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.