S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5803
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 19, 2019
                                ___________
 
 Introduced  by  M.  of A. BARCLAY, BLANKENBUSH, GIGLIO, KOLB, MONTESANO,
   MANKTELOW, BYRNES, DeSTEFANO -- Multi-Sponsored by -- M. of A. CROUCH,
   DiPIETRO, FINCH, GOODELL, McDONOUGH, PALMESANO, SALKA, THIELE --  read
   once and referred to the Committee on Insurance
 
 AN  ACT to amend the insurance law, the penal law and the executive law,
   in relation to establishing the New York  automobile  insurance  fraud
   and premium reduction act; and making an appropriation therefor
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. This act shall be known and may be cited as the  "New  York
 automobile insurance fraud and premium reduction act".
   § 2. The insurance law is amended by adding a new section 5110 to read
 as follows:
   §  5110. CERTIFICATION OF MANAGED CARE ORGANIZATIONS. (A)(1) ANY INDI-
 VIDUAL OR GROUP AUTHORIZED TO  PROVIDE  MEDICAL  OR  OTHER  HEALTH  CARE
 SERVICES  IN  THIS STATE MAY, DIRECTLY OR THROUGH AN AUTHORIZED INSURER,
 MAKE WRITTEN APPLICATION TO THE SUPERINTENDENT TO  BECOME  CERTIFIED  TO
 PROVIDE MANAGED CARE TO INJURED COVERED PERSONS UNDER THIS ARTICLE.
   (2)  CERTIFICATION SHALL BE VALID FOR SUCH PERIOD AND FOR SUCH SERVICE
 AREAS AS  THE  SUPERINTENDENT  MAY  PRESCRIBE,  UNLESS  SOONER  REVOKED,
 SUSPENDED OR AMENDED.
   (3)  EACH  APPLICATION  FOR  CERTIFICATION  SHALL  BE ACCOMPANIED BY A
 REASONABLE FEE PRESCRIBED BY THE SUPERINTENDENT AND A  PROPOSED  MANAGED
 CARE PROGRAM DETAILING ITS SIGNIFICANT FEATURES, METHODS AND PROCEDURES.
   (B)  APPLICATION  FOR  CERTIFICATION  SHALL  BE  MADE IN SUCH FORM AND
 MANNER, AND SHALL SET FORTH SUCH INFORMATION REGARDING THE PROPOSED PLAN
 OF MANAGED CARE FOR PROVIDING MEDICAL AND OTHER HEALTH CARE SERVICES, AS
 THE SUPERINTENDENT MAY PRESCRIBE, INCLUDING:
   (1) THE NAMES AND CREDENTIALS OF ALL INDIVIDUALS OR ORGANIZATIONS THAT
 WILL PROVIDE SERVICES UNDER THE  MANAGED  CARE  PROGRAM,  TOGETHER  WITH
 APPROPRIATE  EVIDENCE  OF COMPLIANCE WITH ANY LICENSING OR CERTIFICATION
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD02472-01-9

