S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1309
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 8, 2021
                                ___________
 
 Introduced  by  M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED,
   WOERNER, FAHY, MONTESANO, SANTABARBARA, PEOPLES-STOKES, GALEF, COLTON,
   GUNTHER, OTIS, BRONSON, HUNTER, ABINANTI, BUTTENSCHON, McMAHON,  CRUZ,
   JOYNER, SAYEGH -- 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 (l) to read as follows:
   (L) 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 AS DEFINED UNDER SECTION  THREE  THOUSAND  TWO  HUNDRED
 FORTY-ONE OF THIS ARTICLE, WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE,
 WHEN  THE  PROVIDER  HAS  RENDERED  SUCH  SERVICES,  HAS  ON FILE A DULY
 EXECUTED ASSIGNMENT OF BENEFITS, AND HAS CAUSED NOTICE OF  SUCH  ASSIGN-
 MENT  TO  BE GIVEN TO THE INSURER, ORGANIZATION, OR CORPORATION LICENSED
 OR CERTIFIED PURSUANT TO ARTICLE  FORTY-THREE  OR  FORTY-SEVEN  OF  THIS
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01780-01-1

 A. 1309                             2
 
 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 OR FORTY-SEVEN OF THIS CHAPTER OR  ARTI-
 CLE  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 ARTICLE 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 AS
 DEFINED UNDER SECTION THREE THOUSAND TWO HUNDRED FORTY-ONE OF THIS ARTI-
 CLE, WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE.
   (3) AN 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 ENSURE THAT  THE  INSURED,
 SUBSCRIBER, OR OTHER COVERED PERSON SHALL INCUR NO GREATER OUT-OF-POCKET
 COSTS  FOR  AMBULANCE SERVICES PROVIDED BY A NONPARTICIPATING OR NONPRE-
 FERRED PROVIDER THAN THE INSURED, SUBSCRIBER, OR  OTHER  COVERED  PERSON
 WOULD  HAVE  INCURRED WITH A PARTICIPATING OR PREFERRED PROVIDER OF SUCH
 SERVICES.
   (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.
   THE  PROVISIONS OF THIS SUBSECTION 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

 A. 1309                             3
 
 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.
   § 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, 2023 and shall apply to
 health care claims submitted for payment after such date.