N.Y. Workers' Compensation Law § 13-b: Authorization of providers, medical bureaus and laboratories by the chair

* § 13-b. Authorization of providers, medical bureaus and laboratories

by the chair. 1. No person shall render medical care or conduct

independent medical examinations under this chapter without such

authorization by the chair. As used in this title, the following

definitions shall have the following meanings unless their context

requires otherwise:

(a) "Acupuncturist" shall mean licensed as having completed a formal

course of study and having passed an examination in accordance with the

education law, the regulations of the commissioner of education, and the

requirements of the board of regents. Acupuncturists are required by the

education law to advise, in writing, each patient of the importance of

consulting with a physician for the condition or conditions

necessitating acupuncture care, as prescribed by the education law.

(b) "Chair" of the board shall mean either the chair or the chair's

designee.

(c) "Chiropractor" shall mean licensed and having completed two years

of preprofessional college study and a four-year resident program in

chiropractic in accordance with the education law, and consistent with

the licensing requirements of the commissioner of education.

(d) "Dentist" shall mean licensed and having completed a four-year

course of study leading to a D.D.S. or D.D.M. degree, or an equivalent

degree, in accordance with the education law and the licensing

requirements of the commissioner of education.

(e) "Employer" shall mean a self-insured employer or, if insured, the

insurance carrier.

(f) "Independent medical examination" shall mean an examination

performed by a physician, podiatrist, chiropractor or psychologist,

authorized under this section to perform such examination, for the

purpose of examining or evaluating injury or illness pursuant to

paragraph (b) of subdivision four of section thirteen-a and section one

hundred thirty-seven of this chapter and as more fully set forth in

regulation.

(g) "Nurse practitioner" shall mean a licensed registered professional

nurse certified pursuant to section sixty-nine hundred ten of the

education law acting within their lawful scope of practice.

(h) "Occupational therapist" shall mean licensed as having at least a

bachelor's or master's degree in occupational therapy from a registered

program with the education department or receipt of a diploma or degree

resulting from completion of not less than four years of postsecondary

study, which includes the professional study of occupational therapy in

accordance with the education law and the regulations of the

commissioner of education.

(i) "Physical therapist" shall mean licensed in accordance with the

education law and the licensing requirements of the commissioner of

education.

(j) "Physician" shall mean licensed with a degree of doctor of

medicine, M.D., or doctor of osteopathic medicine, D.O., or an

equivalent degree in accordance with the education law and the licensing

requirements of the state board of medicine and the regulations of the

commissioner of education.

(k) "Physician assistant" shall mean a licensed provider who is

licensed as a physician assistant pursuant to section sixty-five hundred

forty-one of the education law.

(l) "Podiatrist" shall mean a doctor of podiatric medicine licensed as

having received a doctoral degree in podiatric medicine in accordance

with the regulations of the commissioner of education and the education

law, and must satisfactorily meet all other requirements of the state

board for podiatric medicine.

(m) "Provider" shall mean a duly licensed acupuncturist, chiropractor,

nurse practitioner, occupational therapist, physical therapist,

physician, physician assistant, podiatrist, psychologist, or social

worker authorized by the chair.

(n) "Psychologist" shall mean licensed as having received a doctoral

degree in psychology from a program of psychology registered with the

state education department or the substantial equivalent thereof in

accordance with the education law, the requirements of the state board

for psychology, and the regulations of the commissioner of education.

(o) "Social worker" shall mean a licensed clinical social worker. A

licensed clinical social worker has completed a master's degree of

social work that includes completion of a core curriculum of at least

twelve credit hours of clinical courses or the equivalent post-graduate

clinical coursework, in accordance with the education law and the

regulations of the commissioner of education.

(p) "Physical therapist assistant" shall mean licensed in accordance

with the education law and the licensing requirements of the

commissioner of education.

(q) "Occupational therapy assistant" shall mean licensed in accordance

with the education law and the licensing requirements of the

commissioner of education.

2. Any provider licensed pursuant to the education law to provide

medical care and treatment in the state of New York may render emergency

care and treatment in an emergency hospital or urgent care setting

providing emergency treatment under this chapter without authorization

by the chair under this section; (a) Such licensed provider as

identified in this subdivision who is on staff at any hospital or urgent

care center providing emergency treatment may continue such medical care

under this chapter while an injured employee remains a patient in such

hospital or urgent care setting; and

(b) Under the direct supervision of an authorized provider, medical

care may be rendered by a registered nurse or other person trained in

laboratory or diagnostic techniques within the scope of such person's

specialized training and qualifications. This supervision shall be

evidenced by signed records of instructions for treatment and signed

records of the patient's condition and progress. Reports of such

treatment and supervision shall be made by such provider to the chair in

the format prescribed by the chair at such times as the chair may

require.

