A5361-2011 Actions

• Jul 11, 2011: enacting clause stricken
• Jun 6, 2011: reported referred to rules
• May 19, 2011: print number 5361a
• May 19, 2011: amend and recommit to labor
• Feb 16, 2011: referred to labor

A5361-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 
                                         5361
 2011-2012 Regular Sessions
 I N  ASSEMBLY
 February 16, 2011
 
 Introduced  by  M. of A. HOYT -- read once and referred to the Committee
 on Labor
 

AN ACT to amend the workers' compensation law, in relation to  authoriz
 ing certain care and treatment to injured employees
 

THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section 1. Subdivision (a) of section 13 of the workers'  compensation
 law,  as amended by chapter 6 of the laws of 2007, is amended to read as
 follows:

 (a) The employer shall promptly provide for an injured  employee  such
 medical,  dental, surgical, optometric or other attendance or treatment,
 nurse and hospital service,  medicine,  optometric  services,  crutches,
 eye-glasses,   false   teeth,  artificial  eyes,  orthotics,  prosthetic
 devices, functional assistive and adaptive  devices  and  apparatus  for
 such  period  as the nature of the injury or the process of recovery may
 require. The employer shall be liable for the payment of the expenses of
 medical, dental, surgical, optometric or other attendance or  treatment,
 nurse  and  hospital  service,  medicine, optometric services, crutches,
 eye-glasses,  false  teeth,  artificial  eyes,   orthotics,   prosthetic
 devices,  functional  assistive  and  adaptive devices and apparatus, as
 well as artificial members of the body or other  devices  or  appliances
 necessary in the first instance to replace, support or relieve a portion
 or  part of the body resulting from and necessitated by the injury of an
 employee, for such period as the nature of the injury or the process  of
 recovery may require, and the employer shall also be liable for replace
 ments  or  repairs  of such artificial members of the body or such other
 devices, eye-glasses, false teeth, artificial eyes, orthotics, prosthet
 ic devices, functional assistive  and  adaptive  devices  or  appliances
 necessitated by ordinary wear or loss or damage to a prosthesis, with or
 without bodily injury to the employee. Damage to or loss of a prosthetic
 device  shall  be  deemed  an  injury except that no disability benefits
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD09319-01-1
 
       A. 5361                             2
 shall be payable with respect to such injury under  section  fifteen  of
 this  article. Such a replacement or repair of artificial members of the
 body or such other devices, eye-glasses, false teeth,  artificial  eyes,
 orthotics, prosthetic devices, functional assistive and adaptive devices
 or  appliances or the providing of medical treatment and care as defined
 herein shall not constitute the payment of  compensation  under  section
 twenty-five-a  of  this  article.  All  fees  and other charges for such
 treatment and services shall be limited to such charges  as  prevail  in
 the  same  community  for similar treatment of injured persons of a like
 standard of living.
 The chair shall prepare and establish a schedule  for  the  state,  or
 schedules  limited  to  defined localities, of charges and fees for such
 medical treatment and care, and including all medical, dental, surgical,
 optometric or other attendance or treatment, nurse and hospital service,
 medicine, optometric services, crutches, eye-glasses, false teeth, arti
 ficial eyes, orthotics, prosthetic  devices,  functional  assistive  and
 adaptive  devices  and apparatus in accordance with and to be subject to
 change pursuant to rules promulgated by the chair. Before preparing such
 schedule for the state or schedules for  limited  localities  the  chair
 shall  request  the president of the medical society of the state of New
 York and the president of the New York state osteopathic medical society
 to submit to him or her a report on the amount of remuneration deemed by
 such society to be fair and adequate for the types of medical care to be
 rendered under this chapter, but consideration shall  be  given  to  the
 view  of  other interested parties. In the case of physical therapy fees
 schedules the chair shall request the president of a recognized  profes
 sional  association representing physical therapists in the state of New
 York to submit to him or her a report  on  the  amount  of  remuneration
 deemed  by  such  association  to be fair and reasonable for the type of
 physical therapy services rendered under this chapter, but consideration
 shall be given to the views of other  interested  parties.    The  chair
 shall  also prepare and establish a schedule for the state, or schedules
 limited to defined localities, of charges and fees for outpatient hospi
 tal services not covered  under  the  medical  fee  schedule  previously
 referred to in this subdivision, to be determined in accordance with and
 to  be  subject  to  change  pursuant to rules promulgated by the chair.
 Before preparing such schedule for the state or  schedules  for  limited
 localities the chair shall request the president of the hospital associ
 ation  of  New York state to submit to him or her a report on the amount
 of remuneration deemed by such association to be fair and  adequate  for
 the types of hospital outpatient care to be rendered under this chapter,
 but  consideration  shall  be  given  to  the  views of other interested
 parties. In the case of occupational therapy fees  schedules  the  chair
 shall  request  the  president  of a recognized professional association
 representing occupational therapists in the state of New York to  submit
 to  him  or  her  a  report on the amount of remuneration deemed by such
 association to be fair and reasonable for the type of occupational ther
 apy services rendered under this chapter,  but  consideration  shall  be
 given  to  the views of other interested parties. IN THE CASE OF MASSAGE
 THERAPY FEE SCHEDULES THE CHAIR SHALL REQUEST THE PRESIDENT OF A  RECOG
 NIZED  PROFESSIONAL ASSOCIATION REPRESENTING LICENSED MASSAGE THERAPISTS
 IN THE STATE OF NEW YORK TO SUBMIT TO HIM OR HER A REPORT ON THE  AMOUNT
 OF REMUNERATION DEEMED BY SUCH ASSOCIATION TO BE FAIR AND REASONABLE FOR
 THE  TYPE  OF OCCUPATIONAL THERAPY SERVICES RENDERED UNDER THIS CHAPTER,
 BUT CONSIDERATION SHALL BE  GIVEN  TO  THE  VIEWS  OF  OTHER  INTERESTED
 PARTIES.  The  amounts  payable  by  the employer for such treatment and
 
