Bill Text: NY A04093 | 2011-2012 | General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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
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--B R. R. 102 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. AMEDORE, JOHNS, P. LOPEZ, McENENY, McLAUGHLIN, RAMOS, SWEENEY, TEDISCO -- read once and referred to the Committee on Insurance -- reported and referred to the Commit- tee on Rules -- Rules Committee discharged, bill amended, ordered reprinted as amended and recommitted to the Committee on Rules -- amended on the special order of third reading, ordered reprinted as amended, retaining its place on the special order of third reading 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 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 ARTICLES 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 14 FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH 15 LAW SHALL BE REQUIRED TO PAY SUCH BENEFITS EITHER DIRECTLY TO ANY SIMI- 16 LARLY LICENSED NONPARTICIPATING OR NONPREFERRED PROVIDER AT THE USUAL 17 AND CUSTOMARY CHARGE, WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE, WHEN 18 THE PROVIDER HAS RENDERED SUCH SERVICES, HAS A WRITTEN ASSIGNMENT OF 19 BENEFITS, AND HAS CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE GIVEN EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04592-05-1 A. 4093--B 2 1 TO THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED 2 PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI- 3 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY TO SUCH NONPARTIC- 4 IPATING OR NONPREFERRED PROVIDER AND TO THE INSURED, SUBSCRIBER, OR 5 OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER CASE THE INSUR- 6 ER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTI- 7 CLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF 8 THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENEFIT PAYMENTS 9 DIRECTLY TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT. WHEN PAYMENT IS 10 MADE DIRECTLY TO A PROVIDER OF AMBULANCE SERVICES AS AUTHORIZED BY THIS 11 SECTION, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED 12 PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI- 13 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF 14 SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON. 15 (2) AN INSURER SHALL PROVIDE REIMBURSEMENT FOR THOSE SERVICES 16 PRESCRIBED BY THIS SECTION AT RATES NEGOTIATED BETWEEN THE INSURER AND 17 THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON RATES, AN 18 INSURER SHALL PAY FOR SUCH SERVICES AT THE USUAL AND CUSTOMARY CHARGE, 19 WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE. 20 (3) NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT THE 21 PAYMENT OF DIFFERENT LEVELS OF BENEFITS OR FROM HAVING DIFFERENCES IN 22 COINSURANCE PERCENTAGES APPLICABLE TO BENEFIT LEVELS FOR SERVICES 23 PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR 24 NONPREFERRED PROVIDERS. 25 THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO POLICIES THAT DO NOT 26 INCLUDE COVERAGE FOR AMBULANCE SERVICES. 27 S 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of 28 section 3216 of the insurance law, as added by chapter 506 of the laws 29 of 2001, are amended to read as follows: 30 (C) An insurer shall provide reimbursement for those services 31 prescribed by this section at rates negotiated between the insurer and 32 the provider of such services. In the absence of agreed upon rates, an 33 insurer shall pay for such services at the usual and customary charge, 34 which shall not be excessive or unreasonable. THE INSURER SHALL SEND 35 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF 36 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM 37 WITH THE CLAIM. 38 (D) The provisions of this paragraph shall have no application to 39 transfers of patients between hospitals or health care facilities by an 40 ambulance service as described in subparagraph (A) of this paragraph 41 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. 42 S 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of 43 section 3221 of the insurance law, as added by chapter 506 of the laws 44 of 2001, are amended to read as follows: 45 (C) An insurer shall provide reimbursement for those services 46 prescribed by this section at rates negotiated between the insurer and 47 the provider of such services. In the absence of agreed upon rates, an 48 insurer shall pay for such services at the usual and customary charge, 49 which shall not be excessive or unreasonable. THE INSURER SHALL SEND 50 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF 51 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM 52 WITH THE CLAIM. 53 (D) The provisions of this paragraph shall have no application to 54 transfers of patients between hospitals or health care facilities by an 55 ambulance service as described in subparagraph (A) of this paragraph 56 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. A. 4093--B 3 1 S 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the 2 insurance law, as added by chapter 506 of the laws of 2001, are amended 3 to read as follows: 4 (3) An insurer shall provide reimbursement for those services 5 prescribed by this section at rates negotiated between the insurer and 6 the provider of such services. In the absence of agreed upon rates, an 7 insurer shall pay for such services at the usual and customary charge, 8 which shall not be excessive or unreasonable. THE INSURER SHALL SEND 9 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF 10 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM 11 WITH THE CLAIM. 12 (4) The provisions of this subsection shall have no application to 13 transfers of patients between hospitals or health care facilities by an 14 ambulance service as described in paragraph one of this subsection 15 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. 16 S 5. This act shall take effect January 1, 2012 and shall apply to 17 health care claims submitted for payment after such date.