 A. 5803                             2
 
 REQUIREMENTS FOR SUCH INDIVIDUALS OR ORGANIZATIONS TO PRACTICE  IN  THIS
 STATE;
   (2)  A  DESCRIPTION  OF  THE  TIMES,  PLACES  AND  MANNER OF PROVIDING
 SERVICES UNDER THE MANAGED CARE PROGRAM;
   (3) A DESCRIPTION OF THE TIMES, PLACES AND MANNER OF  PROVIDING  OTHER
 RELATED OPTIONAL SERVICES THE APPLICANT MAY WISH TO PROVIDE; AND
   (4)  A  DESCRIPTION  AND REPRESENTATIVE COPIES OF ALL REMUNERATION AND
 RELATED ARRANGEMENTS BETWEEN THE MANAGED CARE ORGANIZATION AND  INDIVID-
 UAL PROVIDERS OF SERVICES UNDER THE MANAGED CARE PROGRAM.
   (C)  THE SUPERINTENDENT SHALL CERTIFY AN APPLICANT, IF THE SUPERINTEN-
 DENT FINDS THAT THE MANAGED CARE PROGRAM:
   (1) PROVIDES MEDICAL AND OTHER HEALTH CARE SERVICES THAT MEET QUALITY,
 CONTINUITY AND OTHER TREATMENT STANDARDS PRESCRIBED BY  THE  SUPERINTEN-
 DENT  OR  THE COMMISSIONER OF HEALTH, IN A MANNER THAT IS TIMELY, EFFEC-
 TIVE AND CONVENIENT FOR INJURED PERSONS;
   (2) INCLUDES A SUFFICIENT NUMBER OF EACH CATEGORY OF PROVIDER THROUGH-
 OUT THE PROPOSED SERVICE AREAS TO GIVE INJURED PERSONS  ADEQUATE  FLEXI-
 BILITY  TO  CHOOSE  AN  AUTHORIZED PROVIDER FROM AMONG THOSE HEALTH CARE
 PROVIDERS WHO PARTICIPATE IN THE MANAGED CARE PROGRAM;
   (3) PROVIDES APPROPRIATE FINANCIAL INCENTIVES OR OTHER  APPROACHES  TO
 REDUCE COSTS AND MINIMIZE IMPROPER UTILIZATION WITHOUT SACRIFICING QUAL-
 ITY OF SERVICE;
   (4)  PROVIDES ADEQUATE METHODS OF PEER REVIEW, UTILIZATION REVIEW, AND
 DISPUTE RESOLUTION, INCLUDING WHERE APPLICABLE, ACCESS TO  THE  EXTERNAL
 APPEAL  PROCESS  AS  PROVIDED  IN ARTICLE FORTY-NINE OF THIS CHAPTER, IN
 ORDER TO: (A) PREVENT INAPPROPRIATE OR EXCESSIVE  TREATMENT;  (B)  AVOID
 CONFLICTS    OF  INTEREST; (C) EXCLUDE FROM PARTICIPATION IN THE PROGRAM
 THOSE PROVIDERS WHO VIOLATE  REASONABLE  TREATMENT  STANDARDS;  AND  (D)
 PROVIDE FOR THE RESOLUTION OF MEDICAL DISPUTES;
   (5)  PROVIDES  A TIMELY AND ACCURATE METHOD OF REPORTING TO THE SUPER-
 INTENDENT OR THE COMMISSIONER OF HEALTH AS APPROPRIATE, NECESSARY INFOR-
 MATION REGARDING MEDICAL AND HEALTH CARE SERVICE COST AND UTILIZATION TO
 MONITOR THE EFFECTIVENESS OF THE MANAGED CARE PROGRAM;
   (6) PROVIDES A MECHANISM FOR AN INJURED  PERSON  TO  OBTAIN  TREATMENT
 OUTSIDE OF THE MANAGED CARE PROGRAM IF THE SERVICES ARE NOT AVAILABLE OR
 ACCESSIBLE WITHIN THE PROGRAM;
   (7) PROVIDES FOR A REASONABLE AND APPROPRIATE COORDINATION WITH ANOTH-
 ER  HEALTH  CARE  PROVIDER  WHERE  THE INJURED PERSON HAS BEEN RECEIVING
 TREATMENT FROM ANOTHER HEALTH CARE PROVIDER FOR  A  PREVIOUSLY  EXISTING
 CONDITION OR INJURY WHICH HAS BEEN AGGRAVATED BY THE MOTOR VEHICLE ACCI-
 DENT;
   (8)  PROVIDES  FOR  A  MECHANISM FOR NOTIFICATION ABOUT AND TRANSITION
 FROM EMERGENCY CARE; AND
   (9) COMPLIES WITH ANY OTHER REQUIREMENT THE SUPERINTENDENT  DETERMINES
 IS  NECESSARY  TO PROVIDE QUALITY MEDICAL AND OTHER HEALTH CARE SERVICES
 TO INJURED PERSONS.
   (D) THE SUPERINTENDENT MAY CERTIFY A HEALTH  MAINTENANCE  ORGANIZATION
 ISSUED A CERTIFICATE OF AUTHORITY UNDER ARTICLE FORTY-FOUR OF THE PUBLIC
 HEALTH  LAW OR LICENSED UNDER ARTICLE FORTY-THREE OF THIS CHAPTER, IF IT
 MEETS THE REQUIREMENTS OF THIS  SECTION.  THE  SUPERINTENDENT  MAY  ALSO
 CERTIFY  AN  ACCIDENT AND HEALTH INSURER, INCLUDING A CORPORATION ORGAN-
 IZED UNDER ARTICLE FORTY-THREE OF THIS CHAPTER, WHICH HAS A  PARTICIPAT-
 ING OR PREFERRED NETWORK OF PROVIDERS IF SUCH INSURER MEETS THE REQUIRE-
 MENTS  OF  THIS  SECTION.  TO THE EXTENT A MANAGED CARE ORGANIZATION HAS
 BEEN REVIEWED, APPROVED OR CERTIFIED  BY  ANOTHER  STATE  AGENCY  AS  TO
 ACCESSIBILITY,  QUALITY  OR  CONTINUITY  OF CARE OR FOR ANY OF THE OTHER

