FOR IMMEDIATE RELEASE

In December 2010, the New York Workers’ Compensation Board (Board) adopted four Medical Treatment Guidelines for the treatment of injuries to the neck, shoulder, back, and knee. Developed by the Insurance Department’s Workers’ Compensation Reform Task Force and its Advisory Committee, these guidelines create a standard of care using the most effective medical treatments as determined by medical evidence and a consensus of well-respected medical experts.

The Board is committed to keeping the existing guidelines current with evolving medical knowledge and practice. It also intends to develop additional guidelines for treatment of other work-related conditions, following the principles of evidence-based medicine.

To assist in these important tasks, the Chair intends to appoint a Medical Advisory Committee (MAC). The MAC will consist of highly respected medical experts with diverse medical backgrounds and will make recommendations to the Chair. It will be co-chaired by the Board’s Medical Director and Associate Medical Director, Dr. Jaime Szeinuk of Mt. Sinai Medical Center and Dr. Elain Sobol-Berger. Its first task will be to develop guidelines for the management of chronic pain disorders.

The NYS AFL-CIO and the Business Council of New York State will each nominate three medical professionals for appointment to the MAC. The Chair will also appoint three medical professionals based on applications and nominations received from individuals and medical associations throughout the state. The Committee will consult with additional subject matter experts in various health care disciplines, as necessary.

The Board seeks physicians who are recognized as experts in their field. Physicians with the following specialties and sub-specialties are encouraged to apply:

• Anesthesiologist/pain management
• Family medicine, internal medicine, or general practice
• Neurology
• Neurosurgery
• Occupational and environmental medicine
• Orthopedic surgery
• Physical medicine and rehabilitation
• Psychiatry

Nominations should include the individual’s name, contact information, CV, and a brief statement of interest. They should be submitted to MACnominations@wcb.state.ny.us on or before June 15, 2011.

For those of you (or your office staffs) who are dealing with Workers’ Compensation patients, the following web page should be really really useful.  It will help to inform you of who is handling variance requests at the WC carrier involved in your patient’s case.  It will tell you which carriers are participating in the Optional Prior Approval Process, whereby you would file the MG-1 Form.  In addition, it will identify who should receive your request for authorization (C-4 auth Form) at the WC Carrier.  The page also will identify which WC Carriers have chosen not to participate in the optional Prior Approval Process.

In the third paragraph on the page, you or your staff will be able to link to a component that will help you find the WC Carrier for the employer – just in case you don’t have that information.

https://www.wcb.state.ny.us/MTGContact/MTGContactSearch.jsp?searchContacts=Search+for+Carrier+Contacts+and+Participation

At the bottom of this WCB web page, you will also find the email address and 1(800) phone number for the Medical Director’s office at the WCB.  There is also a link for their help desk.

http://www.wcb.state.ny.us/content/main/Workers/MTGFacts.pdf

The link is case sensitive.

Section 325-1.21 Failure to treat.

A physician, podiatrist, chiropractor, psychologist, operator of a medical bureau or laboratory authorized by the chair to render treatment and care to injured employees under the Workers’ Compensation Law:

(a) shall accept and treat such injured employees in a manner corresponding to that accorded other patients in his or her practice, withoutdiscriminating against such injured employees because they are or may be covered by the provisions of the Workers’ Compensation Law; and

(b) shall not refuse to provide treatment and care to such injured employees on the basis of a fee request greater than that set forth in the applicable prescribed fee schedule, but shall submit to arbitration such fee dispute in accordance with the provisions of the Workers’ Compensation Law, nor shall such treatment and care be denied to such injured employees because the source or manner of payment for such treatment and care is pursuant to the provisions of the Workers’ Compensation Law.

Nothing contained in this section shall prevent a voluntary payment by the employer or carrier of an amount higher than the fees and charges found in the fee schedule where agreed to by the employer or carrier. An authorized physician, podiatrist, chiropractor, psychologist, operator of a medical bureau or laboratory whose actions violate or are inconsistent with the provisions of this section shall be charged with misconduct, and his or her authorization to treat workers’ compensation cases shall be subject to suspension or revocation by the chair in accordance with the procedures set forth in the Workers’ Compensation Law.

Q. What is the consequence of Failure to Treat?

A.   A provider can be removed from the list of authorized providers.

Q.  If a physician can’t take on any new WC claimants, would the WCB consider this reportable misconduct?

A.  If a provider is removed from the list of authorized providers, it is reportable to DOH.

Q.  What if the practice cannot financially sustain any more WC claimants?

A.  As the regulation states, “shall accept and treat such injured employees in a manner corresponding to that accorded other patients in his or her practice, without discriminating against such injured employees because they are or may be covered by the provisions of the Workers’ Compensation Law.”

