STATE OF NEW YORK
________________________________________________________________________
6349
2017-2018 Regular Sessions
IN SENATE
May 11, 2017
___________
Introduced by Sen. ALCANTARA -- (at request of the Workers Compensation
Board) -- 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 extending
the board's authority to resolve medical bill disputes and simplify
the process
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 13-b of the workers' compensation law, as amended
2 by chapter 1068 of the laws of 1960, the section heading, subdivisions 1
3 and 2 as amended by chapter 473 of the laws of 2000 and subdivision 3 as
4 amended by section 85 of part A of chapter 58 of the laws of 2010, is
5 amended to read as follows:
6 § 13-b. Authorization of physicians, medical bureaus and laboratories
7 by the chair. 1. [Upon the recommendation of the medical society of the
8 county in which the physician's office is located or of a board desig-
9 nated by such county society or of a board representing duly licensed
10 physicians of any other school of medical practice in such county, the
11 chair may authorize physicians licensed to practice medicine in the
12 state of New York to render medical care under this chapter and to
13 perform independent medical examinations in accordance with subdivision
14 four of section thirteen-a of this article. If, within sixty days after
15 the chair requests such recommendations the medical society of such
16 county or board fails to act, or if there is no such society in such
17 county, the chair shall designate a board of three outstanding physi-
18 cians, who shall make the requisite recommendations.
19 No such authorization shall be made in the absence of a recommendation
20 of the appropriate society or board or of a review and recommendation by
21 the medical appeals unit. No person shall render medical care or conduct
22 independent medical examinations under this chapter without such author-
23 ization by the chair, provided, that:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10066-01-7
S. 6349 2
1 (a)] As used in this title, the following definitions shall have the
2 following meanings unless their context requires otherwise:
3 a. "Acupuncturist" shall mean licensed as having completed a formal
4 course of study and having passed an examination in accordance with the
5 education law, the regulations of the commissioner of education, and the
6 requirements of the board of regents. Acupuncturists are required by the
7 education law to advise, in writing, each patient of the requirement
8 that he or she consult with a physician for the condition or conditions
9 necessitating acupuncture care, as prescribed by the education law.
10 b. "Authorization agreement" shall mean an agreement between the chair
11 and the provider signed by the provider desirous of rendering medical
12 care and/or treatment to claimant or claimants injured in the course of
13 their employment and/or to conduct independent medical examinations.
14 c. "Chair" of the board shall mean either the chair or the chair's
15 designee.
16 d. "Chiropractor" shall mean licensed and having completed two years
17 of preprofessional college study and a four-year resident program in
18 chiropractic in accordance with the education law, and consistent with
19 the licensing requirements of the commissioner of education.
20 e. "Nurse practitioner" shall mean a licensed professional nurse
21 certified by a national certifying body as having completed the required
22 educational program in accordance with the education law and the regu-
23 lations of the commissioner of education.
24 f. "Occupational therapist" shall mean licensed as having a bachelor's
25 or master's degree in occupational therapy from a registered program
26 with the education department or receipt of a diploma or degree result-
27 ing from completion of not less than four years of postsecondary study,
28 which includes the professional study of occupational therapy in accord-
29 ance with the education law and the regulations of the commissioner of
30 education.
31 g. "Physical therapist" shall mean licensed as having completed a
32 master's degree or higher in physical therapy in accordance with the
33 education law and the licensing requirements of the commissioner of
34 education.
35 h. "Physician" shall mean licensed with a degree of doctor of medi-
36 cine, M.D., or doctor of osteopathy, D.O., or an equivalent degree in
37 accordance with the education law and the licensing requirements of the
38 state board of medicine and the regulations of the commissioner of
39 education.
40 i. "Physician assistant" shall mean a licensed provider who has gradu-
41 ated from a two-to-four year state-approved physician assistant program,
42 has passed a licensing examination, and whose actions and duties are
43 within the scope of practice of the supervising physician, in accordance
44 with the education law and the regulations of the commissioner of educa-
45 tion.
46 j. "Podiatrist" shall mean licensed as having received a doctoral
47 degree in podiatry in accordance with the regulations of the commission-
48 er of education and the education law, and must satisfactorily meet all
49 other requirements of the state board for podiatry.
50 k. "Provider" shall mean a duly licensed acupuncturist, chiropractor,
51 independent medical examiner, nurse practitioner, physical therapist,
52 physician, physician's assistant, podiatrist, psychologist, or social
53 worker subject to an authorization agreement.
54 l. "Psychologist" shall mean licensed as having received a doctoral
55 degree in psychology from a program of psychology registered with the
56 state education department or the substantial equivalent thereof in
S. 6349 3
1 accordance with the education law, the requirements of the state board
2 for psychology, and the regulations of the commissioner of education.
3 m. "Social worker" shall mean licensed clinical social worker. A
4 licensed clinical social worker has completed a master's of social work
5 that includes completion of a core curriculum of at least twelve credit
6 hours of clinical courses or the equivalent post-graduate clinical
7 coursework, in accordance with the education law and the commissioner of
8 education.
9 2. Any [physician] provider licensed [to practice medicine] pursuant
10 to the education law to provide medical care and treatment in the state
11 of New York may render emergency [medical] care and treatment in an
12 emergency hospital or urgent care setting providing emergency treatment
13 under this chapter without authorization by the chair under this
14 section; [and]
15 [(b)] (a) Such licensed [physician] provider as identified in this
16 subdivision who is [a member of a constituted medical staff of any
17 hospital] on staff at any hospital or urgent care center providing emer-
18 gency treatment may [render] continue such medical care under this chap-
19 ter while an injured employee remains a patient in such hospital or
20 urgent care setting; and
21 [(c)] (b) Under the [active and personal] direct supervision of an
22 authorized [physician] provider, medical care may be rendered by a
23 registered nurse or other person trained in laboratory or diagnostic
24 techniques within the scope of such person's specialized training and
25 qualifications. This supervision shall be evidenced by signed records of
26 instructions for treatment and signed records of the patient's condition
27 and progress. Reports of such treatment and supervision shall be made by
28 such [physician] provider to the chair on such forms and at such times
29 as the chair may require.
