STATE OF NEW YORK
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4093--B
R. R. 102
2011-2012 Regular Sessions
IN ASSEMBLY
February 1, 2011
___________
Introduced by M. of A. MORELLE, RUSSELL, LATIMER, LIFTON, BENEDETTO,
GUNTHER -- Multi-Sponsored by -- M. of A. AMEDORE, JOHNS, P. LOPEZ,
McENENY, McLAUGHLIN, RAMOS, SWEENEY, TEDISCO -- read once and referred
to the Committee on Insurance -- reported and referred to the Commit-
tee on Rules -- Rules Committee discharged, bill amended, ordered
reprinted as amended and recommitted to the Committee on Rules --
amended on the special order of third reading, ordered reprinted as
amended, retaining its place on the special order of third reading
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 (i) to read as follows:
3 (i) 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 articles 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 a written assignment of bene-
19 fits, and has caused written notice of such assignment to be given to
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04592-05-1
A. 4093--B 2
1 the insurer, organization, or corporation licensed or certified pursuant
2 to article forty-three or forty-seven of this chapter or article forty-
3 four of the public health law or jointly to such nonparticipating or
4 nonpreferred provider and to the insured, subscriber, or other covered
5 person; provided, however, that in either case the insurer, organiza-
6 tion, or corporation licensed or certified pursuant to article forty-
7 three or forty-seven of this chapter or article forty-four of the public
8 health law shall be required to send such benefit payments directly to
9 the provider who has the written assignment. When payment is made
10 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. The insurer shall send
35 such payments directly to the provider of such ambulance services, if
36 the ambulance service includes an executed assignment of benefits form
37 with the claim.
38 (D) The provisions of this paragraph shall have no application to
39 transfers of patients between hospitals or health care facilities by an
40 ambulance service as described in subparagraph (A) of this paragraph
41 unless such services are covered under the policy.
42 § 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of
43 section 3221 of the insurance law, as added by chapter 506 of the laws
44 of 2001, are amended to read as follows:
45 (C) An insurer shall provide reimbursement for those services
46 prescribed by this section at rates negotiated between the insurer and
47 the provider of such services. In the absence of agreed upon rates, an
48 insurer shall pay for such services at the usual and customary charge,
49 which shall not be excessive or unreasonable. The insurer shall send
50 such payments directly to the provider of such ambulance services, if
51 the ambulance service includes an executed assignment of benefits form
52 with the claim.
53 (D) The provisions of this paragraph shall have no application to
54 transfers of patients between hospitals or health care facilities by an
55 ambulance service as described in subparagraph (A) of this paragraph
56 unless such services are covered under the policy.
A. 4093--B 3
1 § 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the
2 insurance law, as added by chapter 506 of the laws of 2001, are amended
3 to read as follows:
4 (3) 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. The insurer shall send
9 such payments directly to the provider of such ambulance services, if
10 the ambulance service includes an executed assignment of benefits form
11 with the claim.
12 (4) The provisions of this subsection shall have no application to
13 transfers of patients between hospitals or health care facilities by an
14 ambulance service as described in paragraph one of this subsection
15 unless such services are covered under the policy.
16 § 5. This act shall take effect January 1, 2012 and shall apply to
17 health care claims submitted for payment after such date.
