A05375 Summary:

BILL NOA05375A
 
SAME ASSAME AS S07918-A
 
SPONSORWeprin
 
COSPNSRJacobson
 
MLTSPNSR
 
Add §§3246 & 4331, Ins L; add §365-q, Soc Serv L
 
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.
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A05375 Actions:

BILL NOA05375A
 
02/13/2025referred to insurance
05/15/2025amend (t) and recommit to insurance
05/15/2025print number 5375a
05/20/2025reported referred to rules
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A05375 Committee Votes:

INSURANCE Chair:Weprin DATE:05/20/2025AYE/NAY:25/0 Action: Favorable refer to committee Rules
WeprinAyeBlankenbushAye
CookAyeHawleyAye
LavineAyePalmesanoAye
SteckAyeGandolfoAye
DilanAyeJensenAye
HunterAyeBlumencranzAye
JacobsonAyeBendettAye
MeeksAye
ForrestAye
AndersonAye
CruzAye
BoresAye
LunsfordAye
BergerAye
EichensteinAye
KayAye
YegerAye
WiederAye

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A05375 Floor Votes:

There are no votes for this bill in this legislative session.
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A05375 Memo:

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
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A05375 Text:



 
                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.
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