Site Navigation

WCB Home Page
Change Font Size
Glossary of WCB Terms
New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
20 Park Street   Albany, New York 12207
Governor Eliot Spitzer


Subject No. 046-203

Changes to Preferred Provider Organization Requirements

Date: September 13, 2007

Workers' Compensation Law Article 10-A authorizes the creation and use of Preferred Provider Organizations (PPOs) to provide medical benefits to workers' compensation claimants. A PPO is an organization which is owned, operated or administered by an entity, licensed pursuant to Workers' Compensation Law §353, to provide for the delivery of all medical services to workers' compensation claimants covered by the plan.

Effective March 13, 2007, the minimum number of available providers in each medical specialty and the minimum number of available hospitals required within a licensed PPO has been reduced. Section 32 of Chapter 6 of the Laws of 2007 amended Workers' Compensation Law § 354 (1) to reduce the minimum number of medical providers from which a claimant may choose from five to two. The minimum number of hospitals from which a claimant may choose has been reduced from three to two. Further, in the event a PPO cannot meet these requirements, the authority to grant a waiver has been transferred from the Chair of the Workers' Compensation Board to the Commissioner of Health.

Additionally, effective March 13, 2007, the State Insurance Fund will now be permitted to utilize PPOs. Section 45 of Chapter 6 of the Laws of 2007, amended Workers' Compensation Law § 351 to allow the State Insurance Fund to contract with a PPO to deliver all medical services required by the Workers' Compensation Law.

If you have any questions regarding this change, please contact Mark Arunasalam at the Bureau of Health Management (800)-781-2362 or mark.arunasalam@wcb.ny.gov.

 

Donna Ferrara
Chair