(b-1) Under the direction and supervision of an authorized

occupational therapist, occupational therapy services may be rendered by

an occupational therapy assistant. Under the direction and supervision

of an authorized physical therapist, physical therapy services may be

rendered by a physical therapist assistant. Where any such care or

treatment is rendered, records of the patient's condition and progress,

together with records of instruction for treatment, if any, shall be

maintained by the physical therapist or occupational therapist and by

the referring physician, physician assistant, podiatrist, or nurse

practitioner. Said records shall be submitted to the chair on forms and

at such times as the chair may require.

(b-2) Under the supervision of any authorized provider, any resident

or fellow who may practice medicine as an exempt person as provided for

in title eight of the education law, may render medical care under this

chapter so long as the supervisory requirements of the education law are

met and neither the supervising provider nor resident or fellow have

been prohibited from treating workers' compensation claimants pursuant

to section thirteen-d of this article.

(c) Where it would place an unreasonable burden upon the employer or

carrier to arrange for, or for the claimant to attend, an independent

medical examination by an authorized provider, the employer or carrier

shall arrange for such examination to be performed by a qualified

provider in a medical facility convenient to the claimant.

(d) Upon the prescription or referral of an authorized physician,

physician assistant, podiatrist, or nurse practitioner acting within the

scope of his or her practice, care or treatment may be rendered to an

injured employee by an authorized physical therapist, occupational

therapist or acupuncturist provided the conditions and the treatment

performed are among the conditions that the physical therapist,

occupational therapist or acupuncturist is authorized to treat pursuant

to the education law or the regulations of the commissioner of

education. Where any such care or treatment is rendered, records of the

patient's condition and progress, together with records of instruction

for treatment, if any, shall be maintained by the physical therapist,

occupational therapist or acupuncturist rendering treatment and by the

referring physician, physician assistant, podiatrist, or nurse

practitioner. Said records shall be submitted to the chair on forms and

at such times as the chair may require.

(e) A record, report or opinion of a physical therapist, occupational

therapist, acupuncturist or physician assistant shall not be considered

as evidence of the causal relationship of any condition to a work

related accident or occupational disease under this chapter. Nor may a

record, report or opinion of a physical therapist, occupational

therapist or acupuncturist be considered evidence of disability. Nor may

a record, report or opinion of a physician assistant be considered

evidence of the presence of a permanent or initial disability or the

degree thereof.

(f) An independent medical examination performed in accordance with

section one hundred thirty-seven of this chapter, may only be performed

by a physician, podiatrist, chiropractor or psychologist authorized to

perform such examinations by the chair, or as specified in regulation,

when qualified by the board.

3. A provider properly licensed or certified pursuant to the

regulations of the commissioner of education and the requirements of the

education law desirous of being authorized to render medical care under

this chapter and/or to conduct independent medical examinations in

accordance with paragraph (b) of subdivision four of section thirteen-a

and section one hundred thirty-seven of this chapter shall file an

application for authorization under this chapter with the chair or

chair's designee. Prior to receiving authorization, a physician must,

together with submission of an application to the chair, submit such

application to the medical society of the county in which the

physician's office is located or of a board designated by such county

society or of a board representing duly licensed physicians of any other

school of medical practice in such county, and such medical society

shall submit the recommendation to the board. In the event such county

society or board fails to take action upon a physician's completed and

signed application within forty-five days, the chair may complete review

of the application without such approval. Upon approval of the

application by the chair or the chair's designee, the applicant shall

further agree to refrain from subsequently treating for remuneration, as

a private patient, any person seeking medical treatment, or submitting

to an independent medical examination, in connection with, or as a

result of, any injury compensable under this chapter, if he or she has

been removed from the list of providers authorized to render medical

care or to conduct independent medical examinations under this chapter,

or if the person seeking such treatment, or submitting to an independent

medical examination, has been transferred from his or her care in

accordance with the provisions of this chapter. This agreement shall run

to the benefit of the injured person so treated or examined, and shall

be available to him or her as a defense in any action by such provider

for payment for treatment rendered by a provider after he or she has

been removed from the list of providers authorized to render medical

care or to conduct independent medical examinations under this chapter,

or after the injured person was transferred from his or her care in

accordance with the provisions of this chapter.

4. Laboratories and bureaus engaged in x-ray diagnosis or treatment or

in physiotherapy or other therapeutic procedures and which participate

in the diagnosis or treatment of injured workers under this chapter

shall be operated or supervised by providers authorized under this

chapter and shall be subject to the provisions of section thirteen-c of

this article. The person in charge of diagnostic clinical laboratories

duly authorized under this chapter shall possess the qualifications

established by the public health and health planning council for

approval by the state commissioner of health or, in the city of New

York, the qualifications approved by the board of health of said city

and shall maintain the standards of work required for such approval.

