Chairman Beloten Announces New Medical Treatment Guidelines for Workers’ Compensation

After continued conversations and meetings with the New York State Workers' Compensation Board, we are now able to confirm updates to the Medical Treatment Guidelines.

Effective February 1, 2013, regulatory changes will be made to the Medical Treatment Guidelines [MTGs] allowing for, among other things, maintenance care for chronic back and neck pain.  This is exciting news indeed!

Regulatory modifications to the MTGs include the following:
  • The new Carpal Tunnel Syndrome MTGs have formally been adopted. 
  • A new maintenance care program has also been adopted, allowing up to 10 visits per year for chronic pain for patients who have reached maximum medical improvement (MMI) and have a permanent disability. 
  • Variance Request transmission requirements are being clarified and simplified in order to reduce the number of technical violation rejections. Details regarding these changes will be released as they become available. 
  • Carriers are now permitted to grant a portion of a variance request. Providers and patients will have the right to request a review of any denied portion of the request. This new allowance provides an opportunity for providers and carriers to reach a compromise, resulting in a reduction in unnecessary litigation due to complete denials. 
It has been noted that, by far, the majority of variance requests (nearly 80%) submitted by providers have been for maintenance care for patients with chronic pain. The Medical Advisory Committee (MAC) continues to develop a chronic pain MTG. In the meantime, the MAC has agreed that some maintenance care (including chiropractic, physical therapy, and occupational therapy) should be available to patients with chronic pain who have received benefit from such treatment in the past. 

Accordingly, the revised MTGs will allow for up to 10 visits for maintenance care per year for patients who have reached maximum medical improvement (MMI) and have a permanent disability. These guidelines will apply to all claims effective February 1, 2013, regardless of the date of accident or the date of disablement.

Additional clarification is expected regarding the definition of “10 visits” (i.e. multiple body sites, CPT codes, and multiple provider types).  However, this is a move in the right direction and is a welcome change to the way workers’ compensation claims are currently administrated.

It is clear how beneficial these changes will be for injured workers and their providers:  The need for variance requests will be minimized or even eliminated for many patients; Employed patients will not have to lose time from work to attend hearings on denied requests; Recurrences of symptoms and exacerbations will be minimized, resulting in a better quality of life for our patients.

We anticipate that the Workers’ Compensation Board will continue to have open dialogue with the NYSCA and other vested organizations as we work together to serve the best interests of our patients and providers.

For more information, please see the official website of the New York State Workers Compensation Board:  http://www.wcb.ny.gov/content/main/SubjectNos/sn046_497.jsp

 

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