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New York proposes changes to medical fee schedule guidelines

Posted On: Feb. 1, 2023 12:07 PM CST

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CORRECTED: An earlier version of this story incorrectly stated that the changes apply to workers compensation claims.

New York lawmakers are proposing changes to guidelines used for medical treatment under the “No-Fault” Comprehensive Motor Vehicle Reparations Act, which uses guidelines under the state’s workers compensation system when it comes to treatment.

S.B. 3550, which was introduced Tuesday, would prohibit insurers from paying for charges that exceed the state’s medical fee schedule or that are not provided for under the current fee schedule and compensable under Medicare. 

Language in the bill says that insurers should never pay any charge for professional health services that exceeds the charges permissible under the schedule established by the chair of the Workers’ Compensation Board.

Deviations from medical treatment guidelines would only be allowed with prior written request to insurers before treatment of injured workers commences.

The bill says that treating physicians will bear the burden of proving the necessary treatment if it deviates from the guidelines, and that failure to provide the request would result in maximum reimbursement of 50% of the treatment guidelines.

The bill would also give insurers the ability to order independent medical examinations of injured workers at any time during the course of treatment.

The measure also states that services not covered under the treatment guidelines or workers comp fee schedule will be determined non-compensable.