Date: April 3, 2012
On February 28, 2012, at the Workers' Compensation Board monthly meeting, the Board adopted new regulations governing the procedures for use of diagnostic testing networks (12 NYCRR 325-7). The regulations supplement Workers' Compensation Law (WCL) §13-a (7) and represent the completion of the workers' compensation reform that began with significant statutory changes in 2007. The adoption of the regulations was published and took effect March 21, 2012.
When workers' compensation carriers and self-insured employers contract with legally and properly organized diagnostic testing networks, claimants are required to obtain diagnostic examinations and tests from providers affiliated with the designated diagnostic testing network. The use of diagnostic testing networks represents an important cost savings component of the 2007 reform efforts. The adopted regulations create procedures to ensure that workers' compensation claimants continue to receive prompt, appropriate and effective medical care.
Several key aspects of the regulation and its implementation are discussed below.
The carrier or employer must provide advance notice to the claimant and treating provider to require use of a diagnostic testing network. The carrier or employer must use Board Form DT-1 or a substantially equivalent form that contains all the elements required by 12 NYCRR 325-7.5(d). The notice does not require a signature and should not be routinely filed with the Board unless notice is disputed. If mailed, receipt of notice is presumed to be five days from date of mailing.
The claimant must receive notice:
Each treating medical provider must receive notice that patients covered by a particular carrier or self-insured employer are required to use a diagnostic testing network. This notice is provided:
In addition, when authorizing a diagnostic test costing more than $1,000 under WCL §13-a(5), a carrier or employer shall notify the requesting physician that the claimant is required to use a diagnostic testing network.
EFFECTIVE DATE OF NOTICE REQUIREMENT: Carriers and self-insured employers that currently mandate use of a diagnostic testing network shall have twenty  days from the date of this Subject Number to notify treating medical providers if using the one-time mailing method.
The carrier or employer must supply the treating medical provider with contact information for the diagnostic testing network and a list or web address for obtaining a list of affiliated network providers. The carrier or employer must also provide details on how to schedule necessary testing.
Exceptions: A claimant does not need to use a diagnostic testing network when:
The regulations require diagnostic testing networks, as well as the self-insured employers and carriers that use them, to file certain information with the Board. Required filings should be submitted electronically to DTNfiling@wcb.ny.gov. Updates to the required filings must be made within 20 days of any change. The Board will request an annual update of ownership information for all diagnostic testing networks via email in February of each year.
The Board is considering developing an application on its website (www.wcb.ny.gov) to allow claimants, physicians, and others to determine whether a particular insurance company or employer requires use of a diagnostic testing network and to obtain necessary information about the network. The Board is in the planning stages and is seeking input from stakeholders on the features of such a look-up application. A survey is available at http://www.surveymonkey.com/s/DTN_PBM_Survey and should be completed by April 20, 2012. If it is determined that a Medical Network Look-up application would be useful, the Board hopes to have it available by late 2012.
Robert E. Beloten