Bill Text: NY S05826 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to the rate of payment of ambulance services to certain providers of such services.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2012-01-04 - REFERRED TO INSURANCE [S05826 Detail]
Download: New_York-2011-S05826-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5826
2011-2012 Regular Sessions
I N S E N A T E
June 18, 2011
___________
Introduced by Sen. SEWARD -- read twice and ordered printed, and when
printed to be committed to the Committee on Rules
AN ACT to amend the insurance law, in relation to payments to certain
providers of ambulance services; and to amend a chapter of the laws of
2011 amending the insurance law relating to payments to prehospital
emergency medical services providers, as proposed in legislative bills
numbers S.2714-B and A.4093-B, in relation to the effectiveness there-
of
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. The subsection heading of subsection (i) of section 3224-a
2 of the insurance law, as added by a chapter of the laws of 2011 amending
3 the insurance law relating to payments to prehospital emergency medical
4 services providers, as proposed in legislative bills numbers S.2714-B
5 and A.4093-B, is amended to read as follows:
6 Payments to nonparticipating or nonpreferred providers of ambulance
7 services licensed under article thirty of the public health law (EXCLUD-
8 ING PAYMENTS FOR SERVICES RELATED TO AIR TRANSPORT).
9 S 2. Paragraph 3 and the closing paragraph of subsection (i) of
10 section 3224-a of the insurance law, as added by a chapter of the laws
11 of 2011 amending the insurance law relating to payments to prehospital
12 emergency medical services providers, as proposed in legislative bills
13 numbers S.2714-B and A.4093-B, are amended to read as follows:
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 AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
19 The provisions of this section shall not [apply to policies that do
20 not include coverage for ambulance services] BE DEEMED TO REQUIRE OR
21 EXPAND COVERAGE NOT OTHERWISE INCLUDED IN THE POLICY.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04592-09-1
S. 5826 2
1 S 3. Subparagraph (C) of paragraph 24 of subsection (i) of section
2 3216 of the insurance law, as amended by a chapter of the laws of 2011
3 amending the insurance law relating to payments to prehospital emergency
4 medical services providers, as proposed in legislative bills numbers
5 S.2714-B and A.4093-B, is amended to read as follows:
6 (C) 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 includes an executed assignment of benefits form
13 with the claim OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
14 ON FILE.
15 S 4. Subparagraph (C) of paragraph 15 of subsection (l) of section
16 3221 of the insurance law, as amended by a chapter of the laws of 2011
17 amending the insurance law relating to payments to prehospital emergency
18 medical services providers, as proposed in legislative bills numbers
19 S.2714-B and A.4093-B, is amended to read as follows:
20 (C) An insurer shall provide reimbursement for those services
21 prescribed by this section at rates negotiated between the insurer and
22 the provider of such services. In the absence of agreed upon rates, an
23 insurer shall pay for such services at the usual and customary charge,
24 which shall not be excessive or unreasonable. The insurer shall send
25 such payments directly to the provider of such ambulance services, if
26 the ambulance service includes an executed assignment of benefits form
27 with the claim OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
28 ON FILE.
29 S 5. Paragraph 3 of subsection (aa) of section 4303 of the insurance
30 law, as amended by a chapter of the laws of 2011 amending the insurance
31 law relating to payments to prehospital emergency medical services
32 providers, as proposed in legislative bills numbers S.2714-B and
33 A.4093-B, is amended to read as follows:
34 (3) An insurer shall provide reimbursement for those services
35 prescribed by this section at rates negotiated between the insurer and
36 the provider of such services. In the absence of agreed upon rates, an
37 insurer shall pay for such services at the usual and customary charge,
38 which shall not be excessive or unreasonable. The insurer shall send
39 such payments directly to the provider of such ambulance services, if
40 the ambulance service includes an executed assignment of benefits form
41 with the claim OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
42 ON FILE.
43 S 6. (A) On or before January 1, 2013, the superintendent of finan-
44 cial services, in consultation with the commissioner of health, the
45 insurance industry and the ambulance industry, shall report to the
46 governor, the speaker of the assembly, the temporary president of the
47 senate, and the chairs of the standing committees of insurance of both
48 the senate and assembly regarding the appropriateness of rates provided
49 to both non-preferred and preferred providers of ambulance services
50 other than those ambulance services provided by a municipally owned and
51 operated provider of ambulance services in a city with a population of
52 one million or more. Such study shall include a review of the appropri-
53 ateness of current medicaid and medicaid managed care rates for ambu-
54 lance services. The superintendent of financial services shall also
55 make recommendations regarding improving the appropriateness of rate
56 structures for non-preferred and preferred providers in different parts
S. 5826 3
1 of the state, other than those ambulance services provided by a munici-
2 pally owned and operated provider of ambulance services in a city with a
3 population of one million or more.
4 (B) On or before January 1, 2014, the superintendent of financial
5 services, in consultation with the commissioner of health, the insurance
6 industry and the ambulance industry, shall make recommendations regard-
7 ing establishing a rate setting process that shall be used by insurers
8 and ambulance providers both non-preferred and preferred, to be used in
9 the state, other than ambulance services provided by a municipally owned
10 and operated provider of ambulance services in a city with a population
11 of one million or more, when reimbursing both emergency and non-emergen-
12 cy services provided by such providers, in an effort to ensure that
13 rates provided are adequate, reasonable, and not excessive. Such recom-
14 mendations shall not be implemented without subsequent legislative
15 approval.
16 S 7. Section 5 of a chapter of the laws of 2011 amending the insur-
17 ance law relating to payments to prehospital emergency medical services
18 providers, as proposed in legislative bills numbers S.2714-B and
19 A.4093-B, is amended to read as follows:
20 S 5. This act shall take effect January 1, 2012 and shall apply to
21 [health care claims submitted for payment] SERVICES PROVIDED after such
22 date; PROVIDED, HOWEVER, THAT AFTER DECEMBER 31, 2014, THIS ACT SHALL
23 ONLY APPLY TO SERVICES PROVIDED BY AMBULANCE SERVICES PROVIDED BY A
24 MUNICIPALLY OWNED AND OPERATED PROVIDER OF AMBULANCE SERVICES IN A CITY
25 WITH A POPULATION OF ONE MILLION OR MORE.
26 S 8. This act shall take effect on the same date and in the same
27 manner as a chapter of the laws of 2011 amending the insurance law
28 relating to payments to prehospital emergency medical services provid-
29 ers, as proposed in legislative bills numbers S.2714-B and A.4093-B,
30 takes effect; provided, however, that after December 31, 2014, this act
31 shall only apply to services provided by ambulance services provided by
32 a municipally owned and operated provider of ambulance services in a
33 city with a population of one million or more.