* NB Effective until January 1, 2028

* § 13-b. Authorization of providers, medical bureaus and laboratories

by the chair. 1. Any provider as defined in paragraph (m) of this

subdivision shall be authorized to render medical care or treatment

under this chapter. Independent medical examinations may only be

performed by a physician, podiatrist, chiropractor, or psychologist

authorized to perform such examinations by the chair, or as specified in

regulations. No provider may conduct independent medical examinations

unless performed in accordance with paragraph (b) of subdivision four of

section thirteen-a and section one hundred thirty-seven of this chapter.

As used in this chapter, the following definitions shall have the

following meanings unless their context requires otherwise:

(a) "Acupuncturist" shall mean licensed as having completed a formal

course of study and having passed an examination in accordance with the

education law, the regulations of the commissioner of education, and the

requirements of the board of regents. Acupuncturists are required by the

education law to advise, in writing, each patient of the importance of

consulting with a physician for the condition or conditions

necessitating acupuncture care, as prescribed by the education law.

(b) "Chair" of the board shall mean either the chair or the chair's

designee.

(c) "Chiropractor" shall mean licensed and having completed two years

of preprofessional college study and a four-year resident program in

chiropractic in accordance with the education law, and consistent with

the licensing requirements of the commissioner of education.

(d) "Dentist" shall mean licensed and having completed a four-year

course of study leading to a D.D.S. or D.D.M. degree, or an equivalent

degree, in accordance with the education law and the licensing

requirements of the commissioner of education.

(e) "Employer" shall mean a self-insured employer or, if insured, the

insurance carrier.

(f) "Independent medical examination" shall mean an examination

performed by a physician, podiatrist, chiropractor or psychologist,

authorized under this section to perform such examination, for the

purpose of examining or evaluating injury or illness in accordance with

paragraph (b) of subdivision four of section thirteen-a and section one

hundred thirty-seven of this chapter and as more fully set forth in

regulation.

(g) "Nurse practitioner" shall mean a licensed registered professional

nurse certified pursuant to section sixty-nine hundred ten of the

education law acting within their lawful scope of practice.

(h) "Occupational therapist" shall mean licensed as having at least a

bachelor's or master's degree in occupational therapy from a registered

program with the education department or receipt of a diploma or degree

resulting from completion of not less than four years of postsecondary

study, which includes the professional study of occupational therapy in

accordance with the education law and the regulations of the

commissioner of education.

(i) "Physical therapist" shall mean licensed in accordance with the

education law and the licensing requirements of the commissioner of

education.

(j) "Physician" shall mean licensed with a degree of doctor of

medicine, M.D., or doctor of osteopathic medicine, D.O., or an

equivalent degree in accordance with the education law and the licensing

requirements of the state board of medicine and the regulations of the

commissioner of education.

(k) "Physician assistant" shall mean a licensed provider who is

licensed as a physician assistant pursuant to section sixty-five hundred

forty-one of the education law.

(l) "Podiatrist" shall mean a doctor of podiatric medicine licensed as

having received a doctoral degree in podiatric medicine in accordance

with the regulations of the commissioner of education and the education

law, and must satisfactorily meet all other requirements of the state

board for podiatric medicine.

(m) "Authorized provider" or "provider" shall mean a duly licensed

acupuncturist, chiropractor, nurse practitioner, occupational therapist,

physical therapist, physician, physician assistant, podiatrist,

psychologist, or social worker as defined in this section who is not

currently on the exclusion list pursuant to section thirteen-d of this

article.

(n) "Psychologist" shall mean licensed as having received a doctoral

degree in psychology from a program of psychology registered with the

state education department or the substantial equivalent thereof in

accordance with the education law, the requirements of the state board

for psychology, and the regulations of the commissioner of education.

(o) "Social worker" shall mean a licensed clinical social worker. A

licensed clinical social worker has completed a master's degree of

social work that includes completion of a core curriculum of at least

twelve credit hours of clinical courses or the equivalent post-graduate

clinical coursework, in accordance with the education law and the

regulations of the commissioner of education.

(p) "Physical therapist assistant" shall mean licensed in accordance

with the education law and the licensing requirements of the

commissioner of education.

(q) "Occupational therapy assistant" shall mean licensed in accordance

with the education law and the licensing requirements of the

commissioner of education.

(r) "Exclusion list" shall mean the list published and maintained by

the chair in accordance with section thirteen-d of this article listing

providers who are currently disqualified from rendering care or from

performing independent medical examinations under this chapter.

