3  the public health law shall be required to send  such  benefit  payments
     4  directly to the provider who has the assignment on file. When payment is
     5  made  directly to a provider of ambulance services as authorized by this
     6  section, the insurer, organization, or corporation licensed or certified
     7  pursuant to article forty-three or forty-seven of this chapter or  arti-
     8  cle  forty-four  of  the  public health law shall give written notice of
     9  such payment to the insured, subscriber, or other covered person.
    10    (2)  An  insurer  shall  provide  reimbursement  for  those   services
    11  prescribed  by  this section at rates negotiated between the insurer and
    12  the provider of such services. In the absence of agreed upon  rates,  an
    13  insurer  shall  pay for such services at the usual and customary charge,
    14  which shall not be excessive or unreasonable.
    15    (3) Nothing contained in this section shall be deemed to prohibit  the
    16  payment  of  different  levels of benefits or from having differences in
    17  coinsurance  percentages  applicable  to  benefit  levels  for  services
    18  provided by participating or preferred providers and nonparticipating or
    19  nonpreferred providers.
    20    The provisions of this section shall not apply to policies that do not
    21  include coverage for ambulance services.
    22    §  2.  Subparagraphs  (C) and (D) of paragraph 24 of subsection (i) of
    23  section 3216 of the insurance law, as added by chapter 506 of  the  laws
    24  of 2001, are amended to read as follows:
    25    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    26  prescribed by this section at rates negotiated between the  insurer  and
    27  the  provider  of such services. In the absence of agreed upon rates, an
    28  insurer shall pay for such services at the usual and  customary  charge,
    29  which  shall  not  be excessive or unreasonable.  The insurer shall send
    30  such payments directly to the provider of such  ambulance  services,  if
    31  the  ambulance  service  has  on file an executed assignment of benefits
    32  form with the claim.
    33    (D) The provisions of this paragraph  shall  have  no  application  to
    34  transfers  of patients between hospitals or health care facilities by an
    35  ambulance service as described in subparagraph  (A)  of  this  paragraph
    36  unless such services are covered under the policy.
    37    §  3.  Subparagraphs  (C) and (D) of paragraph 15 of subsection (l) of
    38  section 3221 of the insurance law, as added by chapter 506 of  the  laws
    39  of 2001, are amended to read as follows:
    40    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    41  prescribed by this section at rates negotiated between the  insurer  and
    42  the  provider  of such services. In the absence of agreed upon rates, an
    43  insurer shall pay for such services at the usual and  customary  charge,
    44  which  shall  not  be excessive or unreasonable.  The insurer shall send
    45  such payments directly to the provider of such  ambulance  services,  if
    46  the  ambulance  service  has  on file an executed assignment of benefits
    47  form with the claim.
    48    (D) The provisions of this paragraph  shall  have  no  application  to
    49  transfers  of patients between hospitals or health care facilities by an
    50  ambulance service as described in subparagraph  (A)  of  this  paragraph
    51  unless such services are covered under the policy.
    52    §  4.  Paragraphs  3  and  4 of subsection (aa) of section 4303 of the
    53  insurance law, as added by chapter 506 of the laws of 2001, are  amended
    54  to read as follows:
    55    (3)   An  insurer  shall  provide  reimbursement  for  those  services
    56  prescribed by this section at rates negotiated between the  insurer  and

        S. 3526                             3
     1  the  provider  of such services. In the absence of agreed upon rates, an
     2  insurer shall pay for such services at the usual and  customary  charge,
     3  which  shall  not  be excessive or unreasonable.  The insurer shall send
     4  such  payments  directly  to the provider of such ambulance services, if
     5  the ambulance service has on file an  executed  assignment  of  benefits
     6  form with the claim.
     7    (4)  The  provisions  of  this subsection shall have no application to
     8  transfers of patients between hospitals or health care facilities by  an
     9  ambulance  service  as  described  in  paragraph  one of this subsection
    10  unless such services are covered under the policy.
    11    § 5. This act shall take effect January 1, 2021  and  shall  apply  to
    12  health care claims submitted for payment after such date.
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