Q.  As an example under managed care, doctors may feel they need to close their panel since it is not economically sustainable to take on new plan patients.

A.  The only acceptable reason not to take on new WC patients is if the practice is not taking on ANY new patients.

Q.  What is the alternative if a physician feels h/she cannot sustain the financial viability of the practice without limiting the number of WC claimants?

A.  The physician may have to turn in their authorization to treat WC patients and cease treating all WC patients.

Q.  Are you saying that the physician has no discretion to limit the number of WC claimants?

A.  Their discretion is limited only to the extent that they may refuse a new WC patient if the practice is not accepting ANY new patients.

The Workers’ Compensation Board has proposed a new fee schedule that includes an across-the-board 30% increase to the Evaluation and Management services codes, effective December 1, 2010. Over the next twelve months, the Board will also conduct a comprehensive review and revision of the physician fee schedule, as well as other health care provider fee schedules.

The NYS Workers’ Compensation Medical Treatment Guidelines will become the mandatory standard of care for the mid and low back, neck, shoulder, and knee, effective for dates of service on or after December 1, 2010. These four body parts were chosen because they represent the most frequent claims and the highest medical costs.

The Medical Treatment Guidelines will:

• Establish a standard of medical care for injured workers,
• Expedite quality care for injured workers,
• Improve the medical outcomes for injured workers,
• Speed return to work by injured workers whenever possible,
• Reduce disputes between payers and medical providers over treatment issues,
• Increase timely payments to medical providers, and reduce overall system costs.

The Medical Treatment Guidelines are mandatory for all work-related injuries or illnesses to these four body parts experienced by employees in New YorkState. With few exceptions, all treatment in accordance with the Guidelines is pre-authorized, so providers will no longer have to obtain prior approval if their treatment conforms to the Guidelines. The regulations require that insurers pay providers for services rendered in accordance with the Guidelines. Treatment that is outside the Guidelines will not be paid unless a variance is approved by the insurer or the Board.

It is essential for medical providers and their staff to become familiar with the Guidelines and the new procedures and forms required to implement the Guidelines. The Board is collaborating with stakeholder groups and provider associations to offer a comprehensive training program. All system participants are encouraged to take the available training to ensure a smooth transition into the new Medical Treatment Guideline process.

Free Web-based, Legal, CME, and CCE Training

A major component of the training program is free web-based training. The courses are available on the Board’s website.

There are several programs available, each designed for different audiences. The medical provider program is accredited for CME credits. There are also courses designed for medical providers’ staffs, and other non-medical persons.

The topics covered include: Medical Treatment Guidelines General Principles, Mid and Low Back Guidelines, Neck Guidelines, Shoulder Guidelines, Knee Guidelines, and Forms and Processes.

Please contact the Board’s Bureau of Health Management at (800) 781-2362 if you have any questions. Additional information on the Guidelines may also be found on the Board’s website under Board Announcements at www.wcb.state.ny.us.

Questions and Additional Information

If you have any questions or suggestions, please contact the Board’s Bureau of Health Management at (800) 781-2362 .

Educational Seminars

In order to educate physician on the new WCB Guidelines, the following seminar is being offered at: Nassau Academy of Medicine – Wed., Dec. 15

An administrative overview of the Workers’ Compensation Reform with emphasis on the Medical Treatment Guidelines also featuring Regina McNally VP of MSSNY’s Socio-Medical Economics Division, and David Austin from the NYS Workers’ Compensation Board, on

Wednesday, December 15,   from 9-11 am at the Nassau Academy of Medicine, 1200 Stewart Ave., Garden City.

Pre-registration is required due to limited seating.

The seminar is free for Nassau County members and Nassau Academy of Medicine members and staff.

The cost is $20 for non-members and their staff. Payment must accompany registration. Make checks payable to Nassau Academy of Medicine and mail to: 1200 Stewart Ave. Garden City, NY11530.

For further information, call 516-832-2300 or email nassaumed@verizon.net

The Workers’ Compensation Board (Board) is preparing to implement a major change in the manner medical care is provided to injured workers. The NYS Workers’ Compensation Medical Treatment Guidelines will become the mandatory standard of care for the mid and low back, neck, shoulder, and knee, effective for dates of service on or after December 1, 2010. These four body parts were chosen because they represent the most frequent claims and the highest medical costs.

