NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8387C
SPONSOR: Pretlow TITLE OF BILL: 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
PURPOSE OF THE BILL:
This bill would reflect modern medical practice by authorizing addi-
tional types of providers, such as nurse practitioners and social work-
ers, to provide healthcare services under the workers' compensation law.
It would also streamline the authorization process by permitting every
medical provider licensed by New York State to enter into a Memorandum
of Understanding ("MOU") with the Workers' Compensation Board ("Board")
regarding fees and dispute resolution.
SUMMARY OF PROVISIONS:
Section 1 of this bill would amend Workers' Compensation Law (WCL) §
13-b to expand the types of providers that may provide healthcare
services and streamlining the process to authorize those providers.
Section 2 of this bill would amend WCL § 13-g to expressly permit the
Board to resolve disputes concerning any medical service or supply
rendered under the broad authority of WCL S 13.
Section 3-5 of this bill would amend WCL §§ 13-k, 13-1, and 13-m to make
corresponding changes to the authorization process as proposed in
Section 1 of the bill.
Section 6 of this bill would amend WCL §§ 54-b to permit enforcement of
judgements for payment of all medical bills.
Section 7 of the bill would set forth the effective date.
JUSTIFICATION:
The bill would amend the WCL expand the types of providers authorized to
provide health care services by allowing for modern medical practices
such as nurse practitioners and social workers to provide care.
The bill would also expand the Board's authority to resolve billing
disputes concerning any medical care, service or supplies rendered in
connection with a Workers' Compensation claim. Authorizing the Chair of
the Board to have discretion to identify arbitrators to resolve medical
bill disputes will ensure that these disputes are addressed in a prompt
and efficient manner by persons with expertise in workers' compensation
matters.
PRIOR LEGISLATIVE HISTORY:
None.
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
The bill would take effect on the 90th day after it becomes law.
STATE OF NEW YORK
________________________________________________________________________
8387--C
2017-2018 Regular Sessions
IN ASSEMBLY
June 12, 2017
___________
Introduced by M. of A. PRETLOW, TAYLOR, D'URSO, GOTTFRIED, STECK, McDO-
NALD -- Multi-Sponsored by -- M. of A. EPSTEIN, PALMESANO -- read once
and referred to the Committee on Labor -- recommitted to the Committee
on Labor in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee -- again reported from said committee with amend-
ments, ordered reprinted as amended and recommitted to said committee
-- again reported from said committee with amendments, ordered
reprinted as amended and recommitted to said committee
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] providers, medical bureaus and
7 laboratories by the chair. 1. [Upon the recommendation of the medical
8 society of the county in which the physician's office is located or of a
9 board designated by such county society or of a board representing duly
10 licensed physicians of any other school of medical practice in such
11 county, the chair may authorize physicians licensed to practice medicine
12 in the state of New York to render medical care under this chapter and
13 to perform independent medical examinations in accordance with subdivi-
14 sion four of section thirteen-a of this article. If, within sixty days
15 after the chair requests such recommendations the medical society of
16 such county or board fails to act, or if there is no such society in
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13065-05-8
A. 8387--C 2
1 such county, the chair shall designate a board of three outstanding
2 physicians, who shall make the requisite recommendations.
3 No such authorization shall be made in the absence of a recommendation
4 of the appropriate society or board or of a review and recommendation by
5 the medical appeals unit.] No person shall render medical care or
6 conduct independent medical examinations under this chapter without such
7 authorization by the chair[, provided, that: (a)]. As used in this
8 title, the following definitions shall have the following meanings
9 unless their context requires otherwise:
10 (a) "Acupuncturist" shall mean licensed as having completed a formal
11 course of study and having passed an examination in accordance with the
12 education law, the regulations of the commissioner of education, and the
13 requirements of the board of regents. Acupuncturists are required by the
14 education law to advise, in writing, each patient of the requirement
15 that he or she consult with a physician for the condition or conditions
16 necessitating acupuncture care, as prescribed by the education law.
17 (b) "Chair" of the board shall mean either the chair or the chair's
18 designee.
19 (c) "Chiropractor" shall mean licensed and having completed two years
20 of preprofessional college study and a four-year resident program in
21 chiropractic in accordance with the education law, and consistent with
22 the licensing requirements of the commissioner of education.
23 (d) "Dentist" shall mean licensed and having completed a four-year
24 course of study leading to a D.D.S. or D.D.M. degree, or an equivalent
25 degree, in accordance with the education law and the licensing require-
26 ments of the commissioner of education.
27 (e) "Employer" shall mean a self-insured employer or, if insured, the
28 insurance carrier.
29 (f) "Independent medical examination" shall mean an examination
30 performed by a medical provider, authorized under this section to
31 perform such examination, for the purpose of examining or evaluating
32 injury or illness pursuant to paragraph (b) of subdivision four of
33 section thirteen-a and section one hundred thirty-seven of this chapter
34 and as more fully set forth in regulation.
35 (g) "Nurse practitioner" shall mean a licensed registered professional
36 nurse certified pursuant to section sixty-nine hundred ten of the educa-
37 tion law.
38 (h) "Occupational therapist" shall mean licensed as having a bach-
39 elor's or master's degree in occupational therapy from a registered
40 program with the education department or receipt of a diploma or degree
41 resulting from completion of not less than four years of postsecondary
42 study, which includes the professional study of occupational therapy in
43 accordance with the education law and the regulations of the commission-
44 er of education.
