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A07885 Summary:

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A07885 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7885--B
                                                                Cal. No. 401
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 28, 2015
                                       ___________
 
        Introduced  by  M. of A. CAHILL, COLTON -- read once and referred to the
          Committee on Labor -- ordered to a third reading -- committed  to  the
          Committee  on Labor in accordance with Rule 3, sec. 2 -- reported from
          committee, advanced to a third reading, amended and ordered reprinted,
          retaining its place on the order of third reading -- again amended  on
          third  reading, ordered reprinted, retaining its place on the order of
          third reading
 
        AN ACT to amend the workers' compensation law, in relation to payment of
          bills for pharmaceutical services
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1. Section 13-g of the workers' compensation law, as added by
     2  chapter 258 of the laws of 1935, subdivision 1 as amended by chapter 674
     3  of the laws of 1994, subdivisions 2 and 3 as amended  by  section  4  of
     4  part  GG  of chapter 57 of the laws of 2013, subdivision 4 as amended by
     5  section 3 of part D of chapter 55 of the laws of 2015, subdivision 5  as
     6  amended by chapter 578 of the laws of 1959, and subdivision 6 as amended
     7  by chapter 639 of the laws of 1996, is amended to read as follows:
     8    §  13-g. Payment of bills for medical care. (1) Within forty-five days
     9  after a bill has been rendered to the employer by the  hospital,  physi-
    10  cian,  pharmacist,  or  self-employed physical or occupational therapist
    11  who has rendered treatment or dispensed medication pursuant to a  refer-
    12  ral  or prescription from the injured employee's authorized physician or
    13  authorized podiatrist  for  treatment  to  the  injured  employee,  such
    14  employer  must  pay  the bill or notify the hospital, physician, pharma-
    15  cist, or self-employed physical or  occupational  therapist  in  writing
    16  that the bill is not being paid and explain the reasons for non-payment.
    17  In  the  event  that  the  employer  fails to make payment or notify the
    18  hospital, physician, pharmacist, or self-employed  physical  or  occupa-
    19  tional  therapist  within such forty-five day period that payment is not
    20  being made, the hospital, physician, pharmacist, self-employed  physical
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11425-04-6
        A. 7885--B                          2
 