 A. 5803                             3
 
 MATTERS WITHIN THE SUPERINTENDENT'S  REVIEW,  THE  SUPERINTENDENT  SHALL
 CONSIDER  THE  REVIEW, APPROVAL OR CERTIFICATION OF ANOTHER STATE AGENCY
 SO AS NOT TO  DUPLICATE  THOSE  REVIEWS,  APPROVALS  OR  CERTIFICATIONS.
 HOWEVER,  NOTHING IN THIS SUBSECTION SHALL BE DEEMED TO LIMIT THE SUPER-
 INTENDENT'S AUTHORITY TO IMPOSE AND REVIEW  ADDITIONAL  REQUIREMENTS  OR
 STANDARDS  ABOVE AND BEYOND THOSE IMPOSED BY ANOTHER STATE AGENCY TO THE
 EXTENT THOSE REQUIREMENTS OR STANDARDS ARE NECESSARY OR APPROPRIATE  FOR
 IMPLEMENTATION OF THIS SECTION.
   (E)  THE  SUPERINTENDENT  SHALL  REFUSE  TO CERTIFY, OR MAY REVOKE, OR
 SUSPEND OR AMEND THE CERTIFICATION OF, ANY MANAGED CARE ORGANIZATION, IF
 THE SUPERINTENDENT FINDS THAT:
   (1) THE MANAGED CARE PROGRAM FOR PROVIDING SERVICES FAILS TO MEET  THE
 REQUIREMENTS OF THIS SECTION; OR
   (2)  SERVICE  UNDER  THE MANAGED CARE PROGRAM IS NOT BEING PROVIDED IN
 ACCORDANCE WITH ITS TERMS AS DESCRIBED IN THE  APPLICATION  FOR  CERTIF-
 ICATION.
   (F)  FOR  PURPOSES  OF  THIS  SECTION, THE SUPERINTENDENT MAY CONSIDER
 WHETHER PROVIDERS UTILIZED BY A MANAGED CARE ORGANIZATION  OR  OTHERWISE
 AUTHORIZED  TO  PROVIDE  SERVICES  UNDER  THE CONTRACT ARE AUTHORIZED TO
 RENDER MEDICAL CARE IN ACCORDANCE WITH SECTION THIRTEEN-B OF  THE  WORK-
 ERS' COMPENSATION LAW.
   (G)  UTILIZATION  REVIEW, QUALITY ASSURANCE AND PEER REVIEW ACTIVITIES
 PURSUANT TO THIS SECTION SHALL BE SUBJECT TO REVIEW BY  THE  SUPERINTEN-
 DENT  AND  THE  COMMISSIONER  OF HEALTH. FINDINGS BY THE COMMISSIONER OF
 HEALTH OF PROFESSIONAL MISCONDUCT, OR DISCIPLINARY ACTIONS  IN  RELATION
 THERETO,  SHALL  BE REPORTED TO THE APPROPRIATE LICENSING BOARDS AND THE
 SUPERINTENDENT.
   (H) DATA GENERATED BY OR RECEIVED IN CONNECTION WITH THESE ACTIVITIES,
 INCLUDING WRITTEN REPORTS, NOTES OR RECORDS OF ANY SUCH ACTIVITIES OR OF
 THE REVIEW THEREOF, SHALL BE CONFIDENTIAL AND SHALL  NOT  BE  DISCLOSED,
 EXCEPT TO THE EXTENT DETERMINED TO BE NECESSARY BY THE SUPERINTENDENT OR
 THE  COMMISSIONER  OF  HEALTH.  NO DATA GENERATED BY UTILIZATION REVIEW,
 QUALITY ASSURANCE OR PEER REVIEW ACTIVITIES PURSUANT TO THIS SECTION, OR
 THE REVIEW THEREOF, SHALL BE USED IN ANY  ACTION,  SUIT  OR  PROCEEDING,
 EXCEPT TO THE EXTENT DETERMINED TO BE NECESSARY BY THE SUPERINTENDENT OR
 THE COMMISSIONER.
   (I)  A  PERSON PARTICIPATING IN UTILIZATION REVIEW, QUALITY ASSURANCE,
 OR PEER REVIEW ACTIVITIES PURSUANT TO THIS SECTION SHALL NOT BE EXAMINED
 AS TO ANY COMMUNICATION MADE IN THE COURSE OF  SUCH  ACTIVITIES  OR  THE
 FINDINGS THEREOF, NOR SHALL ANY SUCH PERSON BE SUBJECT TO A CIVIL ACTION
 FOR ACTIONS TAKEN OR STATEMENTS MADE IN GOOD FAITH.
   (J) PROVIDED THAT THERE IS COMPLIANCE WITH STANDARDS GOVERNING MANAGED
 CARE  ESTABLISHED  BY  THE SUPERINTENDENT, NO PERSON WHO PARTICIPATES IN
 FORMING ANY NETWORK, COLLECTIVELY NEGOTIATING FEES, OR OTHERWISE  SOLIC-
 ITS  OR ENTERS INTO CONTRACTS IN A GOOD FAITH EFFORT, TO PROVIDE MEDICAL
 OR OTHER HEALTH CARE SERVICES ON A MANAGED CARE BASIS IN ACCORDANCE WITH
 THE PROVISIONS OF THIS SECTION, SHALL BE SUBJECT TO ANTITRUST  LIABILITY
 REGARDING SUCH PARTICIPATION.
   (K) THE PROVISIONS OF THIS SECTION SHALL NOT AFFECT THE CONFIDENTIALI-
 TY OR ADMISSION IN EVIDENCE OF A CLAIMANT'S MEDICAL TREATMENT RECORDS.
   (L)  THE  SUPERINTENDENT,  IN  CONSULTATION  WITH  THE COMMISSIONER OF
 HEALTH, SHALL ADOPT SUCH RULES AS MAY BE  NECESSARY  TO  CARRY  OUT  THE
 PROVISIONS OF THIS SECTION.
   §  3.  Paragraph  1 of subsection (a) of section 5102 of the insurance
 law, as amended by chapter 298 of the laws of 2006, is amended  to  read
 as follows:

