S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  363--A
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 4, 2017
                                ___________
 
 Introduced  by  Sens. LITTLE, AKSHAR, CARLUCCI, MURPHY -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Local Government -- reported favorably from said committee and commit-
   ted to the Committee on Finance -- committee discharged, bill amended,
   ordered reprinted as amended and recommitted to said committee
 
 AN  ACT to amend the general municipal law and the town law, in relation
   to authorizing fees and charges for emergency medical services; and to
   amend the insurance law, in relation to payments to prehospital  emer-
   gency medical services providers
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Subdivision 4 of section 209-b of  the  general  municipal
 law,  as  amended by chapter 718 of the laws of 1958, is amended to read
 as follows:
   4. Fees and charges [prohibited] AUTHORIZED.  (A) emergency and gener-
 al ambulance service, INCLUDING EMERGENCY MEDICAL SERVICE AS DEFINED  IN
 SECTION THREE THOUSAND ONE OF THE PUBLIC HEALTH LAW, authorized pursuant
 to  this  section  [shall]  MAY  be furnished without cost to the person
 served; PROVIDED, HOWEVER, THAT THE AUTHORITIES HAVING CONTROL OF A FIRE
 DEPARTMENT OR FIRE COMPANY THAT HAVE AUTHORIZED SUCH FIRE DEPARTMENT  OR
 FIRE  COMPANY  TO PROVIDE SUCH SERVICE OR SERVICES MAY FIX A SCHEDULE OF
 FEES OR CHARGES TO  BE  PAID  BY  PERSONS  REQUESTING  SUCH  SERVICE  OR
 SERVICES.  THE  AUTHORITIES  HAVING CONTROL OF A FIRE DEPARTMENT OR FIRE
 COMPANY MAY PROVIDE FOR THE COLLECTION OF FEES AND CHARGES OR MAY FORMU-
 LATE RULES AND REGULATIONS  FOR  THE  COLLECTION  THEREOF  BY  THE  FIRE
 DEPARTMENT  OR FIRE COMPANY. WHEN FEES AND CHARGES ARE AUTHORIZED PURSU-
 ANT TO THIS  SUBDIVISION,  THE  FEES  AND  CHARGES  COLLECTED  SHALL  BE
 DISBURSED IN ACCORDANCE WITH A WRITTEN CONTRACT ENTERED INTO BETWEEN THE
 AUTHORITY  HAVING  CONTROL  OF A FIRE DEPARTMENT OR FIRE COMPANY AND THE
 FIRE DEPARTMENT OR FIRE COMPANY ITSELF.  The acceptance by  any  fireman
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD00334-02-7

 S. 363--A                           2
 
 of any personal remuneration or gratuity, directly or indirectly, from a
 person  served  shall  be  a ground for his expulsion or suspension as a
 member of the fire department or fire company.
   (B)  NOTWITHSTANDING  THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
 SION, A BASIC LIFE SUPPORT SERVICE WHICH ESTABLISHES A SCHEDULE OF  FEES
 FOR  SERVICE SHALL ENTER INTO A CONTRACT WITH A PROVIDER OR PROVIDERS OF
 ADVANCED LIFE SUPPORT SERVICES TO PROVIDE  SUCH  ADVANCED  LIFE  SUPPORT
 SERVICES.  SUCH  CONTRACT  SHALL  AT  A  MINIMUM  ESTABLISH THE FEES FOR
 ADVANCED LIFE SUPPORT SERVICES AND THE MEANS BY WHICH SAID PROVIDER WILL
 BE REIMBURSED WHEN THE AMBULANCE SERVICE  BILLS  FOR  EMERGENCY  MEDICAL
 SERVICE.
   §  2.  Paragraph  (e) of subdivision 1 of section 122-b of the general
 municipal law, as amended by chapter 303 of the laws of 1980, is amended
 to read as follows:
   (e) [No] A contract [shall]  MAY  be  entered  into  pursuant  to  the
 provisions  of  this section for the services of an emergency rescue and
 first aid squad of a fire department or fire company which is subject to
 the provisions of section two hundred nine-b of [the  general  municipal
 law] THIS CHAPTER;
   § 3. Subdivision 1 of section 184 of the town law, as amended by chap-
 ter 599 of the laws of 1994, is amended to read as follows:
   1.  Whenever  the town board shall have established or extended a fire
 protection district pursuant to the provisions of this article, the town
 board shall provide for the furnishing of  fire  protection  within  the
 district  and  for that purpose may (a) contract with any city, village,
 fire district or incorporated  fire  company  maintaining  adequate  and
 suitable  apparatus and appliances for the furnishing of fire protection
 in such district or (b) may acquire by gift or purchase  such  apparatus
 and  appliances for use in such district and may contract with any city,
 village, fire district or incorporated fire company for operation, main-
 tenance, and  repair  of  the  same  and  for  the  furnishing  of  fire
 protection  in such district, or both. The contract may also provide for
 the furnishing of (1) emergency service in case of accidents, calamities
 or other emergencies in connection with which the services of firefight-
 ers would be required and (2) general ambulance service subject,  howev-
 er,  to  the  provisions  of  section  two hundred nine-b of the general
 municipal law. In the event that the fire  department  or  fire  company
 furnishing fire protection within the district pursuant to contract does
 not  maintain  and  operate an ambulance then a separate contract may be
 made for the furnishing  within  the  district  of  emergency  ambulance
 service or general ambulance service, or both, with any city, village or
 fire district the fire department of which, or with an incorporated fire
 company  having  its  headquarters outside the district which, maintains
 and operates an ambulance subject, however, in the case of general ambu-
 lance service, to the provisions of section two hundred  nine-b  of  the
 general municipal law, or with an ambulance service, certified or regis-
 tered pursuant to article thirty of the public health law[, which is not
 organized  under  the  provisions  of  section two hundred nine-b of the
 general municipal law].  Any  such  contract  with  any  such  ambulance
 service  permitted  herein  shall  be  subject to the provisions of this
 section.
   § 4. 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

