NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A250A
SPONSOR: Magnarelli PURPOSE:
To ensure that responding ambulance service companies receive direct
payment for all emergency ambulance service transports upon submission
of an invoice to the insurance company without the need for the respond-
ing ambulance company to be a preferred provider.
SUMMARY OF PROVISIONS:
Section 1 amends section 3224-a of the insurance law to provide that
payments made to nonparticipating or non-preferred providers of ambu-
lance services made by health insurers shall be done so directly to the
provider or jointly to both the provider and the insured.
Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection
(i) of section 3216 of the insurance law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection
(1) of section 3221 of the insurance law stating that the insurers shall
send such payments directly to the provider' of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers shall send such payments
directly to the provider of such ambulance services if the ambulance
service includes an executed assignment of benefits form with the claim
and the provisions of this paragraph shall apply to transfers of
patients between hospitals or health care facilities.
Section 5. Effective Date.
JUSTIFICATION:
The constant and quick availability of ambulance response is something
that all of our citizens have grown accustomed to and it is essential to
the survivability of all New Yorkers when there is a medical crisis.
Fair and direct reimbursement for those services is paramount to the
financial stability and continued availability of ambulances to respond.
Current law permits insurance companies to pay for ambulance. service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It is
not practical to expect a preferred provider relationship with every
insurance company. But then it is the responsibility of the ambulance
company to try to recoup payment for service from that patient.
All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the
insurance company. Especially as the financial crisis we are currently
facing deepens, more and more patients are pocketing these funds.
Further, the insurance company is not obligated to advise the ambulance
company that they in fact paid the ambulance transport bill direct to
the patient. This disconnect of information leads to confusion and
furthers the lack of proper payment issue.
In New York State, ambulance companies are mandated responders. As such,
most ambulance providers have no knowledge of the patient's ability to
pay or if or by whom they are insured by when a medical emergency.or
accidental event occurs. Ambulance service is one of the few medical
services where payment is not expected at the time of service.
This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need for
the responding ambulance company to be a preferred provider.
LEGISLATIVE HISTORY:
A.1309 of 2021-2022 A.6211-B of 2019-2020;
A.343-A of 2017-2018; A.8581 of 2016;
A. 6195 of 2015;.
A.7534 of 2013-14;
A.4093-B of 2011-12;
A.10735 of 2010;
FISCAL IMPLICATIONS:
None to the State
EFFECTIVE DATE:
This act shall take effect January 1, 2025 and shall apply to health
care claims submitted for payment after such date.
STATE OF NEW YORK
________________________________________________________________________
250--A
2023-2024 Regular Sessions
IN ASSEMBLY(Prefiled)
January 4, 2023
___________
Introduced by M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, WOERNER,
FAHY, SANTABARBARA, PEOPLES-STOKES, COLTON, GUNTHER, OTIS, BRONSON,
HUNTER, BUTTENSCHON, McMAHON, CRUZ, SAYEGH, BURDICK, THIELE, DARLING,
JACKSON, SIMON, DAVILA, MEEKS, STECK, LUPARDO, CLARK, EACHUS, McDO-
NALD, WEPRIN, LUNSFORD, KELLES -- read once and referred to the
Committee on Insurance -- 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 (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) 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-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00274-02-3
A. 250--A 2
1 ment of benefits, and has caused notice of such assignment to be given
2 to the insurer, organization, or corporation licensed or certified
3 pursuant to article forty-three or forty-seven of this chapter or arti-
4 cle forty-four of the public health law or jointly to such nonpartic-
5 ipating or nonpreferred provider and to the insured, subscriber, or
6 other covered person; provided, however, that in either case the insur-
7 er, organization, or corporation licensed or certified pursuant to arti-
8 cle forty-three or forty-seven of this chapter or article forty-four of
9 the public health law shall be required to send such benefit payments
10 directly to the provider who has the assignment on file. When payment is
11 made directly to a provider of ambulance services as authorized by this
12 section, the insurer, organization, or corporation licensed or certified
13 pursuant to article forty-three or forty-seven of this chapter or arti-
14 cle forty-four of the public health law shall give written notice of
15 such payment to the insured, subscriber, or other covered person.
16 (2) An insurer shall provide reimbursement for those services
17 prescribed by this section at rates negotiated between the insurer and
18 the provider of such services. In the absence of agreed upon rates, an
19 insurer shall pay for such services at the usual and customary charge,
20 which shall not be excessive or unreasonable.
21 (3) Nothing contained in this section shall be deemed to prohibit the
22 payment of different levels of benefits or from having differences in
23 coinsurance percentages applicable to benefit levels for services
24 provided by participating or preferred providers and nonparticipating or
25 nonpreferred providers.
26 The provisions of this section shall not apply to policies that do not
27 include coverage for ambulance services.
28 § 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of
29 section 3216 of the insurance law, as added by chapter 506 of the laws
30 of 2001, are amended to read as follows:
31 (C) An insurer shall provide reimbursement for those services
32 prescribed by this section at rates negotiated between the insurer and
33 the provider of such services. In the absence of agreed upon rates, an
34 insurer shall pay for such services at the usual and customary charge,
35 which shall not be excessive or unreasonable. The insurer shall send
36 such payments directly to the provider of such ambulance services, if
37 the ambulance service has on file an executed assignment of benefits
38 form 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. The insurer shall send
51 such payments directly to the provider of such ambulance services, if
52 the ambulance service has on file an executed assignment of benefits
53 form with the claim.
54 (D) The provisions of this paragraph shall have no application to
55 transfers of patients between hospitals or health care facilities by an
A. 250--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. The insurer shall send
11 such payments directly to the provider of such ambulance services, if
12 the ambulance service has on file an executed assignment of benefits
13 form with the claim.
14 (4) The provisions of this subsection shall have no application to
15 transfers of patients between hospitals or health care facilities by an
16 ambulance service as described in paragraph one of this subsection
17 unless such services are covered under the policy.
18 § 5. This act shall take effect January 1, 2025 and shall apply to
19 health care claims submitted for payment after such date.
