S1405-2011 Actions

• Jan 4, 2012: REFERRED TO LABOR
• Jan 7, 2011: REFERRED TO LABOR

S1405-2011 Memo

BILL NUMBER:S1405

TITLE OF BILL:
An act
to amend the workers' compensation law, in relation to chiropractic care

PURPOSE OR GENERAL IDEA OF BILL:
This bill would end years of the most blatant discriminatory
regulation against the consumers of chiropractic. Doctors of
chiropractor have been paid one flat fee for all treatment services
rendered to an injured worker for 31 years while all other providers
including non-doctor providers are paid for virtually every service
they perform. Doctors of Chiropractic are mandated by statute to
provide the same level of care to an injured worker as that of a
private patient but are not reimbursed for the services. Doctors of
Chiropractic are given only a flat "limited office visit" fee. No
other state has a separate and distinct Workers' Compensation fee
schedule/for Doctors of Chiropractic. Doctors of Chiropractic are not
even reimbursed for a main staple of their practice, spinal
adjustments. (AKA spinal manipulation). This policy forces health
care consumers to consult additional providers for these services.
This legislation would recognize that chiropractors provide a variety
of services and to clarify that the workers' compensation system must
pay for the individual modalities employed by chiropractors in
rendering primary health care services to injured workers.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1 amends the Workers' Compensation Law to provide that the
Workers' Compensation Board must reimburse chiropractors for
individual services and modalities lawfully rendered by chiropractors
in treatment of an injured worker. Section 2 sets forth the effective
date of this amendment.

JUSTIFICATION:
In rendering care, chiropractors, like all other primary care
practitioners, engage in a number of individual diagnostic and
treatment services and modalities. Most other primary care providers
are compensated by the Workers' Compensation System for each discrete
service rendered in diagnosing and treating injured workers. For
example, both the medical and physical therapy fee schedule under
Workers' Compensation is a number of pages long, listing and
compensating the full range of individual medical services employed
in caring for injured workers. Although Workers' Compensation
ostensibly recognize the panoply of chiropractic services, the fee
schedule confines payment to office visits. However, there is no
recognition that a variety of individual chiropractic modalities are
routinely employed in accurately diagnosing and treating injured
workers. This bill recognizes the full scope of chiropractic services
and directs the Board to pay for individual diagnostic and treatment
services and modalities rendered.

PRIOR LEGISLATIVE HISTORY:
2005-2010 - Died in Labor Committee.

FISCAL IMPLICATIONS:
None.


EFFECTIVE DATE:
January 1, 2012

S1405-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                         1405
 2011-2012 Regular Sessions
 I N  SENATE
 January 7, 2011
 
 Introduced  by  Sen.  SAVINO -- read twice and ordered printed, and when
 printed to be committed to the Committee on Labor
 

AN ACT to amend the workers' compensation law, in relation to chiroprac
 tic care
 THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section  1. Legislative intent. The legislature recognizes that multi
 ple health professionals are trained and licensed to diagnose and  treat
 the same or similar conditions through the use of modalities, therapies,
 treatments,  services  and  philosophies  that  vary  from profession to
 profession. It is the specific intent of this legislature to assure that
 workers' compensation policies, plans and contracts that provide  cover
 age for the diagnosis and treatment of conditions, complaints, ailments,
 disorders  or injuries, that may be diagnosed and treated by a doctor of
 chiropractic, must provide equivalent access, coverage and fees for  the
 diagnosis and treatment of those conditions, complaints or injuries by a
 duly licensed doctor of chiropractic, within the lawful scope of chirop
 ractic  practice  even  if  different terminology, philosophy, services,
 treatments or modalities are used by the various health professions; and
 such equivalent coverage shall not be abridged by any regulation.
 

