New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 325 - Medical And Surgical Care And Treatment › Subpart 325-7 - Diagnostic Testing Networks › Section 325-7.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Subpart, the following terms shall
						have the following meanings:
(a)
					 Affiliated network provider means a board authorized health care provider or a
					 medical facility affiliated with a diagnostic testing network that performs
					 diagnostic examinations and tests.
(b) Board means the Workers' Compensation
					 Board, except that as provided in the Workers' Compensation Law, the decision
					 of the board in particular cases may be by a member or panel of the board or by
					 a Workers' Compensation Law judge.
(c) Chair means the chair of the Workers'
					 Compensation Board.
(d) Claimant
					 means a worker injured or ill due to a work-related accident and/or
					 occupational disease covered by the Workers' Compensation Law and over which
					 the board has jurisdiction.
(e)
					 Diagnostic examinations and tests shall include for this section diagnostic
					 tests, as defined in subdivision (g) of this section, x-ray examinations,
					 magnetic resonance imaging, and/or other radiological examinations or tests, as
					 defined in subdivision (m) of this section, but shall not include x-ray
					 examinations when such x-rays are medically necessary, and an integral and
					 routine part of the office visit for the diagnosis and treatment of fractures,
					 possible fractures, joint dislocations, tumors, infections, loosening of
					 surgical implants, dislocation of prosthetic joints, spinal instability, or
					 follow-up to surgical procedures.
(f) Diagnostic testing network and diagnostic
					 network mean an entity, including but not limited to, an independent practice
					 association duly organized in compliance with all applicable laws and
					 regulations, professional corporation, professional limited liability
					 corporation, limited liability partnership, or professional partnership that
					 contracts with insurance carriers, to arrange for the performance of diagnostic
					 examinations and tests, pursuant to Workers' Compensation Law section 13-a(7),
					 by contracting with affiliated network providers.
(g) Diagnostic tests means the use of
					 physical, scientific and/or clinical methods to establish the cause and nature
					 of a claimant's illness or injury as well as the potential subsequent
					 functional impairment caused by the pathology, including electromyography (EMG)
					 and nerve conduction studies (NCS). Diagnostic tests can also be used to
					 eliminate other possible diagnoses. Diagnostic test results form the basis for
					 claimant care. Diagnostic tests include tests customarily performed as an
					 outpatient procedure and involve recording techniques performed by a set
					 protocol that produces results that can later be interpreted by one or more
					 trained licensed and authorized professionals.
(h) Independent practice association or IPA
					 means, for purposes of this section and Workers' Compensation Law section
					 13-a(7), a corporation, limited liability company, or professional services
					 limited liability company, duly organized in compliance with all applicable
					 laws and regulations, which, as specified and permitted by its certificate of
					 incorporation or articles of organization, contracts directly with providers of
					 diagnostic examinations and tests, in order that it may then contract with one
					 or more insurance carrier to make the services of such providers available to
					 claimants.
(i) Insurance carrier
					 means the State Insurance Fund, stock corporations, mutual corporations or
					 reciprocal insurers with which employers are insured to provide workers'
					 compensation coverage, employers permitted to pay compensation directly under
					 the provisions of Workers' Compensation Law section 50(3), (3-a) or (4), and
					 any special fund maintained by the board that is responsible for paying for
					 medical treatment and care of injured workers, including but not limited to,
					 the special fund for reopened cases created and governed by Workers'
					 Compensation Law section 25-a and the Uninsured Employers' Fund created and
					 governed by Workers' Compensation Law section 26-a. Insurance carrier shall
					 also mean for purposes of this Subpart third party administrators responsible
					 for all or part of the claims handling, pursuant to a contract, for the claims
					 of the State Insurance Fund, stock corporations, mutual corporations or
					 reciprocal insurers with which employers are insured to provide workers'
					 compensation coverage, employers permitted to pay compensation directly under
					 the provisions of Workers' Compensation Law section 50(3), (3-a) or (4), and
					 any special fund maintained by the board that is responsible for paying for
					 medical treatment and care of injured workers. Insurance carrier shall also
					 mean for purposes of this Subpart a preferred provider organization or PPO
					 licensed pursuant to Workers' Compensation Law section 353 as a plan that is
					 owned, operated, or administered by an entity that provides for the delivery of
					 all services required by the Workers' Compensation Law to all claimants covered
					 by such plan.
(j) Legally and
					 properly organized means an entity which is organized in accordance with all
					 applicable State laws and regulations, and may include:
(1) a professional corporation (PC),
					 professional limited liability company (PLLC), limited liability partnership
					 (LLP), or professional partnership by a New York licensed physician or
					 physicians; or
(2) an independent
					 practice association that meets the requirements of section
					 325-7.3(k) 
					 of this Subpart.