BILL NUMBER:  S4548

 TITLE OF BILL :  An act to amend the social services law, in relation
to establishing factors to be considered when a health care
practitioner  upon examination has a different opinion from an
applicant's treating health care practitioner's opinion as to an
applicant's disability; and requiring an explicit written
determination by the health care practitioner when the diagnoses
differ

 PURPOSE OR GENERAL IDEA OF BILL : To ensure that the opinions and
determinations of a public assistance applicant's treating health care
practitioner are given sufficient weight when making disability
determinations.

 SUMMARY OF SPECIFIC PROVISIONS : Section 1 amends section 332-b of
the social services law, which provides that if a public assistance
applicant is sent to a practitioner to determine if the applicant has
any work limitations, the practitioner must take into account the
applicant's treating health care practitioner's opinion, and give it
sufficient weight based on a number of factors.

 EXISTING LAW : Currently it is within the evaluating practitioner's
discretion what, if any, weight is given to the treating health care
practitioner's opinion.

              

 JUSTIFICATION : If an individual applying for public assistance has
work limitations, disabilities, or health issues which have been
identified by their treating health care practitioner, their diagnosis
and recommendations should be considered to be accurate, in the
absence of any contradictory findings. As the current law is written,
there is little weight given to the treating health care
practitioner's opinion, and if not supplied in a very timely fashion,
is not even considered in making a determination on work limitations.

The social services appointed examining practitioner only sees the
applicant for one short assessment, which is not always sufficient in
exploring many complicated issues related to work limitations. If the
applicant's treating health care practitioner has been following him
or her for a long period of time, they most likely have established
enough of a relationship with their patient which would allow for the
discovery of hidden disabilities that the examiner may never find.

The federal government recognizes the importance of giving sufficient
consideration to a physician's medical opinion, and they follow this
practice explicitly in their Supplemental Security Income
determination procedure, detailed in 20 CFR 416.927. This section of
federal regulation outlines Evaluating Opinion Evidence, and it is
after this federal regulation that this bill has been modeled.

It is for this reason that if the examiner makes any findings contrary
to the treating health care practitioner's diagnosis, the reasons for
the differing diagnosis should have to be defended and explicitly
stated in writing.

 PRIOR LEGISLATIVE HISTORY : 2007: A7946

 FISCAL IMPLICATIONS : None.

 EFFECTIVE DATE : 90 Days