NYSCA Responds to The New York State Workers Compensation Board’s “Proposed Medical Treatment Guidelines”

 

The New York State Workers Compensation Board released their “Proposed Medical Treatment Guidelines” on June 30, 2010.  The guidelines outlined treatment protocols for the neck, lower back, shoulder and knee.  These “Proposed Guidelines” are the product of several years of work on the part of the NYS WCB. A 45 day public comment period followed the release of the guidelines and ended on August 16, 2010.

The NYSCA has been monitoring the workers compensation reform process in New York over the past three years.  The organization took steps to plan for the anticipated changes to the system by forming a committee to monitor the changes, accumulate pertinent scientific literature, and attend conferences in an effort to gather information and to craft responses to the proposals as needed.  The committee met frequently over the last three years and reviewed thousands of pages of guidelines, scientific literature and proposals from the workers compensation board.  Additionally, the committee met personally with representatives of the NYS WCB on several occasions in an effort to influence the direction of the workers compensation reforms.  In fact, the WCB altered their original lower back recommendations based upon comments submitted by the NYSCA.

The NYSCA has received many inquiries regarding the content of the “Proposed Medical Treatment Guidelines” created by the NYS WCB.  The proposed guidelines can be found in their entirety on the NYS WCB website at the following link: http://www.wcb.state.ny.us/content/main/wclaws/Proposed/Proposed_Part324_325.jsp

The NYSCA Workers Compensation Committee has spent the six weeks of the official comment period creating a response to the NYS WCB.  The committee reviewed the recommendations and crafted a series of position statements regarding the NYS WCB’s proposal.  We are hopeful that the NYS WCB recognize the prudent suggestions of the NYSCA and will see fit to further modify their recommendations.  It is our view that the NYSCA treatment guidelines are more appropriate for the patients that are served by the chiropractic profession on behalf of the NYS Workers Compensation System.

 

At this time the NYS WCB will review all the documents, including those submitted by the NYSCA, that they have received during the official comment period.  They are to consider the recommendations that have been made and to then make further changes to the proposed guidelines as they deem appropriate.  There is no firm timeframe in which this process must be completed but the NYS WCB has stated that they intend to have the final draft of the guidelines completed by Oct. 18, 2010.  It is unclear when the guidelines would go into effect.

Here are some important highlights of the “Proposed Medical Treatment Guidelines” in their current form that impact doctors of chiropractic and their workers compensation patients:

  • Spinal manipulation will be covered for a two month period with a frequency of 3 times per week for 4 weeks and then 2 times per week for 4 weeks.  Additional care beyond the previously mentioned parameters is subject to approval by filing a variance form.  (See the NYSCA statement regarding the variance process for further information.)
  • The profession has been verbally informed that chiropractors will be able to bill for a variety of services that are to be listed on the fee schedule.  They will no longer be limited to a global fee.  (We are waiting for written confirmation of this point.)
  • Procedures that are to be listed for reimbursement will include ultrasound, massage and therapeutic exercise.  Unattended EMS and Traction for the lumbar spine were not listed as recommended services in the most recent draft of the guidelines.  Traction for the cervical spine would be listed on the fee schedule for reimbursement.  (See the “Proposed Guidelines” for further information)
  • Any care that would exceed the frequency or duration of the guidelines would be subject to a variance process.  The “burden of proof” to substantiate the need for additional services would fall upon the provider.
  • An updated fee schedule is to be published, possibly by late August, 2010.
  • Chronic care issues have not been addressed and the WCB has not informed the NYSCA of how chronic care for injured workers will be handled under the new treatment guidelines
  • At this point in time it is unclear how those patients who have been classified and authorized to receive “symptomatic care” or “treatment as medically necessary” will fit into the system.  It remains unclear whether they will fall under the new guidelines or whether they will remain under pre-existing treatment approaches.

 

We encourage all members, non-members, patients and the general public to view the NYSCA’s response and recommendations on this topic:

NYSCA Responds to The New York State Workers Compensation Board’s “Proposed Medical Treatment Guidelines”

The NYS Workers Compensation Board is currently creating an online education module that all doctors will be required to complete.  The purpose of the module is to introduce doctors to the Medical Treatment Guidelines and other changes in the system.  Members should plan to complete this education module if they intend to treat injured workers.  Additional information regarding this topic will be shared as it becomes available.

It is likely that the NYS WCB will have a representative in attendance at the NYSCA Fall Convention at the Villa Roma on September 24-26, 2010.  Be sure to attend this convention to hear more about the “Proposed Medical Treatment Guidelines’ and the education component from a representative of the WCB.

All of the WC accomplishments could not have been possible without the help of many NYSCA members. A special thanks goes out to the Executive officers, Dr Mariangela Penna, Dr Doug Van Vorst, Dr Bob Martin, Dr Jason Brown, Dr Lloyd Angel, Dr Malcolm Levitin, Dr Lloyd Kupferman, Dr Chris Vasakiris, Dr Jay Schwartz, Dr. Rob Block, and Dr Doug Taber .Also a special thanks to Dr Karl Kranz and Amy Kellogg. A great deal of work has gone into this process and we are thankful to all who participated in the meetings, conference calls and 100s of e-mails. Thank you all again.

 

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