Bill Text: NY A00242 | 2019-2020 | General Assembly | Introduced
Bill Title: Relates to payment of bills for pharmaceutical services.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2020-01-08 - referred to labor [A00242 Detail]
Download: New_York-2019-A00242-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 242 2019-2020 Regular Sessions IN ASSEMBLY (Prefiled) January 9, 2019 ___________ Introduced by M. of A. CAHILL, COLTON, SIMOTAS -- read once and referred to the Committee on Labor 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 21 therapist or self-employed occupational therapist may notify the chair 22 in writing that the bill has not been paid and request that the board 23 make an award for payment of such bill. The board or the chair may make 24 an award not in excess of the established fee schedules for any such EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD00028-01-9A. 242 2 1 bill or part thereof which remains unpaid after said forty-five day 2 period or thirty days after all other questions duly and timely raised 3 in accordance with the provisions of this chapter, relating to the 4 employer's liability for the payment of such amount, shall have been 5 finally determined adversely to the employer, whichever is later, in 6 accordance with rules promulgated by the chair, and such award may be 7 collected in like manner as an award of compensation. The chair shall 8 assess the sum of fifty dollars against the employer for each such award 9 made by the board, which sum shall be paid into the state treasury. 10 In the event that the employer has provided an explanation in writing 11 why the bill has not been paid, in part or in full, within the aforesaid 12 time period, and the parties [can not] cannot agree as to the value of 13 medical aid rendered under this chapter, such value shall be decided by 14 arbitration if requested by the hospital, physician, pharmacist, or 15 self-employed physical or occupational therapist, in accordance with the 16 provisions of subdivision two or subdivision three of this section, as 17 appropriate, and rules and regulations promulgated by the chair. 18 Where a physician, pharmacist, or physical or occupational therapist 19 bill has been determined to be due and owing in accordance with the 20 provisions of this section the board shall include in the amount of the 21 award interest of not more than one and one-half per cent (1 1/2%) per 22 month payable to the physician, pharmacist, or physical or occupational 23 therapist, in accordance with the rules and regulations promulgated by 24 the board. Interest shall be calculated from the forty-fifth day after 25 the bill was rendered or from the thirtieth day after all other ques- 26 tions duly and timely raised in accordance with the provisions of this 27 chapter, relating to the employer's liability for the payment of such 28 amount, shall have been finally determined adversely to the employer, 29 whichever is later, in accordance with rules promulgated by the chair. 30 (2) (a) If the parties fail to agree to the value of medical aid 31 rendered under this chapter and the amount of the disputed bill is one 32 thousand dollars or less, or if the amount of the disputed medical bill 33 exceeds one thousand dollars and the health care provider expressly so 34 requests, such value shall be decided by a single arbitrator process, 35 pursuant to rules promulgated by the chair. The chair shall appoint a 36 physician who is a member in good standing of the medical society of the 37 state of New York to determine the value of such disputed medical bill. 38 Where the physician whose charges are being arbitrated is a member in 39 good standing of the New York osteopathic society, the value of such 40 disputed bill shall be determined by a member in good standing of the 41 New York osteopathic society appointed by the chair. Where the physician 42 whose charges are being arbitrated is a member in good standing of the 43 New York homeopathic society, the value of such disputed bill shall be 44 determined by a member in good standing of the New York homeopathic 45 society appointed by the chair. Where the value of physical therapy 46 services or occupational therapy services is at issue, such value shall 47 be determined by a member in good standing of a recognized professional 48 association representing its respective profession in the state of New 49 York appointed by the chair. Decisions rendered under the single arbi- 50 trator process shall be conclusive upon the parties as to the value of 51 the services in dispute. 