STATE OF NEW YORK ________________________________________________________________________ 1466--A Cal. No. 345 2023-2024 Regular Sessions IN SENATE January 12, 2023 ___________ Introduced by Sens. BRESLIN, ADDABBO, COONEY, GALLIVAN, HELMING, MANN- ION, O'MARA, RIVERA, SANDERS, SEPULVEDA, SKOUFIS, WALCZYK -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- reported favorably from said committee, ordered to first and second report, ordered to a third reading, amended and ordered reprinted, retaining its place in the order of third reading 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 EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05298-02-3
S. 1466--A 2 1 executed assignment of benefits, and has caused notice of such assign- 2 ment to be given to the insurer, organization, or corporation licensed 3 or certified pursuant to article forty-three or forty-seven of this 4 chapter or article forty-four of the public health law or jointly to 5 such nonparticipating or nonpreferred provider and to the insured, 6 subscriber, or other covered person; provided, however, that in either 7 case the insurer, organization, or corporation licensed or certified 8 pursuant to article forty-three or forty-seven of this chapter or arti- 9 cle forty-four of the public health law shall be required to send such 10 benefit payments directly to the provider who has the assignment on 11 file. When payment is made directly to a provider of ambulance services 12 as authorized by this section, the insurer, organization, or corporation 13 licensed or certified pursuant to article forty-three or forty-seven of 14 this chapter or article forty-four of the public health law shall give 15 written notice of such payment to the insured, subscriber, or other 16 covered person. 17 (2) An insurer shall provide reimbursement for those services 18 prescribed by this section at rates negotiated between the insurer and 19 the provider of such services. In the absence of agreed upon rates, an 20 insurer shall pay for such services at the usual and customary charge as 21 defined under section three thousand two hundred forty-one of this arti- 22 cle, which shall not be excessive or unreasonable. 23 (3) An insurer, organization, or corporation licensed or certified 24 pursuant to article forty-three or forty-seven of this chapter or arti- 25 cle forty-four of the public health law shall ensure that the insured, 26 subscriber, or other covered person shall incur no greater out-of-pocket 27 costs for ambulance services provided by a nonparticipating or nonpre- 28 ferred provider than the insured, subscriber, or other covered person 29 would have incurred with a participating or preferred provider of such 30 services. 31 (4) Nothing contained in this section shall be deemed to prohibit the 32 payment of different levels of benefits or from having differences in 33 coinsurance percentages applicable to benefit levels for services 34 provided by participating or preferred providers and nonparticipating or 35 nonpreferred providers. 36 The provisions of this subsection shall not apply to policies that do 37 not include coverage for ambulance services. 38 § 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of 39 section 3216 of the insurance law, as added by chapter 506 of the laws 40 of 2001, are amended to read as follows: 41 (C) An insurer shall provide reimbursement for those services 42 prescribed by this section at rates negotiated between the insurer and 43 the provider of such services. In the absence of agreed upon rates, an 44 insurer shall pay for such services at the usual and customary charge, 45 which shall not be excessive or unreasonable. Except in a city with a 46 population of one million or more persons, the insurer shall send such 47 payments directly to the provider of such ambulance services, if the 48 ambulance service has on file an executed assignment of benefits form 49 with the claim. 50 (D) The provisions of this paragraph shall have no application to 51 transfers of patients between hospitals or health care facilities by an 52 ambulance service as described in subparagraph (A) of this paragraph 53 unless such services are covered under the policy. 54 § 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of 55 section 3221 of the insurance law, as added by chapter 506 of the laws 56 of 2001, are amended to read as follows:
S. 1466--A 3 1 (C) An insurer shall provide reimbursement for those services 2 prescribed by this section at rates negotiated between the insurer and 3 the provider of such services. In the absence of agreed upon rates, an 4 insurer shall pay for such services at the usual and customary charge, 5 which shall not be excessive or unreasonable. Except in a city with a 6 population of one million or more persons, the insurer shall send such 7 payments directly to the provider of such ambulance services, if the 8 ambulance service has on file an executed assignment of benefits form 9 with the claim. 10 (D) The provisions of this paragraph shall have no application to 11 transfers of patients between hospitals or health care facilities by an 12 ambulance service as described in subparagraph (A) of this paragraph 13 unless such services are covered under the policy. 14 § 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the 15 insurance law, as added by chapter 506 of the laws of 2001, are amended 16 to read as follows: 17 (3) An insurer shall provide reimbursement for those services 18 prescribed by this section at rates negotiated between the insurer and 19 the provider of such services. In the absence of agreed upon rates, an 20 insurer shall pay for such services at the usual and customary charge, 21 which shall not be excessive or unreasonable. Except in a city with a 22 population of one million or more persons, the insurer shall send such 23 payments directly to the provider of such ambulance services, if the 24 ambulance service has on file an executed assignment of benefits form 25 with the claim. 26 (4) The provisions of this subsection shall have no application to 27 transfers of patients between hospitals or health care facilities by an 28 ambulance service as described in paragraph one of this subsection 29 unless such services are covered under the policy. 30 § 5. This act shall take effect January 1, 2025 and shall apply to 31 health care claims submitted for payment after such date.