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NY S06217
Bill
Status
6/4/2025
Primary Sponsor
Nathalia Fernandez
Click for details
AI Summary
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Raises the threshold for workers' compensation treatments requiring employer or board authorization from $1,000 to $1,500 for specialist consultations, surgical operations, therapy procedures, x-ray examinations, and diagnostic laboratory tests
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Clarifies that the list of pre-authorized procedures must be maintained "solely" for expediting treatment authorization and cannot be used as a basis to deny treatments not included on the list
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Removes the requirement that treating providers must demonstrate "appropriateness and medical necessity" for varied treatments not on the pre-authorized list, requiring only compliance with standard authorization procedures
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Establishes that out-of-network providers performing diagnostic tests, x-rays, MRIs, or other radiological examinations costing over $1,500 are entitled to payment at the carrier's negotiated network rate
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Takes effect immediately upon enactment
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
3/4/2026