Bill Text: NY S06349 | 2017-2018 | General Assembly | Introduced
Bill Title: Extends the workers' compensation board's authority to resolve medical bill disputes and simplify the process.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2018-01-03 - REFERRED TO LABOR [S06349 Detail]
Download: New_York-2017-S06349-Introduced.html
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 the8county in which the physician's office is located or of a board desig-9nated by such county society or of a board representing duly licensed10physicians of any other school of medical practice in such county, the11chair may authorize physicians licensed to practice medicine in the12state of New York to render medical care under this chapter and to13perform independent medical examinations in accordance with subdivision14four of section thirteen-a of this article. If, within sixty days after15the chair requests such recommendations the medical society of such16county or board fails to act, or if there is no such society in such17county, the chair shall designate a board of three outstanding physi-18cians, who shall make the requisite recommendations.19No such authorization shall be made in the absence of a recommendation20of the appropriate society or board or of a review and recommendation by21the medical appeals unit. No person shall render medical care or conduct22independent medical examinations under this chapter without such author-23ization by the chair, provided, that:EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10066-01-7S. 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 inS. 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 any17hospital] 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 an31authorized physician physical therapy care may be rendered by a duly32licensed physical therapist. Where physical therapy care is rendered33records of the patient's condition and progress, together with records34of instruction for treatment, if any, shall be maintained by the phys-35ical therapist and physician. Said records shall be submitted to the36chair on such forms and at such times as the chair may require.37(e) Upon the prescription or referral of an authorized physician occu-38pational therapy care may be rendered by a duly licensed occupational39therapist. Where occupational therapy care is rendered records of the40patient's condition and progress, together with records of instruction41for treatment, if any shall be maintained by the occupational therapist42and physician. Said records shall be submitted to the chair on forms and43at 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 orS. 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 York14who 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 an20application for authorization under this chapter with the medical socie-21ty in the county in which his or her office is located, or with a board22designated by such society, or with a board designated by the chair as23provided in this section. In such application the applicant shall state24his or her training and qualifications, and shall agree to limit his or25her professional activities under this chapter to such medical care and26independent medical examinations, as his or her experience and training27qualify him or her to render. The applicant shall further agree to28refrain] 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 medical47society or the board designated by it, or the board as otherwise48provided under this section, if it deems such licensed physician duly49qualified, shall recommend to the chair that such physician be author-50ized to render medical care and/or conduct independent medical examina-51tions under this chapter, and such recommendation and authorization52shall specify the character of the medical care or independent medical53examination which such physician is qualified and authorized to render54under this chapter. Such recommendations shall be advisory to the chair55only and shall not be binding or conclusive upon him or her. The56licensed physician may present to the medical society or board,S. 6349 5 1evidences of additional qualifications at any time subsequent to his or2her original application. If the medical society or board fails to3recommend to the chair that a physician be authorized to render medical4care and/or to conduct independent medical examinations under this chap-5ter, the physician may appeal to the medical appeals unit. The medical6society or the board designated by it, or the board as otherwise7provided under this section, may upon its own initiative, or shall upon8request of the chair, review at any time the qualifications of any9physician as to the character of the medical care or independent medical10examinations which such physician has theretofore been authorized to11render under this chapter and may recommend to the chair that such12physician be authorized to render medical care or to conduct independent13medical examinations thereafter of the character which such physician is14then qualified to render. On such advisory recommendation the chair may15review and after reasonable investigation may revise the authorization16of a physician in respect to the character of medical care and/or to17conduct independent medical examinations which he or she is authorized18to render. If the medical society or board recommends to the chair that19a physician be authorized to render medical care and/or to conduct inde-20pendent medical examinations under this chapter of a character different21from the character of medical care or independent medical examinations22he or she has been theretofore authorized to render, such physician may23appeal from such recommendation to the medical appeals unit.243.] 