30 [(d) Upon the referral which may be directive as to treatment of an
31 authorized physician physical therapy care may be rendered by a duly
32 licensed physical therapist. Where physical therapy care is rendered
33 records of the patient's condition and progress, together with records
34 of instruction for treatment, if any, shall be maintained by the phys-
35 ical therapist and physician. Said records shall be submitted to the
36 chair on such forms and at such times as the chair may require.
37 (e) Upon the prescription or referral of an authorized physician occu-
38 pational therapy care may be rendered by a duly licensed occupational
39 therapist. Where occupational therapy care is rendered records of the
40 patient's condition and progress, together with records of instruction
41 for treatment, if any shall be maintained by the occupational therapist
42 and physician. Said records shall be submitted to the chair on forms and
43 at such times as the chair may require.
44 (f)] (c) Where it would place an unreasonable burden upon the employer
45 or carrier to arrange for, or for the claimant to attend, an independent
46 medical examination by an authorized [physician] provider, the employer
47 or carrier shall arrange for such examination to be performed by a qual-
48 ified [physician] provider in a medical facility convenient to the
49 claimant.
50 [2.] (d) Upon the prescription or referral of an authorized physician,
51 care or treatment may be rendered to an injured employee by an author-
52 ized physical therapist, occupational therapist or acupuncturist
53 provided the conditions and the treatment performed are among the condi-
54 tions that the physical therapist, occupational therapist or acupunctu-
55 rist is authorized to treat pursuant to the education law or the regu-
56 lations of the commissioner of education. Where any such care or
S. 6349 4
1 treatment is rendered, records of the patient's condition and progress,
2 together with records of instruction for treatment, if any, shall be
3 maintained by the physical therapist, occupational therapist or acupunc-
4 turist rendering treatment and by the referring physician. Said records
5 shall be submitted to the chair on forms and at such times as the chair
6 may require.
7 (e) A record, report or opinion of a physical therapist, occupational
8 therapist, acupuncturist or physician assistant shall not be considered
9 as evidence of (1) the causal relationship of any condition to an acci-
10 dent or occupational disease under this chapter or (2) disability or the
11 degree thereof, nor may any such provider perform an independent medical
12 examination concerning a claim under this chapter.
13 3. A [physician licensed to practice medicine in the state of New York
14 who is] provider properly licensed or certified pursuant to the regu-
15 lations of the commissioner of education and the requirements of the
16 education law desirous of being authorized to render medical care under
17 this chapter and/or to conduct independent medical examinations in
18 accordance with paragraph (b) of subdivision four of section thirteen-a
19 and section one hundred thirty-seven of this chapter shall [file an
20 application for authorization under this chapter with the medical socie-
21 ty in the county in which his or her office is located, or with a board
22 designated by such society, or with a board designated by the chair as
23 provided in this section. In such application the applicant shall state
24 his or her training and qualifications, and shall agree to limit his or
25 her professional activities under this chapter to such medical care and
26 independent medical examinations, as his or her experience and training
27 qualify him or her to render. The applicant shall further agree to
28 refrain] sign an authorization agreement. The provider agrees to abide
29 by the terms, conditions, and limitations outlined in the authorization
30 agreement, including, but not limited to refraining from subsequently
31 treating for remuneration, as a private patient, any person seeking
32 medical treatment, or submitting to an independent medical examination,
33 in connection with, or as a result of, any injury compensable under this
34 chapter, if he or she has been removed from the list of [physicians]
35 providers authorized to render medical care or to conduct independent
36 medical examinations under this chapter, or if the person seeking such
37 treatment, or submitting to an independent medical examination, has been
38 transferred from his or her care in accordance with the provisions of
39 this chapter. This agreement shall run to the benefit of the injured
40 person so treated or examined, and shall be available to him or her as a
41 defense in any action by such [physician] provider for payment for
42 treatment rendered by a [physician] provider after he or she has been
43 removed from the list of [physicians] providers authorized to render
44 medical care or to conduct independent medical examinations under this
45 chapter, or after the injured person was transferred from his or her
46 care in accordance with the provisions of this chapter. [The medical
47 society or the board designated by it, or the board as otherwise
48 provided under this section, if it deems such licensed physician duly
49 qualified, shall recommend to the chair that such physician be author-
50 ized to render medical care and/or conduct independent medical examina-
51 tions under this chapter, and such recommendation and authorization
52 shall specify the character of the medical care or independent medical
53 examination which such physician is qualified and authorized to render
54 under this chapter. Such recommendations shall be advisory to the chair
55 only and shall not be binding or conclusive upon him or her. The
56 licensed physician may present to the medical society or board,
S. 6349 5
1 evidences of additional qualifications at any time subsequent to his or
2 her original application. If the medical society or board fails to
3 recommend to the chair that a physician be authorized to render medical
4 care and/or to conduct independent medical examinations under this chap-
5 ter, the physician may appeal to the medical appeals unit. The medical
6 society or the board designated by it, or the board as otherwise
7 provided under this section, may upon its own initiative, or shall upon
8 request of the chair, review at any time the qualifications of any
9 physician as to the character of the medical care or independent medical
10 examinations which such physician has theretofore been authorized to
11 render under this chapter and may recommend to the chair that such
12 physician be authorized to render medical care or to conduct independent
13 medical examinations thereafter of the character which such physician is
14 then qualified to render. On such advisory recommendation the chair may
15 review and after reasonable investigation may revise the authorization
16 of a physician in respect to the character of medical care and/or to
17 conduct independent medical examinations which he or she is authorized
18 to render. If the medical society or board recommends to the chair that
19 a physician be authorized to render medical care and/or to conduct inde-
20 pendent medical examinations under this chapter of a character different
21 from the character of medical care or independent medical examinations
22 he or she has been theretofore authorized to render, such physician may
23 appeal from such recommendation to the medical appeals unit.
