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A00343 Summary:

A00343 Actions:

A00343 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A343
 
SPONSOR: Magnarelli (MS)

 
TITLE OF BILL:  An act to amend the insurance law, in relation to
payments to prehospital emergency medical services providers
 
 
PURPOSE:
 
To ensure that responding ambulance service companies 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.
 
 
SUMMARY OF PROVISIONS:
 
Section 1 amends section 3224-a of the insurance law to provide that
payments made to non-participating or non-preferred providers of ambu-
lance services made by health insurers shall be done so directly to the
provider or jointly to both the provider and the insured.
 
Section 2 amends subparagraphs (c) and (d) of paragraph 24 of subsection
(i)of section 3216 of the Insurance Law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim, and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
 
Section 3 amends subparagraphs (c) and (d) of paragraph 15 of subsection
(1)of section 3221 of the Insurance Law stating that the insurers shall
send such payments directly to the provider of such ambulance services
if the ambulance service includes an executed assignment of benefits
form with the claim, and the provisions of this paragraph shall apply to
transfers of patients between hospitals or health care facilities.
 
Section 4 amends paragraphs 3 and 4 of subsection (aa) of section 4303
of the insurance law stating that the insurers shall send such payments
directly to the provider of such ambulance services if the ambulance
service includes an executed assignment of benefits form with the claim,
and the provisions of this paragraph shall apply to transfers of
patients between hospitals or health care facilities.
 
Section 5 Effective Date.
 
 
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 more 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
pay or 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
 
 
LEGISLATIVE HISTORY:
 
A.8581 of 2016; A. 6195 of 2015; A.7534 of 2013-14; A.4093-B of 2011-12;
10735 of 2010.
 
 
FISCAL IMPLICATIONS:
 
None
 
 
EFFECTIVE DATE:
This act shall take effect January 1, 2019 and shall apply to health
care claims submitted for payment after such date.

A00343 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           343
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                     January 5, 2017
                                       ___________
 
        Introduced  by  M. of A. MAGNARELLI, ZEBROWSKI, STIRPE, COOK, GOTTFRIED,
          WOERNER, FAHY, MOSLEY, FINCH, MONTESANO, LOPEZ,  SANTABARBARA,  BLAKE,
          PEOPLES-STOKES, GALEF, COLTON, JENNE, GUNTHER, OTIS, McDONALD, BRONSON
          -- Multi-Sponsored by -- M. of A. ARROYO, CROUCH, GANTT, HEVESI, HOOP-
          ER, JOHNS, KOLB, LUPINACCI, MAGEE, OAKS, PERRY, RAIA, SEPULVEDA, SIMA-
          NOWITZ -- read once and referred to the Committee on Insurance
 
        AN  ACT to amend the insurance law, in relation to payments to prehospi-
          tal emergency medical services providers
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1. Section 3224-a of the insurance law is amended by adding a
     2  new subsection (k) to read as follows:
     3    (k) Payments to nonparticipating or nonpreferred  providers  of  ambu-
     4  lance  services  licensed under article thirty of the public health law.
     5  (1) Whenever an insurer or an organization, or corporation  licensed  or
     6  certified pursuant to article forty-three or forty-seven of this chapter
     7  or  article forty-four of the public health law provides that any health
     8  care claims submitted under contracts or agreements  issued  or  entered
     9  into  pursuant  to  this  article  or  article forty-two, forty-three or
    10  forty-seven of this chapter and article forty-four of the public  health
    11  law  are  payable  to a participating or preferred provider of ambulance
    12  services for services rendered, the  insurer,  organization,  or  corpo-
    13  ration  licensed  or certified pursuant to article forty-three or forty-
    14  seven of this chapter or article forty-four of  the  public  health  law
    15  shall  be required to pay such benefits either directly to any similarly
    16  licensed nonparticipating or nonpreferred  provider  at  the  usual  and
    17  customary charge, which shall not be excessive or unreasonable, when the
    18  provider  has  rendered such services, has a written assignment of bene-
    19  fits, and has caused written notice of such assignment to  be  given  to
    20  the insurer, organization, or corporation licensed or certified pursuant
    21  to  article forty-three or forty-seven of this chapter or article forty-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00551-01-7
        A. 343                              2
 