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-28cians 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's46office is located at the time or a board designated by such county soci-47ety or a board representing duly licensed physicians of any other school48of medical practice in such county shall investigate, hear and make49findings with respect to all charges as to professional or other miscon-50duct of any authorized physician as herein provided under rules and51procedure to be prescribed by the medical appeals unit, and shall report52evidence of such misconduct, with their findings and recommendation with53respect thereto, to the chair. Failure to commence such investigation54within sixty days from the date the charges are referred to the society55by the chair or submit findings and recommendations relating to the56charges within one hundred eighty days from the date the charges areS. 6349 6 1referred shall empower the chair to appoint, as a hearing officer, a2member of the board, employee, or other qualified hearing officer to3hear and report on the charges to the chair. A qualified hearing offi-4cer, who is neither a member of the board, or employee thereof shall be5paid at a reasonable per diem rate to be fixed by the chair.6Such investigation, hearing, findings, recommendation and report may7be made by the society or board of an adjoining county upon the request8of the medical society of the county in which the alleged misconduct or9infraction of this chapter occurred, subject to the time limit and10conditions set forth herein. The medical appeals unit shall review the11findings and recommendation of such medical society or board, or hearing12officer appointed by the chair upon application of the accused physician13and may reopen the matter and receive further evidence. The findings,14decision and recommendation of such society, board or hearing officer15appointed by the chair or medical appeals unit shall be advisory to the16chair only, and shall not be binding or conclusive upon him or her.172.] 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 any22physician 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 his39or her qualifications in his or her application for the recommendation40of the medical society or board as provided in section thirteen-b of41this 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; orS. 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 this9chapter] agreement; or 10 (g) has directly or indirectly [requested, received or participated in11the division, transference, assignment, rebating, splitting or refunding12of a fee for, or has directly or indirectly requested, received or prof-13ited by means of a credit or other valuable consideration as a commis-14sion, discount or gratuity in connection with the furnishing of medical15or surgical care, an independent medical examination, diagnosis or16treatment or service, including X-ray examination and treatment, or for17or in connection with the sale, rental, supplying or furnishing of clin-18ical laboratory services or supplies, X-ray laboratory services or19supplies, inhalation therapy service or equipment, ambulance service,20hospital or medical supplies, physiotherapy or other therapeutic service21or equipment, artificial limbs, teeth or eyes, orthopedic or surgical22appliances or supplies, optical appliances, supplies or equipment,23devices for aid of hearing, drugs, medication or medical supplies, or24any other goods, services or supplies prescribed for medical diagnosis,25care or treatment, under this chapter; except that reasonable payment,26not exceeding the technical component fee permitted in the medical fee27schedule, established under this chapter for X-ray examinations, diagno-28sis or treatment, may be made by a physician duly authorized as a roent-29genologist to any hospital furnishing facilities and equipment for such30examination, diagnosis or treatment, provided such hospital does not31also submit a charge for the same services. Nothing contained in this32paragraph shall prohibit such physicians who practice as partners, in33groups or as a professional corporation or as a university faculty prac-34tice corporation from pooling fees and moneys received, either by the35partnership, professional corporation, university faculty practice36corporation or group by the individual members thereof, for professional37services furnished by any individual professional member, or employee of38such partnership, corporation or group, nor shall the professionals39constituting the partnerships, corporations, or groups be prohibited40from sharing, dividing or apportioning the fees and moneys received by41them or by the partnership, corporation or group in accordance with a42partnership 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 who2aids another to violate or attempts to induce him to violate the3provisions of paragraph (g) of subdivision two of this section shall be4guilty 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 before15or after investigation by a medical society or board as herein provided,16or to temporarily suspend the authorization of any physician that he may17believe 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 investigation20with respect to charges of professional or other misconduct by a physi-21cian which results in a report, determination or consent order that22includes a finding of professional or other misconduct or incompetency23by such physician, the chair shall have full power and authority to24temporarily suspend, revoke or otherwise limit the authorization under25this chapter of any physician upon such finding by the department of26health that the physician has been guilty of professional or other27misconduct. The recommendations of the department of health shall be28advisory to the chair only and shall not be binding or conclusive upon29the 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 the40hospital, physician or self-employed physical or occupational therapist41who has rendered treatment pursuant to a referral from the injured42employee's authorized physician or authorized podiatrist for treatment43to the injured employee], such employer must pay the bill or notify the 44 [hospital, physician or self-employed physical or occupational therapist45in 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-49tional therapist] medical care provider or supplier within such forty- 50 five day period that payment is not being made, the [hospital, physi-51cian, self-employed physical therapist or self-employed occupational52therapist] 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 remainsS. 