S 2. Subdivision 2 of section 13-l of the workers'  compensation  law,
 as  amended  by  chapter  473 of the laws of 2000, is amended to read as
 follows:

 2. (A) An employee injured under circumstances which make such  injury
 compensable  under  this  article,  when  care is required for an injury
 which consists solely of a condition which may lawfully be treated by  a
 chiropractor  as  defined in section sixty-five hundred fifty-one of the
 education law may select to treat him or her, any  duly  registered  and
 licensed  chiropractor of the state of New York, authorized by the chair
 to render chiropractic care as hereinafter provided. If  the  injury  or
 condition is one which is outside the limits prescribed by the education
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD05693-01-1
 
       S. 1405                             2
 law  for  chiropractic care and treatment, the said chiropractor must so
 advise the said injured employee and instruct him or her  to  consult  a
 physician  of said employee's choice for appropriate care and treatment.
 Such  physician  shall  thenceforth have supervision of the treatment of
 said condition including the future treatment to be administered to  the
 patient  by  the chiropractor. A chiropractor licensed and registered to
 practice chiropractic in the state of New York, who is desirous of being
 authorized to render chiropractic care  under  this  section  and/or  to
 conduct  independent  medical  examinations in accordance with paragraph
 (b) of subdivision three of this section shall file an  application  for
 authorization  under this section with the chiropractic practice commit
 tee. In such application he or she shall agree to  refrain  from  subse
 quently  treating  for  remuneration,  as  a private patient, any person
 seeking chiropractic treatment, or submitting to an independent  medical
 examination, in connection with, or as a result of, any injury compensa
 ble  under  this chapter, if he or she has been removed from the list of
 chiropractors authorized to render chiropractic care or to conduct inde
 pendent medical examinations under this chapter, or if the person  seek
 ing  such treatment has been transferred from his or her care in accord
 ance with the provisions of this section. This agreement  shall  run  to
 the  benefit of the injured person so treated, or examined, and shall be
 available to him or her as a defense in any action by such  chiropractor
 for  payment rendered by a chiropractor after he or she has been removed
 from the list of chiropractors authorized to render chiropractic care or
 to conduct independent medical examinations under this section, or after
 the injured person was transferred from his or her  care  in  accordance
 with the provisions of this section. The chiropractic practice committee
 if it deems such licensed chiropractor duly qualified shall recommend to
 the  chair that such be authorized to render chiropractic care and/or to
 conduct independent medical examinations under this section. Such recom
 mendations shall be advisory to the chair only and shall not be  binding
 or  conclusive  upon him or her. The chair shall prepare and establish a
 schedule for the state, or schedules limited to  defined  localities  of
 charges  and  fees for chiropractic treatment and care, to be determined
 in accordance with and to be subject to change pursuant to rules promul
 gated by the chair.  THE CHIROPRACTIC FEE SCHEDULE PREPARED  AND  ESTAB
 LISHED  BY THE CHAIR SHALL PROVIDE FOR THE PAYMENT OF REMUNERATION WHICH
 IS EQUIVALENT TO THAT APPLICABLE TO CARE OR TREATMENT PROVIDED BY PHYSI
 CIANS IN THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF THE SAME OR  SIMILAR
 CONDITIONS, INJURIES, COMPLAINTS, DISORDERS OR AILMENTS, EVEN IF DIFFER
 ING NOMENCLATURE IS USED TO DESCRIBE THE CONDITION, INJURY, TREATMENT OR
 SERVICE.  Before  preparing such schedule for the state or schedules for
 limited localities the chair shall  request  the  chiropractic  practice
 committee to submit to him or her a report on the amount of remuneration
 deemed  by  such  committee  to  be  fair  and adequate for the types of
 chiropractic care to be rendered under this chapter,  but  consideration
 shall  be  given  to  the  view of other interested parties, the amounts
 payable by the employer for such treatment and  services  shall  be  the
 fees  and  charges  established by such schedule.  CHIROPRACTIC CARE AND
 TREATMENT MAY BE SUBJECT TO REASONABLE UTILIZATION REVIEW, PROVIDED THAT
 ANY SUCH REVIEW: (I) SHALL NOT DISCRIMINATE AGAINST  CHIROPRACTIC  CARE,
 AND  (II)  SHALL  BE NO MORE RESTRICTIVE THAN THAT APPLICABLE TO CARE OR
 TREATMENT PROVIDED BY PHYSICIANS IN THE DIAGNOSIS, TREATMENT AND MANAGE
 MENT OF THE SAME OR SIMILAR CONDITIONS, INJURIES, COMPLAINTS,  DISORDERS
 OR  AILMENTS,  EVEN  IF  DIFFERING  NOMENCLATURE IS USED TO DESCRIBE THE
 CONDITION, INJURY, TREATMENT OR SERVICE.  NOTHING  IN  THIS  SUBDIVISION
 
