senate Bill S2714B

2011-2012 Legislative Session

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 04, 2012 referred to insurance
Jun 24, 2011 committed to rules
Jun 14, 2011 amended on third reading 2714b
Jun 13, 2011 advanced to third reading
amended 2714a
Jun 07, 2011 2nd report cal.
Jun 06, 2011 1st report cal.1020
Jan 31, 2011 referred to insurance

Bill Amendments

Original
A
B (Active)
Original
A
B (Active)

Co-Sponsors

S2714 - Bill Details

See Assembly Version of this Bill:
A4093B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:
S4462, A10735

S2714 - Bill Texts

view summary

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

view sponsor memo
BILL NUMBER:S2714

TITLE OF BILL:
An act
to amend the insurance law, in relation to payments to prehospital
emergency medical services providers

PURPOSE:
To ensure that responding ambulance service companies receive
direct payment for all ambulance service transports upon submission
of an invoice to the insurance company without the need for the
responding ambulance company to be a preferred provider.

SUMMARY OF PROVISIONS:
Section 1 amends section 3224-a of the
insurance law to provide that payments made to nonparticipating or
non-preferred providers of ambulance services made by health insurers
shall be done so directly to the provider or jointly to both the
provider and the insured.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of
subsection (i) of section 321 6 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of
subsection (1) of section 3221 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 4. Effective Date.

JUSTIFICATION:
The constant and quick availability of ambulance
response is something that all of our citizens have grown accustomed
to and it is essential to the survivability of all New Yorkers when
there is a medical crisis, Fair and direct reimbursement for those
services is paramount to the financial stability and continued
availability of ambulances to respond.

Current law permits insurance companies to pay for ambulance service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It
is not practical to expect a preferred provider relationship with
every insurance company. But then it is the responsibility of the
ambulance company to try to recoup payment for service from that
patient.

All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the


insurance company. Especially as the financial crisis we are
currently facing deepens, more and more patients are pocketing these
funds. Further, the insurance company is not obligated to advise the
ambulance company that they in fact paid the ambulance transport bill
direct to the patient. This disconnect of information leads to
confusion and furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As
such, most ambulance providers have no knowledge of the patient's
ability to payor if or by whom they are insured by when a medical
emergency or
accidental event occurs. Ambulance service is one of the few medical
services where payment is not expected at the time of service.

This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need
for the responding ambulance company to be a preferred provider.

LEGISLATIVE HISTORY:
S.4462 of 2010

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect January 1, 2012 and shall
apply to health care claims submitted for payment after such date.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  2714

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 31, 2011
                               ___________

Introduced  by  Sen.  SEWARD -- 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 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 (i) to read as follows:
  (I)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU-
LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC  HEALTH  LAW.
(1) WHENEVER AN INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  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 ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER
AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC-
IPATING  OR  PREFERRED  PROVIDER  OF  AMBULANCE  SERVICES  FOR  SERVICES
RENDERED,  THE  INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER  OR  ARTICLE
FORTY-FOUR  OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE-
FITS EITHER DIRECTLY  TO  ANY  SIMILARLY  LICENSED  NONPARTICIPATING  OR
NONPREFERRED  PROVIDER  AT  SAID  PROVIDER'S USUAL AND CUSTOMARY CHARGE,
WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE,  WHEN  SAID  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 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, ORGANIZATION, OR CORPORATION LICENSED
OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR  ARTICLE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04592-01-1

S. 2714                             2

FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENE-
FIT  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 OF THIS CHAPTER OR
ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL GIVE WRITTEN NOTICE OF
SUCH PAYMENT TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
  (2) 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.
  (3)  THE  PROVISIONS  OF THIS SECTION SHALL NOT APPLY TO CREDIT INSUR-
ANCE, DISABILITY INCOME INSURANCE,  OR  LIMITED  ACCIDENT  AND  SICKNESS
POLICIES  SUCH  AS  HOSPITAL INDEMNITY POLICIES, SPECIFIED DISEASE POLI-
CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES.
  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.
  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.
  S 4. This act shall take effect January 1, 2012  and  shall  apply  to
health care claims submitted for payment after such date.

