Bill Text: NY S03556 | 2021-2022 | 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: Slight Partisan Bill (Democrat 8-5)
Status: (Introduced - Dead) 2022-01-05 - REFERRED TO INSURANCE [S03556 Detail]
Download: New_York-2021-S03556-Introduced.html
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. LBD01780-02-1S. 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 andS. 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.
