Senate Bill S7804

                                 
BILL NUMBER: S7804

SPONSOR: RHOADS
 
TITLE OF BILL:

An act to amend the workers' compensation law, in relation to permitting
payment of testing performed or medications obtained out of network at
the negotiated network rate

 
PURPOSE:

To amend the workers compensation law in relation to permitting payment
of testing performed or medications obtained out of network at the nego-
tiated network rate.

 
SUMMARY OF PROVISIONS:

Section 1. Subdivision (i) of section 13 of the workers' compensation
law is amended by adding a new paragraph 6 to read as follows: (6) A
non-network pharmacy that provides causally related medications to a
claimant shall be entitled to payment at the network if the carrier's
network provides mail order service or is located within a reasonable
              

distance from the claimant.

§ 2. Subdivision 7 of section 13-a of the workers' compensation law is
amended by adding a new paragraph (e) to read as follows: (e) Any
special diagnostic tests, x-ray examinations, magnetic resonance imaging
or other radiological examinations or tests costing more than one thou-
sand dollars performed by a provider who is not a member of the carri-
er's, self-insured's or state insurance funds diagnostic networks, shall
be entitled to payment at the negotiated network rate.

 
JUSTIFICATION:

In 2007 the Legislature permitted employers and carriers to contract
with pharmacy networks and diagnostic test networks in order to provide
for cost savings resulting from bulk purchasing and large-scale
relationships. Statutory and regulatory provisions require employers and
insurers to give adequate notice to the injured worker and their medical
providers about the existence of such networks prior to requiring their
use.

In some circumstances, however, injured workers and providers are
unaware of the existence of such networks or are unable to access treat-
ment through the networks. When services are rendered by non-network
providers, the Workers' Compensation Board has changed its policy from
requiring payment of such bills at the network rate to denying payment
entirely.

In that the goal of the Legislature is to ensure the effective delivery
of medical services to injured workers while maintaining cost savings
for employers and insurers; and in that payment to a non-network provid-
er at the network rate provides delivery of medical services to injured
workers without increasing costs to employers or insurers, this Act
codifies the Board's prior practice of requiring payment to non-network
providers at the network rate.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
This act shall take effect immediately.