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NY A03127
Bill
Status
1/23/2025
Primary Sponsor
Jennifer Lunsford
Click for details
AI Summary
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Raises the threshold for workers' compensation treatments requiring prior employer or board authorization from $1,000 to $1,500 for specialist consultations, surgical operations, therapy procedures, x-rays, and diagnostic lab tests
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Clarifies that the list of pre-authorized procedures exists solely to expedite treatment authorization and cannot be used as a basis to deny treatments not on the list
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Eliminates the requirement for treating providers to demonstrate "appropriateness and medical necessity" for varied treatments not on the pre-authorized list
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Allows non-network providers performing diagnostic tests, x-rays, MRIs, or other radiological exams costing over $1,500 to receive payment at the carrier's negotiated network rate
Legislative Description
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.
Last Action
referred to labor
1/7/2026