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

                                  9995

                          I N  A S S E M B L Y

                             April 30, 2012
                               ___________

Introduced by M. of A. WRIGHT -- 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
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,

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

                                                           LBD09319-04-2

A. 9995                             2

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
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

A. 9995                             3

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
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

A. 9995                             4

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 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
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.