What's happening
This bill requires insurers to pay ambulance service providers directly, including nonparticipating providers, at customary rates if assigned benefits.
Why it matters
Direct payments to ambulance providers, including those not in an insurer’s network, could reduce patient confusion and financial stress. , since patients would no longer be the go-between for insurance reimbursements if they sign an assignment of benefits.
Ensures nonparticipating ambulance services are paid at “usual and customary” rates, as long as those rates are not excessive or unreasonable. This could help protect ambulance providers from low, arbitrary payments, potentially stabilizing their finances and ensuring continued emergency coverage, especially in rural or underserved areas.
By requiring written notice of payment sent to the patient whenever a direct payment is made, the bill promotes transparency. patients are kept informed about how their insurance benefits are being used and what is being paid on their behalf.
The bill does not mandate equal benefit levels for in-network and out-of-network ambulance providers, nor does it require coverage for ambulance services not included in a policy,. meaning some differences in patient cost-sharing or coverage gaps may remain, depending on individual insurance plans.
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Who cares
Headline styles
Pay All Ambulance Providers
Plain English, a few words. Used as the page title.
Sponsors
21 Co-sponsors
- Kenneth Zebrowski
- Albert A. Stirpe
- Vivian Cook
- Richard Gottfried
- Carrie Woerner
- Patricia Fahy
- Walter T. Mosley
- Gary Finch
- Michael Montesano
- Angelo Santabarbara
- Michael Blake
- Crystal Peoples-Stokes
- Sandy Galef
- William Colton
- Addie Jenne
- Aileen Gunther
- Steven Otis
- John T. McDonald III
- Harry B. Bronson
- James Skoufis
- Andrew Raia
History
- Print number 343a
- Amend and recommit to insurance
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Pay All Ambulance Providers
In Senate Committee · Insurance · Sponsor James L. Seward
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
343--A
2017-2018 Regular Sessions
IN ASSEMBLY
January 5, 2017
Introduced by M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED, WOERNER, FAHY, MOSLEY, FINCH, MONTESANO, SANTABARBARA, BLAKE, PEOPLES-STOKES, GALEF, COLTON, JENNE, GUNTHER, OTIS, McDONALD, BRON- SON, SKOUFIS, RAIA -- Multi-Sponsored by -- M. of A. ARROYO, CROUCH, GANTT, HEVESI, HOOPER, JOHNS, KOLB, MAGEE, OAKS, PERRY, SEPULVEDA -read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to payments to prehospital emergency medical services providers
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3224-a of the insurance law is amended by adding a new subsection (k) to read as follows:
(k) Payments to nonparticipating or nonpreferred providers of ambulance services licensed under article thirty of the public health law. (1) Whenever an insurer or an organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law provides that any health care claims submitted under contracts or agreements issued or entered into pursuant to this article or article forty-two, forty-three or forty-seven of this chapter and article forty-four of the public health law are payable to a participating or preferred provider of ambulance services for services rendered, the insurer, organization, or corporation licensed or certified pursuant to article forty-three or fortyseven of this chapter or article forty-four of the public health law shall be required to pay such benefits either directly to any similarly licensed nonparticipating or nonpreferred provider at the usual and customary charge, which shall not be excessive or unreasonable, when the provider has rendered such services, has on file a duly executed assign-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00551-05-8
A. 343--A 2
ment of benefits, and has caused notice of such assignment to be given to the insurer, organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law or jointly to such nonparticipating or nonpreferred provider and to the insured, subscriber, or other covered person; provided, however, that in either case the insurer, organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law shall be required to send such benefit payments directly to the provider who has the assignment on file. When payment is made directly to a provider of ambulance services as authorized by this section, the insurer, organization, or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law shall give written notice of such payment to the insured, subscriber, or other covered person.
(2) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable.
(3) Nothing contained in this section shall be deemed to prohibit the payment of different levels of benefits or from having differences in coinsurance percentages applicable to benefit levels for services provided by participating or preferred providers and nonparticipating or nonpreferred providers.
The provisions of this section shall not apply to policies that do not include coverage for ambulance services.
§ 2. Subparagraphs (C) and (D) of paragraph 24 of subsection (i) of section 3216 of the insurance law, as added by chapter 506 of the laws of 2001, are amended to read as follows:
(C) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable. The insurer shall send such payments directly to the provider of such ambulance services, if the ambulance service has on file an executed assignment of benefits form with the claim.
(D) The provisions of this paragraph shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in subparagraph (A) of this paragraph unless such services are covered under the policy.
§ 3. Subparagraphs (C) and (D) of paragraph 15 of subsection (l) of section 3221 of the insurance law, as added by chapter 506 of the laws of 2001, are amended to read as follows:
(C) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable. The insurer shall send such payments directly to the provider of such ambulance services, if the ambulance service has on file an executed assignment of benefits form with the claim.
(D) The provisions of this paragraph shall have no application to transfers of patients between hospitals or health care facilities by an
A. 343--A 3
ambulance service as described in subparagraph (A) of this paragraph unless such services are covered under the policy.
§ 4. Paragraphs 3 and 4 of subsection (aa) of section 4303 of the insurance law, as added by chapter 506 of the laws of 2001, are amended to read as follows:
(3) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable. The insurer shall send such payments directly to the provider of such ambulance services, if the ambulance service has on file an executed assignment of benefits form with the claim.
(4) The provisions of this subsection shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in paragraph one of this subsection unless such services are covered under the policy.
§ 5. This act shall take effect January 1, 2020 and shall apply to health care claims submitted for payment after such date.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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