     1  therapist  or  self-employed occupational therapist may notify the chair
     2  in writing that the bill has not been paid and request  that  the  board
     3  make  an award for payment of such bill. The board or the chair may make
     4  an  award  not  in  excess of the established fee schedules for any such
     5  bill or part thereof which remains  unpaid  after  said  forty-five  day
     6  period  or  thirty days after all other questions duly and timely raised
     7  in accordance with the provisions  of  this  chapter,  relating  to  the
     8  employer's  liability  for  the  payment of such amount, shall have been
     9  finally determined adversely to the employer,  whichever  is  later,  in
    10  accordance  with  rules  promulgated by the chair, and such award may be
    11  collected in like manner as an award of compensation.  The  chair  shall
    12  assess the sum of fifty dollars against the employer for each such award
    13  made by the board, which sum shall be paid into the state treasury.
    14    In  the event that the employer has provided an explanation in writing
    15  why the bill has not been paid, in part or in full, within the aforesaid
    16  time period, and the parties [can not] cannot agree as to the  value  of
    17  medical  aid rendered under this chapter, such value shall be decided by
    18  arbitration if requested by  the  hospital,  physician,  pharmacist,  or
    19  self-employed physical or occupational therapist, in accordance with the
    20  provisions  of  subdivision two or subdivision three of this section, as
    21  appropriate, and rules and regulations promulgated by the chair.
    22    Where a physician, pharmacist, or physical or  occupational  therapist
    23  bill  has  been  determined  to  be due and owing in accordance with the
    24  provisions of this section the board shall include in the amount of  the
    25  award  interest  of not more than one and one-half per cent (1 1/2%) per
    26  month payable to the physician, pharmacist, or physical or  occupational
    27  therapist,  in  accordance with the rules and regulations promulgated by
    28  the board. Interest shall be calculated from the forty-fifth  day  after
    29  the  bill  was  rendered or from the thirtieth day after all other ques-
    30  tions duly and timely raised in accordance with the provisions  of  this
    31  chapter,  relating  to  the employer's liability for the payment of such
    32  amount, shall have been finally determined adversely  to  the  employer,
    33  whichever is later, in accordance with rules promulgated by the chair.
    34    (2)  (a)  If  the  parties  fail  to agree to the value of medical aid
    35  rendered under this chapter and the amount of the disputed bill  is  one
    36  thousand  dollars or less, or if the amount of the disputed medical bill
    37  exceeds one thousand dollars and the health care provider  expressly  so
    38  requests,  such  value  shall be decided by a single arbitrator process,
    39  pursuant to rules promulgated by the chair. The chair  shall  appoint  a
    40  physician who is a member in good standing of the medical society of the
    41  state  of New York to determine the value of such disputed medical bill.
    42  Where the physician whose charges are being arbitrated is  a  member  in
    43  good  standing  of  the  New York osteopathic society, the value of such
    44  disputed bill shall be determined by a member in good  standing  of  the
    45  New York osteopathic society appointed by the chair. Where the physician
    46  whose  charges  are being arbitrated is a member in good standing of the
    47  New York homeopathic society, the value of such disputed bill  shall  be
    48  determined  by  a  member  in  good standing of the New York homeopathic
    49  society appointed by the chair. Where  the  value  of  physical  therapy
    50  services  or occupational therapy services is at issue, such value shall
    51  be determined by a member in good standing of a recognized  professional
    52  association  representing  its respective profession in the state of New
    53  York appointed by the chair. Decisions rendered under the  single  arbi-
    54  trator  process  shall be conclusive upon the parties as to the value of
    55  the services in dispute.
        A. 7885--B                          3
 
     1    (b) If the parties fail to agree  as  to  the  value  of  medical  aid
     2  rendered  under this chapter and the amount of the disputed bill exceeds
     3  one thousand dollars, such value shall  be  decided  by  an  arbitration
     4  committee  unless  the  health care provider expressly requests a single
     5  arbitrator process in accordance with paragraph (a) of this subdivision.
     6  The  arbitration  committee shall consist of one physician designated by
     7  the president of the medical society of the county in which the  medical
     8  services  were  rendered,  one  physician who is a member of the medical
     9  society of the state of New York, appointed by the employer or  carrier,
    10  and  one physician, also a member of the medical society of the state of
    11  New York, appointed by the chair of the workers' compensation board.  If
    12  the  physician  whose  charges  are being arbitrated is a member in good
    13  standing of the New York osteopathic society or the New York homeopathic
    14  society, the members of such arbitration committee shall  be  physicians
    15  of  such  organization,  one  to  be  appointed by the president of that
    16  organization, one by the employer or carrier and the third by the  chair
    17  of  the workers' compensation board. Where the value of physical therapy
    18  services is at issue and the amount of the  disputed  bill  exceeds  one
    19  thousand dollars, the arbitration committee shall consist of a member in
    20  good  standing  of  a  recognized  professional association representing
    21  physical therapists in the state of New York appointed by the  president
    22  of  such organization, a physician designated by the employer or carrier
    23  and a physician designated by the chair  of  the  workers'  compensation
    24  board provided however, that the chair finds that there are a sufficient
    25  number of physical therapy arbitrations in a geographical area comprised
    26  of  one  or  more  counties  to warrant a committee so comprised. In all
    27  other cases where the value of physical therapy services is at issue and
    28  the amount of the disputed bill exceeds one thousand dollars, the  arbi-
    29  tration  committee shall be similarly selected and identical in composi-
    30  tion, provided that the physical therapist member  shall  serve  without
    31  remuneration,  and  provided further that in the event a physical thera-
    32  pist is not available, the committee shall be comprised of three  physi-
    33  cians  designated  in  the  same  manner  as in cases where the value of
    34  medical aid is at issue.
    35    (c) Where the value of occupational therapy services is at  issue  the
    36  arbitration  committee  shall  consist of a member in good standing of a
    37  recognized professional association representing occupational therapists
    38  in the state of New York appointed by the president  of  such  organiza-
    39  tion;  a physician designated by the employer or carrier and a physician
    40  designated by the chair of the  workers'  compensation  board  provided,
    41  however,  that  the  chair  finds  that there are a sufficient number of
    42  occupational therapy arbitrations in a geographical  area  comprised  of
    43  one  or more counties to warrant a committee so comprised.  In all other
    44  cases where the value of occupational therapy services is at  issue  and
    45  the  amount of the disputed bill exceeds one thousand dollars, the arbi-
    46  tration committee shall be similarly selected and identical in  composi-
    47  tion,  provided that the occupational therapist member shall serve with-
    48  out remuneration, and provided further that in the event an occupational
    49  therapist is not available, the committee shall be  comprised  of  three
    50  physicians  designated in the same manner as in cases where the value of
    51  medical aid is at issue. The majority decision of any  such  arbitration
    52  committee  shall  be  conclusive upon the parties as to the value of the
    53  services in dispute.
    54    (3) (a) If an employer shall have notified the hospital in writing, as
    55  provided in subdivision one of this section, why the bill has  not  been
    56  paid,  in  part  or  in full, and the amount of the disputed bill is one
        A. 7885--B                          4
 