 A. 5803                             4
 
   (1)  All  necessary  expenses  incurred  for:  (i)  medical,  hospital
 (including services rendered in compliance with article forty-one of the
 public health law, whether or not such services are rendered directly by
 a hospital), surgical, nursing, dental, ambulance,  x-ray,  prescription
 drug   and  prosthetic  services;  (ii)  psychiatric,  physical  therapy
 (provided that treatment is rendered pursuant to a referral) and occupa-
 tional therapy and rehabilitation; (iii) any non-medical  remedial  care
 and  treatment rendered in accordance with a religious method of healing
 recognized by the laws of this state; and (iv)  any  other  professional
 health services; all without limitation as to time, provided that within
 one  year after the date of the accident causing the injury it is ascer-
 tainable that further expenses may be incurred as a result of the  inju-
 ry.  For  the  purpose  of determining basic economic loss, the expenses
 incurred under this paragraph shall be in accordance  with  the  limita-
 tions  of  section  five  thousand  one  hundred  eight of this article.
 MEDICAL TREATMENTS, DIAGNOSTIC TESTS AND SERVICES PROVIDED BY THE POLICY
 SHALL BE RENDERED IN ACCORDANCE WITH  COMMONLY  ACCEPTED  PROTOCOLS  AND
 PROFESSIONAL  STANDARDS  AND  PRACTICES  WHICH  ARE COMMONLY ACCEPTED AS
 BEING BENEFICIAL FOR THE TREATMENT OF THE COVERED INJURY.  PROTOCOLS AND
 PROFESSIONAL STANDARDS AND PRACTICES WHICH ARE  DEEMED  TO  BE  COMMONLY
 ACCEPTED  PURSUANT TO THIS SECTION SHALL BE THOSE RECOGNIZED BY NATIONAL
 STANDARD SETTING ORGANIZATIONS, NATIONAL OR STATE PROFESSIONAL ORGANIZA-
 TIONS OF THE SAME DISCIPLINE AS THE TREATING PROVIDER  OR  THOSE  DESIG-
 NATED  OR  APPROVED  BY  THE SUPERINTENDENT IN CONSULTATION WITH PROFES-
 SIONAL LICENSING BOARDS IN THE DEPARTMENT OF HEALTH AND  THE  DEPARTMENT
 OF EDUCATION. THE SUPERINTENDENT, IN CONSULTATION WITH THE COMMISSIONERS
 OF  HEALTH AND EDUCATION, MAY REJECT THE USE OF PROTOCOLS, STANDARDS AND
 PRACTICES OR LISTS OF DIAGNOSTIC TESTS SET BY  ANY  ORGANIZATION  DEEMED
 NOT TO HAVE STANDING OR GENERAL RECOGNITION BY THE PROVIDER COMMUNITY OR
 APPLICABLE  LICENSING  BOARDS.    PROTOCOLS SHALL BE DEEMED TO ESTABLISH
 GUIDELINES AS TO STANDARD APPROPRIATE TREATMENT AND DIAGNOSTIC TESTS FOR
 INJURIES SUSTAINED IN AUTOMOBILE ACCIDENTS,  BUT  THE  ESTABLISHMENT  OF
 STANDARD  TREATMENT  PROTOCOLS  OR  PROTOCOLS  FOR THE ADMINISTRATION OF
 DIAGNOSTIC TESTS SHALL NOT  BE  INTERPRETED  IN  SUCH  A  MANNER  AS  TO
 PRECLUDE  VARIANCE  WHEN  WARRANTED  BY REASON OF MEDICAL NECESSITY. THE
 POLICY FORM MAY PROVIDE FOR  PRE-CERTIFICATION  OF  CERTAIN  PROCEDURES,
 TREATMENTS,  DIAGNOSTIC  TESTS  OR OTHER SERVICES OR FOR THE PURCHASE OF
 DURABLE MEDICAL GOODS OR EQUIPMENT,  EXCEPT  THAT  NO  PRE-CERTIFICATION
 REQUIREMENT  SHALL  APPLY WITHIN TEN DAYS OF THE ACCIDENT GIVING RISE TO
 THE INJURY.
   § 4. Subsection (d) of section 5103 of the insurance law is amended to
 read as follows:
   (d) Insurance policy forms for insurance to satisfy  the  requirements
 of  subsection (a) [hereof] OF THIS SECTION shall be subject to approval
 pursuant to article twenty-three of this chapter. Minimum benefit stand-
 ards for such policies and for self-insurers, and rights of subrogation,
 examination and other such matters, shall be established  by  regulation
 pursuant  to section three hundred one of this chapter, PROVIDED, HOWEV-
 ER, THAT EFFECTIVE  IMMEDIATELY  SUCH  REGULATION  SHALL  BE  DEEMED  TO
 INCLUDE  NEW  PROVISIONS  APPLICABLE TO INJURIES WHICH OCCUR ON OR AFTER
 THE EFFECTIVE DATE OF THE CHAPTER OF THE LAWS OF TWO  THOUSAND  NINETEEN
 THAT  AMENDED  THIS  SUBSECTION  AND ESTABLISHED THE NEW YORK AUTOMOBILE
 INSURANCE FRAUD AND  PREMIUM  REDUCTION  ACT.    SUCH  REGULATION  SHALL
 PROVIDE  THAT THE INITIAL FILING OF A NOTICE OF THE EXISTENCE OF A CLAIM
 OR CLAIMS FOR FIRST PARTY BENEFITS BY A COVERED  PERSON  SHALL  BE  MADE
 WITHIN  THIRTY  DAYS  OF  SUSTAINING  AN  INJURY FOR WHICH SUCH CLAIM OR