       A. 5361                             3
 services shall be the fees and charges  established  by  such  schedule.
 Nothing  in  this  schedule, however, shall prevent voluntary payment of
 amounts higher or lower than the fees and charges fixed therein, but  no
 physician rendering medical treatment or care, and no physical, LICENSED
 MASSAGE  or  occupational therapist rendering their respective physical,
 MASSAGE or occupational therapy services  may  receive  payment  in  any
 higher  amount  unless  such increased amount has been authorized by the
 employer, or by decision as provided in section thirteen-g of this arti
 cle. Nothing in this  section  shall  be  construed  as  preventing  the
 employment  of  a  duly  authorized  physician  on  a salary basis by an
 authorized compensation medical bureau or laboratory.
 

S 2. Subdivisions 1 and 2 of section 13-g of the workers' compensation
 law, subdivision 1 as amended by chapter 674 of the  laws  of  1994  and
 subdivision 2 as amended by chapter 649 of the laws of 1985, are amended
 to read as follows:

 (1)  Within  forty-five  days  after  a  bill has been rendered to the
 employer by the hospital, physician or self-employed physical,  LICENSED
 MASSAGE or occupational therapist who has rendered treatment pursuant to
 a  referral  from the injured employee's authorized physician or author
 ized podiatrist for treatment to the  injured  employee,  such  employer
 must  pay  the  bill  or notify the hospital, physician or self-employed
 physical, LICENSED MASSAGE or occupational therapist in writing that the
 bill is not being paid and explain the reasons for non-payment.  In  the
 event  that  the  employer fails to make payment or notify the hospital,
 physician or self-employed physical, LICENSED  MASSAGE  or  occupational
 therapist  within  such  forty-five day period that payment is not being
 made, the  hospital,  physician,  self-employed  physical  therapist  OR
 SELF-EMPLOYED  LICENSED  MASSAGE THERAPIST or self-employed occupational
 therapist may notify the chair in writing that the  bill  has  not  been
 paid  and request that the board make an award for payment of such bill.
 The board or the chair may make an award not in  excess  of  the  estab
 lished  fee  schedules  for  any such bill or part thereof which remains
 unpaid after said forty-five day period or thirty days after  all  other
 questions  duly  and  timely raised in accordance with the provisions of
 this chapter, relating to the employer's liability for  the  payment  of
 such amount, shall have been finally determined adversely to the employ
 er,  whichever  is  later,  in  accordance with rules promulgated by the
 chair, and such award may be collected in like manner  as  an  award  of
 compensation.  The  chair  shall assess the sum of fifty dollars against
 the employer for each such award made by the board, which sum  shall  be
 paid into the state treasury.
 In  the event that the employer has provided an explanation in writing
 why the bill has not been paid, in part or in full, within the aforesaid
 time period, and the parties can not agree as to the  value  of  medical
 aid  rendered  under  this chapter, such value shall be decided by arbi
 tration if requested by the hospital, physician or  self-employed  phys
 ical, LICENSED MASSAGE or occupational therapist, in accordance with the
 provisions  of  subdivision two or subdivision three of this section, as
 appropriate, and rules and regulations promulgated by the chair.
 Where a physician, physical, LICENSED MASSAGE or  occupational  thera
 pist bill has been determined to be due and owing in accordance with the
 provisions  of this section the board shall include in the amount of the
 award interest of not more than one and one-half per cent (1  1/2%)  per
 month  payable  to  the physician, physical, LICENSED MASSAGE or occupa
 tional therapist, in accordance with the rules and  regulations  promul
 gated  by  the  board. Interest shall be calculated from the forty-fifth
 
