What's happening
This bill allows out-of-network pharmacies and diagnostic providers to be paid at the negotiated network rate under workers' compensation.
Why it matters
Ensures fair reimbursement for out-of-network pharmacies and testing providers,. which may encourage wider participation and access for workers’ compensation claimants, especially in areas where in-network options are limited.
Reduces potential financial penalties for injured workers who cannot conveniently use in-network providers,. as they (and their providers) won’t face lower reimbursement rates if they must go out-of-network.
Could impact negotiations between insurers and provider networks,. as the mandated matching of network rates for out-of-network services may affect leverage and pricing dynamics for both parties.
May help speed up access to essential medications and diagnostics. by removing a financial barrier for providers willing to serve workers’ comp claimants who need urgent care but are not near network options.
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Who cares
Non-network pharmacies
They would be entitled to the carrier’s negotiated pharmacy network rate for causally related medications supplied to workers’ compensation claimants if the network offers mail order service or is within a reasonable distance of the claimant.
Out-of-network diagnostic providers
They would be entitled to negotiated network rates for special diagnostic tests, X-rays, MRIs and other radiological examinations or tests costing more than $1,000.
Workers’ compensation carriers, self-insured employers and the State Insurance Fund
The bill would require payment at negotiated network rates for qualifying services supplied outside their networks.
Workers’ compensation claimants
The bill would establish payment entitlements for non-network pharmacies and diagnostic providers supplying their medications and testing.
Headline styles
Out-of-Network Pays In-Network Rates
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to labor
- Referred to labor
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
306
2025-2026 Regular Sessions
IN SENATE (Prefiled)
January 8, 2025
Introduced by Sen. RHOADS -- read twice and ordered printed, and when printed to be committed to the Committee on Labor
AN ACT to amend the workers' compensation law, in relation to permitting payment of testing performed or medications obtained out of network at the negotiated network rate
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision (i) of section 13 of the workers' compensation law is amended by adding a new paragraph 6 to read as follows:
(6) A non-network pharmacy that provides causally related medications to a claimant shall be entitled to payment at the network rate negotiated between the carrier and the pharmacy network if the carrier's network provides mail order service or is located within a reasonable distance from the claimant.
§ 2. Subdivision 7 of section 13-a of the workers' compensation law is amended by adding a new paragraph (e) to read as follows:
(e) Any special diagnostic tests, x-ray examinations, magnetic resonance imaging or other radiological examinations or tests costing more than one thousand dollars performed by a provider who is not a member of the carrier's, self insured's or state insurance fund's diagnostic networks, shall be entitled to payment at the negotiated network rate.
§ 3. This act shall take effect immediately.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01209-01-5
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the workers' compensation law, in relation to permitting payment of testing performed or medications obtained out of network at the negotiated network rate
Purpose
To amend the workers compensation law in relation to permitting payment of testing performed or medications obtained out of network at the nego- tiated network rate.
Summary of provisions
Section 1. Subdivision (i) of section 13 of the workers' compensation law is amended by adding a new paragraph 6 to read as follows: (6) A non-network pharmacy that provides causally related medications to a claimant shall be entitled to payment at the network if the carrier's network provides mail order service or is located within a reasonable distance from the claimant.
§ 2. Subdivision 7 of section 13-a of the workers' compensation law is amended by adding a new paragraph (e) to read as follows: (e) Any special diagnostic tests, x-ray examinations, magnetic resonance imaging or other radiological examinations or tests costing more than one thou- sand dollars performed by a provider who is not a member of the carri- er's, self-insured's or state insurance funds diagnostic networks, shall be entitled to payment at the negotiated network rate.
Section 3. This act shall take effect immediately.
Justification
In 2007 the Legislature permitted employers and carriers to contract with pharmacy networks and diagnostic test networks in order to provide for cost savings resulting from bulk purchasing and large-scale relationships. Statutory and regulatory provisions require employers and insurers to give adequate notice to the injured worker and their medical providers about the existence of such networks prior to requiring their use.
In some circumstances, however, injured workers and providers are unaware of the existence of such networks or are unable to access treat- ment through the networks. When services are rendered by non-network providers, the Workers' Compensation Board has changed its policy from requiring payment of such bills at the network rate to denying payment entirely.
In that the goal of the Legislature is to ensure the effective delivery of medical services to injured workers while maintaining cost savings for employers and insurers; and in that payment to a non-network provid- er at the network rate provides delivery of medical services to injured workers without increasing costs to employers or insurers, this Act codifies the Board's prior practice of requiring payment to non-network providers at the network rate.
Legislative history
New bill.
Fiscal implications
To be determined.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.