52 (b) If the parties fail to agree as to the value of medical aid 53 rendered under this chapter and the amount of the disputed bill exceeds 54 one thousand dollars, such value shall be decided by an arbitration 55 committee unless the health care provider expressly requests a single 56 arbitrator process in accordance with paragraph (a) of this subdivision.A. 242 3 1 The arbitration committee shall consist of one physician designated by 2 the president of the medical society of the county in which the medical 3 services were rendered, one physician who is a member of the medical 4 society of the state of New York, appointed by the employer or carrier, 5 and one physician, also a member of the medical society of the state of 6 New York, appointed by the chair of the workers' compensation board. If 7 the physician whose charges are being arbitrated is a member in good 8 standing of the New York osteopathic society or the New York homeopathic 9 society, the members of such arbitration committee shall be physicians 10 of such organization, one to be appointed by the president of that 11 organization, one by the employer or carrier and the third by the chair 12 of the workers' compensation board. Where the value of physical therapy 13 services is at issue and the amount of the disputed bill exceeds one 14 thousand dollars, the arbitration committee shall consist of a member in 15 good standing of a recognized professional association representing 16 physical therapists in the state of New York appointed by the president 17 of such organization, a physician designated by the employer or carrier 18 and a physician designated by the chair of the workers' compensation 19 board provided however, that the chair finds that there are a sufficient 20 number of physical therapy arbitrations in a geographical area comprised 21 of one or more counties to warrant a committee so comprised. In all 22 other cases where the value of physical therapy services is at issue and 23 the amount of the disputed bill exceeds one thousand dollars, the arbi- 24 tration committee shall be similarly selected and identical in composi- 25 tion, provided that the physical therapist member shall serve without 26 remuneration, and provided further that in the event a physical thera- 27 pist is not available, the committee shall be comprised of three physi- 28 cians designated in the same manner as in cases where the value of 29 medical aid is at issue. 30 (c) Where the value of occupational therapy services is at issue the 31 arbitration committee shall consist of a member in good standing of a 32 recognized professional association representing occupational therapists 33 in the state of New York appointed by the president of such organiza- 34 tion; a physician designated by the employer or carrier and a physician 35 designated by the chair of the workers' compensation board provided, 36 however, that the chair finds that there are a sufficient number of 37 occupational therapy arbitrations in a geographical area comprised of 38 one or more counties to warrant a committee so comprised. In all other 39 cases where the value of occupational therapy services is at issue and 40 the amount of the disputed bill exceeds one thousand dollars, the arbi- 41 tration committee shall be similarly selected and identical in composi- 42 tion, provided that the occupational therapist member shall serve with- 43 out remuneration, and provided further that in the event an occupational 44 therapist is not available, the committee shall be comprised of three 45 physicians designated in the same manner as in cases where the value of 46 medical aid is at issue. The majority decision of any such arbitration 47 committee shall be conclusive upon the parties as to the value of the 48 services in dispute. 49 (3) (a) If an employer shall have notified the hospital in writing, as 50 provided in subdivision one of this section, why the bill has not been 51 paid, in part or in full, and the amount of the disputed bill is one 52 thousand dollars or less, or where the amount of the disputed medical 53 bill exceeds one thousand dollars and the hospital expressly so 54 requests, such value shall be decided by a single arbitrator process, 55 pursuant to rules promulgated by the chair. The chair shall appoint a 56 physician in good standing licensed to practice in New York state toA. 242 4 1 determine the value of such disputed bill. Decisions rendered under the 2 administrative resolution procedure shall be conclusive upon the parties 3 as to the value of the services in dispute. 4 (b) If an employer shall have notified the hospital in writing, as 5 provided in subdivision one of this section, why the bill has not been 6 paid, in part or in full, and the amount of the disputed bill exceeds 7 one thousand dollars, the value of such bill shall be determined by an 8 arbitration committee appointed by the chair for that purpose, which 9 committee shall consider all of the charges of the hospital, unless the 10 hospital expressly requests a single arbitrator process pursuant to 11 paragraph (a) of this subdivision. The committee shall consist of three 12 physicians. One member of the committee may be nominated by the chair 13 upon recommendation of the president of the hospital association of New 14 York state and one member may be nominated by the employer or insurance 15 carrier. The majority decision of any such committee shall be conclusive 16 upon the parties as to the value of the services rendered. The chair may 17 make reasonable rules and regulations consistent with the provisions of 18 this section. 