 A. 5803                             5
 
 CLAIMS MAY BE MADE, BUT WHICH PERMIT THE FILING OF SUCH  INITIAL  NOTICE
 OF  THE EXISTENCE OF A CLAIM OR CLAIMS AS SOON AS REASONABLY PRACTICABLE
 AFTER THE EXPIRATION OF SUCH THIRTY DAY PERIOD WHERE THE NATURE  OF  THE
 INJURY  RESULTS  IN A REASONABLY JUSTIFIABLE DELAY IN FILING THE INITIAL
 NOTICE DURING SUCH THIRTY DAY PERIOD.
   § 5. Section 5108 of the insurance law is  amended  by  adding  a  new
 subsection (d) to read as follows:
   (D)  PROOF  OF  THE  FACT  AND  COST OF A MEDICAL OR HEALTH SERVICE OR
 TREATMENT WHICH IS NEEDED FOR A COVERED PERSON  TO  RECEIVE  PAYMENT  OR
 REIMBURSEMENT FOR THAT PORTION OF A CLAIM OR CLAIMS ATTRIBUTABLE TO SUCH
 SERVICE  OR  TREATMENT, WHETHER SUCH PROOF IS SUBMITTED TO A FIRST PARTY
 OR ADDITIONAL FIRST PARTY BENEFITS INSURER  BY  THE  COVERED  PERSON  OR
 DIRECTLY BY A MEDICAL PROFESSIONAL OR HEALTH SERVICES PROVIDER ON BEHALF
 OF  SUCH COVERED PERSON, FOR A SERVICE RENDERED BY THE MEDICAL OR HEALTH
 SERVICES PROVIDER TO  THE  COVERED  PERSON  SHALL  BE  SUBMITTED  WITHIN
 FORTY-FIVE  DAYS  FROM  THE DATE THE SERVICE WAS RENDERED TO THE COVERED
 PERSON. AT THE OPTION OF THE INSURER, IN  ANY  CASE  WHERE  MULTIPLE  OR
 CONTINUING  MEDICAL  OR HEALTH TREATMENTS OR SERVICES ARE REQUIRED, SUCH
 TIME LIMIT MAY BE WAIVED AND THE CLAIMS OF ONE OR MORE SUCH  MEDICAL  OR
 HEALTH SERVICE PROVIDERS MAY BE BUNDLED.
   §  6.  Section 5106 of the insurance law, subsection (b) as amended by
 chapter 452 of the laws of 2005 and subsection (d) as amended by section
 8 of part AAA of chapter 59 of the laws of 2017, is amended to  read  as
 follows:
   §  5106.  Fair claims settlement. (a) Payments of first party benefits
 and additional first party  benefits  shall  be  made  as  the  loss  is
 incurred.  Such  benefits are overdue if not paid within [thirty] FORTY-
 FIVE days after the claimant supplies proof of the fact  and  amount  of
 loss  sustained.  If  proof  is not supplied as to the entire claim, the
 amount which is supported by proof is overdue if not paid within  [thir-
 ty]  FORTY-FIVE  days after such proof is supplied. All overdue payments
 shall bear interest at the rate of two percent per  month.  If  a  valid
 claim  or  portion  was  overdue, the claimant shall also be entitled to
 recover  his  attorney's  reasonable  fee,  for   services   necessarily
 performed  in  connection  with  securing  payment of the overdue claim,
 subject to limitations promulgated by the superintendent in regulations.
 THE FAILURE TO ISSUE A DENIAL OF A CLAIM WITHIN THE FORTY-FIVE DAY PERI-
 OD PROVIDED FOR IN THIS SUBSECTION SHALL NOT PRECLUDE THE  INSURER  FROM
 RAISING  A  DEFENSE  TO THE CLAIM WHERE THE INSURER HAS MADE A REPORT TO
 THE INSURANCE FRAUDS BUREAU PURSUANT TO SECTION  FOUR  HUNDRED  FIVE  OF
 THIS  CHAPTER.  AN  INSURER WILL ALSO NOT BE PRECLUDED FROM ESTABLISHING
 THAT THE CLAIMANT HAS FAILED TO MEET ITS PRIMA FACIE BURDEN OF PROOF.
   (b) Every insurer shall [provide] NOTIFY a claimant [with  the  option
 of submitting] THAT any dispute involving the insurer's liability to pay
 first  party  benefits,  or  additional first party benefits, the amount
 thereof or any other matter which may arise pursuant to  subsection  (a)
 of  this section [to] MUST BE SETTLED BY arbitration pursuant to simpli-
 fied procedures to be promulgated or  approved  by  the  superintendent.
 Such  simplified procedures shall include an expedited eligibility hear-
 ing option, when required, to designate  the  insurer  for  first  party
 benefits  pursuant  to  subsection  (d)  of  this section. The expedited
 eligibility hearing option shall be a  forum  for  eligibility  disputes
 only,  and  shall  not  include  the  submission of any particular bill,
 payment or claim for any specific benefit for adjudication, nor shall it
 consider any other defense to payment.

 A. 5803                             6
 
   (c) An award by an arbitrator shall be binding except where vacated or
 modified by a master arbitrator in accordance with simplified procedures
 to be promulgated or approved by the  superintendent.  The  grounds  for
 vacating or modifying an arbitrator's award by a master arbitrator shall
 not  be  limited to those grounds for review set forth in article seven-
 ty-five of the civil practice law and rules. The award of a master arbi-
 trator shall be binding except for the grounds for review set  forth  in
 article  seventy-five of the civil practice law and rules[, and provided
 further that where the amount of such master arbitrator's award is  five
 thousand  dollars or greater, exclusive of interest and attorney's fees,
 the insurer or the claimant may institute a court action  to  adjudicate
 the dispute de novo].
   (d)  (1) Except as provided in paragraph two of this subsection, where
 there is reasonable belief more than one insurer would be the source  of
 first  party benefits, the insurers may agree among themselves, if there
 is a valid basis therefor, that one of them  will  accept  and  pay  the
 claim  initially.  If there is no such agreement, then the first insurer
 to whom notice of claim is given shall be responsible for  payment.  Any
 such dispute shall be resolved in accordance with the arbitration proce-
 dures  established pursuant to section five thousand one hundred five of
 this article and regulations as promulgated by the  superintendent,  and
 any  insurer  paying  first-party  benefits shall be reimbursed by other
 insurers for their proportionate share of the costs of the claim and the
 allocated expenses of processing  the  claim,  in  accordance  with  the
 provisions  entitled  "other  coverage"  contained in regulation and the
 provisions entitled "other sources of first-party benefits" contained in
 regulation. If there is no such insurer and the motor  vehicle  accident
 occurs  in  this  state,  then an applicant who is a qualified person as
 defined in article fifty-two of this chapter shall institute  the  claim
 against the motor vehicle accident indemnification corporation.
   (2)  A  group  policy  issued  pursuant to section three thousand four
 hundred fifty-five of this chapter shall provide  first  party  benefits
 when  a  dispute  exists as to whether a driver was using or operating a
 motor vehicle in connection with a transportation network  company  when
 loss,  damage, injury, or death occurs. A transportation network company
 shall notify the insurer that issued the  owner's  policy  of  liability
 insurance of the dispute within ten business days of becoming aware that
 the  dispute  exists.  When there is a dispute, the group insurer liable
 for the payment of first party benefits under a group policy shall  have
 the  right  to  recover the amount paid from the driver's insurer to the
 extent that the driver would have been  liable  to  pay  damages  in  an
 action at law.
   §  7.   Subsection (c) of section 5303 of the insurance law is amended
 to read as follows:
   (c) Such plan shall provide  for  the  method  of  classifying  risks,
 establishing  territories  and  making  rates  applicable  thereto. Such
 rates[, except with respect to rates for the minimum limits of insurance
 required by article six or seven of the vehicle and traffic law,]  shall
 be  based upon loss and expense experience of the risks insured pursuant
 to the plan.
   § 8. The insurance law is amended by adding a  new  section  405-a  to
 read as follows:
   §  405-A.   COMPENSATION FOR REPORT OF INSURANCE FRAUD TO LAW ENFORCE-
 MENT AUTHORITIES. (A)  ANY  PERSON,  OTHER  THAN  PERSONS  DESCRIBED  IN
 SUBSECTION  (A)  OF  SECTION  FOUR HUNDRED FIVE OF THIS ARTICLE, WHO HAS
 REASON TO BELIEVE THAT A FRAUDULENT INSURANCE ACT PROHIBITED PURSUANT TO