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-15ical or occupational therapist, in accordance with the provisions of16subdivision two or subdivision three of this section, as appropriate,17and] 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-23ical 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. [The37chair shall appoint a physician who is a member in good standing of the38medical society of the state of New York to determine the value of such39disputed medical bill. Where the physician whose charges are being40arbitrated is a member in good standing of the New York osteopathic41society, the value of such disputed bill shall be determined by a member42in good standing of the New York osteopathic society appointed by the43chair. Where the physician whose charges are being arbitrated is a44member in good standing of the New York homeopathic society, the value45of such disputed bill shall be determined by a member in good standing46of the New York homeopathic society appointed by the chair. Where the47value of physical therapy services or occupational therapy services is48at issue, such value shall be determined by a member in good standing of49a recognized professional association representing its respective50profession 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 singleS. 6349 10 1 arbitrator process in accordance with paragraph (a) of this subdivision. 2 The arbitration committee shall [consist of one physician designated by3the president of the medical society of the county in which the medical4services were rendered, one physician who is a member of the medical5society of the state of New York, appointed by the employer or carrier,6and one physician, also a member of the medical society of the state of7New York, appointed by the chair of the workers' compensation board. If8the physician whose charges are being arbitrated is a member in good9standing of the New York osteopathic society or the New York homeopathic10society, the members of such arbitration committee shall be physicians11of such organization, one to be appointed by the president of that12organization, one by the employer or carrier and the third by the chair13of the workers' compensation board. Where the value of physical therapy14services is at issue and the amount of the disputed bill exceeds one15thousand dollars, the arbitration committee shall consist of a member in16good standing of a recognized professional association representing17physical therapists in the state of New York appointed by the president18of such organization, a physician designated by the employer or carrier19and a physician designated by the chair of the workers' compensation20board provided however, that the chair finds that there are a sufficient21number of physical therapy arbitrations in a geographical area comprised22of one or more counties to warrant a committee so comprised. In all23other cases where the value of physical therapy services is at issue and24the amount of the disputed bill exceeds one thousand dollars, the arbi-25tration committee shall be similarly selected and identical in composi-26tion, provided that the physical therapist member shall serve without27remuneration, and provided further that in the event a physical thera-28pist is not available, the committee shall be comprised of three physi-29cians designated in the same manner as in cases where the value of30medical aid is at issue.31(c) Where the value of occupational therapy services is at issue the32arbitration committee shall consist of a member in good standing of a33recognized professional association representing occupational therapists34in the state of New York appointed by the president of such organiza-35tion; a physician designated by the employer or carrier and a physician36designated by the chair of the workers' compensation board provided,37however, that the chair finds that there are a sufficient number of38occupational therapy arbitrations in a geographical area comprised of39one or more counties to warrant a committee so comprised. In all other40cases where the value of occupational therapy services is at issue and41the amount of the disputed bill exceeds one thousand dollars, the arbi-42tration committee shall be similarly selected and identical in composi-43tion, provided that the occupational therapist member shall serve with-44out remuneration, and provided further that in the event an occupational45therapist is not available, the committee shall be comprised of three46physicians designated in the same manner as in cases where the value of47medical 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,53as provided in subdivision one of this section, why the bill has not54been paid, in part or in full, and the amount of the disputed bill is55one thousand dollars or less, or where the amount of the disputed56medical bill exceeds one thousand dollars and the hospital expressly soS. 6349 11 1requests, such value shall be decided by a single arbitrator process,2pursuant to rules promulgated by the chair. The chair shall appoint a3physician in good standing licensed to practice in New York state to4determine the value of such disputed bill. Decisions rendered under the5administrative resolution procedure shall be conclusive upon the parties6as to the value of the services in dispute.7(b) If an employer shall have notified the hospital in writing, as8provided in subdivision one of this section, why the bill has not been9paid, in part or in full, and the amount of the disputed bill exceeds10one thousand dollars, the value of such bill shall be determined by an11arbitration committee appointed by the chair for that purpose, which12committee shall consider all of the charges of the hospital, unless the13hospital expressly requests a single arbitrator process pursuant to14paragraph (a) of this subdivision. The committee shall consist of three15physicians. One member of the committee may be nominated by the chair16upon recommendation of the president of the hospital association of New17York state and one member may be nominated by the employer or insurance18carrier. The majority decision of any such committee shall be conclusive19upon the parties as to the value of the services rendered. The chair may20make reasonable rules and regulations consistent with the provisions of21this 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 an25arbitration committee for medical bills, and each member of an arbi-26tration committee for hospital bills shall be entitled to receive and27shall be paid a fee for each day's attendance at an arbitration session28in any one count in an