New York Senate Bill S03550 Latest Draft

   
  STATE OF NEW YORK ________________________________________________________________________ 3550 2023-2024 Regular Sessions  IN SENATE January 31, 2023 ___________ Introduced by Sens. BRESLIN, COONEY -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, in relation to providing for the use of treatment guidelines under the comprehensive motor vehicle repara- tions act The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 5108 of the insurance law is amended to read as 2 follows: 3 § 5108. Limit on charges by providers of health services. (a) The 4 charges for services specified in paragraph one of subsection (a) of 5 section five thousand one hundred two of this article and any further 6 health service charges which are incurred as a result of the injury and 7 which are in excess of basic economic loss, shall not exceed the charges 8 permissible under the schedules prepared and established by the chairman 9 of the workers' compensation board for industrial accidents, except 10 where the insurer or arbitrator determines that unusual procedures or 11 unique circumstances justify the excess charge, and shall be subject to 12 the treatment guidelines established pursuant to subsection (d) of this 13 section. At no time shall an insurer pay any charge that exceeds the 14 charges permissible under the schedule prepared and established by the 15 chair of the workers' compensation board. 16 (b) The superintendent, after consulting with the chairman of the 17 workers' compensation board and the commissioner of health, shall 18 promulgate rules and regulations implementing and coordinating the 19 provisions of this article and the workers' compensation law with 20 respect to charges for the professional health services specified in 21 paragraph one of subsection (a) of section five thousand one hundred two 22 of this article, including the establishment of schedules for all such 23 services for which schedules have not been prepared and established by 24 the chairman of the workers' compensation board, including, but not EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08322-01-3 
 S. 3550 2 1 limited to, durable medical equipment or supplies. Additionally, the 2 superintendent, after consultation with the workers' compensation board 3 and the commissioner of health, shall promulgate treatment guidelines 4 with respect to treating covered persons. Charges for services that are 5 not specifically scheduled by the superintendent of insurance or the 6 chairman of the workers' compensation board, or are not compensable 7 charges under Medicare are not compensable health service charges under 8 subsection (a) of section five thousand one hundred two of this article. 9 (c) No provider of health services specified in paragraph one of 10 subsection (a) of section five thousand one hundred two of this article 11 may demand or request any payment in addition to the charges authorized 12 pursuant to this section. No such provider may be reimbursed for any 13 services unless the provider complies with subsection (d) of this 14 section. Every insurer shall report to the commissioner of health any 15 patterns of overcharging, excessive treatment or other improper actions 16 by a health provider within thirty days after such insurer has knowledge 17 of such pattern. 18 (d) Notwithstanding any other provision of statute, rule or regulation 19 to the contrary, the following shall apply for all individuals or enti- 20 ties that provide, treat, or charge for services specified in paragraph 21 one of subsection (a) of section five thousand one hundred two of this 22 article: 23 (1) The treating provider shall follow the treatment guidelines estab- 24 lished by the superintendent; 25 (2) Deviations from the treatment guidelines may be permitted under 26 the following conditions: 27 (i) prior written or electronic request is given to the insurer prior 28 to commencing treatment. The request shall contain justification for the 29 deviation from the treatment guidelines. The burden of showing the 30 necessity of the deviation remains solely on the treating provider. 31 Failure to provide this request shall result in a maximum reimbursement 32 of fifty percent of the treatment guidelines. 33 (ii) the insurer shall not be precluded from evaluating the deviation 34 for payment during the pendency of the review, and may utilize peer 35 review for evaluation of the deviation. 36 (iii) any disputes shall be resolved through a panel of experts who 37 have been trained or certified in the treatment guidelines pursuant to 38 subsection (e) of section five thousand one hundred six of this article. 39 (3) An insurer may schedule an independent medical examination at any 40 time during the course of treatment. 41 (4) Services or supplies not covered by the treatment guidelines or 42 the workers' compensation fee schedule shall not be compensable. 43 § 2. Section 5106 of the insurance law is amended by adding a new 44 subsection (e) to read as follows: 45 (e) Every insurer shall provide the treating provider with the option 46 of submitting a dispute involving a request for deviations from the 47 treatment guidelines under subsection (d) of section five thousand one 48 hundred eight of this article to arbitration pursuant to simplified 49 procedures promulgated or approved by the superintendent. Such simpli- 50 fied procedures shall include arbitration through a panel of experts who 51 have been trained or certified in the treatment guidelines. 52 § 3. This act shall take effect immediately and shall apply to all 53 actions and proceedings commenced on or after such date; and shall also 54 apply to any action or proceeding which was commenced prior to such 55 effective date where, as of such date, a trial of the issues has not yet 56 commenced.