 A. 5803                             7
 
 ARTICLE ONE HUNDRED SEVENTY-SIX OF THE PENAL LAW HAS BEEN  COMMITTED  OR
 THAT AN INSURANCE TRANSACTION MAY BE FRAUDULENT, OR HAS KNOWLEDGE THAT A
 FRAUDULENT  INSURANCE  TRANSACTION  IS ABOUT TO TAKE PLACE, OR HAS TAKEN
 PLACE  MAY REPORT SUCH ACT OR TRANSACTION AND ANY ADDITIONAL INFORMATION
 RELATIVE TO THE FACTUAL CIRCUMSTANCES OF THE TRANSACTION AND THE PARTIES
 INVOLVED TO THE ATTORNEY GENERAL, DISTRICT ATTORNEY OR INSURANCE  FRAUDS
 BUREAU.
   (B)  IF THE INSURANCE FRAUDS BUREAU RECOMMENDS TO THE ATTORNEY GENERAL
 OR DISTRICT ATTORNEY TO COMMENCE AN ACTION OR IF THE ATTORNEY GENERAL OR
 DISTRICT ATTORNEY COMMENCES AN ACTION BASED ON INFORMATION PROVIDED BY A
 PERSON PURSUANT TO SUBSECTION (A) OF  THIS  SECTION,  THEN  SUCH  PERSON
 SHALL  BE  ENTITLED TO RECEIVE AN AWARD OF AT LEAST FIFTEEN PERCENT, BUT
 NOT MORE THAN TWENTY-FIVE PERCENT OF  THE  PROCEEDS  OF  THE  ACTION  OR
 SETTLEMENT OF THE CLAIM UP TO A MAXIMUM OF TWENTY-FIVE THOUSAND DOLLARS.
 THE  ATTORNEY  GENERAL OR DISTRICT ATTORNEY SHALL RECOMMEND TO THE COURT
 WHEN A SETTLEMENT IS ENTERED THE AMOUNT OF SUCH AWARD. THE  COURT  SHALL
 BASE SUCH AWARD DECISION ON THE EXTENT TO WHICH THE PERSON SUBSTANTIALLY
 CONTRIBUTED TO THE PROSECUTION OF THE ACTION.
   §  9.  Section  176.00 of the penal law is amended by adding three new
 subdivisions 6, 7 and 8 to read as follows:
   6. "PROVIDER" MEANS AN ATTORNEY, A HEALTH CARE PROFESSIONAL, AN  OWNER
 OR  OPERATOR  OF  A  HEALTH  CARE  PRACTICE  OR FACILITY, ANY PERSON WHO
 CREATES THE IMPRESSION THAT HE OR  SHE,  OR  HIS  OR  HER  PRACTICE  CAN
 PROVIDE  LEGAL OR HEALTH CARE SERVICES, OR ANY PERSON EMPLOYED OR ACTING
 ON BEHALF OF ANY SUCH PERSON.
   7. "PUBLIC MEDIA" MEANS TELEPHONE DIRECTORIES,  PROFESSIONAL  DIRECTO-
 RIES,  NEWSPAPERS  AND  OTHER  PERIODICALS,  RADIO AND TELEVISION, BILL-
 BOARDS, AND MAILED OR ELECTRONICALLY TRANSMITTED WRITTEN  COMMUNICATIONS
 THAT  DO  NOT  INVOLVE  IN-PERSON  CONTACT  WITH  A SPECIFIC PROSPECTIVE
 CLIENT, PATIENT, OR CUSTOMER.
   8. "RUNNER" MEANS A PERSON WHO, FOR A PECUNIARY BENEFIT,  PROCURES  OR
 ATTEMPTS  TO  PROCURE A CLIENT, PATIENT OR CUSTOMER AT THE DIRECTION OF,
 REQUEST OF OR IN COOPERATION WITH A PROVIDER WHEN SUCH PERSON  KNOWS  OR
 HAS  REASON  TO  KNOW  THAT  THE  PURPOSE OF SUCH PROVIDER IS TO SEEK TO
 FALSELY OR FRAUDULENTLY: OBTAIN BENEFITS UNDER A CONTRACT OF  INSURANCE;
 OR ASSERT A CLAIM AGAINST AN INSURED OR AN INSURANCE CARRIER FOR PROVID-
 ING  SERVICES  TO  THE  CLIENT, PATIENT OR CUSTOMER. SUCH TERM SHALL NOT
 INCLUDE A PERSON WHO PROCURES OR ATTEMPTS TO PROCURE  CLIENTS,  PATIENTS
 OR  CUSTOMERS FOR A PROVIDER THROUGH PUBLIC MEDIA OR A PERSON WHO REFERS
 CLIENTS, PATIENTS OR CUSTOMERS AS AUTHORIZED BY LAW.   NOTHING  IN  THIS
 ARTICLE  SHALL  BE  DEEMED TO PROHIBIT AN AGENT, BROKER OR EMPLOYEE OF A
 HEALTH MAINTENANCE ORGANIZATION FROM SEEKING TO SELL HEALTH  MAINTENANCE
 ORGANIZATION  COVERAGE  OR HEALTH INSURANCE COVERAGE TO AN INDIVIDUAL OR
 GROUP.
   § 10. Subdivision 1 of section 176.05 of the penal law, as amended  by
 chapter 211 of the laws of 2011, is amended to read as follows:
   1.  any written statement as part of, or in support of, an application
 for the issuance of, or the rating of a POLICY INSURING  AGAINST  LOSSES
 OR  LIABILITIES  ARISING  OUT  OF  THE OWNERSHIP, OPERATION, OR USE OF A
 MOTOR VEHICLE, A commercial insurance policy, or certificate or evidence
 of self insurance for commercial insurance or commercial self insurance,
 or a claim for payment or other benefit pursuant to an insurance  policy
 or  self  insurance program for commercial or personal insurance that he
 or she knows to:
   (a) contain materially false information concerning any fact  material
 thereto; or

