Bill Text: NY S03542 | 2013-2014 | General Assembly | Introduced
Bill Title: Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.
Spectrum: Moderate Partisan Bill (Republican 7-2)
Status: (Introduced - Dead) 2014-01-08 - REFERRED TO INSURANCE [S03542 Detail]
Download: New_York-2013-S03542-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 3542 2013-2014 Regular Sessions I N S E N A T E February 5, 2013 ___________ Introduced by Sen. SEWARD -- 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 (j) to read as follows: 3 (J) 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 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 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- 25 ER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTI- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD06549-02-3 S. 3542 2 1 CLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF 2 THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENEFIT PAYMENTS 3 DIRECTLY TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT. WHEN PAYMENT IS 4 MADE DIRECTLY TO A PROVIDER OF AMBULANCE SERVICES AS AUTHORIZED BY THIS 5 SECTION, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED 6 PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTI- 7 CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF 8 SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON. 9 (2) AN INSURER SHALL PROVIDE REIMBURSEMENT FOR THOSE SERVICES 10 PRESCRIBED BY THIS SECTION AT RATES NEGOTIATED BETWEEN THE INSURER AND 11 THE PROVIDER OF SUCH SERVICES. IN THE ABSENCE OF AGREED UPON RATES, AN 12 INSURER SHALL PAY FOR SUCH SERVICES AT THE USUAL AND CUSTOMARY CHARGE, 13 WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE. 14 (3) NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT THE 15 PAYMENT OF DIFFERENT LEVELS OF BENEFITS OR FROM HAVING DIFFERENCES IN 16 COINSURANCE PERCENTAGES APPLICABLE TO BENEFIT LEVELS FOR SERVICES 17 PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR 18 NONPREFERRED PROVIDERS. 19 THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO POLICIES THAT DO NOT 20 INCLUDE COVERAGE FOR AMBULANCE SERVICES. 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 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. 36 S 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of 37 section 3221 of the insurance law, as added by chapter 506 of the laws 38 of 2001, are amended to read as follows: 39 (C) An insurer shall provide reimbursement for those services 40 prescribed by this section at rates negotiated between the insurer and 41 the provider of such services. In the absence of agreed upon rates, an 42 insurer shall pay for such services at the usual and customary charge, 43 which shall not be excessive or unreasonable. THE INSURER SHALL SEND 44 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF 45 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM 46 WITH THE CLAIM. 47 (D) The provisions of this paragraph shall have no application to 48 transfers of patients between hospitals or health care facilities by an 49 ambulance service as described in subparagraph (A) of this paragraph 50 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. 51 S 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the 52 insurance law, as added by chapter 506 of the laws of 2001, are amended 53 to read as follows: 54 (3) An insurer shall provide reimbursement for those services 55 prescribed by this section at rates negotiated between the insurer and 56 the provider of such services. In the absence of agreed upon rates, an S. 3542 3 1 insurer shall pay for such services at the usual and customary charge, 2 which shall not be excessive or unreasonable. THE INSURER SHALL SEND 3 SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF 4 THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM 5 WITH THE CLAIM. 6 (4) The provisions of this subsection shall have no application to 7 transfers of patients between hospitals or health care facilities by an 8 ambulance service as described in paragraph one of this subsection 9 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. 10 S 5. This act shall take effect January 1, 2014 and shall apply to 11 health care claims submitted for payment after such date.