19 (4) (a) If an employer shall have notified the pharmacist in writing, 20 as provided in subdivision one of this section, why the bill has not 21 been paid, in part or in full, and the pharmacist expressly so requests, 22 the value and liability shall be decided by a single arbitrator process, 23 pursuant to rules promulgated by the chair. The chair shall appoint a 24 pharmacist in good standing licensed to practice in New York state to 25 determine the value and liability of such disputed bill. Decisions 26 rendered under the administrative resolution procedure shall be conclu- 27 sive upon the parties as to the value and liability of the prescription 28 in dispute. 29 (b) If an employer shall have notified the pharmacist in writing, as 30 provided in subdivision one of this section, why the bill has not been 31 paid, in part or in full, the amount of the disputed bill exceeds five 32 hundred dollars, and the bill has a common vendor, provider, and payer, 33 the value of such bill shall be determined by an arbitration committee 34 appointed by the chair for that purpose, which committee shall consider 35 all of the charges of the pharmacist, unless the pharmacist expressly 36 requests a single arbitrator process pursuant to paragraph (a) of this 37 subdivision. The arbitration committee shall consist of three pharma- 38 cists in good standing licensed to practice in New York state to deter- 39 mine the value and liability of such disputed bill. One member of the 40 committee may be nominated by the chair, one member may be nominated by 41 the professional pharmacy association affiliated with the complainant 42 and one member may be nominated by the employer or insurance carrier. 43 The majority decision of any such committee shall be conclusive upon the 44 parties as to the value of the services rendered. The chair shall make 45 reasonable rules and regulations consistent with the provisions of this 46 section. 47 (5) A provider initiating an arbitration, including a single arbitra- 48 tor process, pursuant to this section shall not pay a fee to cover the 49 costs related to the conduct of such arbitration. Each member of an 50 arbitration committee for medical bills, [and] each member of an arbi- 51 tration committee for hospital bills and each member of an arbitration 52 committee for pharmacy bills shall be entitled to receive and shall be 53 paid a fee for each day's attendance at an arbitration session in any 54 one count in an amount fixed by the chair of the workers' compensation 55 board.A. 242 5 1 [(5)] (6) In claims where the employer has failed to secure compen- 2 sation to his or her employees as required by section fifty of this 3 chapter, the board may make an award for the value of medical and podia- 4 try services or treatment rendered to such employees, in accordance with 5 the schedules of fees and charges prepared and established under the 6 provisions of subdivision (a) of section thirteen[, subdivision a,] and 7 subdivision two of section thirteen-k[, subdivision two,] of this [chap-8ter] article, and for the reasonable value of hospital care in accord- 9 ance with the charges currently in force in hospitals in the same commu- 10 nity for cases coming within the provisions of this chapter. Such award 11 shall be made to the physician, podiatrist, or hospital entitled there- 12 to. A default in the payment of such award may be enforced in the manner 13 provided for the enforcement of compensation awards as set forth in 14 section twenty-six of this [chapter] article. 15 In all cases coming under this subdivision the payment of the claim of 16 the physician, podiatrist, or hospital for medical, podiatry, or surgi- 17 cal services or treatment shall be subordinate to that of the claimant 18 or his or her beneficiaries. 19 [(6)] (7) Notwithstanding any inconsistent provision of law, arbi- 20 tration regarding payments for inpatient hospital services for any 21 patient discharged on or after January first, nineteen hundred ninety- 22 one and prior to December thirty-first, nineteen hundred ninety-six 23 shall be resolved in accordance with paragraph (d) of subdivision three 24 of section twenty-eight hundred seven-c of the public health law. 25 § 2. The chair of the workers' compensation board shall promulgate 26 such regulations as he or she deems appropriate to carry out the 27 purposes of this act. Such regulations may include, but are not limited 28 to, what defenses, if any, may be available to employers or carriers in 29 arbitration to determine the value or liability of a pharmaceutical bill 30 pursuant to the provisions of this act. 31 § 3. This act shall take effect on the one hundred twentieth day after 32 it shall have become a law; provided that, effective immediately, the 33 addition, amendment, and/or repeal of any rules and regulations neces- 34 sary to implement the provisions of this act on its effective date are 35 authorized and directed to be completed on or before such effective 36 date.