amount fixed by the chair of the workers' compen-29sation 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 section36thirteen-k, subdivision two, of] this chapter[, and for the reasonable37value of hospital care in accordance with the charges currently in force38in hospitals in the same community for cases coming within the39provisions of this chapter]. Such award shall be made to the [physician,40podiatrist, 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, or46surgical 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, arbitration49regarding payments for inpatient hospital services for any patient50discharged on or after January first, nineteen hundred ninety-one and51prior to December thirty-first, nineteen hundred ninety-six shall be52resolved in accordance with paragraph (d) of subdivision three of53section 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-26tice podiatry in the state of New York who is desirous of being author-27ized to render podiatry care under this section and/or to conduct inde-28pendent medical examinations in accordance with paragraph (b) of29subdivision three of this section shall file an application for authori-30zation under this section with the podiatry practice committee. In such31application he or she shall agree to refrain from subsequently treating32for remuneration, as a private patient, any person seeking podiatry33treatment, or submitting to an independent medical examination, in34connection with, or as a result of, any injury compensable under this35chapter, if he or she has been removed from the list of podiatrists36authorized to render podiatry care or to conduct independent medical37examinations under this chapter, or if the person seeking such treatment38has been transferred from his or her care in accordance with the39provisions of this section. This agreement shall run to the benefit of40the injured person so treated or examined, and shall be available to him41or her as a defense in any action by such podiatrist for payment for42treatment rendered by a podiatrist after he or she has been removed from43the list of podiatrists authorized to render podiatry care or to conduct44independent medical examinations under this section, or after the45injured person was transferred from his or her care in accordance with46the provisions of this section. The podiatry practice committee if it47deems such licensed podiatrist duly qualified shall recommend to the48chair that such podiatrist be authorized to render podiatry care and/or49to conduct independent medical examinations under this section. Such50recommendation shall be advisory to the chair only and shall not be51binding 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 theS. 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 to51practice chiropractic in the state of New York, who is desirous of being52authorized to render chiropractic care under this section and/or to53conduct independent medical examinations in accordance with paragraph54(b) of subdivision three of this section shall file an application for55authorization under this section with the chiropractic practice commit-56tee. In such application he or she shall agree to refrain from subse-S. 6349 14 1quently treating for remuneration, as a private patient, any person2seeking chiropractic treatment, or submitting to an independent medical3examination, in connection with, or as a result of, any injury compensa-4ble under this chapter, if he or she has been removed from the list of5chiropractors authorized to render chiropractic care or to conduct inde-6pendent medical examinations under this chapter, or if the person seek-7ing such treatment has been transferred from his or her care in accord-8ance with the provisions of this section. This agreement shall run to9the benefit of the injured person so treated, or examined, and shall be10available to him or her as a defense in any action by such chiropractor11for payment rendered by a chiropractor after he or she has been removed12from the list of chiropractors authorized to render chiropractic care or13to conduct independent medical examinations under this section, or after14the injured person was transferred from his or her care in accordance15with the provisions of this section. The chiropractic practice committee16if it deems such licensed chiropractor duly qualified shall recommend to17the chair that such be authorized to render chiropractic care and/or to18conduct independent medical examinations under this section. Such recom-19mendations shall be advisory to the chair only and shall not be binding20or 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[,8upon 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 such19care is rendered by a duly registered, licensed and authorized psychol-20ogist, 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 in26the state of New York, who is desirous of being authorized to render27psychological care under this section and/or to conduct independent28medical examinations in accordance with paragraph (b) of subdivision29four of this section shall file an application for authorization under30this section with the psychology practice committee. The applicant shall31agree to refrain from subsequently treating for remuneration, as a32private patient, any person seeking psychological treatment, or submit-33ting to an independent medical examination, in connection with, or as a34result of, any injury compensable under this chapter, if he or she has35been removed from the list of psychologists authorized to render psycho-36logical care under this chapter. This agreement shall run to the benefit37of the injured person so treated, and shall be available as a defense in38any action by such psychologist for payment for treatment rendered by39such psychologist after being removed from the list of psychologists40authorized to render psychological care or to conduct independent41medical examinations under this section. The psychology practice commit-42tee if it deems such licensed psychologist duly qualified shall recom-43mend to the chair that such person be authorized to render psychological44care and/or to conduct independent medical examinations under this45section. Such recommendations shall be only advisory to the chair and46shall 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.