24 3.] 4. Laboratories and bureaus engaged in x-ray diagnosis or treat-
25 ment or in physiotherapy or other therapeutic procedures and which
26 participate in the diagnosis or treatment of injured [workmen] claimants
27 under this chapter shall be operated or supervised by [qualified physi-
28 cians duly] providers authorized under this chapter and shall be subject
29 to the provisions of section thirteen-c of this article. The person in
30 charge of diagnostic clinical laboratories duly authorized under this
31 chapter shall possess the qualifications established by the public
32 health and health planning council for approval by the state commission-
33 er of health or, in the city of New York, the qualifications approved by
34 the board of health of said city and shall maintain the standards of
35 work required for such approval.
36 § 2. Section 13-d of the workers' compensation law, as amended by
37 chapter 459 of the laws of 1944, the section heading and subdivisions 1
38 and 2 as amended and paragraph (d) of subdivision 2 as added by chapter
39 473 of the laws of 2000, paragraphs (a) and (b) of subdivision 2 as
40 amended and subdivision 5 as added by chapter 6 of the laws of 2007 and
41 subdivision 4 as amended by chapter 1068 of the laws of 1960, is amended
42 to read as follows:
43 § 13-d. Removal of [physicians] providers from lists of those author-
44 ized to render medical care or to conduct independent medical examina-
45 tions. 1. [The medical society of the county in which the physician's
46 office is located at the time or a board designated by such county soci-
47 ety or a board representing duly licensed physicians of any other school
48 of medical practice in such county shall investigate, hear and make
49 findings with respect to all charges as to professional or other miscon-
50 duct of any authorized physician as herein provided under rules and
51 procedure to be prescribed by the medical appeals unit, and shall report
52 evidence of such misconduct, with their findings and recommendation with
53 respect thereto, to the chair. Failure to commence such investigation
54 within sixty days from the date the charges are referred to the society
55 by the chair or submit findings and recommendations relating to the
56 charges within one hundred eighty days from the date the charges are
S. 6349 6
1 referred shall empower the chair to appoint, as a hearing officer, a
2 member of the board, employee, or other qualified hearing officer to
3 hear and report on the charges to the chair. A qualified hearing offi-
4 cer, who is neither a member of the board, or employee thereof shall be
5 paid at a reasonable per diem rate to be fixed by the chair.
6 Such investigation, hearing, findings, recommendation and report may
7 be made by the society or board of an adjoining county upon the request
8 of the medical society of the county in which the alleged misconduct or
9 infraction of this chapter occurred, subject to the time limit and
10 conditions set forth herein. The medical appeals unit shall review the
11 findings and recommendation of such medical society or board, or hearing
12 officer appointed by the chair upon application of the accused physician
13 and may reopen the matter and receive further evidence. The findings,
14 decision and recommendation of such society, board or hearing officer
15 appointed by the chair or medical appeals unit shall be advisory to the
16 chair only, and shall not be binding or conclusive upon him or her.
17 2.] The chair shall [remove from the list of physicians authorized to]
18 temporarily suspend, revoke, or otherwise limit the authorization of any
19 provider to render medical care under this chapter, or to conduct inde-
20 pendent medical examinations in accordance with paragraph (b) of subdi-
21 vision four of section thirteen-a of this article, [the name of any
22 physician who he or she shall find] should he or she find, after reason-
23 able investigation [is disqualified because such physician:], that such
24 provider has failed to render competent, professional, or quality
25 medical care and treatment under this chapter.
26 2. A provider's failure to provide the standard of care or his or her
27 breach of the duty to provide competent, professional, or quality
28 medical care and treatment under this chapter can be found in the
29 following acts of misconduct:
30 (a) has [been guilty of] committed professional, medical, or other
31 misconduct or incompetency in connection with rendering medical services
32 under the law or has violated any of the specified grounds for unprofes-
33 sional conduct as more fully set forth in the education law, specif-
34 ically the rules of the board of regents, the office of professions, or
35 the regulations of the commissioner of the department of education; or
36 (b) has exceeded the limits of his or her professional competence in
37 rendering medical care or in conducting independent medical examinations
38 under the law[,] or has made materially false statements [regarding his
39 or her qualifications in his or her application for the recommendation
40 of the medical society or board as provided in section thirteen-b of
41 this article] in connection with the authorization agreement; or
42 (c) has failed to transmit copies of medical reports to claimant's
43 attorney or licensed representative as provided in subdivision (f) of
44 section thirteen of this article; or has failed to submit full and
45 truthful medical reports of all his or her findings to the employer, and
46 directly to the chair or the board within the time limits provided in
47 subdivision four of section thirteen-a of this article with the excep-
48 tion of injuries which do not require (1) more than ordinary first aid
49 or more than two treatments by a physician or person rendering first
50 aid, or (2) loss of time from regular duties of one day beyond the work-
51 ing day or shift; or
52 (d) knowingly made a false statement or representation as to a materi-
53 al fact in any medical report made pursuant to this chapter or in testi-
54 fying or otherwise providing information for the purposes of this chap-
55 ter; or
S. 6349 7
1 (e) has solicited, or has employed another to solicit for himself or
2 herself or for another, professional treatment, examination or care of
3 an injured employee in connection with any claim under this chapter; or
4 (f) has refused to appear before, to testify, to submit to a deposi-
5 tion, or to answer upon request of, the chair, board, medical appeals
6 unit or any duly authorized officer of the state, any legal question, or
7 to produce any relevant book [or], paper, or response concerning his or
8 her conduct under any authorization [granted to him or her under this
9 chapter] agreement; or
10 (g) has directly or indirectly [requested, received or participated in
11 the division, transference, assignment, rebating, splitting or refunding
12 of a fee for, or has directly or indirectly requested, received or prof-
13 ited by means of a credit or other valuable consideration as a commis-
14 sion, discount or gratuity in connection with the furnishing of medical
15 or surgical care, an independent medical examination, diagnosis or
16 treatment or service, including X-ray examination and treatment, or for
