S03542 Summary:

BILL NOS03542
 
SAME ASSAME AS A07534
 
SPONSORSEWARD
 
COSPNSRADDABBO, BALL, GALLIVAN, MARCHIONE, NOZZOLIO, RITCHIE, ROBACH, SAVINO
 
MLTSPNSR
 
Amd SS3224-a, 3216, 3221 & 4303, Ins L
 
Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.
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S03542 Actions:

BILL NOS03542
 
02/05/2013REFERRED TO INSURANCE
01/08/2014REFERRED TO INSURANCE
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S03542 Floor Votes:

There are no votes for this bill in this legislative session.
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S03542 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3542
 
                               2013-2014 Regular Sessions
 
                    IN SENATE
 
                                    February 5, 2013
                                       ___________
 
        Introduced  by  Sen.  SEWARD -- 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 (j) to read as follows:
     3    (j)  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 a written assignment  of  bene-
    19  fits,  and  has  caused written notice of such assignment to be given to
    20  the insurer, organization, or corporation licensed or certified pursuant

    21  to article forty-three or forty-seven of this chapter or article  forty-
    22  four  of  the  public  health law or jointly to such nonparticipating or
    23  nonpreferred provider and to the insured, subscriber, or  other  covered
    24  person;  provided,  however,  that in either case the insurer, organiza-
    25  tion, or corporation licensed or certified pursuant  to  article  forty-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06549-02-3

        S. 3542                             2
 
     1  three or forty-seven of this chapter or article forty-four of the public

     2  health  law  shall be required to send such benefit payments directly to
     3  the provider who has  the  written  assignment.  When  payment  is  made
     4  directly  to  a  provider  of  ambulance  services as authorized by this
     5  section, the insurer, organization, or corporation licensed or certified
     6  pursuant to article forty-three or forty-seven of this chapter or  arti-
     7  cle  forty-four  of  the  public health law shall give written notice of
     8  such payment to the insured, subscriber, or other covered person.
     9    (2)  An  insurer  shall  provide  reimbursement  for  those   services
    10  prescribed  by  this section at rates negotiated between the insurer and
    11  the provider of such services. In the absence of agreed upon  rates,  an

    12  insurer  shall  pay for such services at the usual and customary charge,
    13  which shall not be excessive or unreasonable.
    14    (3) Nothing contained in this section shall be deemed to prohibit  the
    15  payment  of  different  levels of benefits or from having differences in
    16  coinsurance  percentages  applicable  to  benefit  levels  for  services
    17  provided by participating or preferred providers and nonparticipating or
    18  nonpreferred providers.
    19    The provisions of this section shall not apply to policies that do not
    20  include coverage for ambulance services.
    21    §  2.  Subparagraphs  (C) and (D) of paragraph 24 of subsection (i) of
    22  section 3216 of the insurance law, as added by chapter 506 of  the  laws
    23  of 2001, are amended to read as follows:

    24    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    25  prescribed by this section at rates negotiated between the  insurer  and
    26  the  provider  of such services. In the absence of agreed upon rates, an
    27  insurer shall pay for such services at the usual and  customary  charge,
    28  which  shall  not  be excessive or unreasonable.  The insurer shall send
    29  such payments directly to the provider of such  ambulance  services,  if
    30  the  ambulance  service includes an executed assignment of benefits form
    31  with the claim.
    32    (D) The provisions of this paragraph  shall  have  no  application  to
    33  transfers  of patients between hospitals or health care facilities by an
    34  ambulance service as described in subparagraph  (A)  of  this  paragraph
    35  unless such services are covered under the policy.

    36    §  3.  Subparagraphs  (C) and (D) of paragraph 15 of subsection (l) of
    37  section 3221 of the insurance law, as added by chapter 506 of  the  laws
    38  of 2001, are amended to read as follows:
    39    (C)   An  insurer  shall  provide  reimbursement  for  those  services
    40  prescribed by this section at rates negotiated between the  insurer  and
    41  the  provider  of such services. In the absence of agreed upon rates, an
    42  insurer shall pay for such services at the usual and  customary  charge,
    43  which  shall  not  be excessive or unreasonable.  The insurer shall send
    44  such payments directly to the provider of such  ambulance  services,  if
    45  the  ambulance  service includes an executed assignment of benefits form
    46  with the claim.
    47    (D) The provisions of this paragraph  shall  have  no  application  to

    48  transfers  of patients between hospitals or health care facilities by an
    49  ambulance service as described in subparagraph  (A)  of  this  paragraph
    50  unless such services are covered under the policy.
    51    §  4.  Paragraphs  3  and  4 of subsection (aa) of section 4303 of the
    52  insurance law, as added by chapter 506 of the laws of 2001, are  amended
    53  to read as follows:
    54    (3)   An  insurer  shall  provide  reimbursement  for  those  services
    55  prescribed by this section at rates negotiated between the  insurer  and
    56  the  provider  of such services. In the absence of agreed upon rates, an

        S. 3542                             3
 
     1  insurer shall pay for such services at the usual and  customary  charge,
     2  which  shall  not  be excessive or unreasonable.  The insurer shall send

     3  such payments directly to the provider of such  ambulance  services,  if
     4  the  ambulance  service includes an executed assignment of benefits form
     5  with the claim.
     6    (4) The provisions of this subsection shall  have  no  application  to
     7  transfers  of patients between hospitals or health care facilities by an
     8  ambulance service as described  in  paragraph  one  of  this  subsection
     9  unless such services are covered under the policy.
    10    §  5.  This  act  shall take effect January 1, 2014 and shall apply to
    11  health care claims submitted for payment after such date.
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