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   (b) conceal, for the purpose of misleading, information concerning any
 fact material thereto; or
   §  11. The penal law is amended by adding a new section 176.66 to read
 as follows:
 § 176.66 UNLAWFUL PROCUREMENT OF CLIENTS, PATIENTS OR CUSTOMERS.
   A PERSON IS GUILTY OF UNLAWFUL PROCUREMENT  OF  CLIENTS,  PATIENTS  OR
 CUSTOMERS WHEN, HE OR SHE KNOWINGLY:
   1. ACTS AS A RUNNER; OR
   2.  USES, SOLICITS, DIRECTS, HIRES OR EMPLOYS ANOTHER PERSON TO ACT AS
 A RUNNER.
   UNLAWFUL PROCUREMENT OF CLIENTS, PATIENTS OR CUSTOMERS IS  A  CLASS  E
 FELONY.
   §  12.  Section  176.15 of the penal law, as amended by chapter 515 of
 the laws of 1986, is amended to read as follows:
 § 176.15 Insurance fraud in the fourth degree.
   A person is guilty of insurance fraud in the fourth degree when he  OR
 SHE  commits  a  fraudulent  insurance act and thereby wrongfully takes,
 obtains or withholds, or attempts to wrongfully take, obtain or withhold
 property with a value in excess of [one thousand] FIVE HUNDRED dollars.
   Insurance fraud in the fourth degree is a class E felony.
   § 13. Section 176.20 of the penal law, as amended by  chapter  515  of
 the laws of 1986, is amended to read as follows:
 § 176.20 Insurance fraud in the third degree.
   A  person  is guilty of insurance fraud in the third degree when he OR
 SHE commits a fraudulent insurance act  and  thereby  wrongfully  takes,
 obtains or withholds, or attempts to wrongfully take, obtain or withhold
 property  with  a  value  in excess of [three] ONE thousand FIVE HUNDRED
 dollars.
   Insurance fraud in the third degree is a class D felony.
   § 14. Section 176.25 of the penal law, as added by chapter 515 of  the
 laws of 1986, is amended to read as follows:
 § 176.25 Insurance fraud in the second degree.
   A  person is guilty of insurance fraud in the second degree when he OR
 SHE commits a fraudulent insurance act  and  thereby  wrongfully  takes,
 obtains or withholds, or attempts to wrongfully take, obtain or withhold
 property with a value in excess of [fifty] TWENTY-FIVE thousand dollars.
   Insurance fraud in the second degree is a class C felony.
   §  15. Section 176.30 of the penal law, as added by chapter 515 of the
 laws of 1986, is amended to read as follows:
 § 176.30 Insurance fraud in the first degree.
   A person is guilty of insurance fraud in the first degree when  he  OR
 SHE  commits  a  fraudulent  insurance act and thereby wrongfully takes,
 obtains or withholds, or attempts to wrongfully take, obtain or withhold
 property with a value in excess of [one million] FIVE  HUNDRED  THOUSAND
 dollars.
   Insurance fraud in the first degree is a class B felony.
   §  16. Section 176.35 of the penal law, as added by chapter 635 of the
 laws of 1996, is amended to read as follows:
 § 176.35 Aggravated insurance fraud IN THE THIRD DEGREE.
   A person is guilty of aggravated insurance fraud in the [fourth] THIRD
 degree when he OR SHE commits [a fraudulent insurance act]  THE  OFFENSE
 OF  INSURANCE  FRAUD  IN  THE  FIFTH  DEGREE,  and  has  been previously
 convicted within the preceding five years of any offense,  an  essential
 element of which is the commission of a fraudulent insurance act.
   Aggravated  insurance  fraud in the [fourth] THIRD degree is a class D
 felony.

