This bill has been amended

Bill S2714-2011

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law

Authorizes payments to nonparticipating or nonpreferred providers of ambulance services licensed under article 30 of the public health law.

Details

Actions

  • Jun 7, 2011: 2ND REPORT CAL.
  • Jun 6, 2011: 1ST REPORT CAL.1020
  • Jan 31, 2011: REFERRED TO INSURANCE

Meetings

Calendars

Votes

VOTE: COMMITTEE VOTE: - Insurance - Jun 6, 2011
Ayes (15): Seward, Flanagan, Golden, Grisanti, Lanza, Larkin, LaValle, Martins, Saland, Young, Breslin, Diaz, Espaillat, Kennedy, Smith
Ayes W/R (2): Kruger, Peralta
Absent (1): Parker

Memo

BILL NUMBER:S2714

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 nonparticipating or non-preferred providers of ambulance 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 321 6 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. 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 payor 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: S.4462 of 2010

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect January 1, 2012 and shall apply to health care claims submitted for payment after such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 2714 2011-2012 Regular Sessions IN SENATE January 31, 2011 ___________
Introduced by Sen. SEWARD -- read twice and ordered printed, and when printed to be committed 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: Section 1. Section 3224-a of the insurance law is amended by adding a new subsection (i) to read as follows: (I) PAYMENTS TO NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU- LANCE SERVICES LICENSED UNDER ARTICLE THIRTY OF THE PUBLIC HEALTH LAW. (1) WHENEVER AN INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI- FIED PURSUANT TO ARTICLE FORTY-THREE 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 ARTICLES FORTY-TWO AND FORTY-THREE OF THIS CHAPTER AND ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW ARE PAYABLE TO A PARTIC- IPATING OR PREFERRED PROVIDER OF AMBULANCE SERVICES FOR SERVICES RENDERED, THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTI- FIED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO PAY SUCH BENE- FITS EITHER DIRECTLY TO ANY SIMILARLY LICENSED NONPARTICIPATING OR NONPREFERRED PROVIDER AT SAID PROVIDER'S USUAL AND CUSTOMARY CHARGE, WHICH SHALL NOT BE EXCESSIVE OR UNREASONABLE, WHEN SAID PROVIDER HAS RENDERED SUCH SERVICES, HAS A WRITTEN ASSIGNMENT OF BENEFITS, AND HAS CAUSED WRITTEN NOTICE OF SUCH ASSIGNMENT TO BE GIVEN TO THE INSURER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTICLE FORTY-THREE 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 OF THIS CHAPTER OR ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW SHALL BE REQUIRED TO SEND SUCH BENE- FIT PAYMENTS DIRECTLY TO THE PROVIDER WHO HAS THE WRITTEN ASSIGNMENT. 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 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) 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. (3) THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO CREDIT INSUR- ANCE, DISABILITY INCOME INSURANCE, OR LIMITED ACCIDENT AND SICKNESS POLICIES SUCH AS HOSPITAL INDEMNITY POLICIES, SPECIFIED DISEASE POLI- CIES, LIMITED ACCIDENT POLICIES, OR SIMILAR LIMITED POLICIES. S 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 INCLUDES 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. S 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 INCLUDES 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. S 4. This act shall take effect January 1, 2012 and shall apply to health care claims submitted for payment after such date.

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