What's happening
This bill updates insurance law to give the superintendent authority to set health service charge limits and ensure fair reimbursement for providers treating no-fault claimants.
Why it matters
Shifts authority for setting health service charge limits from the Workers' Compensation Board to the Superintendent of Insurance, potentially allowing for more responsive or specialized regulation of no-fault insurance claims.
Requires that reimbursement rates reflect the actual treatment needs of no-fault claimants, which could lead to better access to appropriate care, especially for those needing specialized medical services.
Mandates the establishment of rates that are sufficient to fairly compensate specialty providers, addressing prior concerns that some providers were underpaid and might refuse to treat no-fault patients.
Empowers the Superintendent to create or update fee schedules by regulation, which could result in more regular adjustments to payment standards and reduce disputes over what constitutes a fair or reasonable charge.
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Who cares
Headline styles
Limit Health Provider Charges
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to insurance
- Referred to insurance
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
33
2017-2018 Regular Sessions
IN ASSEMBLY (Prefiled)
January 4, 2017
Introduced by M. of A. CAHILL -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to limits on charges by providers of health services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsections (a) and (b) of section 5108 of the insurance law are amended to read as follows:
(a) The charges for services specified in paragraph one of subsection (a) of section five thousand one hundred two of this article and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, shall not exceed the charges permissible under the [schedules] schedule prepared and established by the [chairman of the workers' compensation board for industrial accidents] superintendent pursuant to subsection (b) of this section, except where the insurer or arbitrator determines that unusual procedures or unique circumstances justify the excess charge.
(b) The superintendent[, after consulting with the chairman of the workers' compensation board and the commissioner of health,] shall promulgate rules and regulations [implementing and coordinating the provisions of this article and the workers' compensation law] with respect to charges for the professional health services specified in paragraph one of subsection (a) of section five thousand one hundred two of this article, including the establishment of schedules for all such services [for which schedules have not been prepared and established by the chairman of the workers' compensation board]. In establishing such schedules the superintendent shall ensure that provider reimbursement rates accurately reflect the treatment needs of no-fault claimants including the establishment of rates sufficient to reimburse specialty providers who treat no-fault claimants.
§ 2. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01673-01-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.