       S. 1405                             3
 SHALL  BE  CONSTRUED  AS  IMPEDING OR PREVENTING EITHER THE PROVISION OR
 COVERAGE OF CHIROPRACTIC CARE AND TREATMENT BY DULY LICENSED DOCTORS  OF
 CHIROPRACTIC,  WITHIN  THE  LAWFUL  SCOPE  OF  CHIROPRACTIC PRACTICE, IN
 HOSPITAL FACILITIES ON STAFF OR EMPLOYEE BASIS.
 (B)  EVERY  POLICY WHICH INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A
 PHYSICIAN'S OFFICE, OTHER THAN  A  POLICY  THAT  PROVIDES  MANAGED  CARE
 COVERAGE,  SHALL  PROVIDE  COVERAGE FOR CARE PROVIDED IN THE PRACTICE OF
 CHIROPRACTIC, AS DEFINED IN SECTION SIXTY-FIVE HUNDRED FIFTY-ONE OF  THE
 EDUCATION LAW, PROVIDED BY A DOCTOR OF CHIROPRACTIC LICENSED PURSUANT TO
 ARTICLE  ONE HUNDRED THIRTY-TWO OF THE EDUCATION LAW, IN CONNECTION WITH
 THE DETECTION OR CORRECTION BY MANUAL OR MECHANICAL MEANS OF  STRUCTURAL
 IMBALANCE,  DISTORTION  OR SUBLUXATION IN THE HUMAN BODY FOR THE PURPOSE
 OF REMOVING NERVE INTERFERENCE, AND  THE  EFFECTS  THEREOF,  WHERE  SUCH
 INTERFERENCE  IS THE RESULT OF OR RELATED TO DISTORTION, MISALIGNMENT OR
 SUBLUXATION OF  OR  IN  THE  VERTEBRAL  COLUMN.  CHIROPRACTIC  CARE  AND
 SERVICES  MAY  BE  SUBJECT  TO  REASONABLE  FEE SCHEDULES AND REASONABLE
 UTILIZATION REVIEW, PROVIDED THAT ANY SUCH  SCHEDULES  AND  REVIEW:  (I)
 SHALL  NOT DISCRIMINATE AGAINST CHIROPRACTIC CARE, AND (II) INDIVIDUALLY
 AND COLLECTIVELY SHALL BE NO  MORE  RESTRICTIVE  THAN  THOSE  APPLICABLE
 UNDER  THE SAME POLICY TO CARE OR SERVICES PROVIDED BY PHYSICIANS IN THE
 DIAGNOSIS, TREATMENT AND MANAGEMENT OF THE SAME OR  SIMILAR  CONDITIONS,
 INJURIES, COMPLAINTS, DISORDERS OR AILMENTS, EVEN IF DIFFERING NOMENCLA
 TURE  IS USED TO DESCRIBE THE CONDITION, INJURY, COMPLAINT, TREATMENT OR
 SERVICE. NOTHING IN THIS SUBDIVISION SHALL BE CONSTRUED AS  IMPEDING  OR
 PREVENTING  EITHER  THE  PROVISION  OR COVERAGE OF CHIROPRACTIC CARE AND
 SERVICES BY DULY LICENSED DOCTORS OF  CHIROPRACTIC,  WITHIN  THE  LAWFUL
 SCOPE  OF  CHIROPRACTIC  PRACTICE,  IN HOSPITAL FACILITIES ON A STAFF OR
 EMPLOYEE BASIS.
 (C) THE COVERAGE REQUIRED BY THIS SUBDIVISION SHALL NOT BE ABRIDGED BY
 ANY REGULATION PROMULGATED BY THE CHAIR, THE BOARD OR THE SUPERINTENDENT
 OF INSURANCE.
 

