BILL NUMBER: S7799

SPONSOR: RHOADS
 
TITLE OF BILL:

An act to amend the workers' compensation law, in relation to simplify-
ing the procedure by which injured workers obtain treatment for injuries
covered by the workers' compensation law

 
PURPOSE:

An act to amend the workers' compensation law, in relation to simplify-
ing the procedure by which injured workers obtain treatment for injuries
covered by the workers' compensation law.

 
SUMMARY OF PROVISIONS:

Section 1. Subdivision 5 of section 13-a of the workers compensation
law, as amended by section 8 of the part cc of chapter 55 of the laws of
2019, 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 testes 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 by the
board or unless such authorization has been reasonably 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 on a conflicting second
opinion rendered by a physician authorized by the board. The board, with
he approval of the superintendent of financial services, shall issue and
maintain a list of pre-authorized procedures shall be issued and main-
tained solely for the purpose of expediting authorization of treatment
of injured workers.

2. This act shall take effect immediately.

 
JUSTIFICATION:

In 2007 the Legislature amended Workers' Compensation Law Section
13-a(6) to direct the chair of the Workers' Compensation Board to adopt
a list of pre-authorized procedures. The Legislature's intent was to
expedite the delivery of medical care to injured workers in order to
improve outcomes and reduce periods of disability and the extent of
permanent injury.

In 2010, the Board adopted Medical Treatment Guidelines and associated
regulations that, instead of merely pre-authorizing treatment as
directed by the statute, deem any treatment that is not pre-authorized
to be pre- denied. Despite the statutory threshold of $1,000 for prior
authorization, the Guidelines and regulations have been employed to deny
to provision of any medical care, regardless of cost, that is not
authorized by the Guidelines.

The Board has subsequently developed a complex process in which the
burden is placed on treating physicians to seek a "variance" from the
Guidelines in order to obtain prior authorization. Injured workers and
attorneys are excluded from this process, thus imposing a burden upon
health care providers to act as both doctors and patient advocates.

There are widespread reports that this system has resulted in the
routine delay and denial of needed medical treatment, as well as of
significant backlogs in the final stage of the medical appeal process to
the Board's medical director. The system in place also imposes signif-
icant burdens on employers and insurers to receive, review, and respond
to variance requests.

This amendment is intended to clarify existing law that prior authori-
zation is not required for treatments under $1,000 regardless of such
treatment's status in the Medical Treatment Guidelines promulgated by
the Board.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.