45 (i) "Physical therapist" shall mean licensed as having completed a
46 master's degree or higher in physical therapy in accordance with the
47 education law and the licensing requirements of the commissioner of
48 education.
49 (j) "Physician" shall mean licensed with a degree of doctor of medi-
50 cine, M.D., or doctor of osteopathic medicine, D.O., or an equivalent
51 degree in accordance with the education law and the licensing require-
52 ments of the state board of medicine and the regulations of the commis-
53 sioner of education.
54 (k) "Physician assistant" shall mean a licensed provider who has grad-
55 uated from a two- to four-year state-approved physician assistant
56 program, has passed a licensing examination, and whose actions and
A. 8387--C 3
1 duties are within the scope of practice of the supervising physician, in
2 accordance with the education law and the regulations of the commission-
3 er of education.
4 (l) "Podiatrist" shall mean a doctor of podiatric medicine licensed as
5 having received a doctoral degree in podiatric medicine in accordance
6 with the regulations of the commissioner of education and the education
7 law, and must satisfactorily meet all other requirements of the state
8 board for podiatric medicine.
9 (m) "Provider" shall mean a duly licensed acupuncturist, chiropractor,
10 independent medical examiner, nurse practitioner, physical therapist,
11 physician, physician assistant, podiatrist, psychologist, or social
12 worker authorized by the chair.
13 (n) "Psychologist" shall mean licensed as having received a doctoral
14 degree in psychology from a program of psychology registered with the
15 state education department or the substantial equivalent thereof in
16 accordance with the education law, the requirements of the state board
17 for psychology, and the regulations of the commissioner of education.
18 (o) "Social worker" shall mean a licensed clinical social worker. A
19 licensed clinical social worker has completed a master's degree of
20 social work that includes completion of a core curriculum of at least
21 twelve credit hours of clinical courses or the equivalent post-graduate
22 clinical coursework, in accordance with the education law and the regu-
23 lations of the commissioner of education.
24 2. Any [physician] provider licensed [to practice medicine] pursuant
25 to the education law to provide medical care and treatment in the state
26 of New York may render emergency [medical] care and treatment in an
27 emergency hospital or urgent care setting providing emergency treatment
28 under this chapter without authorization by the chair under this
29 section; [and
30 (b)] (a) Such licensed [physician] provider as identified in this
31 subdivision who is [a member of a constituted medical staff of any
32 hospital] on staff at any hospital or urgent care center providing emer-
33 gency treatment may [render] continue such medical care under this chap-
34 ter while an injured employee remains a patient in such hospital or
35 urgent care setting; and
36 [(c)] (b) Under the [active and personal] direct supervision of an
37 authorized [physician] provider, medical care may be rendered by a
38 registered nurse or other person trained in laboratory or diagnostic
39 techniques within the scope of such person's specialized training and
40 qualifications. This supervision shall be evidenced by signed records of
41 instructions for treatment and signed records of the patient's condition
42 and progress. Reports of such treatment and supervision shall be made by
43 such [physician] provider to the chair [on such forms and] in the format
44 prescribed by the chair at such times as the chair may require.
45 [(d) Upon the referral which may be directive as to treatment of an
46 authorized physician physical therapy care may be rendered by a duly
47 licensed physical therapist. Where physical therapy care is rendered
48 records of the patient's condition and progress, together with records
49 of instruction for treatment, if any, shall be maintained by the phys-
50 ical therapist and physician. Said records shall be submitted to the
51 chair on such forms and at such times as the chair may require.
52 (e) Upon the prescription or referral of an authorized physician occu-
53 pational therapy care may be rendered by a duly licensed occupational
54 therapist. Where occupational therapy care is rendered records of the
55 patient's condition and progress, together with records of instruction
56 for treatment, if any shall be maintained by the occupational therapist
A. 8387--C 4
1 and physician. Said records shall be submitted to the chair on forms and
2 at such times as the chair may require.
3 (f)] (c) Where it would place an unreasonable burden upon the employer
4 or carrier to arrange for, or for the claimant to attend, an independent
5 medical examination by an authorized [physician] provider, the employer
6 or carrier shall arrange for such examination to be performed by a qual-
7 ified [physician] provider in a medical facility convenient to the
8 claimant.
9 [2.] (d) Upon the prescription or referral of an authorized physician,
10 or nurse practitioner acting within the scope of his or her practice,
11 care or treatment may be rendered to an injured employee by an author-
12 ized physical therapist, occupational therapist or acupuncturist
13 provided the conditions and the treatment performed are among the condi-
14 tions that the physical therapist, occupational therapist or acupunctu-
15 rist is authorized to treat pursuant to the education law or the regu-
16 lations of the commissioner of education. Where any such care or
17 treatment is rendered, records of the patient's condition and progress,
18 together with records of instruction for treatment, if any, shall be
19 maintained by the physical therapist, occupational therapist or acupunc-
20 turist rendering treatment and by the referring physician or nurse prac-
21 titioner. Said records shall be submitted to the chair on forms and at
22 such times as the chair may require.
23 (e) A record, report or opinion of a physical therapist, occupational
24 therapist, acupuncturist or physician assistant shall not be considered
25 as evidence of the causal relationship of any condition to a work
26 related accident or occupational disease under this chapter. Nor may a
27 record, report or opinion of a physical therapist, occupational thera-
28 pist or acupuncturist be considered evidence of disability. Nor may a
29 record, report or opinion of a physician assistant be considered
30 evidence of the presence of a permanent or initial disability or the
31 degree thereof. Nor may a physical therapist, occupational therapist,
32 acupuncturist or physician assistant perform an independent medical
33 examination concerning a claim under this chapter.
