Senate Bill S7918A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  7918--A
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               May 14, 2025
                                ___________
 
 Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
   printed to be committed 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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09176-03-5
              

 S. 7918--A                          2
 
 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.
   § 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.