NY State Senate Bill 2011-S5826

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 04, 2012	referred to insurance
Jun 18, 2011	referred to rules

2011-S5826 (ACTIVE) - Details

See Assembly Version of this Bill:: A8497
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3224-a, 3216, 3221, 4303, Ins L; amd §5, Chap of 2011 (as proposed in S.2714-B/A.4093-B)

2011-S5826 (ACTIVE) - Summary

Relates to the rate of payment of ambulance services to certain providers of such services.

2011-S5826 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S5826

TITLE OF BILL:
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 thereof

PURPOSE:
To enact a chapter amendment to legislation requiring direct
payment for ambulance services.

SUMMARY OF PROVISIONS:
Section 1 excludes payments for air ambulance
services from the direct payment requirement.

Section 2 of the bill ensures that the superintendent has oversight
relating to benefit levels and ensures that the direct payment
requirement only applies to services already covered under the policy.

Sections 3,4 and 5 of the bill deal with providing notice of an

executed assignment of benefits form.

Section 6 of the bill requires the superintendent of financial
services, in consultation with the commissioner of health, the
insurance industry and the ambulance industry, to rep0l1 on the
appropriateness of rates provided to both non-preferred and preferred
providers of ambulance services. The bill also requires the
superintendent to establish a rate setting process for reimbursement
to ambulance providers.

Section 7 of the bill provides for a sunset of December 31, 2014 for
all services provided by ambulance companies outside of NYC.

JUSTIFICATION:
The constant and quick availability of ambulance
response is something that all of our citizens have grown accustomed
to and it is essential to the survivability of all New Yorkers when
there is a medical crisis.
Fair and direct reimbursement for those services is paramount to the
financial stability and continued availability of ambulances to
respond.

Current law permits insurance companies to pay for ambulance service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It
is not practical to expect a preferred provider relationship with
every insurance company. But then it is the responsibility of the
ambulance company to try to recoup payment for service from that
patient.


All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from
the insurance company. Especially as the financial crisis we are
currently facing deepens, more and 1110re patients are pocketing
these funds. Further, the insurance company is not obligated to
advise the ambulance company that they in fact paid the ambulance
transport bill direct to the patient. This disconnect of information
leads to confusion and furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As
such, most ambulance providers have no knowledge of the patient's
ability to payor if or by whom they are insured by when a medical
emergency or
accidental event occurs. Ambulance service is one of the few medical
services where payment is not expected at the time of service.

This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need
for the responding ambulance company to be a preferred provider.

This chapter amendment makes technical clarifications and requires the
department of financial services to study the appropriateness of
rates paid to ambulance providers, as well as to establish a new rate
setting process for determining adequate reimbursements,

LEGISLATIVE HISTORY:
New bill. Chapter amendment to S.2714-B/A.4093-B

FISCAL IMPLICATIONS:
None to State.

EFFECTIVE DATE:
This act shall take effect on the same date and in the
same manner as 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, take effect; provided, however, that after December
31, 2014, this act shall only apply to services provided by ambulance
services provided by a municipally owned and operated provider of
ambulance services in a city with a population of one million or more.

2011-S5826 (ACTIVE) - Bill Text download pdf

                            
                    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:

  Section  1. The subsection heading of subsection (i) of section 3224-a
of the insurance law, as added by 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, is amended to read as follows:
  Payments to nonparticipating or nonpreferred  providers  of  ambulance
services licensed under article thirty of the public health law (EXCLUD-
ING PAYMENTS FOR SERVICES RELATED TO AIR TRANSPORT).
  S  2.  Paragraph  3  and  the  closing  paragraph of subsection (i) of
section 3224-a of the insurance law, as added by 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, are amended to read as follows:
  (3)  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 AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  The provisions of this section shall not [apply to  policies  that  do
not  include  coverage  for  ambulance services] BE DEEMED TO REQUIRE OR
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

