Provides that 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; reduces costs of treatment by requiring out of network providers accept payment at the carrier's negotiated network rate, while at the same time allowing injured workers to obtain treatment in a timely manner by providing for payment to the provider when they do not obtain the treatment within the network; provides that 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.
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 Assem-bly, do enact as follows:
1 Section 1. Subdivision (i) of section 13 of the workers' compensation
2 law is amended by adding a new paragraph 6 to read as follows:
3 (6) A non-network pharmacy that provides causally related medications
4 to a claimant shall be entitled to payment at the network rate negoti-
5 ated between the carrier and the pharmacy network if the carrier's
6 network provides mail order service or is located within a reasonable
7 distance from the claimant.
8 § 2. Subdivision 7 of section 13-a of the workers' compensation law is
9 amended by adding a new paragraph (e) to read as follows:
10 (e) Any special diagnostic tests, x-ray examinations, magnetic reso-
11 nance imaging or other radiological examinations or tests costing more
12 than one thousand dollars performed by a provider who is not a member of
13 the carrier's, self insured's or state insurance fund's diagnostic
14 networks, shall be entitled to payment at the negotiated network rate.
15 § 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
