Assembly Bill A8498

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

                                  8498

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                              June 19, 2011
                               ___________

Introduced  by M. of A. MORELLE -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance law, in relation to  payments  to  certain
  providers of ambulance services

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

  Section 1. Subsection (i) of section 3224-a of the insurance  law,  as
added by a chapter of the laws of 2011 amending the insurance law relat-
ing  to payments to prehospital emergency medical services providers, as
proposed in legislative bills numbers S.2714-B and A.4093-B, is  amended
to read as follows:
  (i)  Payments  to  nonparticipating or nonpreferred providers of ambu-
lance services licensed under article thirty of the  public  health  law
(EXCLUDING PAYMENTS FOR SERVICES RELATED TO AIR TRANSPORT).  (1) Whenev-
er  an  insurer or an 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 provides that any health care
claims submitted under contracts or agreements issued  or  entered  into
pursuant  to  this  article or articles forty-two, forty-three or forty-
seven of this chapter and article forty-four of the  public  health  law
INCLUDING  AMBULANCE  SERVICES PROVIDED BY A MUNICIPALLY OWNED AND OPER-
ATED PROVIDER OF AMBULANCE SERVICES IN A CITY WITH A POPULATION  OF  ONE
MILLION  OR MORE are payable to a participating or preferred provider of
ambulance services for services rendered, 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  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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04592-11-1
              

A. 8498                             2

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-
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]  EXCEPT  FOR  AMBULANCE
SERVICES  PROVIDED BY A MUNICIPALLY OWNED AND OPERATED PROVIDER OF AMBU-
LANCE SERVICES IN A CITY WITH A POPULATION OF ONE MILLION  OR  MORE,  NO
INSURER  SHALL BE OBLIGATED TO REIMBURSE THE NONPARTICIPATING OR NONPRE-
FERRED PROVIDER AT AN AMOUNT GREATER THAN IT WOULD  HAVE  PAID  FOR  THE
SAME SERVICE IF PROVIDED BY A PARTICIPATING OR PREFERRED PROVIDER.
  (3)  FOR  AMBULANCE SERVICES PROVIDED BY A MUNICIPALLY OWNED AND OPER-
ATED PROVIDER OF AMBULANCE SERVICES IN A CITY WITH A POPULATION  OF  ONE
MILLION  OR  MORE,  AN INSURER SHALL PAY FOR SUCH SERVICES AS DETERMINED
PURSUANT TO A PUBLIC RATEMAKING HEARING THAT INCLUDES AN OPPORTUNITY FOR
PUBLIC COMMENT.
  (4) 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 AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  [The  provisions  of  this section shall not apply to policies that do
not include coverage for ambulance services.]
  S 2. This act shall take effect on the  same  date  and  in  the  same
manner  as  a  chapter  of  the  laws of 2011 amending the insurance law
relating to payments to prehospital emergency medical  services  provid-
ers,  as  proposed  in  legislative bills numbers S.2714-B and A.4093-B,
takes effect.