STATE OF NEW YORK ________________________________________________________________________ 1309 2021-2022 Regular Sessions IN ASSEMBLY January 8, 2021 ___________ Introduced by M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED, WOERNER, FAHY, MONTESANO, SANTABARBARA, PEOPLES-STOKES, GALEF, COLTON, GUNTHER, OTIS, BRONSON, HUNTER, ABINANTI, BUTTENSCHON, McMAHON, CRUZ, JOYNER, SAYEGH -- 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 (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) Except in a city with a population of one million or more persons, 6 whenever an insurer or an organization, or corporation licensed or 7 certified pursuant to article forty-three or forty-seven of this chapter 8 or article forty-four of the public health law provides that any health 9 care claims submitted under contracts or agreements issued or entered 10 into pursuant to this article or article forty-two, forty-three or 11 forty-seven of this chapter and article forty-four of the public health 12 law are payable to a participating or preferred provider of ambulance 13 services for services rendered, the insurer, organization, or corpo- 14 ration licensed or certified pursuant to article forty-three or forty- 15 seven of this chapter or article forty-four of the public health law 16 shall be required to pay such benefits either directly to any similarly 17 licensed nonparticipating or nonpreferred provider at the usual and 18 customary charge as defined under section three thousand two hundred 19 forty-one of this article, which shall not be excessive or unreasonable, 20 when the provider has rendered such services, has on file a duly 21 executed assignment of benefits, and has caused notice of such assign- 22 ment to be given to the insurer, organization, or corporation licensed 23 or certified pursuant to article forty-three or forty-seven of this EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01780-01-1A. 1309 2 1 chapter or article forty-four of the public health law or jointly to 2 such nonparticipating or nonpreferred provider and to the insured, 3 subscriber, or other covered person; provided, however, that in either 4 case the insurer, organization, or corporation licensed or certified 5 pursuant to article forty-three or forty-seven of this chapter or arti- 6 cle forty-four of the public health law shall be required to send such 7 benefit payments directly to the provider who has the assignment on 8 file. When payment is made directly to a provider of ambulance services 9 as authorized by this section, the insurer, organization, or corporation 10 licensed or certified pursuant to article forty-three or forty-seven of 11 this chapter or article forty-four of the public health law shall give 12 written notice of such payment to the insured, subscriber, or other 13 covered person. 14 (2) An insurer shall provide reimbursement for those services 15 prescribed by this section at rates negotiated between the insurer and 16 the provider of such services. In the absence of agreed upon rates, an 17 insurer shall pay for such services at the usual and customary charge as 18 defined under section three thousand two hundred forty-one of this arti- 19 cle, which shall not be excessive or unreasonable. 20 (3) An 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 shall ensure that the insured, 23 subscriber, or other covered person shall incur no greater out-of-pocket 24 costs for ambulance services provided by a nonparticipating or nonpre- 25 ferred provider than the insured, subscriber, or other covered person 26 would have incurred with a participating or preferred provider of such 27 services. 28 (4) Nothing contained in this section shall be deemed to prohibit the 29 payment of different levels of benefits or from having differences in 30 coinsurance percentages applicable to benefit levels for services 31 provided by participating or preferred providers and nonparticipating or 32 nonpreferred providers. 33 The provisions of this subsection shall not apply to policies that do 34 not include coverage for ambulance services. 35 § 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of 36 section 3216 of the insurance law, as added by chapter 506 of the laws 37 of 2001, are amended to read as follows: 38 (C) An insurer shall provide reimbursement for those services 39 prescribed by this section at rates negotiated between the insurer and 40 the provider of such services. In the absence of agreed upon rates, an 41 insurer shall pay for such services at the usual and customary charge, 42 which shall not be excessive or unreasonable. Except in a city with a 43 population of one million or more persons, the insurer shall send such 44 payments directly to the provider of such ambulance services, if the 45 ambulance service has on file 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 § 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of 52 section 3221 of the insurance law, as added by chapter 506 of the laws 53 of 2001, are amended to read as follows: 54 (C) 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, anA. 1309 3 1 insurer shall pay for such services at the usual and customary charge, 2 which shall not be excessive or unreasonable. Except in a city with a 3 population of one million or more persons, the insurer shall send such 4 payments directly to the provider of such ambulance services, if the 5 ambulance service has on file an executed assignment of benefits form 6 with the claim. 7 (D) The provisions of this paragraph shall have no application to 8 transfers of patients between hospitals or health care facilities by an 9 ambulance service as described in subparagraph (A) of this paragraph 10 unless such services are covered under the policy. 11 § 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the 12 insurance law, as added by chapter 506 of the laws of 2001, are amended 13 to read as follows: 14 (3) An insurer shall provide reimbursement for those services 15 prescribed by this section at rates negotiated between the insurer and 16 the provider of such services. In the absence of agreed upon rates, an 17 insurer shall pay for such services at the usual and customary charge, 18 which shall not be excessive or unreasonable. Except in a city with a 19 population of one million or more persons, the insurer shall send such 20 payments directly to the provider of such ambulance services, if the 21 ambulance service has on file an executed assignment of benefits form 22 with the claim. 23 (4) The provisions of this subsection shall have no application to 24 transfers of patients between hospitals or health care facilities by an 25 ambulance service as described in paragraph one of this subsection 26 unless such services are covered under the policy. 27 § 5. This act shall take effect January 1, 2023 and shall apply to 28 health care claims submitted for payment after such date.