S 3. The workers' compensation law is amended by adding a new  section
 356 to read as follows:

 

S  356.  PREFERRED PROVIDER ORGANIZATIONS; CHIROPRACTIC TREATMENT.  1.
 EACH PREFERRED PROVIDER ORGANIZATION SHALL PROVIDE COVERAGE FOR CARE AND
 TREATMENT PROVIDED IN THE COURSE OF THE  PRACTICE  OF  CHIROPRACTIC,  AS
 DEFINED  IN  SECTION  SIXTY-FIVE HUNDRED FIFTY-ONE OF THE EDUCATION LAW,
 PROVIDED BY A DOCTOR OF CHIROPRACTIC LICENSED PURSUANT  TO  ARTICLE  ONE
 HUNDRED  THIRTY-TWO  OF  THE  EDUCATION  LAW,  IN  CONNECTION  WITH  THE
 DETECTION OR CORRECTION BY MANUAL  OR  MECHANICAL  MEANS  OF  STRUCTURAL
 IMBALANCE,  DISTORTION  OR SUBLUXATION IN THE HUMAN BODY FOR THE PURPOSE
 OF REMOVING NERVE INTERFERENCE, AND  THE  EFFECTS  THEREOF,  WHERE  SUCH
 INTERFERENCE  IS THE RESULT OF OR RELATED TO DISTORTION, MISALIGNMENT OR
 SUBLUXATION OF OR IN THE VERTEBRAL COLUMN. CHIROPRACTIC CARE AND  TREAT
 MENT MAY BE SUBJECT TO REASONABLE FEE SCHEDULES, AND REASONABLE UTILIZA
 TION  REVIEW, PROVIDED THAT ANY SUCH SCHEDULES AND REVIEW: (A) SHALL NOT
 DISCRIMINATE AGAINST CHIROPRACTIC CARE; AND (B) INDIVIDUALLY AND COLLEC
 TIVELY SHALL BE NO MORE RESTRICTIVE THAN  THOSE  APPLICABLE  WITHIN  THE
 PREFERRED  PROVIDER ORGANIZATION TO CARE OR TREATMENT PROVIDED BY PHYSI
 CIANS IN THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF THE SAME OR  SIMILAR
 CONDITIONS,  INJURIES  OR  COMPLAINTS, EVEN IF DIFFERING NOMENCLATURE IS
 USED TO DESCRIBE THE CONDITION, INJURY, COMPLAINT, TREATMENT OR SERVICE.
 NOTHING IN THIS SECTION SHALL BE CONSTRUED  AS  IMPEDING  OR  PREVENTING
 EITHER  THE  PROVISION OR COVERAGE OF CHIROPRACTIC CARE AND TREATMENT BY
 DULY LICENSED DOCTORS  OF  CHIROPRACTIC,  WITHIN  THE  LAWFUL  SCOPE  OF
 
       S. 1405                             4
 CHIROPRACTIC  PRACTICE,  IN  HOSPITAL  FACILITIES ON A STAFF OR EMPLOYEE
 BASIS.
 2.  EACH  PREFERRED  PROVIDER  ORGANIZATION SHALL INCLUDE A SUFFICIENT
 NUMBER OF CHIROPRACTORS WITHIN EACH GEOGRAPHIC AREA TO ASSURE ACCESS  TO
 CHIROPRACTIC TREATMENT THAT IS EQUAL TO THAT AVAILABLE TO MEDICAL TREAT
 MENT WITHIN THE SAME PREFERRED PROVIDER ORGANIZATION.
 3.  AN  EMPLOYEE  MAY  SEEK  CHIROPRACTIC  TREATMENT  FROM OUTSIDE THE
 PREFERRED PROVIDER ORGANIZATION THIRTY DAYS AFTER HIS OR HER VISIT TO  A
 PREFERRED PROVIDER ORGANIZATION PROVIDER. IN THE EVENT THAT SUCH EMPLOY
 EE SEEKS CHIROPRACTIC TREATMENT OUTSIDE THE PREFERRED PROVIDER ORGANIZA
 TION,  THE  EMPLOYER MAY REQUIRE A SECOND OPINION FROM A PROVIDER WITHIN
 THE PREFERRED PROVIDER ORGANIZATION.
 4. AN EMPLOYEE MAY SEEK A SECOND OPINION WITH RESPECT TO SUCH  CHIROP
 RACTIC  TREATMENT  FROM  ANOTHER  PROVIDER WITHIN THE PREFERRED PROVIDER
 ORGANIZATION AT ANY TIME.
 5. THE COVERAGE REQUIRED BY THIS SECTION SHALL NOT BE ABRIDGED BY  ANY
 REGULATION PROMULGATED BY THE CHAIR OR THE BOARD.
 

S  4.  This  act  shall take effect January 1, 2012 and shall apply to
 policies and contracts issued, renewed, modified, altered or amended  on
 or after such effective date.

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