34 (f) A nurse practitioner, or licensed certified social worker, may
35 perform an independent medical examination on behalf of an employer only
36 to the extent that the examination concerns treatment rendered by an
37 identical provider type, but may not perform an independent medical
38 examination on behalf of the employer concerning (1) the causal
39 relationship of any condition to a work related accident or occupational
40 disease under this chapter or (2) the presence of a disability or the
41 degree thereof.
42 3. A [physician licensed to practice medicine in the state of New York
43 who is] provider properly licensed or certified pursuant to the regu-
44 lations of the commissioner of education and the requirements of the
45 education law desirous of being authorized to render medical care under
46 this chapter and/or to conduct independent medical examinations in
47 accordance with paragraph (b) of subdivision four of section thirteen-a
48 and section one hundred thirty-seven of this chapter shall file an
49 application for authorization under this chapter with the [medical soci-
50 ety in the county in which his or her office is located, or with a board
51 designated by such society, or with a board designated by the chair as
52 provided in this section. In such application the applicant shall state
53 his or her training and qualifications, and shall agree to limit his or
54 her professional activities under this chapter to such medical care and
55 independent medical examinations, as his or her experience and training
56 qualify him or her to render. The applicant shall further agree to
A. 8387--C 5
1 refrain] chair or chair's designee. Prior to receiving authorization, a
2 physician must, together with submission of an application to the chair,
3 submit such application to the medical society of the county in which
4 the physician's office is located or of a board designated by such coun-
5 ty society or of a board representing duly licensed physicians of any
6 other school of medical practice in such county, and submit the recom-
7 mendation to the board. In the event such county society or board fails
8 to take action upon a physician's application within forty-five days,
9 the chair may complete review of the application without such approval.
10 Upon approval of the application by the chair or the chair's designee,
11 the applicant shall further agree to refrain from subsequently treating
12 for remuneration, as a private patient, any person seeking medical
13 treatment, or submitting to an independent medical examination, in
14 connection with, or as a result of, any injury compensable under this
15 chapter, if he or she has been removed from the list of [physicians]
16 providers authorized to render medical care or to conduct independent
17 medical examinations under this chapter, or if the person seeking such
18 treatment, or submitting to an independent medical examination, has been
19 transferred from his or her care in accordance with the provisions of
20 this chapter. This agreement shall run to the benefit of the injured
21 person so treated or examined, and shall be available to him or her as a
22 defense in any action by such [physician] provider for payment for
23 treatment rendered by a [physician] provider after he or she has been
24 removed from the list of [physicians] providers authorized to render
25 medical care or to conduct independent medical examinations under this
26 chapter, or after the injured person was transferred from his or her
27 care in accordance with the provisions of this chapter. [The medical
28 society or the board designated by it, or the board as otherwise
29 provided under this section, if it deems such licensed physician duly
30 qualified, shall recommend to the chair that such physician be author-
31 ized to render medical care and/or conduct independent medical examina-
32 tions under this chapter, and such recommendation and authorization
33 shall specify the character of the medical care or independent medical
34 examination which such physician is qualified and authorized to render
35 under this chapter. Such recommendations shall be advisory to the chair
36 only and shall not be binding or conclusive upon him or her. The
37 licensed physician may present to the medical society or board,
38 evidences of additional qualifications at any time subsequent to his or
39 her original application. If the medical society or board fails to
40 recommend to the chair that a physician be authorized to render medical
41 care and/or to conduct independent medical examinations under this chap-
42 ter, the physician may appeal to the medical appeals unit. The medical
43 society or the board designated by it, or the board as otherwise
44 provided under this section, may upon its own initiative, or shall upon
45 request of the chair, review at any time the qualifications of any
46 physician as to the character of the medical care or independent medical
47 examinations which such physician has theretofore been authorized to
48 render under this chapter and may recommend to the chair that such
49 physician be authorized to render medical care or to conduct independent
50 medical examinations thereafter of the character which such physician is
51 then qualified to render. On such advisory recommendation the chair may
52 review and after reasonable investigation may revise the authorization
53 of a physician in respect to the character of medical care and/or to
54 conduct independent medical examinations which he or she is authorized
55 to render. If the medical society or board recommends to the chair that
56 a physician be authorized to render medical care and/or to conduct inde-
A. 8387--C 6
1 pendent medical examinations under this chapter of a character different
2 from the character of medical care or independent medical examinations
3 he or she has been theretofore authorized to render, such physician may
4 appeal from such recommendation to the medical appeals unit.
5 3.] 4. Laboratories and bureaus engaged in x-ray diagnosis or treat-
6 ment or in physiotherapy or other therapeutic procedures and which
7 participate in the diagnosis or treatment of injured [workmen] workers
8 under this chapter shall be operated or supervised by [qualified physi-
9 cians duly] providers authorized under this chapter and shall be subject
10 to the provisions of section thirteen-c of this article. The person in
11 charge of diagnostic clinical laboratories duly authorized under this
12 chapter shall possess the qualifications established by the public
13 health and health planning council for approval by the state commission-
14 er of health or, in the city of New York, the qualifications approved by
15 the board of health of said city and shall maintain the standards of
16 work required for such approval.
