•  Summary 
  •  
  •  Actions 
  •  
  •  Committee Votes 
  •  
  •  Floor Votes 
  •  
  •  Memo 
  •  
  •  Text 
  •  
  •  LFIN 
  •  
  •  Chamber Video/Transcript 

S03556 Summary:

BILL NOS03556
 
SAME ASNo Same As
 
SPONSORBRESLIN
 
COSPNSRADDABBO, AKSHAR, BOYLE, GALLIVAN, HELMING, JORDAN, MANNION, RIVERA, SANDERS, SEPULVEDA, SKOUFIS
 
MLTSPNSR
 
Amd §§3224-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.
Go to top    

S03556 Actions:

BILL NOS03556
 
01/30/2021REFERRED TO INSURANCE
03/01/20211ST REPORT CAL.478
03/02/20212ND REPORT CAL.
03/03/2021ADVANCED TO THIRD READING
06/10/2021COMMITTED TO RULES
Go to top

S03556 Memo:

Memo not available
Go to top

S03556 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3556
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                    January 30, 2021
                                       ___________
 
        Introduced  by Sens. BRESLIN, ADDABBO, AKSHAR, BOYLE, GALLIVAN, HELMING,
          RIVERA, SANDERS, SEPULVEDA, SKOUFIS -- 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 (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
    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.
                                                                   LBD01780-02-1

        S. 3556                             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. 3556                             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, 2023  and  shall  apply  to
    12  health care claims submitted for payment after such date.
Go to top