The Medical Treatment Guidelines will:

• Establish a standard of medical care for injured workers,
• Expedite quality care for injured workers,
• Improve the medical outcomes for injured workers,
• Speed return to work by injured workers whenever possible,
• Reduce disputes between payers and medical providers over treatment issues,
• Increase timely payments to medical providers, and
• Reduce overall system costs.

It is essential for medical providers, insurers, legal professionals, and their staffs to become familiar with the Guidelines. The Medical Treatment Guidelines are mandatory for all work-related injuries or illnesses to these four body parts experienced by employees in New York State. With few exceptions, all treatment in accordance with the Guidelines is pre-authorized, so providers will no longer have to obtain prior approval if their treatment conforms to the Guidelines. The regulations require that insurers pay providers for services rendered in accordance with the Guidelines. Treatment that is outside the Guidelines will not be paid unless a variance is approved by the insurer or the Board.

Variety of Training Opportunities Offered

This is a completely new process that involves new procedures, with both new and revised forms, so the Board is collaborating with many stakeholder groups to offer a comprehensive training program. The Board is strongly encouraging medical providers, insurers, legal professionals, and their staffs to take the available training, to ensure a smooth transition into the new Medical Treatment Guideline process.

Free Web-based, LEGAL, CME, and CCE Training

A major component of the training program is free web-based training. The courses will be available starting October 4, 2010 on the Board’s web site, at the following URL: http://www.wcb.state.ny.us/content/main/hcpp/MedicalTreatmentGuidelines/MTGOverview.jsp

There are several programs available, each designed for different audiences. The medical provider program is accredited for CME credits; the chiropractor program is accredited for CCE credits. There are also courses designed for attorneys and claimant representatives, as well as for insurers, medical providers’ staffs, and other non-medical persons.

The topics covered include:

• Medical Treatment Guidelines General Principles,
• Mid and Low Back Guidelines,
• Neck Guidelines,
• Shoulder Guidelines,
• Knee Guidelines, and
• Forms and Processes.

CLE Training

In addition to the web-based legal training, the Board, in cooperation with Albany Law School, will offer a Continuing Legal Education (CLE) program on the Medical Treatment Guidelines. The program, worth 3.5 CLE credits including .5 hours of Ethics, is tentatively scheduled for the morning of November 3, 2010, and will be broadcast to locations around the state. No hearings will be scheduled for that morning to allow practitioners to attend the program. More information concerning the CLE program will be placed on the Board’s web site, www.wcb.state.ny.us, when it becomes available.

In preparation for the CLE program, it is recommended that legal professionals take the free web-based training and become familiar with the various standards of care that the Guidelines specify for treatment of injuries to the mid and low back, neck, shoulder, and knee. It may also be helpful to review some of the new Board forms and processes concerning use of the Medical Treatment Guidelines.

Questions and Additional Information

Please contact the Board’s Bureau of Health Management at (800) 781-2362 begin_of_the_skype_highlighting (800) 781-2362 end_of_the_skype_highlighting if you have any questions. Additional information on the Guidelines may also be found on the Board’s web site under Board Announcements at www.wcb.state.ny.us.

You are strongly encouraged to review the information on the Board’s web site regarding the Guidelines and to take advantage of the available training. Thank you for your cooperation in this critically important initiative.

Chair Robert Beloten Statement on Medical Fee Schedule

Health care providers in the workers’ compensation system have not seen an adjustment to their payment rates since 1996. As a first step to address this, today I am proposing a regulation that will provide for a 30 percent increase to the Evaluation and Management codes in the medical fee schedule.

In addition, over the next twelve months, we will undertake a comprehensive review and revision of the Medical, Podiatry, Psychology and Chiropractic fee schedules.

I believe that these actions will help the Board recruit and retain the best doctors in New York, helping to ensure injured workers receive swift, quality medical care now and into the future.

CONTACT: publicinfo@wcb.state.ny.us

The Workers’ Compensation Board is preparing to implement a major change in how medical care is provided to injured workers. New Medical Treatment Guidelines are anticipated to become the mandatory standard of care for the back, neck, shoulder, and knee, effective October 18, 2010. This will expedite appropriate care and speed provider reimbursement.

With few exceptions, all treatment in accordance with the Guidelines is pre-authorized. Providers can be assured that if they follow the Guidelines, they will be paid by the carrier. Treatment that is outside the Guidelines will not be reimbursed unless it is first approved through a variance process.
The Board will offer free web-based training to medical providers and their staff starting in September 2010. Details on the training, including CME accreditation, will be sent later this summer. Information on the Guidelines is available on the Board’s web site under Board Announcements.