17 § 2. Section 13-g of the workers' compensation law, as added by chap-
18 ter 258 of the laws of 1935, subdivision 1 as amended by chapter 674 of
19 the laws of 1994, subdivisions 2 and 3 as amended by section 4 of part
20 GG of chapter 57 of the laws of 2013, subdivision 4 as amended by
21 section 3 of part D of chapter 55 of the laws of 2015, subdivision 5 as
22 amended by chapter 578 of the laws of 1959 and subdivision 6 as amended
23 by chapter 639 of the laws of 1996, is amended to read as follows:
24 § 13-g. Payment of bills for medical care. (1) Within forty-five days
25 after a bill for medical care or supplies delivered pursuant to section
26 thirteen of this article has been rendered to the employer [by the
27 hospital, physician or self-employed physical or occupational therapist
28 who has rendered treatment pursuant to a referral from the injured
29 employee's authorized physician or authorized podiatrist for treatment
30 to the injured employee], such employer must pay the bill or notify the
31 [hospital, physician or self-employed physical or occupational therapist
32 in writing] medical care provider or supplier in the format prescribed
33 by the chair that the bill is not being paid and explain the reasons for
34 non-payment. In the event that the employer fails to make payment or
35 notify the [hospital, physician or self-employed physical or occupa-
36 tional therapist] medical care provider or supplier within such forty-
37 five day period that payment is not being made, the [hospital, physi-
38 cian, self-employed physical therapist or self-employed occupational
39 therapist] medical care provider or supplier may notify the board in the
40 format prescribed by the chair [in writing] that the bill has not been
41 paid and request that the board make an award for payment of such bill.
42 The board or the chair may make an award not in excess of the estab-
43 lished fee schedules for any such bill or part thereof which remains
44 unpaid after said forty-five day period or thirty days after all other
45 questions duly and timely raised in accordance with the provisions of
46 this chapter, relating to the employer's liability for the payment of
47 such amount, shall have been finally determined adversely to the employ-
48 er, whichever is later, in accordance with rules promulgated by the
49 chair, and such award may be collected in like manner as an award of
50 compensation. The chair shall assess the sum of fifty dollars against
51 the employer for each such award made by the board, which sum shall be
52 paid into the state treasury.
53 In the event that the employer has provided an explanation in writing
54 why the bill has not been paid, in part or in full, within the aforesaid
55 time period, and the parties can not agree as to the value of medical
56 aid rendered under this chapter, such value shall be decided by arbi-
A. 8387--C 7
1 tration [if requested by the hospital, physician or self-employed phys-
2 ical or occupational therapist, in accordance with the provisions of
3 subdivision two or subdivision three of this section, as appropriate,
4 and] as set forth in rules and regulations promulgated by the chair.
5 Where a [physician, physical or occupational therapist] bill for
6 medical care or supplies has been determined to be due and owing in
7 accordance with the provisions of this section the board shall include
8 in the amount of the award interest of not more than one and one-half
9 [per cent] percent (1 1/2%) per month payable to the [physician, phys-
10 ical or occupational therapist] medical care provider or supplier, in
11 accordance with the rules and regulations promulgated by the board.
12 Interest shall be calculated from the forty-fifth day after the bill was
13 rendered or from the thirtieth day after all other questions duly and
14 timely raised in accordance with the provisions of this chapter, relat-
15 ing to the employer's liability for the payment of such amount, shall
16 have been finally determined adversely to the employer, whichever is
17 later, in accordance with rules promulgated by the chair.
18 (2) (a) If the parties fail to agree to the value of medical aid
19 rendered under this chapter and the amount of the disputed bill is one
20 thousand dollars or less, or if the amount of the disputed medical bill
21 exceeds one thousand dollars and the [health] medical care provider or
22 supplier expressly so requests, such value shall be decided by a single
23 arbitrator process, pursuant to rules promulgated by the chair. [The
24 chair shall appoint a physician who is a member in good standing of the
25 medical society of the state of New York to determine the value of such
26 disputed medical bill. Where the physician whose charges are being
27 arbitrated is a member in good standing of the New York osteopathic
28 society, the value of such disputed bill shall be determined by a member
29 in good standing of the New York osteopathic society appointed by the
30 chair. Where the physician whose charges are being arbitrated is a
31 member in good standing of the New York homeopathic society, the value
32 of such disputed bill shall be determined by a member in good standing
33 of the New York homeopathic society appointed by the chair. Where the
34 value of physical therapy services or occupational therapy services is
35 at issue, such value shall be determined by a member in good standing of
36 a recognized professional association representing its respective
37 profession in the state of New York appointed by the chair.] Decisions
38 rendered under the single arbitrator process shall be conclusive upon
39 the parties as to the value of the services in dispute.
