S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5375--A
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 13, 2025
                                ___________
 
 Introduced by M. of A. WEPRIN -- 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  and  the  social  services  law,  in
   relation to reimbursement for anesthesia services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new  section  3246
 to read as follows:
   § 3246. REIMBURSEMENT  FOR ANESTHESIA SERVICES. (A) AN INSURER ISSUING
 A POLICY OF HOSPITAL, MEDICAL, OR SURGICAL EXPENSE INSURANCE PURSUANT TO
 THIS SECTION OR ANY OTHER SECTION OF LAW SHALL NOT IMPOSE ARBITRARY TIME
 CAPS ON REIMBURSEMENT FOR ANESTHESIA SERVICES PROVIDED DURING  MEDICALLY
 NECESSARY PROCEDURES.
   (B) REIMBURSEMENT FOR ANESTHESIA SERVICES SHALL BE DETERMINED BASED ON
 MEDICAL  NECESSITY  AS  DETERMINED BY THE INSURER, TAKING INTO CONSIDER-
 ATION THE COMPLEXITY OF THE PROCEDURE AS EVIDENCED BY THE SUBMISSION  OF
 MEDICAL  RECORDS SUBMITTED BY THE ATTENDING ANESTHESIOLOGIST OR LICENSED
 ANESTHESIA PROVIDER.
   (C) (1) AN INSURER ISSUING A POLICY OF HOSPITAL, MEDICAL, OR  SURGICAL
 EXPENSE  INSURANCE  PURSUANT TO THIS SECTION OR ANY OTHER SECTION OF LAW
 SHALL BE PROHIBITED FROM DENYING PAYMENT FOR ANESTHESIA SERVICES  SOLELY
 BECAUSE THE DURATION OF CARE EXCEEDED A PRE-SET TIME LIMIT.
   (2)  NOTWITHSTANDING  PARAGRAPH ONE OF THIS SUBSECTION, AN INSURER MAY
 USE A TIME RELATED REIMBURSEMENT METHODOLOGY FOR ANESTHESIA SERVICES  IF
 SUCH  METHODOLOGY  IS  BASED UPON CRITERIA ESTABLISHED BY AN INDEPENDENT
 ORGANIZATION, INCLUDING THE CRITERIA USED BY THE  CENTERS  FOR  MEDICARE
 AND MEDICAID SERVICES TO REIMBURSE ANESTHESIA SERVICES UNDER TITLE XVIII
 OF  THE UNITED STATES SOCIAL SECURITY ACT (MEDICARE). IF AN INSURER USES
 A TIME RELATED REIMBURSEMENT METHODOLOGY, IT SHOULD HAVE AN  ESTABLISHED
 PROCESS FOR THE SUBMISSION OF ADDITIONAL MEDICAL RECORDS AND THE SHARING
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09176-02-5
              

