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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: A343A
 
SPONSOR: Magnarelli (MS)

 
TITLE OF BILL:
 
An act to amend the insurance law, in relation to payments to prehospi-
tal 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, 2020 and shall apply to health
care claims submitted for payment after such date.

A00343 Text:

 
                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  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 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
 
     1  ment of benefits, and has caused notice of such assignment to  be  given
     2  to  the  insurer,  organization,  or  corporation  licensed or certified
     3  pursuant to article forty-three or forty-seven of this chapter or  arti-
     4  cle  forty-four  of  the public health law or jointly to such nonpartic-
     5  ipating or nonpreferred provider and  to  the  insured,  subscriber,  or
     6  other  covered person; provided, however, that in either case the insur-
     7  er, organization, or corporation licensed or certified pursuant to arti-
     8  cle forty-three or forty-seven of this chapter or article forty-four  of
     9  the  public  health  law shall be required to send such benefit payments
    10  directly to the provider who has the assignment on file. When payment is
    11  made directly to a provider of ambulance services as authorized by  this
    12  section, the insurer, organization, or corporation licensed or certified
    13  pursuant  to article forty-three or forty-seven of this chapter or arti-
    14  cle forty-four of the public health law shall  give  written  notice  of
    15  such payment to the insured, subscriber, or other covered person.
    16    (2)   An  insurer  shall  provide  reimbursement  for  those  services
    17  prescribed by this section at rates negotiated between the  insurer  and
    18  the  provider  of such services. In the absence of agreed upon rates, an
    19  insurer shall pay for such services at the usual and  customary  charge,
    20  which shall not be excessive or unreasonable.
    21    (3)  Nothing contained in this section shall be deemed to prohibit the
    22  payment of different levels of benefits or from  having  differences  in
    23  coinsurance  percentages  applicable  to  benefit  levels  for  services
    24  provided by participating or preferred providers and nonparticipating or
    25  nonpreferred providers.
    26    The provisions of this section shall not apply to policies that do not
    27  include coverage for ambulance services.
    28    § 2. Subparagraphs (C) and (D) of paragraph 24 of  subsection  (i)  of
    29  section  3216  of the insurance law, as added by chapter 506 of the laws
    30  of 2001, are amended to read as follows:
    31    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    32  prescribed  by  this section at rates negotiated between the insurer and
    33  the provider of such services. In the absence of agreed upon  rates,  an
    34  insurer  shall  pay for such services at the usual and customary charge,
    35  which shall not be excessive or unreasonable.   The insurer  shall  send
    36  such  payments  directly  to the provider of such ambulance services, if
    37  the ambulance service has on file an  executed  assignment  of  benefits
    38  form with the claim.
    39    (D)  The  provisions  of  this  paragraph shall have no application to
    40  transfers of patients between hospitals or health care facilities by  an
    41  ambulance  service  as  described  in subparagraph (A) of this paragraph
    42  unless such services are covered under the policy.
    43    § 3. Subparagraphs (C) and (D) of paragraph 15 of  subsection  (l)  of
    44  section  3221  of the insurance law, as added by chapter 506 of the laws
    45  of 2001, are amended to read as follows:
    46    (C)  An  insurer  shall  provide  reimbursement  for  those   services
    47  prescribed  by  this section at rates negotiated between the insurer and
    48  the provider of such services. In the absence of agreed upon  rates,  an
    49  insurer  shall  pay for such services at the usual and customary charge,
    50  which shall not be excessive or unreasonable.   The insurer  shall  send
    51  such  payments  directly  to the provider of such ambulance services, if
    52  the ambulance service has on file an  executed  assignment  of  benefits
    53  form with the claim.
    54    (D)  The  provisions  of  this  paragraph shall have no application to
    55  transfers of patients between hospitals or health care facilities by  an
        A. 343--A                           3
 
     1  ambulance  service  as  described  in subparagraph (A) of this paragraph
     2  unless such services are covered under the policy.
     3    §  4.  Paragraphs  3  and  4 of subsection (aa) of section 4303 of the
     4  insurance law, as added by chapter 506 of the laws of 2001, are  amended
     5  to read as follows:
     6    (3)   An  insurer  shall  provide  reimbursement  for  those  services
     7  prescribed by this section at rates negotiated between the  insurer  and
     8  the  provider  of such services. In the absence of agreed upon rates, an
     9  insurer shall pay for such services at the usual and  customary  charge,
    10  which  shall  not  be excessive or unreasonable.  The insurer shall send
    11  such payments directly to the provider of such  ambulance  services,  if
    12  the  ambulance  service  has  on file an executed assignment of benefits
    13  form with the claim.
    14    (4) The provisions of this subsection shall  have  no  application  to
    15  transfers  of patients between hospitals or health care facilities by an
    16  ambulance service as described  in  paragraph  one  of  this  subsection
    17  unless such services are covered under the policy.
    18    §  5.  This  act  shall take effect January 1, 2020 and shall apply to
    19  health care claims submitted for payment after such date.