senate Bill S6997

2013-2014 Legislative Session

Requires the medical advisory committee to establish the use of comprehensive nationally recognized treatment guidelines for all body parts or conditions

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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
Jun 20, 2014 committed to rules
May 14, 2014 advanced to third reading
May 13, 2014 2nd report cal.
May 12, 2014 1st report cal.601
Apr 11, 2014 referred to labor

Votes

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May 12, 2014 - Labor committee Vote

S6997
10
3
committee
10
Aye
3
Nay
2
Aye with Reservations
0
Absent
1
Excused
0
Abstained
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Labor Committee Vote: May 12, 2014

aye wr (2)
excused (1)

Co-Sponsors

S6997 - Bill Details

See Assembly Version of this Bill:
A9068
Current Committee:
Senate Rules
Law Section:
Workers' Compensation Law
Laws Affected:
Amd ยง13-a, Work Comp L

S6997 - Bill Texts

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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.

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BILL NUMBER:S6997

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

PURPOSE:

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.

JUSTIFICATION:

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.

LEGISLATIVE HISTORY:

New Bill

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

Immediate.

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

                                  6997

                            I N  S E N A T E

                             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.

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