S T A T E O F N E W Y O R K
________________________________________________________________________
8497
2011-2012 Regular Sessions
I N A S S E M B L Y
June 18, 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; and to amend a chapter of the laws of
2011 amending the insurance law relating to payments to prehospital
emergency medical services providers, as proposed in legislative bills
numbers S.2714-B and A.4093-B, in relation to the effectiveness there-
of
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The subsection heading of subsection (i) of section 3224-a
of the insurance law, as added by a chapter of the laws of 2011 amending
the insurance law relating 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:
Payments to nonparticipating or nonpreferred providers of ambulance
services licensed under article thirty of the public health law (EXCLUD-
ING PAYMENTS FOR SERVICES RELATED TO AIR TRANSPORT).
S 2. Paragraph 3 and the closing paragraph of subsection (i) of
section 3224-a of the insurance law, as added by a chapter of the laws
of 2011 amending the insurance law relating to payments to prehospital
emergency medical services providers, as proposed in legislative bills
numbers S.2714-B and A.4093-B, are amended to read as follows:
(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 AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
The provisions of this section shall not [apply to policies that do
not include coverage for ambulance services] BE DEEMED TO REQUIRE OR
EXPAND COVERAGE NOT OTHERWISE INCLUDED IN THE POLICY.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04592-09-1
A. 8497 2
S 3. Subparagraph (C) of paragraph 24 of subsection (i) of section
3216 of the insurance law, as amended by a chapter of the laws of 2011
amending the insurance law relating 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:
(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 OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
ON FILE.
S 4. Subparagraph (C) of paragraph 15 of subsection (l) of section
3221 of the insurance law, as amended by a chapter of the laws of 2011
amending the insurance law relating 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:
(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 OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
ON FILE.
S 5. Paragraph 3 of subsection (aa) of section 4303 of the insurance
law, as amended by a chapter of the laws of 2011 amending the insurance
law relating 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:
(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 OR PROVIDE NOTICE OF EXECUTED ASSIGNMENT OF BENEFITS FORM
ON FILE.
S 6. (A) On or before January 1, 2013, the superintendent of finan-
cial services, in consultation with the commissioner of health, the
insurance industry and the ambulance industry, shall report to the
governor, the speaker of the assembly, the temporary president of the
senate, and the chairs of the standing committees of insurance of both
the senate and assembly regarding the appropriateness of rates provided
to both non-preferred and preferred providers of ambulance services
other than those ambulance services provided by a municipally owned and
operated provider of ambulance services in a city with a population of
one million or more. Such study shall include a review of the appropri-
ateness of current medicaid and medicaid managed care rates for ambu-
lance services. The superintendent of financial services shall also
make recommendations regarding improving the appropriateness of rate
structures for non-preferred and preferred providers in different parts
A. 8497 3
of the state, other than those ambulance services provided by a munici-
pally owned and operated provider of ambulance services in a city with a
population of one million or more.
(B) On or before January 1, 2014, the superintendent of financial
services, in consultation with the commissioner of health, the insurance
industry and the ambulance industry, shall make recommendations regard-
ing establishing a rate setting process that shall be used by insurers
and ambulance providers both non-preferred and preferred, to be used in
the state, other than ambulance services provided by a municipally owned
and operated provider of ambulance services in a city with a population
of one million or more, when reimbursing both emergency and non-emergen-
cy services provided by such providers, in an effort to ensure that
rates provided are adequate, reasonable, and not excessive. Such recom-
mendations shall not be implemented without subsequent legislative
approval.
S 7. Section 5 of a chapter of the laws of 2011 amending the insur-
ance law relating 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:
S 5. This act shall take effect January 1, 2012 and shall apply to
[health care claims submitted for payment] SERVICES PROVIDED after such
date; PROVIDED, HOWEVER, THAT AFTER DECEMBER 31, 2014, THIS ACT SHALL
ONLY APPLY TO SERVICES PROVIDED BY AMBULANCE SERVICES PROVIDED BY A
MUNICIPALLY OWNED AND OPERATED PROVIDER OF AMBULANCE SERVICES IN A CITY
WITH A POPULATION OF ONE MILLION OR MORE.
S 8. 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; provided, however, that after December 31, 2014, this act
shall only apply to services provided by ambulance services provided by
a municipally owned and operated provider of ambulance services in a
city with a population of one million or more.