Establishes a fee schedule covering the costs of ambulance services provided to injured employees

BILL NUMBER:S5662

Title of bill

An act to amend the workers' compensation law, in relation to the establishment of a fee schedule covering the costs of ambulance services provided to injured employees

Purpose of the Bill:

The purpose of this bill is to authorize the Chair of the Workers' Compensation Board (WCB) to adopt a fee schedule establishing maximum fees for ambulance services.

Summary of Provisions:

Section 1 of the bill would amend subdivision (a) of section 13 of the Workers' Compensation Law (WCL) to provide for the establishment of a fee schedule covering fees for ambulance services including fees for air transport and to clarify that the employer or its insurer is liable for the payment of such services.

Section 2 of the bill would provide for an effective date of 180 days after it becomes law.

Existing Law:

WCL § 13 provides for the establishment of fee schedules for most types of medical treatment and care but does not include fees for ambulance services. Fees for ambulance services including air transport are already covered under the WCL. Under WCL § 13-f, providers only have recourse for the payment of fees for health care and services against the employer and its insurer.

Prior Legislative History:

This is a new bill.

Statement in Support:

Fee schedules are widely required under the WCL and apply to almost all types of health care for injured workers. These fee schedules help control costs by preventing exorbitant charges by providers, permitting efficient bill handling and avoiding billing disputes.

Currently, there is no fee schedule applicable to workers' compensation cases in New York that covers fees for ambulance services. Without a fee schedule in place, the standard for determining the fee for ambulance services is whether it is usual and customary. Under this standard, workers' compensation insurers must pay the amount billed unless they can either negotiate a lower fee with the ambulance service or establish that the fee is unreasonable. This ad hoc approach results in an inefficient payment process with wide fee disparities, and in some instances, exorbitant fees.

NYSIF believes that the adoption of a fee schedule is the best way to bring greater consistency to the workers' compensation system while assuring that ambulance services are appropriately compensated for the services they provide. A fee schedule would make the workers'

compensation system more efficient by precluding the need for insurance carriers to negotiate bills with providers on an individual basis and avoid litigation of billing disputes. Cost containment would be achieved by standardizing fees.

This bill would also add clarifying language to the WCL to explicitly state that ambulance services including air transport are covered under the WCL.

Fiscal Implications:

None for the State.

Effective Date:

This bill would take effect 180 days after it becomes law.