     1  thousand dollars or less, or where the amount of  the  disputed  medical
     2  bill  exceeds  one  thousand  dollars  and  the  hospital  expressly  so
     3  requests, such value shall be decided by a  single  arbitrator  process,
     4  pursuant  to  rules  promulgated by the chair. The chair shall appoint a
     5  physician in good standing licensed to practice in  New  York  state  to
     6  determine  the value of such disputed bill. Decisions rendered under the
     7  administrative resolution procedure shall be conclusive upon the parties
     8  as to the value of the services in dispute.
     9    (b) If an employer shall have notified the  hospital  in  writing,  as
    10  provided  in  subdivision one of this section, why the bill has not been
    11  paid, in part or in full, and the amount of the  disputed  bill  exceeds
    12  one  thousand  dollars, the value of such bill shall be determined by an
    13  arbitration committee appointed by the chair  for  that  purpose,  which
    14  committee  shall consider all of the charges of the hospital, unless the
    15  hospital expressly requests a  single  arbitrator  process  pursuant  to
    16  paragraph  (a) of this subdivision. The committee shall consist of three
    17  physicians. One member of the committee may be nominated  by  the  chair
    18  upon  recommendation of the president of the hospital association of New
    19  York state and one member may be nominated by the employer or  insurance
    20  carrier. The majority decision of any such committee shall be conclusive
    21  upon the parties as to the value of the services rendered. The chair may
    22  make  reasonable rules and regulations consistent with the provisions of
    23  this section.
    24    (4) (a) If an employer shall have notified the pharmacist in  writing,
    25  as  provided  in  subdivision  one of this section, why the bill has not
    26  been paid, in part or in full, and the pharmacist expressly so requests,
    27  the value and liability shall be decided by a single arbitrator process,
    28  pursuant to rules promulgated by the chair. The chair  shall  appoint  a
    29  pharmacist  in  good  standing licensed to practice in New York state to
    30  determine the value and  liability  of  such  disputed  bill.  Decisions
    31  rendered  under the administrative resolution procedure shall be conclu-
    32  sive upon the parties as to the value and liability of the  prescription
    33  in dispute.
    34    (b)  If  an employer shall have notified the pharmacist in writing, as
    35  provided in subdivision one of this section, why the bill has  not  been
    36  paid,  in  part or in full, the amount of the disputed bill exceeds five
    37  hundred dollars, and the bill has a common vendor, provider, and  payer,
    38  the  value  of such bill shall be determined by an arbitration committee
    39  appointed by the chair for that purpose, which committee shall  consider
    40  all  of  the  charges of the pharmacist, unless the pharmacist expressly
    41  requests a single arbitrator process pursuant to paragraph (a)  of  this
    42  subdivision.  The  arbitration  committee shall consist of three pharma-
    43  cists in good standing licensed to practice in New York state to  deter-
    44  mine  the  value and liability of such disputed bill.  One member of the
    45  committee may be nominated by the chair, one member may be nominated  by
    46  the  professional  pharmacy  association affiliated with the complainant
    47  and one member may be nominated by the employer  or  insurance  carrier.
    48  The majority decision of any such committee shall be conclusive upon the
    49  parties  as to the value of the services rendered.  The chair shall make
    50  reasonable rules and regulations consistent with the provisions of  this
    51  section.
    52    [(4)]  (5)  A  provider  initiating an arbitration, including a single
    53  arbitrator process, pursuant to this section shall  not  pay  a  fee  to
    54  cover  the costs related to the conduct of such arbitration. Each member
    55  of an arbitration committee for medical bills, [and] each member  of  an
    56  arbitration  committee  for  hospital  bills and each member of an arbi-
        A. 7885--B                          5
 