 S. 363--A                           3
 
 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 SIMILARLY
 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 BENE-
 FITS, 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 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,  ORGANIZA-
 TION,  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 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.
   § 5. 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. 363--A                           4
 
   § 6. 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.
   §  7.  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.
   §  8.  This  act shall take effect on the ninetieth day after it shall
 have become a law, except that sections four, five,  six  and  seven  of
 this  act  shall  take effect January 1, 2019, and shall apply to health
 care claims submitted on or after such date.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  363--B
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 4, 2017
                                ___________
 
 Introduced  by  Sens. LITTLE, AKSHAR, BROOKS, CARLUCCI, FUNKE, GALLIVAN,
   HELMING, MURPHY -- read twice and ordered printed, and when printed to
   be committed to the Committee on Local Government -- reported  favora-
   bly  from  said committee and committed to the Committee on Finance --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to said committee -- recommitted to the Committee on Local
   Government  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 general municipal law and the town law, in  relation
   to authorizing fees and charges for emergency medical services; and to
   amend  the insurance law, in relation to payments to prehospital emer-
   gency medical services providers
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.    Subdivision 4 of section 209-b of the general municipal
 law, as amended by chapter 718 of the laws of 1958, is amended  to  read
 as follows:
   4. Fees and charges [prohibited] AUTHORIZED.  (A) emergency and gener-
 al  ambulance service, INCLUDING EMERGENCY MEDICAL SERVICE AS DEFINED IN
 SECTION THREE THOUSAND ONE OF THE PUBLIC HEALTH LAW, authorized pursuant
 to this section [shall] MAY be furnished  without  cost  to  the  person
 served; PROVIDED, HOWEVER, THAT THE AUTHORITIES HAVING CONTROL OF A FIRE
 DEPARTMENT  OR FIRE COMPANY THAT HAVE AUTHORIZED SUCH FIRE DEPARTMENT OR
 FIRE COMPANY TO PROVIDE SUCH SERVICE OR SERVICES MAY FIX A  SCHEDULE  OF
 FEES  OR  CHARGES  TO  BE  PAID  BY  PERSONS  REQUESTING SUCH SERVICE OR
 SERVICES. THE AUTHORITIES HAVING CONTROL OF A FIRE  DEPARTMENT  OR  FIRE
 COMPANY MAY PROVIDE FOR THE COLLECTION OF FEES AND CHARGES OR MAY FORMU-
 LATE  RULES  AND  REGULATIONS  FOR  THE  COLLECTION  THEREOF BY THE FIRE
 DEPARTMENT OR FIRE COMPANY. WHEN FEES AND CHARGES ARE AUTHORIZED  PURSU-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD00334-04-8

