S T A T E O F N E W Y O R K
________________________________________________________________________
1940
2019-2020 Regular Sessions
I N S E N A T E
January 17, 2019
___________
Introduced by Sens. LITTLE, AKSHAR, BROOKS, CARLUCCI, FUNKE, GALLIVAN,
HELMING -- read twice and ordered printed, and when printed to be
committed to the Committee on Local Government
AN ACT to amend the general municipal law and the town law, in relation
to authorizing fees and charges for emergency medical services; and to
amend the insurance law, in relation to payments to prehospital emer-
gency medical services providers
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subdivision 4 of section 209-b of the general municipal
law, as amended by chapter 476 of the laws of 2018, is amended to read
as follows:
4. Fees and charges [prohibited] AUTHORIZED. (A) Emergency and gener-
al ambulance service, INCLUDING EMERGENCY MEDICAL SERVICE AS DEFINED IN
SECTION THREE THOUSAND ONE OF THE PUBLIC HEALTH LAW, authorized pursuant
to this section [shall] MAY be furnished without cost to the person
served; PROVIDED, HOWEVER, THAT THE AUTHORITIES HAVING CONTROL OF A FIRE
DEPARTMENT OR FIRE COMPANY THAT HAVE AUTHORIZED SUCH FIRE DEPARTMENT OR
FIRE COMPANY TO PROVIDE SUCH SERVICE OR SERVICES MAY FIX A SCHEDULE OF
FEES OR CHARGES TO BE PAID BY PERSONS REQUESTING SUCH SERVICE OR
SERVICES. THE AUTHORITIES HAVING CONTROL OF A FIRE DEPARTMENT OR FIRE
COMPANY MAY PROVIDE FOR THE COLLECTION OF FEES AND CHARGES OR MAY FORMU-
LATE RULES AND REGULATIONS FOR THE COLLECTION THEREOF BY THE FIRE
DEPARTMENT OR FIRE COMPANY. WHEN FEES AND CHARGES ARE AUTHORIZED PURSU-
ANT TO THIS SUBDIVISION, THE FEES AND CHARGES COLLECTED SHALL BE
DISBURSED IN ACCORDANCE WITH A WRITTEN CONTRACT ENTERED INTO BETWEEN THE
AUTHORITY HAVING CONTROL OF A FIRE DEPARTMENT OF FIRE COMPANY AND THE
FIRE DEPARTMENT OR FIRE COMPANY ITSELF. The acceptance by any fire-
fighter of any personal remuneration or gratuity, directly or indirect-
ly, from a person served shall be a ground for his or her expulsion or
suspension as a member of the fire department or fire company.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02799-03-9
S. 1940 2
(B) NOTWITHSTANDING THE PROVISIONS OF PARAGRAPH (A) OF THIS SUBDIVI-
SION, A BASIC LIFE SUPPORT SERVICE WHICH ESTABLISHES A SCHEDULE OF FEES
FOR SERVICE SHALL ENTER INTO A CONTRACT WITH A PROVIDER OR PROVIDERS OF
ADVANCED LIFE SUPPORT SERVICES TO PROVIDE SUCH ADVANCED LIFE SUPPORT
SERVICES. SUCH CONTRACT SHALL AT A MINIMUM ESTABLISH THE FEES FOR
ADVANCED LIFE SUPPORT SERVICES AND THE MEANS BY WHICH SAID PROVIDER WILL
BE REIMBURSED WHEN THE AMBULANCE SERVICE BILLS FOR EMERGENCY MEDICAL
SERVICE.
§ 2. Paragraph (e) of subdivision 1 of section 122-b of the general
municipal law, as amended by chapter 303 of the laws of 1980, is amended
to read as follows:
(e) [No] A contract [shall] MAY be entered into pursuant to the
provisions of this section for the services of an emergency rescue and
first aid squad of a fire department or fire company which is subject to
the provisions of section two hundred nine-b of [the general municipal
law] THIS CHAPTER;
§ 3. Subdivision 1 of section 184 of the town law, as amended by chap-
ter 599 of the laws of 1994, is amended to read as follows:
1. Whenever the town board shall have established or extended a fire
protection district pursuant to the provisions of this article, the town
board shall provide for the furnishing of fire protection within the
district and for that purpose may (a) contract with any city, village,
fire district or incorporated fire company maintaining adequate and
suitable apparatus and appliances for the furnishing of fire protection
in such district or (b) may acquire by gift or purchase such apparatus
and appliances for use in such district and may contract with any city,
village, fire district or incorporated fire company for operation, main-
tenance, and repair of the same and for the furnishing of fire
protection in such district, or both. The contract may also provide for
the furnishing of (1) emergency service in case of accidents, calamities
or other emergencies in connection with which the services of firefight-
ers would be required and (2) general ambulance service subject, howev-
er, to the provisions of section two hundred nine-b of the general
municipal law. In the event that the fire department or fire company
furnishing fire protection within the district pursuant to contract does
not maintain and operate an ambulance then a separate contract may be
made for the furnishing within the district of emergency ambulance
service or general ambulance service, or both, with any city, village or
fire district the fire department of which, or with an incorporated fire
company having its headquarters outside the district which, maintains
and operates an ambulance subject, however, in the case of general ambu-
lance service, to the provisions of section two hundred nine-b of the
general municipal law, or with an ambulance service, certified or regis-
tered pursuant to article thirty of the public health law[, which is not
organized under the provisions of section two hundred nine-b of the
general municipal law]. Any such contract with any such ambulance
service permitted herein shall be subject to the provisions of this
section.
§ 4. 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
S. 1940 3
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 A WRITTEN ASSIGNMENT OF BENE-
FITS, 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 OR FORTY-SEVEN 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, ORGANIZA-
TION, 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 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.
§ 5. 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.
§ 6. 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:
S. 1940 4
(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.
§ 7. 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.
§ 8. This act shall take effect on the ninetieth day after it shall
have become a law, except that sections four, five, six and seven of
this act shall take effect January 1, 2022, and shall apply to health
care claims submitted on or after such date.