40 (b) If the parties fail to agree as to the value of medical aid
41 rendered under this chapter and the amount of the disputed bill exceeds
42 one thousand dollars, such value shall be decided by an arbitration
43 committee unless the [health] medical care provider or supplier express-
44 ly requests a single arbitrator process in accordance with paragraph (a)
45 of this subdivision. The arbitration committee shall [consist of one
46 physician designated by the president of the medical society of the
47 county in which the medical services were rendered, one physician who is
48 a member of the medical society of the state of New York, appointed by
49 the employer or carrier, and one physician, also a member of the medical
50 society of the state of New York, appointed by the chair of the workers'
51 compensation board. If the physician whose charges are being arbitrated
52 is a member in good standing of the New York osteopathic society or the
53 New York homeopathic society, the members of such arbitration committee
54 shall be physicians of such organization, one to be appointed by the
55 president of that organization, one by the employer or carrier and the
56 third by the chair of the workers' compensation board. Where the value
A. 8387--C 8
1 of physical therapy services is at issue and the amount of the disputed
2 bill exceeds one thousand dollars, the arbitration committee shall
3 consist of a member in good standing of a recognized professional asso-
4 ciation representing physical therapists in the state of New York
5 appointed by the president of such organization, a physician designated
6 by the employer or carrier and a physician designated by the chair of
7 the workers' compensation board provided however, that the chair finds
8 that there are a sufficient number of physical therapy arbitrations in a
9 geographical area comprised of one or more counties to warrant a commit-
10 tee so comprised. In all other cases where the value of physical therapy
11 services is at issue and the amount of the disputed bill exceeds one
12 thousand dollars, the arbitration committee shall be similarly selected
13 and identical in composition, provided that the physical therapist
14 member shall serve without remuneration, and provided further that in
15 the event a physical therapist is not available, the committee shall be
16 comprised of three physicians designated in the same manner as in cases
17 where the value of medical aid is at issue.
18 (c) Where the value of occupational therapy services is at issue the
19 arbitration committee shall consist of a member in good standing of a
20 recognized professional association representing occupational therapists
21 in the state of New York appointed by the president of such organiza-
22 tion; a physician designated by the employer or carrier and a physician
23 designated by the chair of the workers' compensation board provided,
24 however, that the chair finds that there are a sufficient number of
25 occupational therapy arbitrations in a geographical area comprised of
26 one or more counties to warrant a committee so comprised. In all other
27 cases where the value of occupational therapy services is at issue and
28 the amount of the disputed bill exceeds one thousand dollars, the arbi-
29 tration committee shall be similarly selected and identical in composi-
30 tion, provided that the occupational therapist member shall serve with-
31 out remuneration, and provided further that in the event an occupational
32 therapist is not available, the committee shall be comprised of three
33 physicians designated in the same manner as in cases where the value of
34 medical aid is at issue.] have three members designated by the chair in
35 consultation with the medical director's office of the workers' compen-
36 sation board. The majority decision of any such arbitration committee
37 shall be conclusive upon the parties as to the value of the services in
38 dispute.
39 (3) [(a) If an employer shall have notified the hospital in writing,
40 as provided in subdivision one of this section, why the bill has not
41 been paid, in part or in full, and the amount of the disputed bill is
42 one thousand dollars or less, or where the amount of the disputed
43 medical bill exceeds one thousand dollars and the hospital expressly so
44 requests, such value shall be decided by a single arbitrator process,
45 pursuant to rules promulgated by the chair. The chair shall appoint a
46 physician in good standing licensed to practice in New York state to
47 determine the value of such disputed bill. Decisions rendered under the
48 administrative resolution procedure shall be conclusive upon the parties
49 as to the value of the services in dispute.
50 (b) If an employer shall have notified the hospital in writing, as
51 provided in subdivision one of this section, why the bill has not been
52 paid, in part or in full, and the amount of the disputed bill exceeds
53 one thousand dollars, the value of such bill shall be determined by an
54 arbitration committee appointed by the chair for that purpose, which
55 committee shall consider all of the charges of the hospital, unless the
56 hospital expressly requests a single arbitrator process pursuant to
A. 8387--C 9
1 paragraph (a) of this subdivision. The committee shall consist of three
2 physicians. One member of the committee may be nominated by the chair
3 upon recommendation of the president of the hospital association of New
4 York state and one member may be nominated by the employer or insurance
5 carrier. The majority decision of any such committee shall be conclusive
6 upon the parties as to the value of the services rendered. The chair may
7 make reasonable rules and regulations consistent with the provisions of
8 this section.
9 (4)] A provider or supplier initiating an arbitration, including a
10 single arbitrator process, pursuant to this section shall not pay a fee
11 to cover the costs related to the conduct of such arbitration. [Each
12 member of an arbitration committee for medical bills, and each member of
13 an arbitration committee for hospital bills shall be entitled to receive
14 and shall be paid a fee for each day's attendance at an arbitration
15 session in any one count in an amount fixed by the chair of the workers'
16 compensation board.
17 (5)] (4) In claims where the employer has failed to secure compen-
18 sation to his employees as required by section fifty of this chapter,
19 the board may make an award for the value of medical [and podiatry]
20 services, supplies or treatment rendered to such employees, in accord-
21 ance with the schedules of fees and charges prepared and established
22 under the provisions of [section thirteen, subdivision a, and section
23 thirteen-k, subdivision two, of] this chapter[, and for the reasonable
24 value of hospital care in accordance with the charges currently in force
25 in hospitals in the same community for cases coming within the
26 provisions of this chapter]. Such award shall be made to the [physician,
27 podiatrist, or hospital] medical care provider or supplier entitled
28 thereto. A default in the payment of such award may be enforced in the
29 manner provided for the enforcement of compensation awards as set forth
30 in section twenty-six of this [chapter] article.
31 In all cases coming under this subdivision the payment of the claim
32 [of the physician, podiatrist, or hospital for medical, podiatry, or
33 surgical services or treatment] for medical care or supplies shall be
34 subordinate to that of the claimant or his or her beneficiaries.
