S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7298
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 25, 2025
                                ___________
 
 Introduced  by M. of A. WOERNER -- read once and referred to the Commit-
   tee on Insurance
 
 AN ACT to amend the financial services law,  in  relation  to  including
   ambulance services to the emergency room as part of emergency services
   for the purposes of surprise bills

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subsection (b) of section 603  of  the  financial  services
 law, as added by section 26 of part H of chapter 60 of the laws of 2014,
 is amended to read as follows:
   (b)  "Emergency  services"  means, with respect to an emergency condi-
 tion:  (1) a medical screening examination  as  required  under  section
 1867 of the social security act, 42 U.S.C. § 1395dd, which is within the
 capability  of  the emergency department of a hospital, including ancil-
 lary services routinely available to the emergency department to  evalu-
 ate  such emergency medical condition; [and] (2) within the capabilities
 of the staff and facilities available  at  the  hospital,  such  further
 medical  examination and treatment as are required under section 1867 of
 the social security act, 42 U.S.C. § 1395dd, to stabilize  the  patient;
 AND  (3)  PUBLIC OR PRIVATE AMBULANCE SERVICES TO THE EMERGENCY ROOM FOR
 TREATMENT OF AN EMERGENCY CONDITION.
   § 2. Paragraphs 1 and 2 of subsection (a) of section 605 of the finan-
 cial services law, as amended by section 5 of subpart A of  part  AA  of
 chapter 57 of the laws of 2022, are amended to read as follows:
   (1)  When  a  health  care plan receives a bill for emergency services
 from a  non-participating  provider,  including  a  bill  for  AMBULANCE
 SERVICES OR inpatient services which follow an emergency room visit, the
 health  care  plan  shall pay an amount that it determines is reasonable
 for the emergency services, including AMBULANCE  SERVICES  OR  inpatient
 services  which follow an emergency room visit, rendered by the non-par-
 ticipating provider, in  accordance  with  section  three  thousand  two
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11139-01-5
              

 A. 7298                             2
 
 hundred  twenty-four-a  of  the  insurance law, except for the insured's
 co-payment, coinsurance or deductible, if any, and shall ensure that the
 insured shall incur no greater out-of-pocket  costs  for  the  emergency
 services,  including  AMBULANCE  SERVICES  OR  inpatient  services which
 follow an emergency room visit, than the  insured  would  have  incurred
 with  a  participating provider. The non-participating provider may bill
 the health care plan for the services  rendered.  Upon  receipt  of  the
 bill,  the health care plan shall pay the non-participating provider the
 amount prescribed by this section and any subsequent  amount  determined
 to  be  owed  to  the  provider  in  relation  to the emergency services
 provided, including  AMBULANCE  SERVICES  OR  inpatient  services  which
 follow an emergency room visit.
   (2)  A  non-participating  provider or a health care plan may submit a
 dispute regarding a fee or payment  for  emergency  services,  including
 AMBULANCE  SERVICES OR inpatient services which follow an emergency room
 visit, for review to an independent dispute resolution entity.
   § 2-a. Paragraphs 1 and 2 of subsection (a)  of  section  605  of  the
 financial services law, as amended by section 13 of subpart A of part II
 of chapter 57 of the laws of 2023, are amended to read as follows:
   (1)  When  a  health  care plan receives a bill for emergency services
 from a  non-participating  provider,  including  a  bill  for  AMBULANCE
 SERVICES  OR inpatient services which follow an emergency room visit, or
 a bill for services from a mobile crisis intervention services  provider
 licensed, certified, or designated by the office of mental health or the
 office  of  addiction  services and supports, the health care plan shall
 pay an amount  that  it  determines  is  reasonable  for  the  emergency
 services,  including  AMBULANCE  SERVICES  OR  inpatient  services which
 follow an emergency room visit or for  the  mobile  crisis  intervention
 services, rendered by the non-participating provider, in accordance with
 section  three  thousand two hundred twenty-four-a of the insurance law,
 except for the insured's co-payment, coinsurance or deductible, if  any,
 and  shall  ensure that the insured shall incur no greater out-of-pocket
 costs for the emergency services, including AMBULANCE SERVICES OR  inpa-
 tient  services  which  follow an emergency room visit or for the mobile
 crisis intervention services, than the insured would have incurred  with
 a  participating  provider.  The non-participating provider may bill the
 health care plan for the services rendered. Upon receipt  of  the  bill,
 the health care plan shall pay the non-participating provider the amount
 prescribed  by  this  section and any subsequent amount determined to be
 owed to the provider in relation to  the  emergency  services  provided,
 including AMBULANCE SERVICES OR inpatient services which follow an emer-
 gency room visit or for the mobile crisis intervention services.
   (2)  A  non-participating  provider or a health care plan may submit a
 dispute regarding a fee or payment  for  emergency  services,  including
 AMBULANCE  SERVICES OR inpatient services which follow an emergency room
 visit, or for services rendered by a mobile crisis intervention services
 provider licensed, certified, or designated  by  the  office  of  mental
 health  or  the office of addiction services and supports, for review to
 an independent dispute resolution entity.
   § 3. Paragraph 1 of subsection (b) of section  605  of  the  financial
 services  law,  as  amended by section 2 of part YY of chapter 56 of the
 laws of 2020, is amended to read as follows:
   (1) A patient that is not an insured or the  patient's  physician  may
 submit a dispute regarding a fee for emergency services, including AMBU-
 LANCE  SERVICES  OR  inpatient  services  which follow an emergency room
 A. 7298                             3
 
 visit, for review to  an  independent  dispute  resolution  entity  upon
 approval of the superintendent.
   §  4.  Subsection (b) of section 606 of the financial services law, as
 amended by section 7 of subpart A of part AA of chapter 57 of  the  laws
 of 2022, is amended to read as follows:
   (b)  A  non-participating provider shall not bill an insured for emer-
 gency services, including AMBULANCE SERVICES OR inpatient services which
 follow an emergency room visit, except  for  any  applicable  copayment,
 coinsurance  or  deductible that would be owed if the insured utilized a
 participating provider.
   § 4-a. Subsection (b) of section 606 of the financial services law, as
 amended by section 14 of subpart A of part II of chapter 57 of the  laws
 of 2023, is amended to read as follows:
   (b)  A  non-participating provider shall not bill an insured for emer-
 gency services, including AMBULANCE SERVICES OR inpatient services which
 follow an emergency room visit, or for services  rendered  by  a  mobile
 crisis intervention services provider licensed, certified, or designated
 by  the  office of mental health or the office of addiction services and
 supports, except for any applicable copayment, coinsurance or deductible
 that would be owed if the insured utilized a participating provider.
   § 5. This act shall take effect immediately and shall apply  to  poli-
 cies  and  contracts issued, renewed, amended, modified or altered on or
 after such date; provided however, that section two-a of this act  shall
 take  effect  on  the  same date and in the same manner as section 13 of
 subpart A of part II of chapter 57 of the laws of  2023,  takes  effect;
 and  provided  further however, that section four-a shall take effect on
 the same date and in the same manner as section 14 of subpart A of  part
 II of chapter 57 of the laws of 2023, takes effect.