 A. 5375--A                          2
 
 OF  ELECTRONIC  MEDICAL  RECORDS  TO  ASSESS  WHETHER AN INCREASE TO THE
 REIMBURSEMENT IS WARRANTED.
   § 2. The insurance law is amended by adding a new section 4331 to read
 as follows:
   §  4331.  REIMBURSEMENT FOR ANESTHESIA SERVICES. (A) EVERY CORPORATION
 SUBJECT TO  THE  PROVISIONS  OF  THIS  ARTICLE  THAT  PROVIDE  HOSPITAL,
 MEDICAL,  OR  SURGICAL EXPENSE INSURANCE COVERAGE SHALL NOT IMPOSE ARBI-
 TRARY TIME CAPS ON REIMBURSEMENT FOR ANESTHESIA SERVICES PROVIDED DURING
 MEDICALLY NECESSARY PROCEDURES.
   (B) REIMBURSEMENT FOR ANESTHESIA SERVICES SHALL BE DETERMINED BASED ON
 MEDICAL NECESSITY AS DETERMINED BY THE CORPORATION, TAKING INTO  CONSID-
 ERATION  THE  COMPLEXITY OF THE PROCEDURE AS EVIDENCED BY THE SUBMISSION
 OF MEDICAL  RECORDS  SUBMITTED  BY  THE  ATTENDING  ANESTHESIOLOGIST  OR
 LICENSED ANESTHESIA PROVIDER.
   (C)(1)  A  CORPORATION  ISSUING HOSPITAL, MEDICAL, OR SURGICAL EXPENSE
 INSURANCE COVERAGE SHALL BE PROHIBITED FROM DENYING  PAYMENT  FOR  ANES-
 THESIA  SERVICES  SOLELY BECAUSE THE DURATION OF CARE EXCEEDED A PRE-SET
 TIME LIMIT.
   (2) NOTWITHSTANDING PARAGRAPH ONE OF THIS  SUBSECTION,  A  CORPORATION
 MAY USE A TIME RELATED REIMBURSEMENT METHODOLOGY FOR ANESTHESIA SERVICES
 IF SUCH METHODOLOGY IS BASED UPON CRITERIA ESTABLISHED BY AN INDEPENDENT
 ORGANIZATION,  INCLUDING  THE  CRITERIA USED BY THE CENTERS FOR MEDICARE
 AND MEDICAID SERVICES TO REIMBURSE ANESTHESIA SERVICES UNDER TITLE XVIII
 OF THE UNITED STATES SOCIAL SECURITY ACT (MEDICARE).  IF  A  CORPORATION
 USES  A TIME RELATED REIMBURSEMENT METHODOLOGY, IT SHOULD HAVE AN ESTAB-
 LISHED PROCESS FOR THE SUBMISSION OF ADDITIONAL MEDICAL RECORDS AND  THE
 SHARING  OF  ELECTRONIC MEDICAL RECORDS TO ASSESS WHETHER AN INCREASE TO
 THE REIMBURSEMENT IS WARRANTED.
   § 3. The social services law is amended by adding a new section  365-q
 to read as follows:
   § 365-Q. REIMBURSEMENT FOR ANESTHESIA SERVICES. 1. ANY MEDICAL ASSIST-
 ANCE  PROVIDER  WHOSE MEDICAL ASSISTANCE INCLUDES THE PROVISION OF ANES-
 THESIA, INCLUDING SUCH  ASSISTANCE  FURNISHED  THROUGH  A  MANAGED  CARE
 PROGRAM,  SHALL  NOT  BE SUBJECT TO ARBITRARY TIME CAPS ON REIMBURSEMENT
 WHEN FURNISHED DURING MEDICALLY NECESSARY PROCEDURES, AND  SUCH  PAYMENT
 SHALL  NOT  BE DENIED FOR SUCH ASSISTANCE SOLELY BECAUSE THE DURATION OF
 SUCH ASSISTANCE EXCEEDED A PRE-SET TIME LIMIT.
   2. NOTWITHSTANDING SUBDIVISION ONE OF THIS  SECTION,  A  MANAGED  CARE
 PROVIDER MAY USE A TIME RELATED REIMBURSEMENT METHODOLOGY FOR ANESTHESIA
 SERVICES  IF  SUCH  METHODOLOGY IS BASED UPON CRITERIA ESTABLISHED BY AN
 INDEPENDENT ORGANIZATION, INCLUDING THE CRITERIA USED BY THE CENTERS FOR
 MEDICARE AND MEDICAID SERVICES TO REIMBURSE  ANESTHESIA  SERVICES  UNDER
 TITLE  XVIII  OF  THE UNITED STATES SOCIAL SECURITY ACT (MEDICARE). IF A
 MANAGED CARE PROVIDER USES A TIME RELATED REIMBURSEMENT METHODOLOGY,  IT
 SHOULD  HAVE  AN  ESTABLISHED  PROCESS  FOR THE SUBMISSION OF ADDITIONAL
 MEDICAL RECORDS AND THE SHARING OF ELECTRONIC MEDICAL RECORDS TO  ASSESS
 WHETHER AN INCREASE TO THE REIMBURSEMENT IS WARRANTED.
   § 4. This act shall take effect January 1, 2026.