17 or in connection with the sale, rental, supplying or furnishing of clin-
18 ical laboratory services or supplies, X-ray laboratory services or
19 supplies, inhalation therapy service or equipment, ambulance service,
20 hospital or medical supplies, physiotherapy or other therapeutic service
21 or equipment, artificial limbs, teeth or eyes, orthopedic or surgical
22 appliances or supplies, optical appliances, supplies or equipment,
23 devices for aid of hearing, drugs, medication or medical supplies, or
24 any other goods, services or supplies prescribed for medical diagnosis,
25 care or treatment, under this chapter; except that reasonable payment,
26 not exceeding the technical component fee permitted in the medical fee
27 schedule, established under this chapter for X-ray examinations, diagno-
28 sis or treatment, may be made by a physician duly authorized as a roent-
29 genologist to any hospital furnishing facilities and equipment for such
30 examination, diagnosis or treatment, provided such hospital does not
31 also submit a charge for the same services. Nothing contained in this
32 paragraph shall prohibit such physicians who practice as partners, in
33 groups or as a professional corporation or as a university faculty prac-
34 tice corporation from pooling fees and moneys received, either by the
35 partnership, professional corporation, university faculty practice
36 corporation or group by the individual members thereof, for professional
37 services furnished by any individual professional member, or employee of
38 such partnership, corporation or group, nor shall the professionals
39 constituting the partnerships, corporations, or groups be prohibited
40 from sharing, dividing or apportioning the fees and moneys received by
41 them or by the partnership, corporation or group in accordance with a
42 partnership or other agreement.] while temporarily suspended, benefited
43 from the splitting or pooling of fees by managing or directing a medical
44 practice employing or hiring other authorized providers to render treat-
45 ment under this chapter, supervised care and treatment under this chap-
46 ter, or submitted for reimbursement board forms for services rendered
47 under this chapter; or
48 (h) has violated any of the provisions outlined in section thirteen of
49 this section, the rules, policies, and regulations promulgated by the
50 board, the provider's medical license requirements, as more fully set
51 forth in the public health law and the education law, or the require-
52 ments set forth in the authorization agreement; or
53 (i) has been subject to a condition, limitation, or finding by the
54 department of health in a report, determination, or any type of order
55 resulting from allegations of misconduct.
S. 6349 8
1 3. [Any person who violates or attempts to violate, and any person who
2 aids another to violate or attempts to induce him to violate the
3 provisions of paragraph (g) of subdivision two of this section shall be
4 guilty of a misdemeanor] Once suspended, revoked, or limited, a surgeon
5 may provided only required and necessary post-surgical care and treat-
6 ment to a workers' compensation patient recovering from a surgical
7 procedure performed within a reasonable time-frame prior to the effec-
8 tive date of the provider's authorization suspension or revocation.
9 4. [Nothing] In addition to the power or duty of the chair to tempo-
10 rarily suspend, revoke, or otherwise limit the authorization of a
11 provider in the event that one of the acts of professional, medical, or
12 other misconduct is found to exist, nothing in this section shall be
13 construed as limiting in any respect the [power or duty of the chairman]
14 chair's authority to [investigate instances of misconduct, either before
15 or after investigation by a medical society or board as herein provided,
16 or to temporarily suspend the authorization of any physician that he may
17 believe to be guilty of such misconduct] impose a fine not to exceed
18 five thousand dollars.
19 [5. Whenever the department of health shall conduct an investigation
20 with respect to charges of professional or other misconduct by a physi-
21 cian which results in a report, determination or consent order that
22 includes a finding of professional or other misconduct or incompetency
23 by such physician, the chair shall have full power and authority to
24 temporarily suspend, revoke or otherwise limit the authorization under
25 this chapter of any physician upon such finding by the department of
26 health that the physician has been guilty of professional or other
27 misconduct. The recommendations of the department of health shall be
28 advisory to the chair only and shall not be binding or conclusive upon
29 the chair.]
30 § 3. Section 13-g of the workers' compensation law, as added by chap-
31 ter 258 of the laws of 1935, subdivision 1 as amended by chapter 674 of
32 the laws of 1994, subdivisions 2 and 3 as amended by section 4 of part
33 GG of chapter 57 of the laws of 2013, subdivision 4 as amended by
34 section 3 of part D of chapter 55 of the laws of 2015, subdivision 5 as
35 amended by chapter 578 of the laws of 1959 and subdivision 6 as amended
36 by chapter 639 of the laws of 1996, is amended to read as follows:
37 § 13-g. Payment of bills for medical care. (1) Within forty-five days
38 after a bill for medical care or supplies delivered pursuant to section
39 thirteen of this article has been rendered to the employer [by the
40 hospital, physician or self-employed physical or occupational therapist
41 who has rendered treatment pursuant to a referral from the injured
42 employee's authorized physician or authorized podiatrist for treatment
43 to the injured employee], such employer must pay the bill or notify the
44 [hospital, physician or self-employed physical or occupational therapist
45 in writing] medical care provider or supplier in the format prescribed
46 by the chair that the bill is not being paid and explain the reasons for
47 non-payment. In the event that the employer fails to make payment or
48 notify the [hospital, physician or self-employed physical or occupa-
49 tional therapist] medical care provider or supplier within such forty-
50 five day period that payment is not being made, the [hospital, physi-
51 cian, self-employed physical therapist or self-employed occupational
52 therapist] medical care provider or supplier may notify the board in the
53 format prescribed by the chair [in writing] that the bill has not been
54 paid and request that the board make an award for payment of such bill.
55 The board or the chair may make an award not in excess of the estab-
56 lished fee schedules for any such bill or part thereof which remains
S. 6349 9
1 unpaid after said forty-five day period or thirty days after all other
2 questions duly and timely raised in accordance with the provisions of
3 this chapter, relating to the employer's liability for the payment of
4 such amount, shall have been finally determined adversely to the employ-
5 er, whichever is later, in accordance with rules promulgated by the
6 chair, and such award may be collected in like manner as an award of
7 compensation. The chair shall assess the sum of fifty dollars against
8 the employer for each such award made by the board, which sum shall be
9 paid into the state treasury.
