Bill Text: NY S06929 | 2023-2024 | General Assembly | Introduced

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Bill Title: Allows for treatment costing less than $1,500 to be done without prior approval, and more clearly defines the list of "pre-authorized procedures" as a floor on treatment as opposed to its current status as a ceiling; allows non-network providers of testing to be compensated at the provider network rate negotiated by the carrier.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced) 2024-02-26 - ADVANCED TO THIRD READING [S06929 Detail]

Download: New_York-2023-S06929-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6929

                               2023-2024 Regular Sessions

                    IN SENATE

                                      May 15, 2023
                                       ___________

        Introduced by Sen. FERNANDEZ -- read twice and ordered printed, and when
          printed to be committed to the Committee on Labor

        AN  ACT  to amend the workers' compensation law, in relation to workers'
          access to treatment

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    §  1.  Subdivision 5 of section 13-a of the workers' compensation law,
     2  as amended by section 8 of part CC of chapter 55 of the laws of 2019, is
     3  amended to read as follows:
     4    (5)  No  claim  for  specialist  consultations,  surgical  operations,
     5  physiotherapeutic or occupational therapy procedures, x-ray examinations
     6  or  special  diagnostic  laboratory tests costing more than one thousand
     7  five hundred dollars shall be valid and  enforceable,  as  against  such
     8  employer, unless such special services shall have been authorized by the
     9  employer  or  by the board, or unless such authorization has been unrea-
    10  sonably withheld, or withheld for a period of more than thirty  calendar
    11  days from receipt of a request for authorization, or unless such special
    12  services are required in an emergency, provided, however, that the basis
    13  for  a  denial  of such authorization by the employer must be based on a
    14  conflicting second opinion rendered by a  physician  authorized  by  the
    15  board.  The  board, with the approval of the superintendent of financial
    16  services, shall issue and maintain a list of  pre-authorized  procedures
    17  under  this  section.  Such  list  of pre-authorized procedures shall be
    18  issued and maintained solely for the purpose of expediting authorization
    19  of treatment of injured workers. Such list of pre-authorized  procedures
    20  shall  not  prohibit varied treatment [when the treating provider demon-
    21  strates the appropriateness and medical necessity of  such],  nor  shall
    22  the  list  be  used  as a basis to deny treatment not contained therein.
    23  Requests for varied treatment need only comply with  the  provisions  of
    24  this subdivision.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09959-04-3
        S. 6929                             2

     1    § 2. Subdivision 7 of section 13-a of the workers' compensation law is
     2  amended by adding a new paragraph (e) to read as follows:
     3    (e)  Any  special diagnostic tests, x-ray examinations, magnetic reso-
     4  nance imaging or other radiological examinations or tests  costing  more
     5  than  one  thousand  five hundred dollars performed by a provider who is
     6  not a member of the carrier's, self-insured's or state insurance  fund's
     7  diagnostic  network  or  networks,  shall  be entitled to payment at the
     8  negotiated network rate.
     9    § 3. This act shall take effect immediately.