Co-Sponsors

S2714A - Bill Details

See Assembly Version of this Bill:
A4093B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:
S4462, A10735

S2714A - Bill Texts

view summary

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

view sponsor memo
BILL NUMBER:S2714A

TITLE OF BILL:
An act
to amend the insurance law, in relation to payments to prehospital
emergency medical services providers

PURPOSE: To ensure that responding ambulance service
companies receive
direct payment for all ambulance service transports upon submission
of an invoice to the insurance company without the need for the
responding ambulance company to be a preferred provider.

SUMMARY OF PROVISIONS: Section 1 amends section
3224-a of the
insurance law to provide that payments made to nonparticipating or
non-preferred providers of ambulance services made by health insurers
shall be done so directly to the provider or jointly to both the
provider and the insured.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of
subsection (i) of section 3216 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of
subsection (1) of section 3221 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers 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 and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.

Section 5. Effective Date.

JUSTIFICATION: The constant and quick availability of
ambulance
response is something that all of our citizens have grown accustomed
to and it is essential to the survivability of all New Yorkers when
there is a medical crisis. Fair and direct reimbursement for those
services is paramount to the financial stability and continued
availability of ambulances to respond.

Current law permits insurance companies to pay for ambulance service
charges direct to the patient until and unless the ambulance company
becomes a preferred provider of that specific insurance company. It
is not practical to expect a preferred provider relationship with


every insurance company. But then it is the responsibility of the
ambulance company to try to recoup payment for service from that
patient.

All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the
insurance company. Especially as the financial crisis we are
currently facing deepens, more and more patients are pocketing these
funds. Further, the insurance company is not obligated to advise the
ambulance company that they in fact paid the ambulance transport bill
direct to the patient. This disconnect of information leads to
confusion and furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As
such, most ambulance providers have no knowledge of the patient's
ability to pay or if or by whom they are insured by when a medical
emergency or accidental event occurs. Ambulance service is one of the
few medical services where payment is not expected at the time of
service.

This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need
for the responding ambulance company to be a preferred provider.

LEGISLATIVE HISTORY: S.4462 of 2010.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect January 1.
2012 and shall
apply to health care claims submitted for payment after such date.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2714--A
    Cal. No. 1020

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 31, 2011
                               ___________

Introduced  by  Sens.  SEWARD, KLEIN, MAZIARZ, VALESKY -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Insurance  -- reported favorably from said committee, ordered to first
  and second report, amended on second report, ordered to a third  read-
  ing,  and to be reprinted as amended, retaining its place in the order
  of third reading

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 (i) to read as follows:
  (I)  PAYMENTS  TO  NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU-
LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC  HEALTH  LAW.
(1) WHENEVER AN INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  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 ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER
AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC-
IPATING  OR  PREFERRED  PROVIDER  OF  AMBULANCE  SERVICES  FOR  SERVICES
RENDERED,  THE  INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI-
FIED  PURSUANT  TO  ARTICLE  FORTY-THREE  OF  THIS  CHAPTER  OR  ARTICLE
FORTY-FOUR  OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE-
FITS 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 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  OF
THIS  CHAPTER  OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04592-02-1

S. 2714--A                          2

TO SUCH NONPARTICIPATING OR NONPREFERRED PROVIDER AND  TO  THE  INSURED,
SUBSCRIBER,  OR  OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER
CASE THE INSURER, ORGANIZATION, OR  CORPORATION  LICENSED  OR  CERTIFIED
PURSUANT TO ARTICLE FORTY-THREE 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 OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF
THE  PUBLIC  HEALTH LAW SHALL GIVE WRITTEN NOTICE OF SUCH PAYMENT TO THE
INSURED, SUBSCRIBER, OR OTHER COVERED PERSON.
  (2) 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.
  (3)  THE  PROVISIONS  OF THIS SECTION SHALL NOT APPLY TO CREDIT INSUR-
ANCE, DISABILITY INCOME INSURANCE,  OR  LIMITED  ACCIDENT  AND  SICKNESS
POLICIES  SUCH  AS  HOSPITAL INDEMNITY POLICIES, SPECIFIED DISEASE POLI-
CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES.
  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.
  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.
  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:
  (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

