S T A T E   O F   N E W   Y O R K
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                                  7534

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                              May 23, 2013
                               ___________

Introduced by M. of A. ROBERTS, NOJAY, FINCH, COOK -- Multi-Sponsored by
  --  M.  of  A. ARROYO, CROUCH, GIBSON, PERRY, SEPULVEDA, SIMANOWITZ --
  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:

  Section 1. Section 3224-a of the insurance law is amended by adding  a
new subsection (j) to read as follows:
  (J)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU-
LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC  HEALTH  LAW.
(1)  WHENEVER  AN INSURER OR AN ORGANIZATION, OR CORPORATION LICENSED OR
CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OR FORTY-SEVEN 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  ARTICLE  FORTY-TWO,  FORTY-THREE  OR
FORTY-SEVEN  OF THIS CHAPTER AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW ARE PAYABLE TO A PARTICIPATING OR PREFERRED  PROVIDER  OF  AMBULANCE
SERVICES  FOR  SERVICES  RENDERED,  THE INSURER, ORGANIZATION, OR CORPO-
RATION  LICENSED  OR  CERTIFIED  PURSUANT  TO  ARTICLE  FORTY-THREE   OR
FORTY-SEVEN  OF  THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH
LAW SHALL BE REQUIRED TO PAY SUCH BENEFITS EITHER DIRECTLY TO ANY  SIMI-
LARLY  LICENSED  NONPARTICIPATING  OR NONPREFERRED PROVIDER AT THE USUAL
AND CUSTOMARY CHARGE, WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE, WHEN
THE 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 OR FORTY-SEVEN OF THIS CHAPTER OR ARTI-
CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY  TO  SUCH  NONPARTIC-
IPATING  OR  NONPREFERRED  PROVIDER  AND  TO THE INSURED, SUBSCRIBER, OR
OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER CASE THE  INSUR-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06549-02-3
              

A. 7534                             2

ER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTI-
CLE  FORTY-THREE OR FORTY-SEVEN OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF
THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND  SUCH  BENEFIT  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 OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
CLE  FORTY-FOUR  OF  THE  PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF
SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
  (2)  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.
  (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.
  THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO POLICIES THAT DO NOT
INCLUDE COVERAGE FOR AMBULANCE SERVICES.
  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
UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
  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
UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
  S  4.  Paragraphs  3  and  4 of subsection (aa) of section 4303 of the
insurance law, as added by chapter 506 of the laws of 2001, are  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

A. 7534                             3

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.
  (4)  The  provisions  of  this subsection shall have no application to
transfers of patients between hospitals or health care facilities by  an
ambulance  service  as  described  in  paragraph  one of this subsection
UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
  S 5. This act shall take effect January 1, 2014  and  shall  apply  to
health care claims submitted for payment after such date.