35 [(6) Notwithstanding any inconsistent provision of law, arbitration
36 regarding payments for inpatient hospital services for any patient
37 discharged on or after January first, nineteen hundred ninety-one and
38 prior to December thirty-first, nineteen hundred ninety-six shall be
39 resolved in accordance with paragraph (d) of subdivision three of
40 section twenty-eight hundred seven-c of the public health law.]
41 § 3. Subdivisions 1 and 2 and paragraph (b) of subdivision 3 of
42 section 13-k of the workers' compensation law, subdivision 1 as added by
43 chapter 787 of the laws of 1952 and subdivision 2 and paragraph (b) of
44 subdivision 3 as amended by chapter 473 of the laws of 2000, are amended
45 to read as follows:
46 1. When the term "chairman" is hereinafter used, it shall be deemed to
47 mean the [chairman] chair of the [workmen's] workers' compensation board
48 of the state of New York.
49 2. An employee injured under circumstances which make such injury
50 compensable under this article, when care is required for an injury to
51 the foot which injury or resultant condition therefrom may lawfully be
52 treated by a duly registered and licensed podiatrist of the state of New
53 York, may select to treat him or her any podiatrist authorized by the
54 chair to render [podiatry] podiatric medical care, as hereinafter
55 provided. If the injury or condition is one which is without the limits
56 prescribed by the education law for [podiatry] podiatric medical care
A. 8387--C 10
1 and treatment, or the injuries involved affect other parts of the body
2 in addition to the foot, the said podiatrist must so advise the said
3 injured employee and instruct him or her to consult a physician of said
4 employee's choice for appropriate care and treatment. Such physician
5 shall thenceforth have overall supervision of the treatment of said
6 patient including the future treatment to be administered to the patient
7 by the podiatrist. If for any reason during the period when [podiatry]
8 podiatric medical treatment and care is required, the employee wishes to
9 transfer his or her treatment and care to another authorized podiatrist
10 he or she may do so, in accordance with rules prescribed by the chair,
11 provided however that the employer shall be liable for the proper fees
12 of the original podiatrist for the care and treatment he or she shall
13 have rendered. [A podiatrist licensed and registered to practice podia-
14 try in the state of New York who is desirous of being authorized to
15 render podiatry care under this section and/or to conduct independent
16 medical examinations in accordance with paragraph (b) of subdivision
17 three of this section shall file an application for authorization under
18 this section with the podiatry practice committee. In such application
19 he or she shall agree to refrain from subsequently treating for remuner-
20 ation, as a private patient, any person seeking podiatry treatment, or
21 submitting to an independent medical examination, in connection with, or
22 as a result of, any injury compensable under this chapter, if he or she
23 has been removed from the list of podiatrists authorized to render
24 podiatry care or to conduct independent medical examinations under this
25 chapter, or if the person seeking such treatment has been transferred
26 from his or her care in accordance with the provisions of this section.
27 This agreement shall run to the benefit of the injured person so treated
28 or examined, and shall be available to him or her as a defense in any
29 action by such podiatrist for payment for treatment rendered by a podia-
30 trist after he or she has been removed from the list of podiatrists
31 authorized to render podiatry care or to conduct independent medical
32 examinations under this section, or after the injured person was trans-
33 ferred from his or her care in accordance with the provisions of this
34 section. The podiatry practice committee if it deems such licensed
35 podiatrist duly qualified shall recommend to the chair that such podia-
36 trist be authorized to render podiatry care and/or to conduct independ-
37 ent medical examinations under this section. Such recommendation shall
38 be advisory to the chair only and shall not be binding or conclusive
39 upon him or her.] The chair shall prepare and establish a schedule for
40 the state, or schedules limited to defined localities, of charges and
41 fees for [podiatry] podiatric medical treatment and care, to be deter-
42 mined in accordance with and to be subject to change pursuant to rules
43 promulgated by the chair. Before preparing such schedule for the state
44 or schedules for limited localities the chair shall request the [podia-
45 try] podiatric medicine practice committee to submit to him or her a
46 report on the amount of remuneration deemed by such committee to be fair
47 and adequate for the types of [podiatry] podiatric medical care to be
48 rendered under this chapter, but consideration shall be given to the
49 view of other interested parties. The amounts payable by the employer
50 for such treatment and services shall be the fees and charges estab-
51 lished by such schedule.
52 (b) Upon receipt of the notice provided for by paragraph (a) of this
53 subdivision, the employer, the carrier and the claimant each shall be
54 entitled to have the claimant examined by a qualified podiatrist author-
55 ized by the chair in accordance with [subdivision two of this] section
56 thirteen-b and section one hundred thirty-seven of this chapter, at a
A. 8387--C 11
1 medical facility convenient to the claimant and in the presence of the
2 claimant's podiatrist, and refusal by the claimant to submit to such
3 independent medical examination at such time or times as may reasonably
4 be necessary in the opinion of the board shall bar the claimant from
5 recovering compensation for any period during which he or she has
6 refused to submit to such examination.
7 § 4. Subdivisions 1 and 2 and paragraph (b) of subdivision 3 of
8 section 13-l of the workers' compensation law, subdivision 1 as added by
9 chapter 940 of the laws of 1973 and subdivision 2 and paragraph (b) of
10 subdivision 3 as amended by chapter 473 of the laws of 2000, are amended
11 to read as follows:
12 1. Where the term "chairman" is hereinafter used, it shall be deemed
13 to mean the [chairman] chair of the [workmen's] workers' compensation
14 board of the state of New York.