10 In the event that the employer has provided an explanation in writing
11 why the bill has not been paid, in part or in full, within the aforesaid
12 time period, and the parties can not agree as to the value of medical
13 aid rendered under this chapter, such value shall be decided by arbi-
14 tration [if requested by the hospital, physician or self-employed phys-
15 ical or occupational therapist, in accordance with the provisions of
16 subdivision two or subdivision three of this section, as appropriate,
17 and] as set forth in rules and regulations promulgated by the chair.
18 Where a [physician, physical or occupational therapist] bill for
19 medical care or supplies has been determined to be due and owing in
20 accordance with the provisions of this section the board shall include
21 in the amount of the award interest of not more than one and one-half
22 [per cent] percent (1 1/2%) per month payable to the [physician, phys-
23 ical or occupational therapist] medical care provider or supplier, in
24 accordance with the rules and regulations promulgated by the board.
25 Interest shall be calculated from the forty-fifth day after the bill was
26 rendered or from the thirtieth day after all other questions duly and
27 timely raised in accordance with the provisions of this chapter, relat-
28 ing to the employer's liability for the payment of such amount, shall
29 have been finally determined adversely to the employer, whichever is
30 later, in accordance with rules promulgated by the chair.
31 (2) (a) If the parties fail to agree to the value of medical aid
32 rendered under this chapter and the amount of the disputed bill is one
33 thousand dollars or less, or if the amount of the disputed medical bill
34 exceeds one thousand dollars and the [health] medical care provider or
35 supplier expressly so requests, such value shall be decided by a single
36 arbitrator process, pursuant to rules promulgated by the chair. [The
37 chair shall appoint a physician who is a member in good standing of the
38 medical society of the state of New York to determine the value of such
39 disputed medical bill. Where the physician whose charges are being
40 arbitrated is a member in good standing of the New York osteopathic
41 society, the value of such disputed bill shall be determined by a member
42 in good standing of the New York osteopathic society appointed by the
43 chair. Where the physician whose charges are being arbitrated is a
44 member in good standing of the New York homeopathic society, the value
45 of such disputed bill shall be determined by a member in good standing
46 of the New York homeopathic society appointed by the chair. Where the
47 value of physical therapy services or occupational therapy services is
48 at issue, such value shall be determined by a member in good standing of
49 a recognized professional association representing its respective
50 profession in the state of New York appointed by the chair.] Decisions
51 rendered under the single arbitrator process shall be conclusive upon
52 the parties as to the value of the services in dispute.
53 (b) If the parties fail to agree as to the value of medical aid
54 rendered under this chapter and the amount of the disputed bill exceeds
55 one thousand dollars, such value shall be decided by an arbitration
56 committee unless the health care provider expressly requests a single
S. 6349 10
1 arbitrator process in accordance with paragraph (a) of this subdivision.
2 The arbitration committee shall [consist of one physician designated by
3 the president of the medical society of the county in which the medical
4 services were rendered, one physician who is a member of the medical
5 society of the state of New York, appointed by the employer or carrier,
6 and one physician, also a member of the medical society of the state of
7 New York, appointed by the chair of the workers' compensation board. If
8 the physician whose charges are being arbitrated is a member in good
9 standing of the New York osteopathic society or the New York homeopathic
10 society, the members of such arbitration committee shall be physicians
11 of such organization, one to be appointed by the president of that
12 organization, one by the employer or carrier and the third by the chair
13 of the workers' compensation board. Where the value of physical therapy
14 services is at issue and the amount of the disputed bill exceeds one
15 thousand dollars, the arbitration committee shall consist of a member in
16 good standing of a recognized professional association representing
17 physical therapists in the state of New York appointed by the president
18 of such organization, a physician designated by the employer or carrier
19 and a physician designated by the chair of the workers' compensation
20 board provided however, that the chair finds that there are a sufficient
21 number of physical therapy arbitrations in a geographical area comprised
22 of one or more counties to warrant a committee so comprised. In all
23 other cases where the value of physical therapy services is at issue and
24 the amount of the disputed bill exceeds one thousand dollars, the arbi-
25 tration committee shall be similarly selected and identical in composi-
26 tion, provided that the physical therapist member shall serve without
27 remuneration, and provided further that in the event a physical thera-
28 pist is not available, the committee shall be comprised of three physi-
29 cians designated in the same manner as in cases where the value of
30 medical aid is at issue.
31 (c) Where the value of occupational therapy services is at issue the
32 arbitration committee shall consist of a member in good standing of a
33 recognized professional association representing occupational therapists
34 in the state of New York appointed by the president of such organiza-
35 tion; a physician designated by the employer or carrier and a physician
36 designated by the chair of the workers' compensation board provided,
37 however, that the chair finds that there are a sufficient number of
38 occupational therapy arbitrations in a geographical area comprised of
39 one or more counties to warrant a committee so comprised. In all other
40 cases where the value of occupational therapy services is at issue and
41 the amount of the disputed bill exceeds one thousand dollars, the arbi-
42 tration committee shall be similarly selected and identical in composi-
43 tion, provided that the occupational therapist member shall serve with-
44 out remuneration, and provided further that in the event an occupational
45 therapist is not available, the committee shall be comprised of three
46 physicians designated in the same manner as in cases where the value of
47 medical aid is at issue.] have three members designated by the chair in
48 constitution with the medical director's office of the workers' compen-
49 sation board. The majority decision of any such arbitration committee
50 shall be conclusive upon the parties as to the value of the services in
51 dispute.
