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.
S T A T E O F N E W Y O R K
________________________________________________________________________
3127
2025-2026 Regular Sessions
I N A S S E M B L Y
January 23, 2025
___________
Introduced by M. of A. LUNSFORD, CRUZ, GLICK, CONRAD, McMAHON, ZACCARO,
SIMON, MAMDANI, BURDICK, EPSTEIN, SHRESTHA, COLTON, LUCAS, TAYLOR --
read once and referred 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. Subdivision 5 of section 13-a of the workers' compensation law,
as amended by section 8 of part CC of chapter 55 of the laws of 2019, is
amended to read as follows:
(5) No claim for specialist consultations, surgical operations,
physiotherapeutic or occupational therapy procedures, x-ray examinations
or special diagnostic laboratory tests costing more than one thousand
FIVE HUNDRED dollars shall be valid and enforceable, as against such
employer, unless such special services shall have been authorized by the
employer or by the board, or unless such authorization has been unrea-
sonably withheld, or withheld for a period of more than thirty calendar
days from receipt of a request for authorization, or unless such special
services are required in an emergency, provided, however, that the basis
for a denial of such authorization by the employer must be based on a
conflicting second opinion rendered by a physician authorized by the
board. The board, with the approval of the superintendent of financial
services, shall issue and maintain a list of pre-authorized procedures
under this section. Such list of pre-authorized procedures shall be
issued and maintained SOLELY for the purpose of expediting authorization
of treatment of injured workers. Such list of pre-authorized procedures
shall not prohibit varied treatment [when the treating provider demon-
strates the appropriateness and medical necessity of such], NOR SHALL
THE LIST BE USED AS A BASIS TO DENY treatment NOT CONTAINED THEREIN.
REQUESTS FOR VARIED TREATMENT NEED ONLY COMPLY WITH THE PROVISIONS OF
THIS SUBDIVISION.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04384-01-5
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