Bill Text: NY A00250 | 2023-2024 | 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: Partisan Bill (Democrat 36-0)
Status: (Introduced - Dead) 2023-06-09 - substituted by s1466 [A00250 Detail]
Download: New_York-2023-A00250-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 250--A 2023-2024 Regular Sessions IN ASSEMBLY (Prefiled) January 4, 2023 ___________ Introduced by M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, WOERNER, FAHY, SANTABARBARA, PEOPLES-STOKES, COLTON, GUNTHER, OTIS, BRONSON, HUNTER, BUTTENSCHON, McMAHON, CRUZ, SAYEGH, BURDICK, THIELE, DARLING, JACKSON, SIMON, DAVILA, MEEKS, STECK, LUPARDO, CLARK, EACHUS, McDO- NALD, WEPRIN, LUNSFORD, KELLES -- 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 (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- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD00274-02-3A. 250--A 2 1 ment of benefits, and has caused notice of such assignment to be given 2 to the insurer, organization, or corporation licensed or certified 3 pursuant to article forty-three or forty-seven of this chapter or arti- 4 cle forty-four of the public health law or jointly to such nonpartic- 5 ipating or nonpreferred provider and to the insured, subscriber, or 6 other covered person; provided, however, that in either case the insur- 7 er, organization, or corporation licensed or certified pursuant to arti- 8 cle forty-three or forty-seven of this chapter or article forty-four of 9 the public health law shall be required to send such benefit payments 10 directly to the provider who has the assignment on file. When payment is 11 made directly to a provider of ambulance services as authorized by this 12 section, the insurer, organization, or corporation licensed or certified 13 pursuant to article forty-three or forty-seven of this chapter or arti- 14 cle forty-four of the public health law shall give written notice of 15 such payment to the insured, subscriber, or other covered person. 16 (2) An insurer shall provide reimbursement for those services 17 prescribed by this section at rates negotiated between the insurer and 18 the provider of such services. In the absence of agreed upon rates, an 19 insurer shall pay for such services at the usual and customary charge, 20 which shall not be excessive or unreasonable. 21 (3) Nothing contained in this section shall be deemed to prohibit the 22 payment of different levels of benefits or from having differences in 23 coinsurance percentages applicable to benefit levels for services 24 provided by participating or preferred providers and nonparticipating or 25 nonpreferred providers. 26 The provisions of this section shall not apply to policies that do not 27 include coverage for ambulance services. 28 § 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of 29 section 3216 of the insurance law, as added by chapter 506 of the laws 30 of 2001, are amended to read as follows: 31 (C) An insurer shall provide reimbursement for those services 32 prescribed by this section at rates negotiated between the insurer and 33 the provider of such services. In the absence of agreed upon rates, an 34 insurer shall pay for such services at the usual and customary charge, 35 which shall not be excessive or unreasonable. The insurer shall send 36 such payments directly to the provider of such ambulance services, if 37 the ambulance service has on file an executed assignment of benefits 38 form with the claim. 39 (D) The provisions of this paragraph shall have no application to 40 transfers of patients between hospitals or health care facilities by an 41 ambulance service as described in subparagraph (A) of this paragraph 42 unless such services are covered under the policy. 43 § 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of 44 section 3221 of the insurance law, as added by chapter 506 of the laws 45 of 2001, are amended to read as follows: 46 (C) An insurer shall provide reimbursement for those services 47 prescribed by this section at rates negotiated between the insurer and 48 the provider of such services. In the absence of agreed upon rates, an 49 insurer shall pay for such services at the usual and customary charge, 50 which shall not be excessive or unreasonable. The insurer shall send 51 such payments directly to the provider of such ambulance services, if 52 the ambulance service has on file an executed assignment of benefits 53 form with the claim. 54 (D) The provisions of this paragraph shall have no application to 55 transfers of patients between hospitals or health care facilities by anA. 250--A 3 1 ambulance service as described in subparagraph (A) of this paragraph 2 unless such services are covered under the policy. 3 § 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the 4 insurance law, as added by chapter 506 of the laws of 2001, are amended 5 to read as follows: 6 (3) An insurer shall provide reimbursement for those services 7 prescribed by this section at rates negotiated between the insurer and 8 the provider of such services. In the absence of agreed upon rates, an 9 insurer shall pay for such services at the usual and customary charge, 10 which shall not be excessive or unreasonable. The insurer shall send 11 such payments directly to the provider of such ambulance services, if 12 the ambulance service has on file an executed assignment of benefits 13 form with the claim. 14 (4) The provisions of this subsection shall have no application to 15 transfers of patients between hospitals or health care facilities by an 16 ambulance service as described in paragraph one of this subsection 17 unless such services are covered under the policy. 18 § 5. This act shall take effect January 1, 2025 and shall apply to 19 health care claims submitted for payment after such date.
