N.Y. Comp. Codes R. & Regs. tit. 11 § 68.1

Current through Register Vol. 46, No. 45, November 2, 2024

Section 68.1 - Adoption of certain workers' compensation schedules

(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.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 68.1

Amended New York State Register August 7, 2019/Volume XLI, Issue 32, eff. 8/7/2019

Amended New York State Register April 22, 2020/Volume XLII, Issue 16, eff. 4/22/2020

Amended New York State Register February 15, 2023/Volume XLIV, Issue 07, eff. 2/15/2023