Establishes factors and requirements to be considered when a health care practitioner's opinion differs from that of an applicant's treating health care practitioner as to an applicant's disability.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A3045
SPONSOR: Hevesi (MS) 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 examina-
tion has a different opinion from an applicant's treating health care
practitioner's opinion as to an applicant's disability
PURPOSE OR GENERAL IDEA OF BILL:
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 SPECIFIC PROVISIONS:
Section 1 amends subdivision 4 of section 332-b of the social services
law, by adding a new subdivision 4-b.
Section 2 is the effective date.
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 regu-
lation outlines Evaluating Opinion Evidence, and it is after this feder-
al 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.
PRIOR LEGISLATIVE HISTORY:
2015-2016: A3450 (Wright M-S);
2013-2014: A2960;
2011-2012: A2957;
2010: A1417;
2009: A1417;
2008: A7946;
2007: A7946
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law.
