BILL NUMBER:  S5547

 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 :
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 PROVISIONS :
Section 1 amends section 332-b of the social services law, by 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 after.

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.

 LEGISLATIVE HISTORY :
2007: S.1509, A.7946
2005: S.1745, A.5402
2003: S.6424, A.9983

 FISCAL IMPLICATIONS :
None.
 EFFECTIVE DATE :
90 Days.