Bill S3542-2013

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.

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  • Jan 8, 2014: REFERRED TO INSURANCE
  • Feb 5, 2013: REFERRED TO INSURANCE

Memo

BILL NUMBER:S3542

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 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: S.2714-B of 2011-12; S.4462 of 2010.

FISCAL IMPLICATIONS: None

EFFECTIVE DATE: This act shall take effect January 1, 2014 and shall apply to health care claims submitted for payment after such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 3542 2013-2014 Regular Sessions IN SENATE February 5, 2013 ___________
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 (j) to read as follows: (J) PAYMENTS TO NONPARTICIPATING OR NONPREFERRED PROVIDERS OF AMBU- LANCE 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 CORPO- RATION 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 PAY SUCH BENEFITS EITHER DIRECTLY TO ANY SIMI- LARLY 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 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 OR FORTY-SEVEN OF THIS CHAPTER OR ARTI- CLE FORTY-FOUR OF THE PUBLIC HEALTH LAW OR JOINTLY TO SUCH NONPARTIC- IPATING OR NONPREFERRED PROVIDER AND TO THE INSURED, SUBSCRIBER, OR OTHER COVERED PERSON; PROVIDED, HOWEVER, THAT IN EITHER CASE THE INSUR- ER, ORGANIZATION, OR CORPORATION LICENSED OR CERTIFIED PURSUANT TO ARTI-
CLE 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 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 OR FORTY-SEVEN OF THIS CHAPTER OR ARTI- CLE 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. 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 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. 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 UNLESS SUCH SERVICES ARE COVERED UNDER THE POLICY. S 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 INCLUDES 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. S 5. This act shall take effect January 1, 2014 and shall apply to health care claims submitted for payment after such date.

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