S T A T E O F N E W Y O R K
________________________________________________________________________
3716
2009-2010 Regular Sessions
I N A S S E M B L Y
January 28, 2009
___________
Introduced by M. of A. LENTOL -- Multi-Sponsored by -- M. of A. LIFTON
-- read once and referred 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.
LBD05904-01-9
A. 3716 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
A. 3716 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
A. 3716 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, 2010 and shall apply to
policies and contracts issued, renewed, modified, altered or amended on
or after such effective date.