Bill Text: NY A04093 | 2011-2012 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         4093
                              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, DESTITO -- read once
         and referred 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 (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  SAID  PROVIDER'S USUAL AND CUSTOMARY CHARGE,
   17  WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE,  WHEN  SAID  PROVIDER  HAS
   18  RENDERED  SUCH  SERVICES,  HAS A WRITTEN ASSIGNMENT OF BENEFITS, AND HAS
   19  CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE  GIVEN  TO  THE  INSURER,
   20  ORGANIZATION,  OR  CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE
   21  FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH
   22  LAW  OR JOINTLY TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND TO
   23  THE INSURED, SUBSCRIBER, OR OTHER  COVERED  PERSON;  PROVIDED,  HOWEVER,
   24  THAT  IN  EITHER CASE THE INSURER, ORGANIZATION, OR CORPORATION LICENSED
   25  OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR  ARTICLE
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD04592-01-1
       A. 4093                             2
    1  FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENE-
    2  FIT  PAYMENTS  DIRECTLY  TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT.
    3  WHEN PAYMENT IS MADE DIRECTLY TO A PROVIDER  OF  AMBULANCE  SERVICES  AS
    4  AUTHORIZED  BY  THIS  SECTION, THE INSURER, ORGANIZATION, OR CORPORATION
    5  LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR
    6  ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF
    7  SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
    8    (2) NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT  THE
    9  PAYMENT  OF  DIFFERENT  LEVELS OF BENEFITS OR FROM HAVING DIFFERENCES IN
   10  COINSURANCE  PERCENTAGES  APPLICABLE  TO  BENEFIT  LEVELS  FOR  SERVICES
   11  PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR
   12  NONPREFERRED PROVIDERS.
   13    (3)  THE  PROVISIONS  OF THIS SECTION SHALL NOT APPLY TO CREDIT INSUR-
   14  ANCE, DISABILITY INCOME INSURANCE,  OR  LIMITED  ACCIDENT  AND  SICKNESS
   15  POLICIES  SUCH  AS  HOSPITAL INDEMNITY POLICIES, SPECIFIED DISEASE POLI-
   16  CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES.
   17    S 2. Subparagraphs (C) and (D) of paragraph 24 of  subsection  (i)  of
   18  section  3216  of the insurance law, as added by chapter 506 of the laws
   19  of 2001, are amended to read as follows:
   20    (C)  An  insurer  shall  provide  reimbursement  for  those   services
   21  prescribed  by  this section at rates negotiated between the insurer and
   22  the provider of such services. In the absence of agreed upon  rates,  an
   23  insurer  shall  pay for such services at the usual and customary charge,
   24  which shall not be excessive or unreasonable.   THE INSURER  SHALL  SEND
   25  SUCH  PAYMENTS  DIRECTLY  TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF
   26  THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF  BENEFITS  FORM
   27  WITH THE CLAIM.
   28    (D)  The  provisions  of this paragraph shall have [no] application to
   29  transfers of patients between hospitals or health care facilities by  an
   30  ambulance service as described in subparagraph (A) of this paragraph.
   31    S  3.  Subparagraphs  (C) and (D) of paragraph 15 of subsection (l) of
   32  section 3221 of the insurance law, as added by chapter 506 of  the  laws
   33  of 2001, are amended to read as follows:
   34    (C)   An  insurer  shall  provide  reimbursement  for  those  services
   35  prescribed by this section at rates negotiated between the  insurer  and
   36  the  provider  of such services. In the absence of agreed upon rates, an
   37  insurer shall pay for such services at the usual and  customary  charge,
   38  which  shall  not  be excessive or unreasonable.  THE INSURER SHALL SEND
   39  SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF
   40  THE  AMBULANCE  SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
   41  WITH THE CLAIM.
   42    (D) The provisions of this paragraph shall have  [no]  application  to
   43  transfers  of patients between hospitals or health care facilities by an
   44  ambulance service as described in subparagraph (A) of this paragraph.
   45    S 4. This act shall take effect January 1, 2012  and  shall  apply  to
   46  health care claims submitted for payment after such date.