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HOUSE DOCKET, NO. 122         FILED ON: 1/7/2013

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 863

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

James M. Cantwell

_______________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
              Court assembled:

              The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to payment for use of ambulance services.

_______________

PETITION OF:

 

Name:

District/Address:

James M. Cantwell

4th Plymouth

Jonathan Hecht

29th Middlesex

Kenneth J. Donnelly

Fourth Middlesex

Patricia A. Haddad

5th Bristol

Josh S. Cutler

6th Plymouth

William C. Galvin

6th Norfolk

Jennifer E. Benson

37th Middlesex

Cleon H. Turner

1st Barnstable

Susan Williams Gifford

2nd Plymouth

James J. Dwyer

30th Middlesex

Rhonda Nyman

5th Plymouth

Angelo J. Puppolo, Jr.

12th Hampden

Kimberly N. Ferguson

1st Worcester

Peter J. Durant

6th Worcester

Jason Lewis

 

Michael D. Brady

9th Plymouth

David T. Vieira

3rd Barnstable

Benjamin Swan

11th Hampden

James M. Murphy

4th Norfolk

Robert M. Koczera

11th Bristol

Colleen M. Garry

36th Middlesex

William Smitty Pignatelli

4th Berkshire

Thomas J. Calter

12th Plymouth

Kay Khan

11th Middlesex

Jeffrey N. Roy

10th Norfolk

Paul McMurtry

11th Norfolk

David Paul Linsky

5th Middlesex

John F. Keenan

Norfolk and Plymouth

Jennifer L. Flanagan

Worcester and Middlesex

Daniel A. Wolf

Cape and Islands

Stephen L. DiNatale

3rd Worcester

Randy Hunt

5th Barnstable

Tricia Farley-Bouvier

3rd Berkshire

Angelo L. D'Emilia

8th Plymouth

Geoff Diehl

7th Plymouth

Denise Andrews

2nd Franklin

Viriato Manuel deMacedo

1st Plymouth

John W. Scibak

2nd Hampshire

Marjorie C. Decker

25th Middlesex

Stephen Kulik

1st Franklin

Katherine M. Clark

Fifth Middlesex

Carolyn C. Dykema

8th Middlesex

Matthew A. Beaton

11th Worcester

James E. Timilty

Bristol and Norfolk

Gailanne M. Cariddi

1st Berkshire

Christine E. Canavan

10th Plymouth

Timothy R. Madden

Barnstable, Dukes and Nantucket

Nicholas A. Boldyga

3rd Hampden

John V. Fernandes

10th Worcester

John P. Fresolo

16th Worcester

James J. Lyons, Jr.

18th Essex

Lori A. Ehrlich

8th Essex

Denise Provost

27th Middlesex

James R. Miceli

19th Middlesex

Tom Sannicandro

7th Middlesex

Gloria L. Fox

7th Suffolk

Chris Walsh

6th Middlesex

Anne M. Gobi

5th Worcester

John J. Lawn, Jr.

10th Middlesex

Paul K. Frost

7th Worcester

Christopher M. Markey

9th Bristol

Paul A. Schmid, III

8th Bristol

Donald H. Wong

9th Essex

Edward F. Coppinger

10th Suffolk

Todd M. Smola

1st Hampden

David M. Nangle

17th Middlesex

Donald Humason

 

Carlos Henriquez

5th Suffolk

Dennis A. Rosa

4th Worcester

John H. Rogers

12th Norfolk

Alice Hanlon Peisch

14th Norfolk

Kevin J. Kuros

8th Worcester

Elizabeth A. Poirier

14th Bristol

Theodore C. Speliotis

13th Essex

Bruce J. Ayers

1st Norfolk


HOUSE DOCKET, NO. 122        FILED ON: 1/7/2013

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 863

By Mr. Cantwell of Marshfield, a petition (accompanied by bill, House, No. 863) of James M. Cantwell and others relative to insurance payments for use of ambulance services.  Financial Services. 


The Commonwealth of Massachusetts
 

_______________

In the Year Two Thousand Thirteen

_______________

 

An Act relative to payment for use of ambulance services.
 

              Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

              SECTION XX. Chapter 176D of the General Laws is hereby amended by inserting after section 3B the following section:-

              Section 3C. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-

              “Ambulance service provider”, a person or entity licensed by the department of public health under section 6 of chapter 111C to establish or maintain an ambulance service.

              “Emergency ambulance services”, emergency services that an ambulance service provider is authorized to render under its ambulance service license when a condition or situation in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by the individual, a bystander or an emergency medical services provider.

              “Insurance policy” and “insurance contract”, a contract of insurance, motor vehicle insurance, indemnity, medical or hospital service, dental or optometric, suretyship or annuity issued, proposed for issuance or intended for issuance by any insurer.

              “Insured”, an individual entitled to ambulance services benefits under an insurance policy or insurance contract.

              “Insurer”, a person as defined in section 1 of chapter 176D; any health maintenance organization as defined in section 1 of chapter 176G; a non-profit hospital service corporation organized under chapter 176A; any organization as defined in section 1 of chapter 176I that participates in a preferred provider arrangement also as defined in said section 1 of said chapter 176I; any carrier offering a small group health insurance plan under chapter 176J; any company as defined in section 1 chapter 175; any employee benefit trust; any self-insurance plan, and any company certified under section 34A of chapter 90 and authorized to issue a policy of motor vehicle liability insurance under section 113A of chapter 175 that provides insurance for the expense of medical coverage.

              (b) Notwithstanding any general or special provision of law to the contrary, in any instance in which an ambulance service provider provides an emergency ambulance service to an insured but is not an ambulance service provider under contract to the insurer maintaining or providing the insured’s insurance policy or insurance contract, the insurer maintaining or providing such insurance policy or insurance contract shall pay the ambulance service provider directly and promptly for the emergency ambulance service rendered to the insured. Such payment shall be made to the ambulance service provider notwithstanding that the insured’s insurance policy or insurance contract contains a prohibition against the insured assigning benefits thereunder so long as the insured executes an assignment of benefits to the ambulance service provider and such payment shall be made to the ambulance service provider in the event an insured is either incapable or unable as a practical matter to execute an assignment of benefits under an insurance policy or insurance contract pursuant to which an assignment of benefits is not prohibited, or in connection with an insurance policy or insurance contract that contains a prohibition against any such assignment of benefits. An ambulance service provider shall not be considered to have been paid for an emergency ambulance service rendered to an insured if the insurer makes payment for the emergency ambulance service to the insured. An ambulance service provider shall have a right of action against an insurer that fails to make a payment to it pursuant to this subsection.

              (c) Payment to an ambulance service provider under subsection (b) shall be at a rate equal to the rate established by the municipality where the patient was transported from.

              (d) An ambulance service provider receiving payment for an ambulance service in accordance with subsections (b) and (c) shall be deemed to have been paid in full for the ambulance service provided to the insured, and shall have no further right or recourse to further bill the insured for said ambulance service with the exception of coinsurance, co-payments or deductibles for which the insured is responsible under the insured’s insurance policy or insurance contract.

              (e) No term or provision of this section 3C shall be construed as limiting or adversely affecting an insured’s right to receive benefits under any insurance policy or insurance contract providing insurance coverage for ambulance services. No term or provision of this section 3C shall create an entitlement on behalf of an insured to coverage for ambulance services if the insured’s insurance policy or insurance contract provides no coverage for ambulance services”.

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