S T A T E   O F   N E W   Y O R K
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                                  6195

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             March 16, 2015
                               ___________

Introduced  by  M. of A. ROBERTS, NOJAY, FINCH, COOK, TENNEY, MONTESANO,
  LOPEZ, ZEBROWSKI, GOTTFRIED -- Multi-Sponsored by -- M. of A.  ARROYO,
  CROUCH,  GANTT, HOOPER, JOHNS, KOLB, LUPINACCI, MAGEE, McDONALD, OAKS,
  PERRY, RAIA, 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 (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-

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

A. 6195                             2

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  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:

A. 6195                             3

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