15 2. An employee injured under circumstances which make such injury
16 compensable under this article, when care is required for an injury
17 which consists solely of a condition which may lawfully be treated by a
18 chiropractor as defined in section sixty-five hundred fifty-one of the
19 education law may select to treat him or her, any duly registered and
20 licensed chiropractor of the state of New York, authorized by the chair
21 to render chiropractic care as hereinafter provided. If the injury or
22 condition is one which is outside the limits prescribed by the education
23 law for chiropractic care and treatment, the said chiropractor must so
24 advise the said injured employee and instruct him or her to consult a
25 physician of said employee's choice for appropriate care and treatment.
26 Such physician shall thenceforth have supervision of the treatment of
27 said condition including the future treatment to be administered to the
28 patient by the chiropractor. [A chiropractor licensed and registered to
29 practice chiropractic in the state of New York, who is desirous of being
30 authorized to render chiropractic care under this section and/or to
31 conduct independent medical examinations in accordance with paragraph
32 (b) of subdivision three of this section shall file an application for
33 authorization under this section with the chiropractic practice commit-
34 tee. In such application he or she shall agree to refrain from subse-
35 quently treating for remuneration, as a private patient, any person
36 seeking chiropractic treatment, or submitting to an independent medical
37 examination, in connection with, or as a result of, any injury compensa-
38 ble under this chapter, if he or she has been removed from the list of
39 chiropractors authorized to render chiropractic care or to conduct inde-
40 pendent medical examinations under this chapter, or if the person seek-
41 ing such treatment has been transferred from his or her care in accord-
42 ance with the provisions of this section. This agreement shall run to
43 the benefit of the injured person so treated, or examined, and shall be
44 available to him or her as a defense in any action by such chiropractor
45 for payment rendered by a chiropractor after he or she has been removed
46 from the list of chiropractors authorized to render chiropractic care or
47 to conduct independent medical examinations under this section, or after
48 the injured person was transferred from his or her care in accordance
49 with the provisions of this section. The chiropractic practice committee
50 if it deems such licensed chiropractor duly qualified shall recommend to
51 the chair that such be authorized to render chiropractic care and/or to
52 conduct independent medical examinations under this section. Such recom-
53 mendations shall be advisory to the chair only and shall not be binding
54 or conclusive upon him or her.] The chair shall prepare and establish a
55 schedule for the state, or schedules limited to defined localities of
56 charges and fees for chiropractic treatment and care, to be determined
A. 8387--C 12
1 in accordance with and to be subject to change pursuant to rules promul-
2 gated by the chair. Before preparing such schedule for the state or
3 schedules for limited localities the chair shall request the chiroprac-
4 tic practice committee to submit to him or her a report on the amount of
5 remuneration deemed by such committee to be fair and adequate for the
6 types of chiropractic care to be rendered under this chapter, but
7 consideration shall be given to the view of other interested parties,
8 the amounts payable by the employer for such treatment and services
9 shall be the fees and charges established by such schedule.
10 (b) Upon receipt of the notice provided for by paragraph (a) of this
11 subdivision, the employer, the carrier, and the claimant each shall be
12 entitled to have the claimant examined by a qualified chiropractor
13 authorized by the chair in accordance with [subdivision two of this]
14 section thirteen-b and section one hundred thirty-seven of this chapter
15 at a medical facility convenient to the claimant and in the presence of
16 the claimant's chiropractor, and refusal by the claimant to submit to
17 such independent medical examination at such time or times as may
18 reasonably be necessary in the opinion of the board shall bar the claim-
19 ant from recovering compensation, for any period during which he or she
20 has refused to submit to such examination.
21 § 5. Subdivisions 1, 2 and 3 and paragraph (b) of subdivision 4 of
22 section 13-m of the workers' compensation law, subdivisions 1 and 2 as
23 added by chapter 589 of the laws of 1989 and subdivision 3 and paragraph
24 (b) of subdivision 4 as amended by chapter 473 of the laws of 2000, are
25 amended to read as follows:
26 1. Where the term "chairman" is hereinafter used, it shall be deemed
27 to mean the [chairman] chair of the workers' compensation board of the
28 state of New York.
29 2. (a) An injured employee, injured under circumstances which make
30 such injury compensable under this article, may lawfully be treated[,
31 upon the referral of an authorized physician,] by a psychologist, duly
32 registered and licensed by the state of New York, authorized by the
33 [chairman] chair to render psychological care pursuant to [this] section
34 thirteen-b of this article. Such services shall be within the scope of
35 such psychologist's specialized training and qualifications as defined
36 in article one hundred fifty-three of the education law.
37 (b) Medical bureaus, medical centers jointly operated by labor and
38 management representatives, hospitals and health maintenance organiza-
39 tions, authorized to provide medical care pursuant to section thirteen-c
40 of this [chapter] article, may provide psychological services when
41 required[, upon the referral of an authorized physician, provided such
42 care is rendered by a duly registered, licensed and authorized psychol-
43 ogist, as required by this section].
44 (c) A psychologist rendering service pursuant to this section shall
45 maintain records of the patient's psychological condition and treatment,
46 and such records or reports shall be submitted to the [chairman] chair
47 on such forms and at such times as the [chairman] chair may require.
