Bill > A05375

This bill modifies insurance law and social services law to regulate how insurers and medical assistance providers reimburse anesthesia services. Specifically, insurers and medical providers cannot impose arbitrary time caps on anesthesia services during medically necessary procedures, and cannot deny payment solely because the duration of care exceeded a pre-set time limit. However, they may use a time-related reimbursement methodology if it is based on criteria established by an independent organization, such as the Centers for Medicare and Medicaid Services (CMS). When using such a methodology, the insurer or provider must have a process for submitting and sharing additional medical records to assess whether increased reimbursement is warranted. The bill applies to various types of insurance, including hospital, medical, and surgical expense insurance, and extends to medical assistance providers, including those operating through managed care programs. The provisions aim to ensure fair compensation for anesthesia services by considering the complexity of medical procedures and preventing arbitrary restrictions on reimbursement. The bill will take effect on January 1, 2026.

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https://www.nysenate.gov/legislation/bills/2025/A5375