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   § 17. The penal law is amended by adding two new sections  176.36  and
 176.37 to read as follows:
 § 176.36 AGGRAVATED INSURANCE FRAUD IN THE SECOND DEGREE.
   A  PERSON IS GUILTY OF AGGRAVATED INSURANCE FRAUD IN THE SECOND DEGREE
 WHEN HE OR SHE COMMITS THE OFFENSE OF  INSURANCE  FRAUD  IN  THE  FOURTH
 DEGREE,  AND  HAS  BEEN  PREVIOUSLY  CONVICTED WITHIN THE PRECEDING FIVE
 YEARS OF ANY OFFENSE, AN ESSENTIAL ELEMENT OF WHICH IS THE COMMISSION OF
 A FRAUDULENT INSURANCE ACT.
   AGGRAVATED INSURANCE FRAUD IN THE SECOND DEGREE IS A CLASS C FELONY.
 § 176.37 AGGRAVATED INSURANCE FRAUD IN THE FIRST DEGREE.
   A PERSON IS GUILTY OF AGGRAVATED INSURANCE FRAUD IN THE  FIRST  DEGREE
 WHEN  HE  OR  SHE  COMMITS  THE  OFFENSE OF INSURANCE FRAUD IN THE THIRD
 DEGREE, AND HAS BEEN PREVIOUSLY  CONVICTED  WITHIN  THE  PRECEDING  FIVE
 YEARS OF ANY OFFENSE, AN ESSENTIAL ELEMENT OF WHICH IS THE COMMISSION OF
 A FRAUDULENT INSURANCE ACT.
   AGGRAVATED INSURANCE FRAUD IN THE FIRST DEGREE IS A CLASS B FELONY.
   § 18. Paragraph (a) of subdivision 2 of section 846-m of the executive
 law,  as  amended  by  section  6 of part T of chapter 57 of the laws of
 2000, is amended to read as follows:
   (a) The moneys received by the fund shall be expended in a manner that
 is consistent with the plan of  operation,  pursuant  to  appropriation,
 only  to reimburse costs incurred by provider agencies for pilot program
 activities relating to the detection, prevention or reduction  of  motor
 vehicle theft and motor vehicle insurance fraud, PROVIDED, HOWEVER, THAT
 BEGINNING JANUARY FIRST, TWO THOUSAND TWENTY, ADDITIONAL MONIES RECEIVED
 BY  THE  FUND PURSUANT TO AN APPROPRIATION MADE BY A CHAPTER OF THE LAWS
 OF TWO THOUSAND NINETEEN ESTABLISHING THE NEW YORK AUTOMOBILE  INSURANCE
 FRAUD  AND  PREMIUM  REDUCTION  ACT SHALL BE USED EXCLUSIVELY TO SUPPORT
 EFFORTS UNDERTAKEN BY DISTRICT ATTORNEYS TO DETECT, IDENTIFY AND  PROSE-
 CUTE FRAUD PERTAINING TO ARTICLE FIFTY-ONE OF THE INSURANCE LAW.
   §  19.  No later than eighteen months after the effective date of this
 act, the superintendent of insurance shall study, evaluate and report to
 the governor and legislature on the impact and effect  of  this  act  on
 private  passenger  automobile  insurance costs, by rating territory, in
 New York state. The superintendent of insurance shall recommend for each
 insurer, by rating territory,  a  one-time  premium  reduction  for  the
 insurance  required  pursuant  to  article  51 of the insurance law that
 reflects the reduced cost of this type of coverage as a  result  of  the
 provisions  enacted pursuant to this act. Notwithstanding the provisions
 of article 23 of the insurance law, any such recommended reduction shall
 be binding unless demonstrated by an insurer, based on sound  underwrit-
 ing and actuarial principles reasonably related to actual or anticipated
 loss experience, that such reduction would result in underwriting losses
 for policies issued in such rating territory.
   §  20.    The  sum  of  three  million  one  hundred  thousand dollars
 ($3,100,000), or so much thereof as may be necessary, is  hereby  appro-
 priated  to  the  department  of transportation out of any moneys in the
 state treasury in the general fund to the credit of  the  motor  vehicle
 theft  and  insurance fraud prevention fund, not otherwise appropriated,
 and made immediately available, for the  purpose  of  carrying  out  the
 provisions  of  paragraph  (a)  of subdivision 2 of section 846-m of the
 executive law, as amended pursuant to  section  eighteen  of  this  act.
 Such moneys shall be payable on the audit and warrant of the comptroller
 on  vouchers certified or approved by the commissioner of transportation
 in the manner prescribed by law.

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   § 21.  Severability clause. If any clause, sentence, paragraph, subdi-
 vision, section or part contained in any  part  of  this  act  shall  be
 adjudged  by  any  court  of  competent jurisdiction to be invalid, such
 judgment shall not affect, impair, or invalidate the remainder  thereof,
 but  shall  be  confined in its operation to the clause, sentence, para-
 graph, subdivision, section or part of this act contained  in  any  part
 thereof  directly  involved  in  the  controversy in which such judgment
 shall have been rendered. It is hereby declared to be the intent of  the
 legislature  that  this act would have been enacted even if such invalid
 provisions had not been included herein.
   § 22. This act shall take effect on the ninetieth day after  it  shall
 have become a law.