A 5375: 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.

  
  STATE OF NEW YORK ________________________________________________________________________ 5375 2025-2026 Regular Sessions  IN ASSEMBLY February 13, 2025 ___________ Introduced by M. of A. WEPRIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law and the social services law, in relation to prohibiting health insurers, including medical assistance programs, from imposing arbitrary time caps on reimbursement for anes- thesia 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. Prohibition on arbitrary time caps for anesthesia services. 1. 4 An insurer issuing a policy of hospital, medical, or surgical expense 5 insurance pursuant to this section or any other section of law shall not 6 impose arbitrary time caps on reimbursement for anesthesia services 7 provided during medically necessary procedures. 8 2. Reimbursement for anesthesia services shall be determined based on 9 medical necessity as assessed by the attending anesthesiologist or 10 licensed anesthesia provider. 11 3. An insurer issuing a policy of hospital, medical, or surgical 12 expense insurance pursuant to this section or any other section of law 13 shall be prohibited from denying payment for anesthesia services solely 14 because the duration of care exceeded a pre-set time limit. 15 4. The department of health shall: 16 (a) conduct periodic audits of health insurers to access compliance 17 with the provisions of this section; and 18 (b) investigate allegations of noncompliance with the provisions of 19 this section by patients, providers and other stakeholders. 20 5. Not later than one year from the effective date of this section, 21 and every three years thereafter, the department of health shall submit 22 a report to the speaker of the assembly and the temporary president of 23 the senate. Such report shall include: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09176-01-5 
 A. 5375 2 1 (a) the findings of any audits conducted pursuant to paragraph (a) of 2 subdivision four of this section; 3 (b) the number and nature of violations of the provisions of this 4 section reported; and 5 (c) recommendations, if any, for improving compliance with the 6 provisions of this section. 7 § 2. The social services law is amended by adding a new section 365-q 8 to read as follows: 9 § 365-q. Prohibition on arbitrary time caps for anesthesia services. 10 Any medical assistance provider whose medical assistance includes the 11 provision of anesthesia, including such assistance furnished through a 12 managed care program, shall not be subject to arbitrary time caps on 13 reimbursement when furnished during medically necessary procedures, as 14 determined by the attending anesthesiologist or other provider of such 15 anesthesia, and such payment shall not be denied for such assistance 16 solely because the duration of such assistance exceeded a pre-set time 17 limit. 18 § 3. This act shall take effect immediately.