NY State Senate Bill 2015-S1764A

Senate Bill S1764A

2015-2016 Legislative Session

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law

download bill text pdf

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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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 11, 2016	print number 1764a
Jan 11, 2016	amend and recommit to insurance
Jan 06, 2016	referred to insurance
Jan 14, 2015	referred to insurance

Bill Amendments

Original

A (Active)

co-Sponsors

View additional co-sponsors

2015-S1764 - Details

See Assembly Version of this Bill:: A8581
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S4462, A10735
2011-2012: S2714, A1341, A4093
2013-2014: S3542, A7534
2017-2018: S2527, A343
2019-2020: S3526, A6211
2021-2022: S3556, A1309
2023-2024: S1466, A250

2015-S1764 - Summary

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

2015-S1764 - Sponsor Memo

                                BILL NUMBER:S1764

TITLE OF BILL:  An act to amend the insurance law, in relation to
payments to prehospital emergency medical services providers

PURPOSE: To ensure that responding ambulance service companies 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.

SUMMARY OF PROVISIONS: Section 1 amends section 3224-a of the
insurance law to provide that payments made to nonparticipating or
non-preferred providers of ambulance services made by health insurers
shall be done so directly to the provider or jointly to both the
provider and the insured

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of
subsection (i) of section 3216 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of
subsection (1) of section 3221 of the insurance law stating that the

insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers 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 and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities

Section 5 Effective Date

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 more 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 pay or 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.

LEGISLATIVE HISTORY:  S.3542 of 2013-14; S 2714-B of 2011-12; S 4462
of 2010

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect January 1, 2016 and shall
apply to health care claims submitted for payment after such date.

2015-S1764 - Bill Text download pdf

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

                                  1764

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            January 14, 2015
                               ___________

Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
  printed to be committed 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 (k) to read as follows:
  (K)  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-
ER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07093-01-5

S. 1764                             2

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
the  provider  of such services. In the absence of agreed upon rates, an

S. 1764                             3

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, 2016 and shall apply to
health care claims submitted for payment after such date.

co-Sponsors

View additional co-sponsors

2015-S1764A (ACTIVE) - Details

See Assembly Version of this Bill:: A8581
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S4462, A10735
2011-2012: S2714, A1341, A4093
2013-2014: S3542, A7534
2017-2018: S2527, A343
2019-2020: S3526, A6211
2021-2022: S3556, A1309
2023-2024: S1466, A250

2015-S1764A (ACTIVE) - Summary

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

2015-S1764A (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S1764A

 TITLE OF BILL :  An act to amend the insurance law, in relation to
payments to prehospital emergency medical services providers

 PURPOSE :

To ensure that responding ambulance service companies 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.

 SUMMARY OF PROVISIONS :

Section 1 amends section 3224-a of the insurance law to provide that
payments made to nonparticipating or non-preferred providers of
ambulance services made by health insurers shall be done so directly
to the provider or jointly to both the provider and the insured.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of
subsection (i) of section 3216 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of
subsection (1) of section 3221 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers 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 and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.

Section 5. Effective Date.

 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 more 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 pay or 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.

 LEGISLATIVE HISTORY :

S.3542 of 2013-14;
S.2714-B of 2011-12;
S.4462 of 2010.

 FISCAL IMPLICATIONS :

None.

 EFFECTIVE DATE :
This act shall take effect January 1, 2017 and shall apply to health
care claims submitted for payment after such date.

2015-S1764A (ACTIVE) - Bill Text download pdf

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

                                 1764--A

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            January 14, 2015
                               ___________

Introduced  by  Sens.  SEWARD,  ADDABBO, AVELLA, BOYLE, FUNKE, GALLIVAN,
  MARCHIONE -- read twice and ordered printed, and when  printed  to  be
  committed  to the Committee on Insurance -- recommitted to the Commit-
  tee on Insurance in accordance with Senate Rule 6, sec. 8 -- committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

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 (k) to read as follows:
  (K)  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-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07093-03-6

S. 1764--A                          2

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-
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. 1764--A                          3

  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
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, 2017 and shall apply to
health care claims submitted for payment after such date.

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Senate Bill S1764A

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Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

Bill Amendments

co-Sponsors

2015-S1764 - Details

2015-S1764 - Summary

2015-S1764 - Sponsor Memo

2015-S1764 - Bill Text download pdf

co-Sponsors

2015-S1764A (ACTIVE) - Details

2015-S1764A (ACTIVE) - Summary

2015-S1764A (ACTIVE) - Sponsor Memo

2015-S1764A (ACTIVE) - Bill Text download pdf

Comments