S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6211
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 4, 2019
                                ___________
 
 Introduced  by  M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED,
   WOERNER,  FAHY,  MOSLEY,  FINCH,   MONTESANO,   SANTABARBARA,   BLAKE,
   PEOPLES-STOKES,  GALEF, COLTON, GUNTHER, OTIS, BRONSON, RAIA -- Multi-
   Sponsored by -- M. of A.  ARROYO, CROUCH, GANTT, HEVESI, JOHNS,  KOLB,
   PERRY -- read once and referred 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 (k) to read as follows:
   (K) 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  ARTICLE 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 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 ON FILE A DULY EXECUTED ASSIGN-
 MENT  OF  BENEFITS, AND HAS CAUSED NOTICE OF SUCH ASSIGNMENT TO BE 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00646-01-9

 A. 6211                             2
 
 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 ASSIGNMENT ON FILE. 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.
   §  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  HAS  ON FILE 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.
   §  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  HAS  ON FILE 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.
   §  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:

 A. 6211                             3
 
   (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  HAS  ON FILE 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.
   §  5.  This  act  shall take effect January 1, 2021 and shall apply to
 health care claims submitted for payment after such date.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6211--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               March 4, 2019
                                ___________
 
 Introduced  by  M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED,
   WOERNER,  FAHY,  MOSLEY,  FINCH,   MONTESANO,   SANTABARBARA,   BLAKE,
   PEOPLES-STOKES,  GALEF,  COLTON, GUNTHER, OTIS, BRONSON, RAIA, HUNTER,
   JAFFEE -- Multi-Sponsored by -- M. of A. ARROYO, CROUCH, GANTT,  HEVE-
   SI,  JOHNS,  KOLB, PERRY -- read once and referred to the Committee on
   Insurance -- committee discharged, bill amended, ordered reprinted  as
   amended and recommitted to said committee
 
 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 (k) to read as follows:
   (K) PAYMENTS TO NONPARTICIPATING OR NONPREFERRED  PROVIDERS  OF  AMBU-
 LANCE  SERVICES  LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC HEALTH LAW.
 (1) EXCEPT IN A CITY WITH A POPULATION OF ONE MILLION OR  MORE  PERSONS,
 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  ARTICLE  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  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 ON FILE A DULY EXECUTED ASSIGN-
 MENT OF BENEFITS, AND HAS CAUSED NOTICE OF SUCH ASSIGNMENT TO  BE  GIVEN
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00646-02-9

 A. 6211--A                          2
 
 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 ASSIGNMENT ON FILE. 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.
   §  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.  EXCEPT IN A CITY WITH A
 POPULATION OF ONE MILLION OR MORE PERSONS, THE INSURER SHALL  SEND  SUCH
 PAYMENTS  DIRECTLY  TO  THE  PROVIDER OF SUCH AMBULANCE SERVICES, IF THE
 AMBULANCE SERVICE HAS ON FILE 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.
   § 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.  EXCEPT IN A CITY  WITH  A
 POPULATION  OF  ONE MILLION OR MORE PERSONS, THE INSURER SHALL SEND SUCH
 PAYMENTS DIRECTLY TO THE PROVIDER OF SUCH  AMBULANCE  SERVICES,  IF  THE
 AMBULANCE  SERVICE  HAS  ON FILE 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

 A. 6211--A                          3
 
 ambulance service as described in subparagraph  (A)  of  this  paragraph
 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY.
   §  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.  EXCEPT IN A CITY WITH A
 POPULATION OF ONE MILLION OR MORE PERSONS, THE INSURER SHALL  SEND  SUCH
 PAYMENTS  DIRECTLY  TO  THE  PROVIDER OF SUCH AMBULANCE SERVICES, IF THE
 AMBULANCE SERVICE HAS ON FILE 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.
   § 5. This act shall take effect January 1, 2021  and  shall  apply  to
 health care claims submitted for payment after such date.