52 (3) [(a) If an employer shall have notified the hospital in writing,
53 as provided in subdivision one of this section, why the bill has not
54 been paid, in part or in full, and the amount of the disputed bill is
55 one thousand dollars or less, or where the amount of the disputed
56 medical bill exceeds one thousand dollars and the hospital expressly so
S. 6349 11
1 requests, such value shall be decided by a single arbitrator process,
2 pursuant to rules promulgated by the chair. The chair shall appoint a
3 physician in good standing licensed to practice in New York state to
4 determine the value of such disputed bill. Decisions rendered under the
5 administrative resolution procedure shall be conclusive upon the parties
6 as to the value of the services in dispute.
7 (b) If an employer shall have notified the hospital in writing, as
8 provided in subdivision one of this section, why the bill has not been
9 paid, in part or in full, and the amount of the disputed bill exceeds
10 one thousand dollars, the value of such bill shall be determined by an
11 arbitration committee appointed by the chair for that purpose, which
12 committee shall consider all of the charges of the hospital, unless the
13 hospital expressly requests a single arbitrator process pursuant to
14 paragraph (a) of this subdivision. The committee shall consist of three
15 physicians. One member of the committee may be nominated by the chair
16 upon recommendation of the president of the hospital association of New
17 York state and one member may be nominated by the employer or insurance
18 carrier. The majority decision of any such committee shall be conclusive
19 upon the parties as to the value of the services rendered. The chair may
20 make reasonable rules and regulations consistent with the provisions of
21 this section.
22 (4)] A provider initiating an arbitration, including a single arbitra-
23 tor process, pursuant to this section shall not pay a fee to cover the
24 costs related to the conduct of such arbitration. [Each member of an
25 arbitration committee for medical bills, and each member of an arbi-
26 tration committee for hospital bills shall be entitled to receive and
27 shall be paid a fee for each day's attendance at an arbitration session
28 in any one count in an amount fixed by the chair of the workers' compen-
29 sation board.
30 (5)] (4) In claims where the employer has failed to secure compen-
31 sation to his employees as required by section fifty of this chapter,
32 the board may make an award for the value of medical [and podiatry]
33 services, supplies or treatment rendered to such employees, in accord-
34 ance with the schedules of fees and charges prepared and established
35 under the provisions of [section thirteen, subdivision a, and section
36 thirteen-k, subdivision two, of] this chapter[, and for the reasonable
37 value of hospital care in accordance with the charges currently in force
38 in hospitals in the same community for cases coming within the
39 provisions of this chapter]. Such award shall be made to the [physician,
40 podiatrist, or hospital] medical care provider or supplier entitled
41 thereto. A default in the payment of such award may be enforced in the
42 manner provided for the enforcement of compensation awards as set forth
43 in section twenty-six of this [chapter] article.
44 In all cases coming under this subdivision the payment of the claim
45 [of the physician, podiatrist, or hospital for medical, podiatry, or
46 surgical services or treatment] for medical care or supplies shall be
47 subordinate to that of the claimant or his or her beneficiaries.
48 [(6) Notwithstanding any inconsistent provision of law, arbitration
49 regarding payments for inpatient hospital services for any patient
50 discharged on or after January first, nineteen hundred ninety-one and
51 prior to December thirty-first, nineteen hundred ninety-six shall be
52 resolved in accordance with paragraph (d) of subdivision three of
53 section twenty-eight hundred seven-c of the public health law.]
54 § 4. Subdivisions 1 and 2 and paragraphs (a) and (b) of subdivision 3
55 of section 13-k of the workers' compensation law, subdivisions 1 as
56 added by chapter 787 of the laws of 1952 and subdivision 2 and para-
S. 6349 12
1 graphs (a) and (b) of subdivision 3 as amended by chapter 473 of the
2 laws of 2000, are amended to read as follows:
3 1. When the term "chairman" is hereinafter used, it shall be deemed to
4 mean the [chairman] chair of the [workmen's] workers' compensation board
5 of the state of New York.
6 2. An employee injured under circumstances which make such injury
7 compensable under this article, when care is required for an injury to
8 the foot which injury or resultant condition therefrom may lawfully be
9 treated by a duly registered and licensed podiatrist of the state of New
10 York, may select to treat him or her any podiatrist authorized by the
11 chair to render podiatry care, as hereinafter provided. If the injury or
12 condition is one which is without the limits prescribed by the education
13 law for podiatry care and treatment, or the injuries involved affect
14 other parts of the body in addition to the foot, the said podiatrist
15 must so advise the said injured employee and instruct him or her to
16 consult a physician of said employee's choice for appropriate care and
17 treatment. Such physician shall thenceforth have overall supervision of
18 the treatment of said patient including the future treatment to be
19 administered to the patient by the podiatrist. If for any reason during
20 the period when podiatry treatment and care is required, the employee
21 wishes to transfer his or her treatment and care to another authorized
22 podiatrist he or she may do so, in accordance with rules prescribed by
23 the chair, provided however that the employer shall be liable for the
24 proper fees of the original podiatrist for the care and treatment he or
25 she shall have rendered. [A podiatrist licensed and registered to prac-
26 tice podiatry in the state of New York who is desirous of being author-
27 ized to render podiatry care under this section and/or to conduct inde-
28 pendent medical examinations in accordance with paragraph (b) of
29 subdivision three of this section shall file an application for authori-
30 zation under this section with the podiatry practice committee. In such
31 application he or she shall agree to refrain from subsequently treating
32 for remuneration, as a private patient, any person seeking podiatry
33 treatment, or submitting to an independent medical examination, in
34 connection with, or as a result of, any injury compensable under this
35 chapter, if he or she has been removed from the list of podiatrists
36 authorized to render podiatry care or to conduct independent medical
37 examinations under this chapter, or if the person seeking such treatment
38 has been transferred from his or her care in accordance with the
39 provisions of this section. This agreement shall run to the benefit of
40 the injured person so treated or examined, and shall be available to him
41 or her as a defense in any action by such podiatrist for payment for
42 treatment rendered by a podiatrist after he or she has been removed from
43 the list of podiatrists authorized to render podiatry care or to conduct
44 independent medical examinations under this section, or after the
45 injured person was transferred from his or her care in accordance with
46 the provisions of this section. The podiatry practice committee if it
47 deems such licensed podiatrist duly qualified shall recommend to the
48 chair that such podiatrist be authorized to render podiatry care and/or
49 to conduct independent medical examinations under this section. Such
50 recommendation shall be advisory to the chair only and shall not be
51 binding or conclusive upon him or her.] The chair shall prepare and
52 establish a schedule for the state, or schedules limited to defined
53 localities, of charges and fees for podiatry treatment and care, to be
54 determined in accordance with and to be subject to change pursuant to
55 rules promulgated by the chair. Before preparing such schedule for the
56 state or schedules for limited localities the chair shall request the
S. 6349 13
1 podiatry practice committee to submit to him or her a report on the
2 amount of remuneration deemed by such committee to be fair and adequate
3 for the types of podiatry care to be rendered under this chapter, but
4 consideration shall be given to the view of other interested parties.