  S 3. Subparagraph (C) of paragraph 24 of  subsection  (i)  of  section
3216  of  the insurance law, as amended by 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, is 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 OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
ON FILE.
  S 4. Subparagraph (C) of paragraph 15 of  subsection  (l)  of  section
3221  of  the insurance law, as amended by 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, is 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 OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
ON FILE.
  S 5. Paragraph 3 of subsection (aa) of section 4303 of  the  insurance
law,  as amended by 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, is amended to read as follows:
  (3)  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 OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
ON FILE.
  S  6.   (A) On or before January 1, 2013, the superintendent of finan-
cial services, in consultation with  the  commissioner  of  health,  the
insurance  industry  and  the  ambulance  industry,  shall report to the
governor, the speaker of the assembly, the temporary  president  of  the
senate,  and  the chairs of the standing committees of insurance of both
the senate and assembly regarding the appropriateness of rates  provided
to  both  non-preferred  and  preferred  providers of ambulance services
other than those ambulance services provided by a municipally owned  and
operated  provider  of ambulance services in a city with a population of
one million or more. Such study shall include a review of the  appropri-
ateness  of  current  medicaid and medicaid managed care rates for ambu-
lance services.   The superintendent of financial  services  shall  also
make  recommendations  regarding  improving  the appropriateness of rate
structures for non-preferred and preferred providers in different  parts

S. 5826                             3

of  the state, other than those ambulance services provided by a munici-
pally owned and operated provider of ambulance services in a city with a
population of one million or more.
  (B)  On  or  before  January  1, 2014, the superintendent of financial
services, in consultation with the commissioner of health, the insurance
industry and the ambulance industry, shall make recommendations  regard-
ing  establishing  a rate setting process that shall be used by insurers
and ambulance providers both non-preferred and preferred, to be used  in
the state, other than ambulance services provided by a municipally owned
and  operated provider of ambulance services in a city with a population
of one million or more, when reimbursing both emergency and non-emergen-
cy services provided by such providers, in  an  effort  to  ensure  that
rates  provided are adequate, reasonable, and not excessive. Such recom-
mendations shall  not  be  implemented  without  subsequent  legislative
approval.
  S  7.   Section 5 of a chapter of the laws of 2011 amending the insur-
ance law relating to payments to prehospital emergency medical  services
providers,  as  proposed  in  legislative  bills  numbers  S.2714-B  and
A.4093-B, is amended to read as follows:
  S 5. This act shall take effect January 1, 2012  and  shall  apply  to
[health care claims submitted for payment]  SERVICES PROVIDED after such
date;  PROVIDED,  HOWEVER,  THAT AFTER DECEMBER 31, 2014, THIS ACT SHALL
ONLY APPLY TO SERVICES PROVIDED BY  AMBULANCE  SERVICES  PROVIDED  BY  A
MUNICIPALLY  OWNED AND OPERATED PROVIDER OF AMBULANCE SERVICES IN A CITY
WITH A POPULATION OF ONE MILLION OR MORE.
  S 8. This act shall take effect on the  same  date  and  in  the  same
manner  as  a  chapter  of  the  laws of 2011 amending the insurance law
relating to payments to prehospital emergency medical  services  provid-
ers,  as  proposed  in  legislative bills numbers S.2714-B and A.4093-B,
takes effect; provided, however, that after December 31, 2014, this  act
shall  only apply to services provided by ambulance services provided by
a municipally owned and operated provider of  ambulance  services  in  a
city with a population of one million or more.

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Senate Bill S5826

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2011-S5826 (ACTIVE) - Details

2011-S5826 (ACTIVE) - Summary

2011-S5826 (ACTIVE) - Sponsor Memo

2011-S5826 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S5826

Share this bill

Sponsored By

James L. Seward

Archive: Last Bill Status - In Senate Committee Insurance Committee

2011-S5826 (ACTIVE) - Details

2011-S5826 (ACTIVE) - Summary

2011-S5826 (ACTIVE) - Sponsor Memo

2011-S5826 (ACTIVE) - Bill Text download pdf

Comments