senate Bill S5476

2011-2012 Legislative Session

Relates to pre-authorized procedures

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Archive: Last Bill Status - In Committee


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 04, 2012 referred to labor
May 25, 2011 referred to labor

S5476 - Bill Details

See Assembly Version of this Bill:
A7934
Current Committee:
Senate Labor
Law Section:
Workers' Compensation Law
Laws Affected:
Amd ยง13-a, Work Comp L

S5476 - Bill Texts

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

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BILL NUMBER:S5476

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.


PRIOR LEGISLATIVE HISTORY:
New bill.

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
Unknown.

EFFECTIVE DATE:
This act shall take effect immediately.

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

    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.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10942-01-1

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