48 3. [A psychologist, licensed and registered to practice psychology in
49 the state of New York, who is desirous of being authorized to render
50 psychological care under this section and/or to conduct independent
51 medical examinations in accordance with paragraph (b) of subdivision
52 four of this section shall file an application for authorization under
53 this section with the psychology practice committee. The applicant shall
54 agree to refrain from subsequently treating for remuneration, as a
55 private patient, any person seeking psychological treatment, or submit-
56 ting to an independent medical examination, in connection with, or as a
A. 8387--C 13
1 result of, any injury compensable under this chapter, if he or she has
2 been removed from the list of psychologists authorized to render psycho-
3 logical care under this chapter. This agreement shall run to the benefit
4 of the injured person so treated, and shall be available as a defense in
5 any action by such psychologist for payment for treatment rendered by
6 such psychologist after being removed from the list of psychologists
7 authorized to render psychological care or to conduct independent
8 medical examinations under this section. The psychology practice commit-
9 tee if it deems such licensed psychologist duly qualified shall recom-
10 mend to the chair that such person be authorized to render psychological
11 care and/or to conduct independent medical examinations under this
12 section. Such recommendations shall be only advisory to the chair and
13 shall not be binding or conclusive.] The chair shall prepare and estab-
14 lish a schedule for the state or schedules limited to defined localities
15 of charges and fees for psychological treatment and care, to be deter-
16 mined in accordance with and be subject to change pursuant to rules
17 promulgated by the chair. Before preparing such schedule for the state
18 or schedules for limited localities the chair shall request the psychol-
19 ogy practice committee to submit to such chair a report on the amount of
20 remuneration deemed by such committee to be fair and adequate for the
21 types of psychological care to be rendered under this chapter, but
22 consideration shall be given to the view of other interested parties.
23 The amounts payable by the employer for such treatment and services
24 shall be the fees and charges established by such schedule.
25 (b) Upon receipt of the notice provided for by paragraph (a) of this
26 subdivision, the employer, the carrier, and the claimant each shall be
27 entitled to have the claimant examined by a qualified psychologist,
28 authorized by the chair in accordance with [subdivision three of this]
29 section thirteen-b and section one hundred thirty-seven of this chapter,
30 at a medical facility convenient to the claimant and in the presence of
31 the claimant's psychologist, and refusal by the claimant to submit to
32 such independent medical examination at such time or times as may
33 reasonably be necessary in the opinion of the board shall bar the claim-
34 ant from recovering compensation, for any period during which he or she
35 has refused to submit to such examination.
36 § 6. Section 54-b of the workers' compensation law, as amended by
37 chapter 6 of the laws of 2007, is amended to read as follows:
38 § 54-b. Enforcement on failure to pay award or judgment. In case of
39 default by a carrier or self-insured employer in the payment of any
40 compensation due under an award for the period of thirty days after
41 payment is due and payable, or in the case of failure by a carrier or
42 self-insured employer to make full payment of an award for medical care
43 or supplies issued by the board or the chair pursuant to section thir-
44 teen-g of this chapter, the chair in any such case or on the chair's
45 consent any party to an award may file with the county clerk for the
46 county in which the injury occurred or the county in which the carrier
47 or self-insured employer has his or her principal place of business, (1)
48 a certified copy of the decision of the board awarding compensation or
49 ending, diminishing or increasing compensation previously awarded, from
50 which no appeal has been taken within the time allowed therefor, or if
51 an appeal has been taken by a carrier or self-insured employer who has
52 not complied with the provisions of section fifty of this article, where
53 he or she fails to deposit with the chair the amount of the award as
54 security for its payment within ten days after the same is due and paya-
55 ble, or (2) a certified copy of the award for medical care or supplies
56 issued pursuant to section thirteen-g of this chapter, and thereupon
A. 8387--C 14
1 judgment must be entered in the supreme court by the clerk of such coun-
2 ty in conformity therewith immediately upon such filing. If the payment
3 in default be an installment, the board may declare the entire award due
4 and judgment may be entered in accordance with the provisions of this
5 section. Such judgment shall be entered in the same manner, have the
6 same effect and be subject to the same proceedings as though rendered in
7 a suit duly heard and determined by the supreme court, except that no
8 appeal may be taken therefrom. The court shall vacate or modify such
9 judgment to conform to any later award or decision of the board upon
10 presentation of a certified copy of such award or decision. The award
11 may be so compromised by the board as in the discretion of the board may
12 best serve the interest of the persons entitled to receive the compen-
13 sation or benefits. Where an award has been made against a carrier or
14 self-insured employer in accordance with the provisions of subdivision
15 nine of section fifteen, or of section twenty-five-a of this chapter,
16 such an award may be similarly compromised by the board, upon notice to
17 a representative of the fund to which the award is payable, but if there
18 be no representative of any such fund, notice shall be given to such
19 representative as may be designated by the chair of the board; and
20 notwithstanding any other provision of law, such compromise shall be
21 effective without the necessity of any approval by the state comp-
22 troller. Neither the chair nor any party in interest shall be required
23 to pay any fee to any public officer for filing or recording any paper
24 or instrument or for issuing a transcript of any judgment executed in
25 pursuance of this section. The carrier or self-insured employer shall be
26 liable for all costs and attorneys fees necessary to enforce the award.
27 For the purposes of this section, the term "carrier" shall include the
28 state insurance fund and any stock corporation, mutual corporation or
29 reciprocal insurer authorized to transact the business of workers'
30 compensation insurance in this state.
31 § 7. This act shall take effect on the ninetieth day after it shall
32 have become a law.
