Bill Text: NY A04093 | 2011-2012 | General Assembly | Amended
Bill Title: Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.
Spectrum: Slight Partisan Bill (Democrat 14-8)
Status: (Introduced - Dead) 2012-01-04 - referred to insurance [A04093 Detail]
Download: New_York-2011-A04093-Amended.html
S T A T E O F N E W Y O R K
________________________________________________________________________
4093--A
2011-2012 Regular Sessions
I N A S S E M B L Y
February 1, 2011
___________
Introduced by M. of A. MORELLE, RUSSELL, LATIMER, LIFTON, BENEDETTO,
GUNTHER -- Multi-Sponsored by -- M. of A. JOHNS, P. LOPEZ, McENENY,
McLAUGHLIN, RAMOS, SWEENEY, TEDISCO -- 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 (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, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
6 FIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE
7 FORTY-FOUR OF THE PUBLIC HEALTH LAW PROVIDES THAT ANY HEALTH CARE CLAIMS
8 SUBMITTED UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO PURSUANT
9 TO THIS ARTICLE OR ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER
10 AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC-
11 IPATING OR PREFERRED PROVIDER OF AMBULANCE SERVICES FOR SERVICES
12 RENDERED, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
13 FIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE
14 FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE-
15 FITS EITHER DIRECTLY TO ANY SIMILARLY LICENSED NONPARTICIPATING OR
16 NONPREFERRED PROVIDER AT THE USUAL AND CUSTOMARY CHARGE, WHICH SHALL NOT
17 BE EXCESSIVE OR UNREASONABLE, WHEN THE PROVIDER HAS RENDERED SUCH
18 SERVICES, HAS A WRITTEN ASSIGNMENT OF BENEFITS, AND HAS CAUSED WRITTEN
19 NOTICE OF SUCH ASSIGNMENT TO BE GIVEN TO THE INSURER, ORGANIZATION, OR
20 CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF
21 THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04592-03-1
A. 4093--A 2
1 TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND TO THE INSURED,
2 SUBSCRIBER, OR OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER
3 CASE THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED
4 PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF
5 THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENEFIT PAYMENTS
6 DIRECTLY TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT. WHEN PAYMENT IS
7 MADE DIRECTLY TO A PROVIDER OF AMBULANCE SERVICES AS AUTHORIZED BY THIS
8 SECTION, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED
9 PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF
10 THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF SUCH PAYMENT TO THE
11 INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
12 (2) NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT THE
13 PAYMENT OF DIFFERENT LEVELS OF BENEFITS OR FROM HAVING DIFFERENCES IN
14 COINSURANCE PERCENTAGES APPLICABLE TO BENEFIT LEVELS FOR SERVICES
15 PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR
16 NONPREFERRED PROVIDERS.
17 (3) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO CREDIT INSUR-
18 ANCE, DISABILITY INCOME INSURANCE, OR LIMITED ACCIDENT AND SICKNESS
19 POLICIES SUCH AS HOSPITAL INDEMNITY POLICIES, SPECIFIED DISEASE POLI-
20 CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES.
21 S 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 S 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of
36 section 3221 of the insurance law, as added by chapter 506 of the laws
37 of 2001, are amended to read as follows:
38 (C) An insurer shall provide reimbursement for those services
39 prescribed by this section at rates negotiated between the insurer and
40 the provider of such services. In the absence of agreed upon rates, an
41 insurer shall pay for such services at the usual and customary charge,
42 which shall not be excessive or unreasonable. THE INSURER SHALL SEND
43 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF
44 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
45 WITH THE CLAIM.
46 (D) The provisions of this paragraph shall have [no] application to
47 transfers of patients between hospitals or health care facilities by an
48 ambulance service as described in subparagraph (A) of this paragraph.
49 S 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the
50 insurance law, as added by chapter 506 of the laws of 2001, are amended
51 to read as follows:
52 (3) An insurer shall provide reimbursement for those services
53 prescribed by this section at rates negotiated between the insurer and
54 the provider of such services. In the absence of agreed upon rates, an
55 insurer shall pay for such services at the usual and customary charge,
56 which shall not be excessive or unreasonable. THE INSURER SHALL SEND
A. 4093--A 3
1 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF
2 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
3 WITH THE CLAIM.
4 (4) The provisions of this subsection shall have [no] application to
5 transfers of patients between hospitals or health care facilities by an
6 ambulance service as described in paragraph one of this subsection.
7 S 5. This act shall take effect January 1, 2012 and shall apply to
8 health care claims submitted for payment after such date.
