What Providers Need to Know - Archived Updates
March 17, 2025
Governor Hochul Announces Historic Proposals to Improve Workers' Access to Medical Treatment
In her 2025 State of the State agenda, Governor Kathy Hochul included four legislative proposals and a regulatory change designed to give New York's injured workers more options for timely, high-quality medical care. The Governor's plan would:
- automatically authorize all eligible licensed medical providers, in good standing, to treat injured workers,
- extend authorization to fellow and resident physicians,
- amend NYS Insurance Law and codify a 2006 General Counsel opinion from the Department of Financial Services directing health care insurers to pay for medical treatment for workers' compensation claimants, with no co-pay, while their worker's comp claim is disputed,
- amend the Workers' Compensation Law so workers' compensation insurers can pay for medical treatment, without accepting liability, for up to one year in medical-only cases and
- increase medical fee schedules to be more in line with private insurance.
The majority of these changes would make it easier and better for health care providers to participate in the NYS workers' compensation system, which would give injured workers better access to care.
Read more in the Governor's press release as well this fact sheet that summarizes the proposals.
CMS-1500 Electronic Submission Requirement for Health Care Providers - Prepare Today!
Please be reminded that the Board will require health care providers to contract with an electronic submission partner to submit the CMS-1500 universal medical billing form electronically on their behalf effective August 1, 2025. Health care providers are encouraged to make the transition as soon as possible to take advantage of key benefits including faster payment.
Read more in a notification dated January 7, 2025 .
Combatting Improper C-8.1B filings
The Board issued new guidance to payers regarding improper filings of the Notice of Objection to a Payment of a Bill for Treatment Provided (Form C-8.1B), which have increasingly become a problem. Less improper objections means more timely payments to providers.
Read more in a notification dated January 6, 2025 .
Adoption of Amendment to Section 329-1.3 of Title 12 of the NYCRR (Physical Therapy Assistants and Occupational Therapy Assistants)
A second emergency adoption of an amendment to Section 329-1.3 of Title 12 of the NYCRR regarding physical therapy assistants and occupational therapy assistants has been adopted by the Chair of the Workers' Compensation Board to keep the regulation in effect until the permanent adoption can be filed and published in the State Register. The Notice of Emergency Adoption was published in the February 5, 2025, edition of the State Register.
Read more in Subject Number 046-1741.
Proposed Amendments to Sections 440.3, 440.4, and 441.3 and Title 12 of the NYCRR (Network Pharmacies)
The Chair proposed amendments to section 440.3, 440.4, and 441.3 of Title 12 of the NYCRR to provide that a payer must notify the claimant that they may use a non-network pharmacy when the payer maintains (or will maintain) a legal objection that the medication is for treatment of an injury or condition that has not yet been accepted or established by the Board.
Read more in Subject Number 046-1731 and watch for updates following the Board's review of public comments on the proposal.
Reminders
- Interested in treating injured workers? If you are interested in applying for Board authorization to treat injured workers, the process is easy and is done online. Read more about becoming authorized on the Board's website.
- The What Providers Need to Know section of the Board's website features a one-stop-shop that walks health care providers through getting started in the workers' compensation system, treating injured workers, billing for services, and more.
- Telehealth is now a permanent option in the workers' compensation system. Read more in Subject Number 046-1613.
- Use of the CMS-1500 form is mandatory. Visit CMS-1500 initiative for more details and send your questions to CMS1500@wcb.ny.gov.
- Visit the Board's website for OnBoard training guides, webinar recordings, and other resources.
- Efficiency Enhancements is a new communication with tips and best practices on using Board systems, processes, and forms in the most efficient, effective manner. Sign up to receive these, and other updates, straight to your inbox.
- The latest versions of several Paid Family Leave presentations are available, including family care, foster care/adoption, military leave, and bonding. Visit the Paid Family Leave website for more information.
Stay Informed!
Check out Recorded Webinars for health care providers on the Board's website. Health Care Providers Recorded Webinars web page for past webinars.
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