Relates to reimbursement for anesthesia services; provides that an insurer may use a time related reimbursement methodology for anesthesia services if such methodology is based upon criteria established by an independent organization.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5375A
SPONSOR: Weprin TITLE OF BILL:
An act to amend the insurance law and the social services law, in
relation to reimbursement for anesthesia services
PURPOSE OR GENERAL IDEA OF BILL:
This legislation will prohibit health insurers from imposing arbitrary
time caps on reimbursement for anesthesia services provided during
medically necessary procedures.
SUMMARY OF PROVISIONS:
Section 1 adds a new section to the insurance law: 3246.
Section 2 adds a new section to the social services law: 365-q.
Section 3 is the effective date.
JUSTIFICATION:
Anesthesia care is essential and must be determined by medical necessi-
ty, not arbitrary time limits set by health insurers. Time caps on
reimbursement jeopardize patient safety, impose financial burdens, and
interfere with informed medical decisions.
Such caps can hinder the ability of healthcare professionals to provide
optimal care and undermine patient safety, leading to potential compli-
cations and prolonged recovery times. Prohibiting such practices
protects patients, promotes fairness, and ensures equitable access to
essential healthcare services.
Last year an insurer attempted to implement a policy stating it would
not pay for anesthesia care beyond a particular predetermined time limit
for a surgery or procedure. There are many reasons why a surgery or
procedure can take longer than its scheduled time. This would have left
patients to pay out of pocket for anesthesia services that went beyond
the predetermined time limit. These costs could easily amount to several
thousands of dollars and lead to crippling medical debt.
"The now-rescinded policy was inconsistent with prevailing standards,
regulations and billing norms, and revealed a diminished dedication to
patient safety on the part of Anthem," the American Society of Anesthe-
siologists stated.
This legislation would prohibit insurers in New York State from ever
attempting to implement such an egregious policy ever again.
LEGISLATIVE HISTORY:
None
FISCAL IMPLICATIONS:
None
EFFECTIVE DATE:
This act shall take effect immediately
STATE OF NEW YORK
________________________________________________________________________
5375--A
2025-2026 Regular Sessions
IN ASSEMBLY
February 13, 2025
___________
Introduced by M. of A. WEPRIN -- read once and referred to the Committee
on Insurance -- committee discharged, bill amended, ordered reprinted
as amended and recommitted to said committee
AN ACT to amend the insurance law and the social services law, in
relation to reimbursement for anesthesia services
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The insurance law is amended by adding a new section 3246
2 to read as follows:
3 § 3246. Reimbursement for anesthesia services. (a) An insurer issuing
4 a policy of hospital, medical, or surgical expense insurance pursuant to
5 this section or any other section of law shall not impose arbitrary time
6 caps on reimbursement for anesthesia services provided during medically
7 necessary procedures.
8 (b) Reimbursement for anesthesia services shall be determined based on
9 medical necessity as determined by the insurer, taking into consider-
10 ation the complexity of the procedure as evidenced by the submission of
11 medical records submitted by the attending anesthesiologist or licensed
12 anesthesia provider.
13 (c) (1) An insurer issuing a policy of hospital, medical, or surgical
14 expense insurance pursuant to this section or any other section of law
15 shall be prohibited from denying payment for anesthesia services solely
16 because the duration of care exceeded a pre-set time limit.
17 (2) Notwithstanding paragraph one of this subsection, an insurer may
18 use a time related reimbursement methodology for anesthesia services if
19 such methodology is based upon criteria established by an independent
20 organization, including the criteria used by the centers for Medicare
21 and Medicaid services to reimburse anesthesia services under title XVIII
22 of the United States Social Security Act (Medicare). If an insurer uses
23 a time related reimbursement methodology, it should have an established
24 process for the submission of additional medical records and the sharing
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09176-02-5
A. 5375--A 2
1 of electronic medical records to assess whether an increase to the
2 reimbursement is warranted.
3 § 2. The insurance law is amended by adding a new section 4331 to read
4 as follows:
5 § 4331. Reimbursement for anesthesia services. (a) Every corporation
6 subject to the provisions of this article that provide hospital,
7 medical, or surgical expense insurance coverage shall not impose arbi-
8 trary time caps on reimbursement for anesthesia services provided during
9 medically necessary procedures.
10 (b) Reimbursement for anesthesia services shall be determined based on
11 medical necessity as determined by the corporation, taking into consid-
12 eration the complexity of the procedure as evidenced by the submission
13 of medical records submitted by the attending anesthesiologist or
14 licensed anesthesia provider.
15 (c)(1) A corporation issuing hospital, medical, or surgical expense
16 insurance coverage shall be prohibited from denying payment for anes-
17 thesia services solely because the duration of care exceeded a pre-set
18 time limit.
19 (2) Notwithstanding paragraph one of this subsection, a corporation
20 may use a time related reimbursement methodology for anesthesia services
21 if such methodology is based upon criteria established by an independent
22 organization, including the criteria used by the centers for Medicare
23 and Medicaid services to reimburse anesthesia services under title XVIII
24 of the United States Social Security Act (Medicare). If a corporation
25 uses a time related reimbursement methodology, it should have an estab-
26 lished process for the submission of additional medical records and the
27 sharing of electronic medical records to assess whether an increase to
28 the reimbursement is warranted.
29 § 3. The social services law is amended by adding a new section 365-q
30 to read as follows:
31 § 365-q. Reimbursement for anesthesia services. 1. Any medical assist-
32 ance provider whose medical assistance includes the provision of anes-
33 thesia, including such assistance furnished through a managed care
34 program, shall not be subject to arbitrary time caps on reimbursement
35 when furnished during medically necessary procedures, and such payment
36 shall not be denied for such assistance solely because the duration of
37 such assistance exceeded a pre-set time limit.
38 2. Notwithstanding subdivision one of this section, a managed care
39 provider may use a time related reimbursement methodology for anesthesia
40 services if such methodology is based upon criteria established by an
41 independent organization, including the criteria used by the centers for
42 Medicare and Medicaid services to reimburse anesthesia services under
43 title XVIII of the United States Social Security Act (Medicare). If a
44 managed care provider uses a time related reimbursement methodology, it
45 should have an established process for the submission of additional
46 medical records and the sharing of electronic medical records to assess
47 whether an increase to the reimbursement is warranted.
48 § 4. This act shall take effect January 1, 2026.