5 The amounts payable by the employer for such treatment and services
6 shall be the fees and charges established by such schedule.
7 (a) No claim for podiatry care or treatment shall be valid and
8 enforceable as against the employer or employee unless within forty-
9 eight hours following the first treatment the podiatrist giving such
10 care or treatment furnish to the employer and directly to the chair a
11 preliminary notice of such injury and treatment, within fifteen days
12 thereafter a more complete report and subsequent thereto progress
13 reports as requested in writing by the chair, board, employer or insur-
14 ance carrier, at intervals of not less than three weeks apart or at less
15 frequent intervals if requested on forms prescribed by the chair. The
16 board may excuse the failure to give such notices within the designated
17 periods when it finds it to be in the interest of justice to do so.
18 (b) Upon receipt of the notice provided for by paragraph (a) of this
19 subdivision, the employer, the carrier and the claimant each shall be
20 entitled to have the claimant examined by a qualified podiatrist author-
21 ized by the chair in accordance with [subdivision two of this] section
22 thirteen-b and section one hundred thirty-seven of this chapter, at a
23 medical facility convenient to the claimant and in the presence of the
24 claimant's podiatrist, and refusal by the claimant to submit to such
25 independent medical examination at such time or times as may reasonably
26 be necessary in the opinion of the board shall bar the claimant from
27 recovering compensation for any period during which he or she has
28 refused to submit to such examination.
29 § 5. Subdivisions 1 and 2 and paragraphs (a) and (b) of subdivision 3
30 of section 13-l of the workers' compensation law, subdivision 1 as added
31 by chapter 940 of the laws of 1973 and subdivision 2 and paragraphs (a)
32 and (b) of subdivision 3 as amended by chapter 473 of the laws of 2000,
33 are amended to read as follows:
34 1. Where the term "chairman" is hereinafter used, it shall be deemed
35 to mean the [chairman] chair of the [workmen's] workers' compensation
36 board of the state of New York.
37 2. An employee injured under circumstances which make such injury
38 compensable under this article, when care is required for an injury
39 which consists solely of a condition which may lawfully be treated by a
40 chiropractor as defined in section sixty-five hundred fifty-one of the
41 education law may select to treat him or her, any duly registered and
42 licensed chiropractor of the state of New York, authorized by the chair
43 to render chiropractic care as hereinafter provided. If the injury or
44 condition is one which is outside the limits prescribed by the education
45 law for chiropractic care and treatment, the said chiropractor must so
46 advise the said injured employee and instruct him or her to consult a
47 physician of said employee's choice for appropriate care and treatment.
48 Such physician shall thenceforth have supervision of the treatment of
49 said condition including the future treatment to be administered to the
50 patient by the chiropractor. [A chiropractor licensed and registered to
51 practice chiropractic in the state of New York, who is desirous of being
52 authorized to render chiropractic care under this section and/or to
53 conduct independent medical examinations in accordance with paragraph
54 (b) of subdivision three of this section shall file an application for
55 authorization under this section with the chiropractic practice commit-
56 tee. In such application he or she shall agree to refrain from subse-
S. 6349 14
1 quently treating for remuneration, as a private patient, any person
2 seeking chiropractic treatment, or submitting to an independent medical
3 examination, in connection with, or as a result of, any injury compensa-
4 ble under this chapter, if he or she has been removed from the list of
5 chiropractors authorized to render chiropractic care or to conduct inde-
6 pendent medical examinations under this chapter, or if the person seek-
7 ing such treatment has been transferred from his or her care in accord-
8 ance with the provisions of this section. This agreement shall run to
9 the benefit of the injured person so treated, or examined, and shall be
10 available to him or her as a defense in any action by such chiropractor
11 for payment rendered by a chiropractor after he or she has been removed
12 from the list of chiropractors authorized to render chiropractic care or
13 to conduct independent medical examinations under this section, or after
14 the injured person was transferred from his or her care in accordance
15 with the provisions of this section. The chiropractic practice committee
16 if it deems such licensed chiropractor duly qualified shall recommend to
17 the chair that such be authorized to render chiropractic care and/or to
18 conduct independent medical examinations under this section. Such recom-
19 mendations shall be advisory to the chair only and shall not be binding
20 or conclusive upon him or her.] The chair shall prepare and establish a
21 schedule for the state, or schedules limited to defined localities of
22 charges and fees for chiropractic treatment and care, to be determined
23 in accordance with and to be subject to change pursuant to rules promul-
24 gated by the chair. Before preparing such schedule for the state or
25 schedules for limited localities the chair shall request the chiroprac-
26 tic practice committee to submit to him or her a report on the amount of
27 remuneration deemed by such committee to be fair and adequate for the
28 types of chiropractic care to be rendered under this chapter, but
29 consideration shall be given to the view of other interested parties,
30 the amounts payable by the employer for such treatment and services
31 shall be the fees and charges established by such schedule.
