Relates to the rate of payment of ambulance services to certain providers of such services

Summary of provisions

Section 1 excludes payments for air ambulance services from the direct payment requirement.

Section 2 of the bill ensures that the superintendent has oversight relating to benefit levels and ensures that the direct payment requirement only applies to services already covered under the policy.

Sections 3,4 and 5 of the bill deal with providing notice of an executed assignment of benefits form.

Section 6 of the bill requires the superintendent of financial services, in consultation with the commissioner of health, the insurance industry and the ambulance industry, to rep0l1 on the appropriateness of rates provided to both non-preferred and preferred providers of ambulance services. The bill also requires the superintendent to establish a rate setting process for reimbursement to ambulance providers.

Section 7 of the bill provides for a sunset of December 31, 2014 for all services provided by ambulance companies outside of NYC.

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 1110re 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 payor 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.

This chapter amendment makes technical clarifications and requires the department of financial services to study the appropriateness of rates paid to ambulance providers, as well as to establish a new rate setting process for determining adequate reimbursements,

Legislative history

New bill. Chapter amendment to S.2714-B/A.4093-B

Fiscal implications

None to State.

Effective date

This act shall take effect on the same date and in the same manner as a chapter of the laws of 2011 amending the insurance law relating to payments to prehospital emergency medical services providers, as proposed in legislative bills numbers S.2714-B and A.4093-B, take effect; provided, however, that after December 31, 2014, this act shall only apply to services provided by ambulance services provided by a municipally owned and operated provider of ambulance services in a city with a population of one million or more.