S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  1341

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced  by M. of A. DESTITO -- read once and referred to the Commit-
  tee 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:

  Section 1. Section 3224-a of the insurance law is amended by adding  a
new subsection (i) to read as follows:
  (I)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU-
LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC  HEALTH  LAW.
(1) WHENEVER AN INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER  OR  ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW PROVIDES THAT ANY HEALTH CARE CLAIMS
SUBMITTED UNDER CONTRACTS OR AGREEMENTS ISSUED OR ENTERED INTO  PURSUANT
TO  THIS  ARTICLE  OR ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER
AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC-
IPATING  OR  PREFERRED  PROVIDER  OF  AMBULANCE  SERVICES  FOR  SERVICES
RENDERED,  THE  INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER  OR  ARTICLE
FORTY-FOUR  OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE-
FITS EITHER DIRECTLY  TO  ANY  SIMILARLY  LICENSED  NONPARTICIPATING  OR
NONPREFERRED  PROVIDER  AT  SAID  PROVIDER'S USUAL AND CUSTOMARY CHARGE,
WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE,  WHEN  SAID  PROVIDER  HAS
RENDERED  SUCH  SERVICES,  HAS A WRITTEN ASSIGNMENT OF BENEFITS, AND HAS
CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE  GIVEN  TO  THE  INSURER,
ORGANIZATION,  OR  CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE
FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE  PUBLIC  HEALTH
LAW  OR JOINTLY TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND TO
THE INSURED, SUBSCRIBER, OR OTHER  COVERED  PERSON;  PROVIDED,  HOWEVER,
THAT  IN  EITHER CASE THE INSURER, ORGANIZATION, OR CORPORATION LICENSED

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD04592-01-1

A. 1341                             2

OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR  ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENE-
FIT  PAYMENTS  DIRECTLY  TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT.
WHEN  PAYMENT  IS  MADE  DIRECTLY TO A PROVIDER OF AMBULANCE SERVICES AS
AUTHORIZED BY THIS SECTION, THE INSURER,  ORGANIZATION,  OR  CORPORATION
LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR
ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF
SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
  (2)  NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO PROHIBIT THE
PAYMENT OF DIFFERENT LEVELS OF BENEFITS OR FROM  HAVING  DIFFERENCES  IN
COINSURANCE  PERCENTAGES  APPLICABLE  TO  BENEFIT  LEVELS  FOR  SERVICES
PROVIDED BY PARTICIPATING OR PREFERRED PROVIDERS AND NONPARTICIPATING OR
NONPREFERRED PROVIDERS.
  (3) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY  TO  CREDIT  INSUR-
ANCE,  DISABILITY  INCOME  INSURANCE,  OR  LIMITED ACCIDENT AND SICKNESS
POLICIES SUCH AS HOSPITAL INDEMNITY POLICIES,  SPECIFIED  DISEASE  POLI-
CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES.
  S  2.  Subparagraphs  (C) and (D) of paragraph 24 of subsection (i) of
section 3216 of the insurance law, as added by chapter 506 of  the  laws
of 2001, are amended to read as follows:
  (C)   An  insurer  shall  provide  reimbursement  for  those  services
prescribed by this section at rates negotiated between the  insurer  and
the  provider  of such services. In the absence of agreed upon rates, an
insurer shall pay for such services at the usual and  customary  charge,
which  shall  not  be excessive or unreasonable.  THE INSURER SHALL SEND
SUCH PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF
THE  AMBULANCE  SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF BENEFITS FORM
WITH THE CLAIM.
  (D) The provisions of this paragraph shall have  [no]  application  to
transfers  of patients between hospitals or health care facilities by an
ambulance service as described in subparagraph (A) of this paragraph.
  S 3. Subparagraphs (C) and (D) of paragraph 15 of  subsection  (l)  of
section  3221  of the insurance law, as added by chapter 506 of the laws
of 2001, are amended to read as follows:
  (C)  An  insurer  shall  provide  reimbursement  for  those   services
prescribed  by  this section at rates negotiated between the insurer and
the provider of such services. In the absence of agreed upon  rates,  an
insurer  shall  pay for such services at the usual and customary charge,
which shall not be excessive or unreasonable.   THE INSURER  SHALL  SEND
SUCH  PAYMENTS  DIRECTLY  TO THE PROVIDER OF SUCH AMBULANCE SERVICES, IF
THE AMBULANCE SERVICE INCLUDES AN EXECUTED ASSIGNMENT OF  BENEFITS  FORM
WITH THE CLAIM.
  (D)  The  provisions  of this paragraph shall have [no] application to
transfers of patients between hospitals or health care facilities by  an
ambulance service as described in subparagraph (A) of this paragraph.
  S  4.  This  act  shall take effect January 1, 2012 and shall apply to
health care claims submitted for payment after such date.