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S01466 Summary:

S01466 Actions:

S01466 Committee Votes:

S01466 Floor Votes:

S01466 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          1466
 
                               2023-2024 Regular Sessions
 
                    IN SENATE
 
                                    January 12, 2023
                                       ___________
 
        Introduced  by  Sens. BRESLIN, ADDABBO, COONEY, GALLIVAN, HELMING, MANN-
          ION, RIVERA, SANDERS, SEPULVEDA, SKOUFIS --  read  twice  and  ordered
          printed,  and  when printed to be committed to the Committee on Insur-
          ance
 
        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-
    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
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05298-01-3
        S. 1466                             2
 
     1  other  covered person; provided, however, that in either case the insur-
     2  er, organization, or corporation licensed or certified pursuant to arti-
     3  cle forty-three or forty-seven of this chapter or article forty-four  of
     4  the  public  health  law shall be required to send such benefit payments
     5  directly to the provider who has the assignment on file. When payment is
     6  made directly to a provider of ambulance services as authorized by  this
     7  section, the insurer, organization, or corporation licensed or certified
     8  pursuant  to article forty-three or forty-seven of this chapter or arti-
     9  cle forty-four of the public health law shall  give  written  notice  of
    10  such payment to the insured, subscriber, or other covered person.
    11    (2)   An  insurer  shall  provide  reimbursement  for  those  services
    12  prescribed by this section at rates negotiated between the  insurer  and
    13  the  provider  of such services. In the absence of agreed upon rates, an
    14  insurer shall pay for such services at the usual and  customary  charge,
    15  which shall not be excessive or unreasonable.
    16    (3)  Nothing contained in this section shall be deemed to prohibit the
    17  payment of different levels of benefits or from  having  differences  in
    18  coinsurance  percentages  applicable  to  benefit  levels  for  services
    19  provided by participating or preferred providers and nonparticipating or
    20  nonpreferred providers.
    21    The provisions of this section shall not apply to policies that do not
    22  include coverage for ambulance services.
    23    § 2. Subparagraphs (C) and (D) of paragraph 24 of  subsection  (i)  of
    24  section  3216  of the insurance law, as added by chapter 506 of the laws
    25  of 2001, are amended to read as follows:
    26    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    27  prescribed  by  this section at rates negotiated between the insurer and
    28  the provider of such services. In the absence of agreed upon  rates,  an
    29  insurer  shall  pay for such services at the usual and customary charge,
    30  which shall not be excessive or unreasonable.   The insurer  shall  send
    31  such  payments  directly  to the provider of such ambulance services, if
    32  the ambulance service has on file an  executed  assignment  of  benefits
    33  form with the claim.
    34    (D)  The  provisions  of  this  paragraph shall have no application to
    35  transfers of patients between hospitals or health care facilities by  an
    36  ambulance  service  as  described  in subparagraph (A) of this paragraph
    37  unless such services are covered under the policy.
    38    § 3. Subparagraphs (C) and (D) of paragraph 15 of  subsection  (l)  of
    39  section  3221  of the insurance law, as added by chapter 506 of the laws
    40  of 2001, are amended to read as follows:
    41    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    42  prescribed  by  this section at rates negotiated between the insurer and
    43  the provider of such services. In the absence of agreed upon  rates,  an
    44  insurer  shall  pay for such services at the usual and customary charge,
    45  which shall not be excessive or unreasonable.   The insurer  shall  send
    46  such  payments  directly  to the provider of such ambulance services, if
    47  the ambulance service has on file an  executed  assignment  of  benefits
    48  form with the claim.
    49    (D)  The  provisions  of  this  paragraph shall have no application to
    50  transfers of patients between hospitals or health care facilities by  an
    51  ambulance  service  as  described  in subparagraph (A) of this paragraph
    52  unless such services are covered under the policy.
    53    § 4. Paragraphs 3 and 4 of subsection (aa)  of  section  4303  of  the
    54  insurance  law, as added by chapter 506 of the laws of 2001, are amended
    55  to read as follows:
        S. 1466                             3
 
     1    (3)  An  insurer  shall  provide  reimbursement  for  those   services
     2  prescribed  by  this section at rates negotiated between the insurer and
     3  the provider of such services. In the absence of agreed upon  rates,  an
     4  insurer  shall  pay for such services at the usual and customary charge,
     5  which  shall  not  be excessive or unreasonable.  The insurer shall send
     6  such payments directly to the provider of such  ambulance  services,  if
     7  the  ambulance  service  has  on file an executed assignment of benefits
     8  form with the claim.
     9    (4) The provisions of this subsection shall  have  no  application  to
    10  transfers  of patients between hospitals or health care facilities by an
    11  ambulance service as described  in  paragraph  one  of  this  subsection
    12  unless such services are covered under the policy.
    13    §  5.  This  act  shall take effect January 1, 2025 and shall apply to
    14  health care claims submitted for payment after such date.