     1  tration committee for pharmacy bills shall be entitled  to  receive  and
     2  shall  be paid a fee for each day's attendance at an arbitration session
     3  in any one count in an amount fixed by the chair of the workers' compen-
     4  sation board.
     5    [(5)]  (6)  In  claims where the employer has failed to secure compen-
     6  sation to his or her employees as required  by  section  fifty  of  this
     7  chapter, the board may make an award for the value of medical and podia-
     8  try services or treatment rendered to such employees, in accordance with
     9  the  schedules  of  fees  and charges prepared and established under the
    10  provisions of section thirteen, subdivision a, and  section  thirteen-k,
    11  subdivision two, of this chapter, and for the reasonable value of hospi-
    12  tal  care in accordance with the charges currently in force in hospitals
    13  in the same community for cases coming within  the  provisions  of  this
    14  chapter.  Such  award  shall  be  made  to the physician, podiatrist, or
    15  hospital entitled thereto. A default in the payment of such award may be
    16  enforced in the manner provided  for  the  enforcement  of  compensation
    17  awards as set forth in section twenty-six of this [chapter] article.
    18    In all cases coming under this subdivision the payment of the claim of
    19  the  physician, podiatrist, or hospital for medical, podiatry, or surgi-
    20  cal services or treatment shall be subordinate to that of  the  claimant
    21  or his or her beneficiaries.
    22    [(6)]  (7)  Notwithstanding  any  inconsistent provision of law, arbi-
    23  tration regarding payments  for  inpatient  hospital  services  for  any
    24  patient  discharged  on or after January first, nineteen hundred ninety-
    25  one and prior to  December  thirty-first,  nineteen  hundred  ninety-six
    26  shall  be resolved in accordance with paragraph (d) of subdivision three
    27  of section twenty-eight hundred seven-c of the public health law.
    28    § 2. The chair of the workers'  compensation  board  shall  promulgate
    29  such  regulations  as  he  or  she  deems  appropriate  to carry out the
    30  purposes of this act. Such regulations may include, but are not  limited
    31  to,  what defenses, if any, may be available to employers or carriers in
    32  arbitration to determine the value or liability of a pharmaceutical bill
    33  pursuant to the provisions of this act.
    34    § 3. This act shall take effect on the one hundred twentieth day after
    35  it shall have become a law; provided that,  effective  immediately,  the
    36  addition,  amendment,  and/or repeal of any rules and regulations neces-
    37  sary to implement the provisions of this act on its effective  date  are
    38  authorized  and  directed  to  be  completed on or before such effective
    39  date.