NY State Senate Bill 2009-S4464

Senate Bill S4464

2009-2010 Legislative Session

Requires health care insurers to pay for ambulance services performed by non-preferred providers

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

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2010	referred to insurance
Apr 23, 2009	referred to insurance

2009-S4464 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Add §3224-c, Ins L

2009-S4464 (ACTIVE) - Summary

Requires health care insurers to pay for ambulance services performed by non-preferred providers.

2009-S4464 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S4464

 TITLE OF BILL :

An act to amend the insurance law, in relation to requiring health
care insurers to pay for ambulance services performed by non-preferred
providers


 PURPOSE OR GENERAL IDEA OF BILL :

This legislation provides that the responding 911 ambulance service
will be paid their usual and customary charge for the applicable
treatment regardless of whether or not they were a preferred provider
of the insurance company.

 SUMMARY OF PROVISIONS :

Section 1 of the insurance law is amended by adding a new section
3224-c which requires the reimbursement amount paid by health insurers
to providers of ambulance services to be based on providers usual and
customary charge regardless of whether or not they are a preferred
provider of the health insurance company.

 JUSTIFICATION :

When any New Yorker dials 911 for a medical emergency, they expect an
ambulance to be there and to be there fast. Their health insurance
policy coverage is probably farthest from their mind at that moment.
The burden of finding an ambulance provider with a preferred insurance
relationship should not be a concern of the patient in an emergency.

In NYS all ambulance companies participating in the 911 emergency
system are mandated responders. This duty to respond comes without
knowledge of the patient's ability to payor if they are insured when a
medical or accidental event occurs. Emergency 911 ambulance services
response is essential to the survivability of all New Yorkers during
an emergency request and payment for those services is paramount to
the continued availability of ambulances to respond.

Many times, the responding 911 ambulance company does not have a
preferred provider relationship with their patient's insurance
company. Once the emergency has subsided and it is time to settle the
bills for service, the responding 911 ambulance company should be paid
for the service they provided. This legislation provides that the
responding 911 ambulance service will be paid their usual and
customary charge for the applicable treatment regardless of whether or
not they were a preferred provider of the insurance company.

 PRIOR LEGISLATIVE HISTORY :
This is a new bill.

 FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
This act shall take effect immediately after it shall have become a
law.

2009-S4464 (ACTIVE) - Bill Text download pdf

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

                                  4464

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                             April 23, 2009
                               ___________

Introduced  by  Sen. BRESLIN -- 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 requiring health  care
  insurers  to  pay  for  ambulance  services performed by non-preferred
  providers

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The insurance law is amended by adding a new section 3224-c
to read as follows:
  S 3224-C. HEALTH BENEFIT PLANS PROVIDING INCENTIVES TO USE SERVICES OF
PREFERRED  PROVIDERS; MINIMUM REQUIREMENTS. (A) HEALTH CARE INSURERS MAY
ISSUE HEALTH BENEFIT PLANS WHICH  PROVIDE  FOR  INCENTIVES  FOR  COVERED
PERSONS TO USE THE AMBULANCE SERVICES OF PREFERRED PROVIDERS. SUCH POLI-
CIES  OR  SUBSCRIBER  CERTIFICATES  SHALL CONTAIN AT LEAST THE FOLLOWING
PROVISIONS:
  (1) A PROVISION THAT IF A COVERED PERSON RECEIVES EMERGENCY CARE  FROM
AMBULANCE  SERVICE PROVIDERS LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC
HEALTH LAW, FOR SERVICES SPECIFIED IN THE PREFERRED PROVIDER ARRANGEMENT
AND CANNOT REASONABLY REACH A PREFERRED PROVIDER,  THAT  EMERGENCY  CARE
RENDERED  DURING THE COURSE OF THE EMERGENCY WILL BE PAID FOR IN ACCORD-
ANCE WITH THE TERMS OF THE AMBULANCE  SERVICE  PROVIDER,  BASED  ON  THE
USUAL  AND  CUSTOMARY CHARGES, WHICH SHALL NOT BE EXCESSIVE OR UNREASON-
ABLE FOR THE APPLICABLE TREATMENT, IN THE AREA WHERE  THE  TREATMENT  IS
PROVIDED; AND
  (2)  A  PROVISION  WHICH CLEARLY IDENTIFIES THE DIFFERENCES IN BENEFIT
LEVELS FOR AMBULANCE SERVICES OF PREFERRED PROVIDERS AND BENEFIT  LEVELS
FOR AMBULANCE SERVICES OF NONPREFERRED PROVIDERS.
  (B) FOR PURPOSES OF THIS SECTION, WHEN A REQUEST FOR EMERGENCY CARE IS
MADE  THROUGH THE EMERGENCY 911 SYSTEM ON BEHALF OF A COVERED PERSON AND
THE NON-AIRBORNE TRANSPORTATION THAT WAS DISPATCHED IN RESPONSE  TO  THE
REQUEST IS NOT A PREFERRED PROVIDER, FOR PURPOSES OF PAYMENT UNDER PARA-
GRAPH  ONE  OF SUBSECTION (A) OF THIS SECTION, IT SHALL BE PRESUMED THAT
THE COVERED PERSON COULD NOT REASONABLY REACH A PREFERRED PROVIDER.
  S 2. This act shall take effect immediately.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10550-02-9

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