Bill S5476-2011

Relates to pre-authorized procedures

Amends the worker's compensation law, in relation to pre-authorized procedures.



  • Jan 4, 2012: REFERRED TO LABOR
  • May 25, 2011: REFERRED TO LABOR



TITLE OF BILL: An act to amend the workers' compensation law, in relation to pre-authorized procedures

PURPOSE OR GENERAL IDEA OF BILL: This bill would effectively repeal the medical treatment guidelines enacted by the workers compensation board in December of 2010.

SUMMARY OF SPECIFIC PROVISIONS: Section 1: Amends Subdivision 5 of section 13-a of the workers' compensation law such that the list of pre-authorized (medical) procedures issued by the workers' compensation board, with the approval of the superintendent of insurance;

-Shall be used and maintained for the sole purpose of expediting authorization for patient treatment.

-None of the workers comp preauthorized procedures shall be utilized as medical guidelines, used to direct patient care in any way, nor given any preference over an alternative form of treatment that has not been placed on the pre-authorized procedures list.

JUSTIFICATION: The New York State Workers' Compensation Board implemented its Medical Treatment Guidelines on December 1, 2010. The guidelines limit treatment by type, frequency (days per week), and duration (weeks) and failed to include treatment guidelines for injured workers with chronic conditions. Many of these patients require long-term chiropractic care to alleviate shoulder, neck and back pain and keep them on the job.

Under the new guidelines a patient will no longer receive treatment for a longer duration than is included in the guidelines if that patient does not obtain a variance from the carrier or Workers' Compensation Board. This process could be lengthy, in many cases taking a number of months, in which time the claimant may be denied treatment. This denial of treatment could hinder a claimant's ability to remain employed and cause the claimants medical condition to lead to financial distress. This is in direct opposition to the intent of the Workers' Compensation Law.

Furthermore, since an employer can refuse to reimburse a provider for treatment not included in the guidelines and a provider is prohibited by law from charging the patient, these guidelines are harming the ability of chiropractors to make the most cost-effective, medically sound long term treatment decisions for their patients. Further, the new guidelines are also having a negative impact on small business. In addition to increased paperwork, the higher regulatory compliance costs have forced many practitioners to layoff employees, and in some cases close their practices entirely.



EFFECTIVE DATE: This act shall take effect immediately.


STATE OF NEW YORK ________________________________________________________________________ S. 5476 A. 7934 2011-2012 Regular Sessions S E N A T E - A S S E M B L Y May 25, 2011 ___________
IN SENATE -- Introduced by Sen. RITCHIE -- read twice and ordered print- ed, and when printed to be committed to the Committee on Labor IN ASSEMBLY -- Introduced by M. of A. TENNEY -- read once and referred to the Committee on Labor AN ACT to amend the workers' compensation law, in relation to pre-au- thorized procedures 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, is amended to read as follows: (5) 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 insurance, shall issue and maintain a list of pre-authorized procedures under this section. SUCH LIST OF PRE-AUTHORIZED PROCEDURES SHALL BE ISSUED AND MAINTAINED FOR THE SOLE PURPOSE OF EXPEDITING AUTHORIZATION OF PATIENT TREATMENT. SUCH LIST OF PRE-AUTHORIZED PROCEDURES SHALL NOT BE UTILIZED AS MEDICAL GUIDELINES OR TO DIRECT PATIENT CARE IN ANY WAY NOR SHALL ANY PRE-AU- THORIZED PROCEDURE BE GIVEN PREFERENCE OVER AN ALTERNATIVE FORM OF TREATMENT THAT HAS NOT BEEN PLACED ON THE PRE-AUTHORIZED PROCEDURES LIST. S 2. This act shall take effect immediately.


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