 S. 363--B                           2
 
 ANT  TO  THIS  SUBDIVISION,  THE  FEES  AND  CHARGES  COLLECTED SHALL BE
 DISBURSED IN ACCORDANCE WITH A WRITTEN CONTRACT ENTERED INTO BETWEEN THE
 AUTHORITY HAVING CONTROL OF A FIRE DEPARTMENT OR FIRE  COMPANY  AND  THE
 FIRE  DEPARTMENT  OR FIRE COMPANY ITSELF.  The acceptance by any fireman
 of any personal remuneration or gratuity, directly or indirectly, from a
 person served shall be a ground for his expulsion  or  suspension  as  a
 member of the fire department or fire company.
   (B)  NOTWITHSTANDING  THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
 SION, A BASIC LIFE SUPPORT SERVICE WHICH ESTABLISHES A SCHEDULE OF  FEES
 FOR  SERVICE SHALL ENTER INTO A CONTRACT WITH A PROVIDER OR PROVIDERS OF
 ADVANCED LIFE SUPPORT SERVICES TO PROVIDE  SUCH  ADVANCED  LIFE  SUPPORT
 SERVICES.  SUCH  CONTRACT  SHALL  AT  A  MINIMUM  ESTABLISH THE FEES FOR
 ADVANCED LIFE SUPPORT SERVICES AND THE MEANS BY WHICH SAID PROVIDER WILL
 BE REIMBURSED WHEN THE AMBULANCE SERVICE  BILLS  FOR  EMERGENCY  MEDICAL
 SERVICE.
   §  2.  Paragraph  (e) of subdivision 1 of section 122-b of the general
 municipal law, as amended by chapter 303 of the laws of 1980, is amended
 to read as follows:
   (e) [No] A contract [shall]  MAY  be  entered  into  pursuant  to  the
 provisions  of  this section for the services of an emergency rescue and
 first aid squad of a fire department or fire company which is subject to
 the provisions of section two hundred nine-b of [the  general  municipal
 law] THIS CHAPTER;
   § 3. Subdivision 1 of section 184 of the town law, as amended by chap-
 ter 599 of the laws of 1994, is amended to read as follows:
   1.  Whenever  the town board shall have established or extended a fire
 protection district pursuant to the provisions of this article, the town
 board shall provide for the furnishing of  fire  protection  within  the
 district  and  for that purpose may (a) contract with any city, village,
 fire district or incorporated  fire  company  maintaining  adequate  and
 suitable  apparatus and appliances for the furnishing of fire protection
 in such district or (b) may acquire by gift or purchase  such  apparatus
 and  appliances for use in such district and may contract with any city,
 village, fire district or incorporated fire company for operation, main-
 tenance, and  repair  of  the  same  and  for  the  furnishing  of  fire
 protection  in such district, or both. The contract may also provide for
 the furnishing of (1) emergency service in case of accidents, calamities
 or other emergencies in connection with which the services of firefight-
 ers would be required and (2) general ambulance service subject,  howev-
 er,  to  the  provisions  of  section  two hundred nine-b of the general
 municipal law. In the event that the fire  department  or  fire  company
 furnishing fire protection within the district pursuant to contract does
 not  maintain  and  operate an ambulance then a separate contract may be
 made for the furnishing  within  the  district  of  emergency  ambulance
 service or general ambulance service, or both, with any city, village or
 fire district the fire department of which, or with an incorporated fire
 company  having  its  headquarters outside the district which, maintains
 and operates an ambulance subject, however, in the case of general ambu-
 lance service, to the provisions of section two hundred  nine-b  of  the
 general municipal law, or with an ambulance service, certified or regis-
 tered pursuant to article thirty of the public health law[, which is not
 organized  under  the  provisions  of  section two hundred nine-b of the
 general municipal law].  Any  such  contract  with  any  such  ambulance
 service  permitted  herein  shall  be  subject to the provisions of this
 section.

 S. 363--B                           3
 
   § 4. 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  SIMILARLY
 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  BENE-
 FITS,  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 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, ORGANIZA-
 TION, 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  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.
   §  5.  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.

 S. 363--B                           4
 
   (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.
   §  6.  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.
   §  7.  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.
   §  8.  This  act shall take effect on the ninetieth day after it shall
 have become a law, except that sections four, five,  six  and  seven  of
 this  act  shall  take effect January 1, 2020, and shall apply to health
 care claims submitted on or after such date.