       A. 5361                             4
 day after the bill was rendered or from  the  thirtieth  day  after  all
 other questions duly and timely raised in accordance with the provisions
 of this chapter, relating to the employer's liability for the payment of
 such amount, shall have been finally determined adversely to the employ
 er,  whichever  is  later,  in  accordance with rules promulgated by the
 chair.
 (2) If the parties fail to agree  as  to  the  value  of  medical  aid
 rendered  under  this  chapter,  such value shall be decided by an arbi
 tration committee consisting of one physician designated by  the  presi
 dent  of the medical society of the county in which the medical services
 were rendered, one physician who is a member of the medical  society  of
 the  state  of  New  York, appointed by the employer or carrier, and one
 physician, also a member of the medical society  of  the  state  of  New
 York,  appointed  by  the  [chairman] CHAIR of the workers' compensation
 board. The majority decision of any such committee shall  be  conclusive
 upon the parties as to the value of the services rendered. If the physi
 cian  whose charges are being arbitrated is a member in good standing of
 the New York osteopathic society or the New  York  homeopathic  society,
 the  members  of  such arbitration committee shall be physicians of such
 organization, one to be appointed by the president of that organization,
 one by the employer or carrier and the third by the [chairman] CHAIR  of
 the  workers'  compensation  board.  Where the value of physical therapy
 services is at issue the arbitration committee shall consist of a member
 in good standing of a recognized professional  association  representing
 physical  therapists in the state of New York appointed by the president
 of such organization, a physician designated by the employer or  carrier
 and  a  physician  designated  by  the  [chairman] CHAIR of the workers'
 compensation board provided however, that  the  [chairman]  CHAIR  finds
 that there are a sufficient number of physical therapy arbitrations in a
 geographical area comprised of one or more counties to warrant a commit
 tee so comprised. In all other cases where the value of physical therapy
 services  is  at  issue,  the  arbitration  committee shall be similarly
 selected and identical in composition, provided that the physical thera
 pist member shall serve without remuneration, and provided further  that
 in  the event a physical therapist is not available, the committee shall
 be comprised of three physicians designated in the  same  manner  as  in
 cases  where  the  value of medical aid is at issue.  WHERE THE VALUE OF
 MASSAGE THERAPY SERVICES IS AT ISSUE  THE  ARBITRATION  COMMITTEE  SHALL
 CONSIST  OF A MEMBER IN GOOD STANDING OF A RECOGNIZED PROFESSIONAL ASSO
 CIATION REPRESENTING LICENSED MASSAGE THERAPISTS IN  THE  STATE  OF  NEW
 YORK APPOINTED BY THE PRESIDENT OF SUCH ORGANIZATION, A PHYSICIAN DESIG
 NATED BY THE EMPLOYER OR CARRIER AND A PHYSICIAN DESIGNATED BY THE CHAIR
 OF  THE  WORKERS'  COMPENSATION  BOARD  PROVIDED HOWEVER, THAT THE CHAIR
 FINDS THAT THERE ARE A SUFFICIENT NUMBER OF MASSAGE THERAPY ARBITRATIONS
 IN A GEOGRAPHICAL AREA COMPRISED OF ONE OR MORE COUNTIES  TO  WARRANT  A
 COMMITTEE  SO COMPRISED.   IN ALL OTHER CASES WHERE THE VALUE OF MASSAGE
 THERAPY SERVICES IS AT ISSUE, THE ARBITRATION COMMITTEE SHALL  BE  SIMI
 LARLY  SELECTED AND IDENTICAL IN COMPOSITION, PROVIDED THAT THE LICENSED
 MASSAGE THERAPIST MEMBER SHALL SERVE WITHOUT REMUNERATION, AND  PROVIDED
 FURTHER THAT IN THE EVENT A LICENSED MASSAGE THERAPIST IS NOT AVAILABLE,
 THE  COMMITTEE  SHALL BE COMPRISED OF THREE PHYSICIANS DESIGNATED IN THE
 SAME MANNER AS IN CASES WHERE THE VALUE OF MEDICAL AID IS AT ISSUE.
 Where the value of occupational therapy services is at issue the arbi
 tration committee shall consist of a member in good standing of a recog
 nized professional association representing occupational  therapists  in
 the state of New York appointed by the president of such organization; a
 
       A. 5361                             5
 physician  designated  by the employer or carrier and a physician desig
 nated by  the  [chairman]  CHAIR  of  the  workers'  compensation  board
 provided,  however,  that  the  [chairman]  CHAIR finds that there are a
 sufficient number of occupational therapy arbitrations in a geographical
 area  comprised  of  one  or  more  counties  to  warrant a committee so
 comprised. In all other cases where the value  of  occupational  therapy
 services  is  at  issue,  the  arbitration  committee shall be similarly
 selected and identical in composition, provided  that  the  occupational
 therapist  member shall serve without remuneration, and provided further
 that in the event  an  occupational  therapist  is  not  available,  the
 committee  shall be comprised of three physicians designated in the same
 manner as in cases where the value of medical aid is at issue.
 

S 3. This act shall take effect immediately.

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