     1  four of the public health law or jointly  to  such  nonparticipating  or
     2  nonpreferred  provider  and to the insured, subscriber, or other covered
     3  person; provided, however, that in either case  the  insurer,  organiza-
     4  tion,  or  corporation  licensed or certified pursuant to article forty-
     5  three or forty-seven of this chapter or article forty-four of the public
     6  health law shall be required to send such benefit payments  directly  to
     7  the  provider  who  has  the  written  assignment.  When payment is made
     8  directly to a provider of  ambulance  services  as  authorized  by  this
     9  section, the insurer, organization, or corporation licensed or certified
    10  pursuant  to article forty-three or forty-seven of this chapter or arti-
    11  cle forty-four of the public health law shall  give  written  notice  of
    12  such payment to the insured, subscriber, or other covered person.
    13    (2)   An  insurer  shall  provide  reimbursement  for  those  services
    14  prescribed by this section at rates negotiated between the  insurer  and
    15  the  provider  of such services. In the absence of agreed upon rates, an
    16  insurer shall pay for such services at the usual and  customary  charge,
    17  which shall not be excessive or unreasonable.
    18    (3)  Nothing contained in this section shall be deemed to prohibit the
    19  payment of different levels of benefits or from  having  differences  in
    20  coinsurance  percentages  applicable  to  benefit  levels  for  services
    21  provided by participating or preferred providers and nonparticipating or
    22  nonpreferred providers.
    23    The provisions of this section shall not apply to policies that do not
    24  include coverage for ambulance services.
    25    § 2. Subparagraphs (C) and (D) of paragraph 24 of  subsection  (i)  of
    26  section  3216  of the insurance law, as added by chapter 506 of the laws
    27  of 2001, are amended to read as follows:
    28    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    29  prescribed  by  this section at rates negotiated between the insurer and
    30  the provider of such services. In the absence of agreed upon  rates,  an
    31  insurer  shall  pay for such services at the usual and customary charge,
    32  which shall not be excessive or unreasonable.   The insurer  shall  send
    33  such  payments  directly  to the provider of such ambulance services, if
    34  the ambulance service includes an executed assignment of  benefits  form
    35  with the claim.
    36    (D)  The  provisions  of  this  paragraph shall have no application to
    37  transfers of patients between hospitals or health care facilities by  an
    38  ambulance  service  as  described  in subparagraph (A) of this paragraph
    39  unless such services are covered under the policy.
    40    § 3. Subparagraphs (C) and (D) of paragraph 15 of  subsection  (l)  of
    41  section  3221  of the insurance law, as added by chapter 506 of the laws
    42  of 2001, are amended to read as follows:
    43    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    44  prescribed  by  this section at rates negotiated between the insurer and
    45  the provider of such services. In the absence of agreed upon  rates,  an
    46  insurer  shall  pay for such services at the usual and customary charge,
    47  which shall not be excessive or unreasonable.   The insurer  shall  send
    48  such  payments  directly  to the provider of such ambulance services, if
    49  the ambulance service includes an executed assignment of  benefits  form
    50  with the claim.
    51    (D)  The  provisions  of  this  paragraph shall have no application to
    52  transfers of patients between hospitals or health care facilities by  an
    53  ambulance  service  as  described  in subparagraph (A) of this paragraph
    54  unless such services are covered under the policy.
        A. 343                              3
 
     1    § 4. Paragraphs 3 and 4 of subsection (aa)  of  section  4303  of  the
     2  insurance  law, as added by chapter 506 of the laws of 2001, are amended
     3  to read as follows:
     4    (3)   An  insurer  shall  provide  reimbursement  for  those  services
     5  prescribed by this section at rates negotiated between the  insurer  and
     6  the  provider  of such services. In the absence of agreed upon rates, an
     7  insurer shall pay for such services at the usual and  customary  charge,
     8  which  shall  not  be excessive or unreasonable.  The insurer shall send
     9  such payments directly to the provider of such  ambulance  services,  if
    10  the  ambulance  service includes an executed assignment of benefits form
    11  with the claim.
    12    (4) The provisions of this subsection shall  have  no  application  to
    13  transfers  of patients between hospitals or health care facilities by an
    14  ambulance service as described  in  paragraph  one  of  this  subsection
    15  unless such services are covered under the policy.
    16    §  5.  This  act  shall take effect January 1, 2019 and shall apply to
    17  health care claims submitted for payment after such date.