2. Any provider rendering medical care or treatment under this chapter

must comply with all applicable laws, regulations and guidance,

including any applicable New York Medical Treatment Guidelines and the

Official New York Medical Fee Schedule(s).

(a) Such provider as identified in this subdivision who is on staff at

any hospital or urgent care center providing emergency treatment may

continue such medical care or treatment under this chapter while an

injured employee remains a patient in such hospital or urgent care

setting.

(b) Under the direct supervision of an authorized provider, medical

care may be rendered by a registered nurse or other person trained in

laboratory or diagnostic techniques within the scope of such person's

specialized training and qualifications. This supervision shall be

evidenced by signed records of instructions for treatment and signed

records of the patient's condition and progress. Reports of such

treatment and supervision shall be made by such provider to the chair in

the format prescribed by the chair at such times as the chair may

require.

(b-1) Under the direction and supervision of an authorized

occupational therapist, occupational therapy services may be rendered by

an occupational therapy assistant. Under the direction and supervision

of an authorized physical therapist, physical therapy services may be

rendered by a physical therapist assistant. Where any such care or

treatment is rendered, records of the patient's condition and progress,

together with records of instruction for treatment, if any, shall be

maintained by the physical therapist or occupational therapist and by

the referring physician, physician assistant, podiatrist, or nurse

practitioner. Said records shall be submitted to the chair on forms and

at such times as the chair may require.

(b-2) Under the supervision of any authorized provider, any resident

or fellow who may practice medicine as an exempt person as provided for

in title eight of the education law, may render medical care or

treatment under this chapter so long as the supervisory requirements of

the education law are met and neither the supervising provider nor

resident or fellow have been prohibited from treating workers'

compensation claimants pursuant to section thirteen-d of this article.

(c) Where it would place an unreasonable burden upon the employer or

carrier to arrange for, or for the claimant to attend, an independent

medical examination by a provider authorized to perform independent

medical examinations in accordance with paragraph (b) of subdivision

four of section thirteen-a of this article and section one hundred

thirty-seven of this chapter, the employer or carrier shall arrange for

such examination to be performed by a qualified provider in a medical

facility convenient to the claimant.

(d) Upon the prescription or referral of a physician, physician

assistant, podiatrist, or nurse practitioner who is not currently on the

exclusion list pursuant to section thirteen-d of this article acting

within the scope of their practice, medical care or treatment may be

rendered to an injured employee by a physical therapist, occupational

therapist or acupuncturist who is not currently on the exclusion list

pursuant to section thirteen-d of this article provided the conditions

and the treatment performed are among the conditions that the physical

therapist, occupational therapist or acupuncturist is authorized to

treat pursuant to the education law or the regulations of the

commissioner of education. Where any such medical care or treatment is

rendered, records of the patient's condition and progress, together with

records of instruction for treatment, if any, shall be maintained by the

physical therapist, occupational therapist or acupuncturist rendering

treatment and by the referring physician, physician assistant,

podiatrist, or nurse practitioner. Said records shall be submitted to

the chair on forms and at such times as the chair may require.

(e) A record, report or opinion of a physical therapist, occupational

therapist, acupuncturist or physician assistant shall not be considered

as evidence of the causal relationship of any condition to a work

related accident or occupational disease under this chapter. Nor may a

record, report or opinion of a physical therapist, occupational

therapist or acupuncturist be considered evidence of disability. Nor may

a record, report or opinion of a physician assistant be considered

evidence of the presence of a permanent or initial disability or the

degree thereof.

(f) An independent medical examination performed in accordance with

section one hundred thirty-seven of this chapter, may only be performed

by a physician, podiatrist, chiropractor or psychologist authorized to

perform such examinations by the chair, or as specified in regulation,

when qualified by the board.

3. In order to perform independent medical examinations in accordance

with paragraph (b) of subdivision four of section thirteen-a and section

one hundred thirty-seven of this chapter, a physician, podiatrist,

chiropractor, or psychologist properly licensed or certified pursuant to

the regulations of the commissioner of education and the requirements of

the education law shall file an application for authorization under this

chapter with the chair or chair's designee in the format prescribed by

the chair.

4. Laboratories and bureaus engaged in x-ray diagnosis or treatment or

in physiotherapy or other therapeutic procedures and which participate

in the diagnosis or treatment of injured workers under this chapter

shall be operated or supervised by providers authorized under this

chapter and shall be subject to the provisions of section thirteen-c of

this article. The person in charge of diagnostic clinical laboratories

duly authorized under this chapter shall possess the qualifications

established by the public health and health planning council for

approval by the state commissioner of health or, in the city of New

York, the qualifications approved by the board of health of said city

and shall maintain the standards of work required for such approval.

* NB Effective January 1, 2028