New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter B - Property and Casualty Insurance
Part 68 - Charges For Professional Health Services
Section 68.1 - Adoption of certain workers' compensation schedules
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 68.1
Current through Register Vol. 46, No. 39, September 25, 2024
(a)
(1) The existing fee schedules prepared and
established by the chair of the Workers' Compensation Board for industrial
accidents are hereby adopted by the Superintendent of Financial Services with
appropriate modification so as to adapt such schedules for use pursuant to the
provisions of Insurance Law section 5108.
(2)
(i)
Notwithstanding paragraph (1) of this subdivision, and except as provided in
subparagraph (ii) of this paragraph, the amendments to the fee schedules set
forth in Parts 329, 333, 343, and 348 of Title 12 NYCRR that were promulgated
by the chair of the Workers' Compensation Board on December 11, 2018, and the
amendments to the fee schedules set forth in Parts 329, 333, and 348 of Title
12 NYCRR that were adopted by the chair of the Workers' Compensation Board on
November 19, 2019, shall take effect for purposes of Insurance Law section 5108
on October 1, 2020, and shall only apply to all charges for health services
performed on or after October 1, 2020.
(ii) The following ground rules in the
amendments to the fee schedules set forth in Parts 329, 333, 343, and 348 of 12
NYCRR that were promulgated by the chair of the Workers' Compensation Board on
December 11, 2018, shall take effect for purposes of Insurance Law section 5108
on April 1, 2019, and shall apply to all charges for health services performed
on or after April 1, 2019:
(a) General Ground
Rule 10 in the Workers' Compensation Chiropractic Fee Schedule set forth in 12
NYCRR 348;
(b) General Ground Rule
19 in the Workers' Compensation Medical Fee Schedule set forth in 12 NYCRR
329;
(c) General Ground Rule 13 in
the Workers' Compensation Behavioral Health Fee Schedule (formerly the
Psychology Fee Schedule) set forth in 12 NYCRR 333, and;
(d) General Ground Rule 16 in the Workers'
Compensation Podiatry Fee Schedule set forth in 12 NYCRR
343.
(b)
(1) The
charges for services specified in Insurance Law section 5102(a)(1) and any
further health service charges that are incurred as a result of the injury and
that are in excess of basic economic loss, shall not exceed the charges
permissible under the schedules prepared and established by the chair of the
Workers' Compensation Board for industrial accidents that are in effect for
purposes of no-fault at the time the charges are incurred. However, references
to workers' compensation reporting and procedural requirements in such
schedules do not apply to no-fault, e.g., requirements that provide for
authorization to perform surgical procedures. The general instructions and
ground rules in the workers' compensation fee schedules apply, but those rules
that refer to workers' compensation claim forms, pre-authorization approval,
time limitations within which health services must be performed, enhanced
reimbursement for providers of certain designated services, and dispute
resolution guidelines do not apply, unless specified in this
Part.
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