NY State Senate Bill 2023-S1466

Senate Bill S1466

Signed By Governor

2023-2024 Legislative Session

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

download bill text pdf

Current Bill Status - Signed by Governor

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Nov 17, 2023	signed chap.649
Nov 13, 2023	delivered to governor
Jun 09, 2023	returned to senate passed assembly ordered to third reading rules cal.748 substituted for a250a
Jun 06, 2023	referred to insurance delivered to assembly passed senate
Jun 05, 2023	amend by restoring to original print 1466
Feb 15, 2023	advanced to third reading
Feb 14, 2023	2nd report cal.
Feb 13, 2023	1st report cal.345
Jan 12, 2023	referred to insurance
May 08, 2023	amended on third reading 1466a

Votes

- Jun 6, 2023 - Floor Vote
  S1466
  
  62
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  1
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Jun 6, 2023
      
      aye (62)
      
      Addabbo Jr.
      
      Ashby
      
      Bailey
      
      Borrello
      
      Breslin
      
      Brisport
      
      Brouk
      
      Canzoneri-Fitzpatrick
      
      Chu
      
      Cleare
      
      Comrie
      
      Cooney
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Gonzalez
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martinez
      
      Martins
      
      Mattera
      
      May
      
      Mayer
      
      Murray
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rhoads
      
      Rivera
      
      Rolison
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      Sepúlveda
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Walczyk
      
      Webb
      
      Weber
      
      Weik
      
      excused (1)
      
      Felder
  Feb 13, 2023 - Insurance Committee Vote
  S1466
  
  11
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: Feb 13, 2023
      
      aye (11)
      
      Addabbo Jr.
      
      Borrello
      
      Breslin
      
      Cooney
      
      Harckham
      
      Helming
      
      Kennedy
      
      Martinez
      
      O'Mara
      
      Sanders Jr.
      
      Scarcella-Spanton

Bill Amendments

Original

co-Sponsors

View additional co-sponsors

2023-S1466 (ACTIVE) - Details

See Assembly Version of this Bill:: A250
Law Section:: Insurance Law
Laws Affected:: Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S4462, A10735
2011-2012: S2714, A1341, A4093
2013-2014: S3542, A7534
2015-2016: S1764, A6195, A8581
2017-2018: S2527, A343
2019-2020: S3526, A6211
2021-2022: S3556, A1309

2023-S1466 (ACTIVE) - Summary

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

2023-S1466 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1466

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law, in relation to payments to prehospi-
tal 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 he 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 ambu-
lance 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 ambu-
lance services even though the patient receives payment from the insur-
ance 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.3556 of 2022-22:

S.3526 of 2019-20;

S.2527a of 2017-18;

S.1764 of 2015-16;

S.3542 of 2013-14;

S.2714-8 of 2011-12;

S.4462 of 2010.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect January 1, 2025 and shall apply to health
care claims submitted for payment after such date.

2023-S1466 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1466
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 12, 2023
                                ___________
 
 Introduced  by  Sens. BRESLIN, ADDABBO, COONEY, GALLIVAN, HELMING, MANN-
   ION, RIVERA, SANDERS, SEPULVEDA, SKOUFIS --  read  twice  and  ordered
   printed,  and  when printed to be committed to the Committee on Insur-
   ance
 
 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)  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-
 IPATING OR NONPREFERRED PROVIDER AND  TO  THE  INSURED,  SUBSCRIBER,  OR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05298-01-3

 S. 1466                             2
 
 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:
 S. 1466                             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, 2025 and shall apply to
 health care claims submitted for payment after such date.

co-Sponsors

View additional co-sponsors

2023-S1466A - Details

See Assembly Version of this Bill:: A250
Law Section:: Insurance Law
Laws Affected:: Amd §§3224-a, 3216, 3221 & 4303, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S4462, A10735
2011-2012: S2714, A1341, A4093
2013-2014: S3542, A7534
2015-2016: S1764, A6195, A8581
2017-2018: S2527, A343
2019-2020: S3526, A6211
2021-2022: S3556, A1309

2023-S1466A - Summary

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

2023-S1466A - Sponsor Memo

                                 
BILL NUMBER: S1466A

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law, in relation to payments to prehospi-
tal emergency medical services providers

 
PURPOSE:

To ensure that responding ambulance service companies receive direct
payment for all emergency ambulance service transports upon submission
of an invoice to the insurance company without the need for the respond-
ing 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 non-participating or non-preferred providers of ambu-
lance services made by health insurers shall be done so directly to the
provider or jointly to both the provider and the insured outside the
City of New York. This section also provides that the insured person

shall be held harmless for payment to the ambulance service provider
except to the extent for which they would be charged for co-payments or
co-insurance for an in-network provider.

Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection
(i)of section 3216 of the Insurance Law stating that outside of the City
of New York, 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, if such services are covered under a policy.

Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection
(1)of section 3221 of the Insurance Law stating that outside of the City
of New York, 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 if such services are covered under a policy.

Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that outside of the City of New York, the
insurers shall send such payments directly to the provider of such ambu-
lance 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 if such services are covered under a policy.

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.3556 of 2022-22:

S.3526 of 2019-20;

S.2527a of 2017-18;

S.1764 of 2015-16;

S.3542 of 2013-14;

S.2714-8 of 2011-12;

S.4462 of 2010.

 
FISCAL IMPLICATIONS:

None

 
EFFECTIVE DATE:
This act shall take effect January 1, 2025 and shall apply to health
care claims submitted for payment after such date.

2023-S1466A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1466--A
     Cal. No. 345
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 12, 2023
                                ___________
 
 Introduced  by  Sens. BRESLIN, ADDABBO, COONEY, GALLIVAN, HELMING, MANN-
   ION, O'MARA, RIVERA, SANDERS,  SEPULVEDA,  SKOUFIS,  WALCZYK  --  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,  ordered  to a third reading,
   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 (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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD05298-02-3
 S. 1466--A                          2
 
 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
 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:
 S. 1466--A                          3
 
   (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.
   § 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, 2025 and shall apply to
 health care claims submitted for payment after such date.

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Senate Bill S1466

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Sponsored By

Current Bill Status - Signed by Governor

Bill Amendments

co-Sponsors

2023-S1466 (ACTIVE) - Details

2023-S1466 (ACTIVE) - Summary

2023-S1466 (ACTIVE) - Sponsor Memo

2023-S1466 (ACTIVE) - Bill Text download pdf

co-Sponsors

2023-S1466A - Details

2023-S1466A - Summary

2023-S1466A - Sponsor Memo

2023-S1466A - Bill Text download pdf

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