S. 2714--A                          3

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.
  S  5.  This  act  shall take effect January 1, 2012 and shall apply to
health care claims submitted for payment after such date.

Co-Sponsors

S2714B (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A4093B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:
S4462, A10735

S2714B (ACTIVE) - Bill Texts

view summary

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

view sponsor memo
BILL NUMBER:S2714B

TITLE OF BILL:
An act
to amend the insurance law, in relation to payments to prehospital
emergency medical services providers

PURPOSE:
To ensure that responding ambulance service companies receive
direct payment for all ambulance service transports upon submission
of an invoice to the insurance company without the need for the
responding ambulance company to be a preferred provider.

SUMMARY OF PROVISIONS:
Section 1 amends section 3224-a of the
insurance law to provide that payments made to nonparticipating or
non-preferred providers of ambulance services made by health insurers
shall be done so directly to the provider or jointly to both the
provider and the insured.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of
subsection (i) of section 3216 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of
subsection (1) of section 3221 of the insurance law stating that the
insurers 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 and the provisions of this
paragraph shall apply to transfers of patients between hospitals or
health care facilities.

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers 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 and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.

Section 5. Effective Date.

JUSTIFICATION:
The constant and quick availability of ambulance
response is something that all of our citizens have grown accustomed
to and it is essential to the survivability of all New Yorkers when
there is a medical crisis.
Fair and direct reimbursement for those services is paramount to the
financial stability and continued availability of ambulances to
respond.

Current law permits insurance companies to pay for ambulance service
charges direct to the patient until and unless the ambulance company


becomes a preferred provider of that specific insurance company. It is
not practical to expect a preferred provider relationship with every
insurance company. But then it is the responsibility of the ambulance
company to try to recoup payment for service from that patient.

All types of EMS providers routinely are not paid by the patient for
ambulance services even though the patient receives payment from the
insurance company. Especially as the financial crisis we are
currently facing deepens, more and more patients are pocketing these
funds. Further, the insurance company is not obligated to advise the
ambulance company that they in fact paid the ambulance transport bill
direct to the patient. This disconnect of information leads to
confusion and furthers the lack of proper payment issue.

In New York State, ambulance companies are mandated responders. As
such, most ambulance providers have no knowledge of the patient's
ability to payor if or by whom they are insured by when a medical
emergency or accidental event occurs. Ambulance service is one of the
few medical services where payment is not expected at the time of
service.

This legislation will assure that responding ambulance service will
receive direct payment for all ambulance service transports upon
submission of an invoice to the insurance company without the need
for the responding ambulance company to be a preferred provider.

LEGISLATIVE HISTORY:
S.4462 of 2010.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect January 1, 2012 and shall
apply to health care claims submitted for payment after such date.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2714--B
    Cal. No. 1020

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                            January 31, 2011
                               ___________

Introduced  by  Sens.  SEWARD, KLEIN, MAZIARZ, VALESKY -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Insurance  -- reported favorably from said committee, ordered to first
  and second report, amended on second report, ordered to a third  read-
  ing,  and to be reprinted as amended, retaining its place in the order
  of third reading -- again amended and ordered reprinted, retaining its
  place in the order of third reading

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 (i) to read as follows:
  (I)  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  ARTICLES  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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04592-06-1

S. 2714--B                          2

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.
  (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. 2714--B                          3

  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:
  (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, 2012 and shall apply to
health care claims submitted for payment after such date.

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