Provides factors to be considered when a health care practitioner's opinion differs from that of referral's treating health care practitioner as to a disability; requires such health care practitioner to provide an explicit written determination and to present evidence when such practitioner's diagnosis differs from that of the treating health care practitioner who referred the patient.
STATE OF NEW YORK
________________________________________________________________________
4548
2009-2010 Regular Sessions
IN SENATE
April 24, 2009
___________
Introduced by Sen. SQUADRON -- read twice and ordered printed, and when
printed to be committed to the Committee on Social Services
AN ACT to amend the social services law, in relation to establishing
factors to be considered when a health care practitioner upon exam-
ination 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 practi-
tioner when the diagnoses differ
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 332-b of the social services law is amended by
2 adding two new subdivisions 4-a and 4-b to read as follows:
3 4-a. If the practitioner to whom the individual is referred pursuant
4 to subdivision four or paragraph (b) of subdivision two of this section
5 issues an opinion that differs from the applicant's treating health care
6 practitioner, the practitioner must provide an explicit written determi-
7 nation as to why the practitioner disagrees with the applicant's treat-
8 ing health care practitioner's disability determination and present
9 evidence that supports the opinion.
10 4-b. In the event the practitioner to whom the individual is referred
11 pursuant to subdivision four or paragraph (b) of subdivision two of this
12 section issues an opinion that differs from the applicant's treating
13 health care practitioner's opinion, the applicant's treating health care
14 practitioner's opinion is generally controlling, subject to, but not
15 limited to, the following factors:
16 (a) the length and frequency of the treatment provided,
17 (b) consistency of the opinion with the record as a whole,
18 (c) the degree to which the opinion is supported by concrete evidence,
19 and
20 (d) the practitioner's specialty.
21 § 2. This act shall take effect on the ninetieth day after it shall
22 have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00416-03-9
