NY governor vetoes bill to increase comp preapproval threshold

New York Gov. Kathy Hochul vetoed a bill that would have increased the threshold for determining whether medical procedures need prior approval.

S.B. 6929 would have raised the preauthorization limit for treatment that can be provided without prior approval to $1,500 from $1,000. The bill also would have clarified that procedures can’t be summarily denied because they’re not in the medical treatment guidelines.

“Based on industry data, at this time, only treatments within the (medical treatment guidelines) are receiving authorization, which others consistently get denied as not medically necessary despite the authorization request having come from a medical provider,” the justification for the bill states. “This has led to a drastic decrease in doctors willing to participate in the workers compensation system — providers often will not perform a preauthorized procedure without receiving authorization for fear that the carrier will still deny the bills.”

The bill would also have required that diagnostic tests costing more than $1,500 and performed by a provider who is not part of a payer’s network shall be paid at the negotiated network rate.

The Senate voted 58-1 to pass the bill June 5, and the Assembly voted 136-5 to pass it June 8.

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