N.Y. Workers’ Comp Board Seeks Changes to Medical Treatment Guidelines

November 19, 2012

The New York State Workers’ Compensation Board has proposed new regulations to improve the medical treatment guidelines adopted in 2010. The proposed regulations, announced last week, aim to expedite the best medical care for injured workers and reduce medical costs.

In 2010, the Board implemented medical treatment guidelines that pre-authorize appropriate evidence-based treatment for the neck, back, shoulder, and knee. Providers can request a variance from the guidelines with proof that treating outside of the guidelines will aid the worker’s recovery.

Although the initial regulations were effective in reducing unnecessary treatment, the process became burdened with duplicate requests and hearings to resolve disputes, the Board said.

The Board noted that, through discussions with various stakeholders, it identified opportunities for improvement and simplification that will reduce the administrative burden on providers and payers while maintaining control over inappropriate utilization.

The proposed changes would:

• Adopt guidelines for the treatment of carpal tunnel syndrome;
• Allow more disputes to be decided by the Board’s medical director;
• Define clear criteria and limitations for the utilization of maintenance treatment such as chiropractic care and physical therapy; and
• Simplify and improve administrative process and procedures.

The proposed regulations will require a formal 45-day comment period before becoming effective. If the comment period requires no substantive changes to the regulations, they will become effective February 1, 2013.

“These improvements, crafted from discussions with our stakeholders and two years of experience with medical guidelines, will simplify process, reduce friction costs, curb inappropriate care, and improve medical outcomes,” Board Executive Director Jeffrey Fenster said.

 

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