Requires 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.
TITLE OF BILL: 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 purpose of this bill is to establish the nationally recognized medical treatment guidelines for workers compensation cases when the state medical advisory committee has not yet established a guideline for conditions or body parts when no such guideline exists.
SUMMARY OF PROVISIONS:
Section 1: Section 1. Subdivision 5 of section 13-a of the workers' compensation law - requiring the Medical Advisory Committee (MAC) to recommend and the New York State Workers' Compensation Board (WCB) to 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 MAC makes a recommendation for a body part or a particular condition and the WCB adopts guidelines for said body part or condition a qualifying nationally recognized treatment guideline shall be used for treatment covered under Workers' Compensation in New York State.
The MAC shall have 180 days to issue a written recommendation indicating the selection of a qualifying guideline to the WCB for immediate adoption based upon review of nationally recognized evidence-based medical treatment guidelines that meet the following criteria: 1) are updated at least annually to reflect the best science and 2) the current version of which has been adopted verbatim by legislation, regulation or rule in at least five U.S. 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 recommendation and the WCB has adopted a guideline for treatment of a body part or condition. After the first two years and every two years thereafter, if the advisory committee has not made a recommendation and the WCB 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 WCB shall adopt a two year extension of such guidelines by a two thirds vote of the MAC or establish a new qualifying treatment guideline.
S 2. This act shall take effect immediately.
In 2007 the legislature adopted comprehensive workers' compensation reform legislation (Chapter 6 of the Laws of 2007). The purpose of the workers' compensation reform was to increase benefits and improve delivery of services to injured and ill employees (claimants), while
at the same time reducing costs The goal of these changes was "to remove impediments to prompt diagnostic and treatment measures and to better reflect current medical service costs.
In connection with the reform law the Superintendent of Insurance (with the assistance of the Board and the Department of Labor) developed medical treatment guidelines to account for modern diagnostic and treatment techniques and evidence-based standards of medical treatment and care. An advisory committee was established comprised of representatives from the Insurance Department, the Board, and the Department of Labor, and highly respected medical professionals selected by labor, business, and the Insurance Department.
The Task Force ultimately developed four consensus guidelines: the back, neck, shoulder, and knee for guidelines because those injuries account for 40% of all claims and 60% of system medical costs. This bill would allow the Board to continue its work to provide guidance to treatment and efficient delivery of services for injured workers.
STATE OF NEW YORK ________________________________________________________________________ 6997 IN SENATE April 11, 2014 ___________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 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 S. 6997 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.