S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  9068

                          I N  A S S E M B L Y

                             March 12, 2014
                               ___________

Introduced by M. of A. BRONSON, HEASTIE -- read once and referred to the
  Committee on Labor

AN  ACT to amend the workers' compensation law, in relation to requiring
  the medical advisory committee to establish the use  of  comprehensive
  nationally  recognized  treatment  guidelines  for  all  body parts or
  conditions which have no recommendations by such advisory committee

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

  Section  1. Subdivision 5 of section 13-a of the workers' compensation
law, as amended by chapter 6 of the laws of 2007 and as further  amended
by  section  104 of part A of chapter 62 of the laws of 2011, is amended
to read as follows:
  (5) (A) No claim for specialist  consultations,  surgical  operations,
physiotherapeutic or occupational therapy procedures, x-ray examinations
or  special  diagnostic  laboratory tests costing more than one thousand
dollars shall be valid and enforceable, as against such employer, unless
such special services shall have been authorized by the employer  or  by
the  board, or unless such authorization has been unreasonably withheld,
or withheld for a period of more than thirty calendar days from  receipt
of  a  request  for  authorization,  or unless such special services are
required in an emergency, provided, however, that the basis for a denial
of such authorization by the employer must be  based  on  a  conflicting
second  opinion  rendered  by  a  physician authorized by the board. The
board, with the approval of the superintendent  of  financial  services,
shall  issue and maintain a list of pre-authorized procedures under this
section.
  (B)(I) THE MEDICAL ADVISORY COMMITTEE SHALL RECOMMEND  AND  THE  BOARD
SHALL  ADOPT  THE  TEMPORARY  USE OF COMPREHENSIVE NATIONALLY RECOGNIZED
TREATMENT GUIDELINES FOR BODY PARTS OR CONDITIONS WHERE NO  AGREED  UPON
WORKERS'  COMPENSATION TREATMENT GUIDELINE EXISTS.  UNTIL SUCH TIME THAT
THE MEDICAL ADVISORY COMMITTEE MAKES A RECOMMENDATION FOR A BODY PART OR
A PARTICULAR CONDITION AND THE BOARD ADOPTS  GUIDELINES  FOR  SAID  BODY
PART  OR  CONDITION, A QUALIFYING NATIONALLY RECOGNIZED TREATMENT GUIDE-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13521-03-4
              

A. 9068                             2

LINE SHALL BE USED FOR TREATMENT COVERED UNDER WORKERS' COMPENSATION  IN
NEW YORK STATE.
  (II) THE MEDICAL ADVISORY COMMITTEE SHALL HAVE ONE HUNDRED EIGHTY DAYS
TO ISSUE A WRITTEN RECOMMENDATION INDICATING THE SELECTION OF A QUALIFY-
ING  GUIDELINE  TO THE BOARD FOR IMMEDIATE ADOPTION BASED UPON REVIEW OF
NATIONALLY RECOGNIZED, EVIDENCE-BASED MEDICAL TREATMENT GUIDELINES  THAT
MEET  THE  FOLLOWING  CRITERIA:  (A)  ARE  UPDATED  AT LEAST ANNUALLY TO
REFLECT THE BEST SCIENCE; AND (B) THE CURRENT VERSION OF WHICH HAS  BEEN
ADOPTED  VERBATIM  BY  LEGISLATION,  REGULATION OR RULE IN AT LEAST FIVE
STATES FOR TREATMENT COVERED UNDER WORKERS' COMPENSATION. THE QUALIFYING
NATIONALLY RECOGNIZED GUIDELINES SHALL BE TEMPORARY AND IN EFFECT FOR  A
PERIOD OF TWO YEARS OR UNTIL THE ADVISORY COMMITTEE HAS MADE A RECOMMEN-
DATION  AND  THE  BOARD  HAS ADOPTED A GUIDELINE FOR TREATMENT OF A BODY
PART OR CONDITION.  IF, AFTER THE FIRST TWO YEARS AND  EVERY  TWO  YEARS
THEREAFTER, THE ADVISORY COMMITTEE HAS NOT MADE A RECOMMENDATION AND THE
BOARD HAS NOT ADOPTED A GUIDELINE ON A PARTICULAR BODY PART OR CONDITION
THEN  THE  ADVISORY  COMMITTEE  SHALL  REVIEW  THE QUALIFYING NATIONALLY
RECOGNIZED GUIDELINES AND THE BOARD SHALL ADOPT A TWO YEAR EXTENSION  OF
SUCH  GUIDELINES  BY  A TWO-THIRDS MAJORITY VOTE OF THE MEDICAL ADVISORY
COMMITTEE OR ESTABLISH A NEW QUALIFYING TREATMENT GUIDELINE.
  S 2. This act shall take effect immediately.