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Pending emergency adoption for Prior Authorization Requests (PAR)

March 25, 2021 · Public Policy & Regulatory Affairs Team

The New York Workers’ Compensation Board (WCB) issued a notice and pending emergency rules alerting payers of how to properly report their Prior Authorization Request (PAR) point of contact(s). 

Payers such as insurance carriers, self-insured employers and TPAs will be required to designate and provide their PAR reviewing entity/individual to the WCB. This information will ensure that, when using New York’s OnBoard system, both the provider requesting PAR and the WCB will have access to the proper review entity/individual for the various PAR processes. 

PAR processes can vary across medical services – from Medical Treatment Guidelines (MTG) deviations to Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) to drug formulary requests. 

To make certain self-ensured employers comply with the requirement to provide contact information for the point(s) of contact for a PAR “in a manner prescribed by the Chair,” the Board signaled that it plans to propose and adopt – on an emergency basis – a regulation requiring this contact information be designated on or before May 1, 2021. The emergency rule will be published soon in the State Register and a Subject Number will be issued.

The new PAR requirements take effect June 7, 2021 for all medical services and products.

Payers should:

  • Begin processes to comply with this deadline
  • Ensure they secure their designated review entity/individual to handle PAR requests 
  • Once secured, provide this information to the WCB, more than likely via the OnBoard system 

OnBoard rollout events

As the WCB moves forward with the initial phase of their OnBoard roll-out/Limited Release, they have issued several permanent and emergency rules to support OnBoard development.

In the first half of March 2021, the WCB released rules related to the (DMEPOS) fee schedule, PARs for medical services, Medical Treatment Guideline (MTG) variances and updates to the Drug Formulary.

Additionally, it appears the WCB is looking to roll-out the OnBoard Limited Release requirements on or around the June 7, 29021 timeframe.

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