Assembly Bill A5526

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5526
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 10, 2017
                                ___________
 
 Introduced  by M. of A. BRONSON -- read once and referred to the Commit-
   tee 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. THE LIST OF PRE-AUTHORIZED PROCEDURES, INCLUDING MEDICAL TREAT-
 MENT  AUTHORIZED  BY ANY GUIDELINES PROMULGATED OR ADOPTED BY THE BOARD,
 SHALL NOT BE UTILIZED TO DENY OR  PRE-DETERMINE  THE  NEED  FOR  MEDICAL
 SERVICES THAT VARY FROM SUCH LIST OR THE GUIDELINES.
   (B)(I)  THE  MEDICAL  ADVISORY COMMITTEE SHALL RECOMMEND AND THE BOARD
 SHALL  ADOPT  THE  TEMPORARY  USE  OF  COMPREHENSIVE,  EVIDENCE   BASED,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD07859-01-7

 A. 5526                             2
 
 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 RECOMMENDA-
 TION  FOR  A  BODY  PART  OR A PARTICULAR CONDITION AND THE BOARD ADOPTS
 GUIDELINES FOR SAID BODY  PART  OR  CONDITION,  A  QUALIFYING,  EVIDENCE
 BASED,  NATIONALLY  RECOGNIZED  TREATMENT  GUIDELINE  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 EVERY TWO YEARS TO
 REFLECT THE BEST SCIENCE; AND (B) ARE COMPREHENSIVE IN NATURE,  COVERING
 AT  LEAST  NINETY-FIVE  PERCENT  OF CONDITIONS AND BODY PARTS COVERED BY
 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 BOARD HAS ADOPTED A
 GUIDELINE FOR TREATMENT OF A BODY PART OR CONDITION THAT HAS  NO  RECOM-
 MENDATION.   IF, AFTER THE FIRST TWO YEARS AND EVERY TWO YEARS THEREAFT-
 ER, 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 GUIDE-
 LINES BY A TWO-THIRDS MAJORITY VOTE OF THE MEDICAL ADVISORY COMMITTEE OR
 ESTABLISH A NEW QUALIFYING TREATMENT GUIDELINE.
   § 2. This act shall take effect immediately.