32 (a) No claim for chiropractic care or treatment shall be valid and
33 enforceable as against the employer or employees unless within forty-
34 eight hours following the first treatment the chiropractor giving such
35 care or treatment furnishes to the employer and directly to the chair a
36 preliminary notice of such injury and treatment, and within fifteen days
37 thereafter a more complete report and subsequent thereto progress
38 reports as requested in writing by the chair, board, employer or insur-
39 ance carrier, at intervals of not less than three weeks apart or at less
40 frequent intervals if requested on forms prescribed by the chair. The
41 board may excuse the failure to give such notices within the designated
42 periods when it finds it to be in the interest of justice to do so.
43 (b) Upon receipt of the notice provided for by paragraph (a) of this
44 subdivision, the employer, the carrier, and the claimant each shall be
45 entitled to have the claimant examined by a qualified chiropractor
46 authorized by the chair in accordance with [subdivision two of this]
47 section thirteen-b and section one hundred thirty-seven of this chapter
48 at a medical facility convenient to the claimant and in the presence of
49 the claimant's chiropractor, and refusal by the claimant to submit to
50 such independent medical examination at such time or times as may
51 reasonably be necessary in the opinion of the board shall bar the claim-
52 ant from recovering compensation, for any period during which he or she
53 has refused to submit to such examination.
54 § 6. Subdivisions 1, 2 and 3 and paragraphs (a) and (b) of subdivision
55 4 of section 13-m of the worker's compensation law, subdivisions 1 and 2
56 as added by chapter 589 of the laws of 1989 and subdivision 3 and para-
S. 6349 15
1 graphs (a) and (b) of subdivision 4 as amended by chapter 473 of the
2 laws of 2000, are amended to read as follows:
3 1. Where the term "chairman" is hereinafter used, it shall be deemed
4 to mean the [chairman] chair of the workers' compensation board of the
5 state of New York.
6 2. (a) An injured employee, injured under circumstances which make
7 such injury compensable under this article, may lawfully be treated[,
8 upon the referral of an authorized physician,] by a psychologist, duly
9 registered and licensed by the state of New York, authorized by the
10 chairman to render psychological care pursuant to [this] section thir-
11 teen-b of this article. Such services shall be within the scope of such
12 psychologist's specialized training and qualifications as defined in
13 article one hundred fifty-three of the education law.
14 (b) Medical bureaus, medical centers jointly operated by labor and
15 management representatives, hospitals and health maintenance organiza-
16 tions, authorized to provide medical care pursuant to section thirteen-c
17 of this [chapter] article, may provide psychological services when
18 required[, upon the referral of an authorized physician, provided such
19 care is rendered by a duly registered, licensed and authorized psychol-
20 ogist, as required by this section].
21 (c) A psychologist rendering service pursuant to this section shall
22 maintain records of the patient's psychological condition and treatment,
23 and such records or reports shall be submitted to the [chairman] chair
24 on such forms and at such times as the [chairman] chair may require.
25 3. [A psychologist, licensed and registered to practice psychology in
26 the state of New York, who is desirous of being authorized to render
27 psychological care under this section and/or to conduct independent
28 medical examinations in accordance with paragraph (b) of subdivision
29 four of this section shall file an application for authorization under
30 this section with the psychology practice committee. The applicant shall
31 agree to refrain from subsequently treating for remuneration, as a
32 private patient, any person seeking psychological treatment, or submit-
33 ting to an independent medical examination, in connection with, or as a
34 result of, any injury compensable under this chapter, if he or she has
35 been removed from the list of psychologists authorized to render psycho-
36 logical care under this chapter. This agreement shall run to the benefit
37 of the injured person so treated, and shall be available as a defense in
38 any action by such psychologist for payment for treatment rendered by
39 such psychologist after being removed from the list of psychologists
40 authorized to render psychological care or to conduct independent
41 medical examinations under this section. The psychology practice commit-
42 tee if it deems such licensed psychologist duly qualified shall recom-
43 mend to the chair that such person be authorized to render psychological
44 care and/or to conduct independent medical examinations under this
45 section. Such recommendations shall be only advisory to the chair and
46 shall not be binding or conclusive.] The chair shall prepare and estab-
47 lish a schedule for the state or schedules limited to defined localities
48 of charges and fees for psychological treatment and care, to be deter-
49 mined in accordance with and be subject to change pursuant to rules
50 promulgated by the chair. Before preparing such schedule for the state
51 or schedules for limited localities the chair shall request the psychol-
52 ogy practice committee to submit to such chair a report on the amount of
53 remuneration deemed by such committee to be fair and adequate for the
54 types of psychological care to be rendered under this chapter, but
55 consideration shall be given to the view of other interested parties.
S. 6349 16
1 The amounts payable by the employer for such treatment and services
2 shall be the fees and charges established by such schedule.
3 (a) No claim for psychological care or treatment shall be valid and
4 enforceable as against the employer or employees unless within forty-
5 eight hours following the first treatment the psychologist giving such
6 care or treatment furnishes to the employer and directly to the chair a
7 preliminary notice of such injury and treatment, and within fifteen days
8 thereafter a more complete report and subsequent thereto progress
9 reports as requested in writing by the chair, board, employer or insur-
10 ance carrier, at intervals of not less than three weeks apart or at less
11 frequent intervals if requested on forms prescribed by the chair. The
12 board may excuse the failure to give such notices within the designated
13 periods when it finds it to be in the interest of justice to do so.
14 (b) Upon receipt of the notice provided for by paragraph (a) of this
15 subdivision, the employer, the carrier, and the claimant each shall be
16 entitled to have the claimant examined by a qualified psychologist,
17 authorized by the chair in accordance with [subdivision three of this]
18 section thirteen-b and section one hundred thirty-seven of this chapter,
19 at a medical facility convenient to the claimant and in the presence of
20 the claimant's psychologist, and refusal by the claimant to submit to
21 such independent medical examination at such time or times as may
22 reasonably be necessary in the opinion of the board shall bar the claim-
23 ant from recovering compensation, for any period during which he or she
24 has refused to submit to such examination.
25 § 7. This act shall take effect on the ninetieth day after it shall
26 have become a law.