A 3716
Version: Introduced
Author: Lentol
STATE OF NEW YORK
3716
2009-2010 Regular Sessions
IN ASSEMBLY
January 28, 2009
Introduced by M. of A. LENTOL -- Multi-Sponsored by -- M. of A. LIFTON -- read
once and referred to the Committee on Labor
AN ACT to amend the workers' compensation law, in relation to chiropractic
care
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEMBLY,
DO ENACT AS FOLLOWS:
Section 1. Legislative intent. The legislature recognizes that multiple
health professionals are trained and licensed to diagnose and treat the same
or similar conditions through the use of modalities, therapies, treatments,
services and philosophies that vary from profession to profession. It is the
specific intent of this legislature to assure that workers' compensation
policies, plans and contracts that provide coverage for the diagnosis and
treatment of conditions, complaints, ailments, disorders or injuries, that
may be diagnosed and treated by a doctor of chiropractic, must provide
equivalent access, coverage and fees for the diagnosis and treatment of those
conditions, complaints or injuries by a duly licensed doctor of chiropractic,
within the lawful scope of chiropractic practice even if different
terminology, philosophy, services, treatments or modalities are used by the
various health professions; and such equivalent coverage shall not be
abridged by any regulation.
Section 2. Subdivision 2 of section 13-l of the workers' compensation law,
as amended by chapter 473 of the laws of 2000, is amended to read as follows:
2. (A) An employee injured under circumstances which make such injury
compensable under this article, when care is required for an injury which
consists solely of a condition which may lawfully be treated by a
chiropractor as defined in section sixty-five hundred fifty-one of the
education law may select to treat him or her, any duly registered and
licensed chiropractor of the state of New York, authorized by the chair to
render chiropractic care as hereinafter provided. If the injury or condition
is one which is outside the limits prescribed by the education law for
chiropractic care and treatment, the said chiropractor must so advise the
said injured employee and instruct him or her to consult a physician of said
employee's choice for appropriate care and treatment. Such physician shall
thenceforth have supervision of the treatment of said condition including the
future treatment to be administered to the patient by the chiropractor. A
chiropractor licensed and registered to practice chiropractic in the state of
New York, who is desirous of being authorized to render chiropractic care
under this section and/or to conduct independent medical examinations in
accordance with paragraph (b) of subdivision three of this section shall file
an application for authorization under this section with the chiropractic
practice committee. In such application he or she shall agree to refrain from
subsequently treating for remuneration, as a private patient, any person
seeking chiropractic treatment, or submitting to an independent medical
examination, in connection with, or as a result of, any injury compensable
under this chapter, if he or she has been removed from the list of
chiropractors authorized to render chiropractic care or to conduct
independent medical examinations under this chapter, or if the person seeking
such treatment has been transferred from his or her care in accordance with
the provisions of this section. This agreement shall run to the benefit of
the injured person so treated, or examined, and shall be available to him or
her as a defense in any action by such chiropractor for payment rendered by a
chiropractor after he or she has been removed from the list of chiropractors
authorized to render chiropractic care or to conduct independent medical
examinations under this section, or after the injured person was transferred
from his or her care in accordance with the provisions of this section. The
chiropractic practice committee if it deems such licensed chiropractor duly
qualified shall recommend to the chair that such be authorized to render
chiropractic care and/or to conduct independent medical examinations under
this section. Such recommendations shall be advisory to the chair only and
shall not be binding or conclusive upon him or her. The chair shall prepare
and establish a schedule for the state, or schedules limited to defined
localities of charges and fees for chiropractic treatment and care, to be
determined in accordance with and to be subject to change pursuant to rules
promulgated by the chair.
THE CHIROPRACTIC FEE SCHEDULE PREPARED AND
ESTABLISHED BY THE CHAIR SHALL PROVIDE FOR THE PAYMENT OF REMUNERATION WHICH
IS EQUIVALENT TO THAT APPLICABLE TO CARE OR TREATMENT PROVIDED BY PHYSICIANS
IN THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF THE SAME OR SIMILAR CONDITIONS,
INJURIES, COMPLAINTS, DISORDERS OR AILMENTS, EVEN IF DIFFERING NOMENCLATURE
IS USED TO DESCRIBE THE CONDITION, INJURY, TREATMENT OR SERVICE. Before
preparing such schedule for the state or schedules for limited localities the
chair shall request the chiropractic practice committee to submit to him or
her a report on the amount of remuneration deemed by such committee to be
fair and adequate for the types of chiropractic care to be rendered under
this chapter, but consideration shall be given to the view of other
interested parties, the amounts payable by the employer for such treatment
and services shall be the fees and charges established by such schedule.
CHIROPRACTIC CARE AND TREATMENT MAY BE SUBJECT TO REASONABLE UTILIZATION
REVIEW, PROVIDED THAT ANY SUCH REVIEW: (I) SHALL NOT DISCRIMINATE AGAINST
CHIROPRACTIC CARE, AND (II) SHALL BE NO MORE RESTRICTIVE THAN THAT APPLICABLE
TO CARE OR TREATMENT PROVIDED BY PHYSICIANS IN THE DIAGNOSIS, TREATMENT AND
MANAGEMENT OF THE SAME OR SIMILAR CONDITIONS, INJURIES, COMPLAINTS, DISORDERS
OR AILMENTS, EVEN IF DIFFERING NOMENCLATURE IS USED TO DESCRIBE THE
CONDITION, INJURY, TREATMENT OR SERVICE. NOTHING IN THIS SUBDIVISION SHALL BE
CONSTRUED AS IMPEDING OR PREVENTING EITHER THE PROVISION OR COVERAGE OF
CHIROPRACTIC CARE AND TREATMENT BY DULY LICENSED DOCTORS OF CHIROPRACTIC,
WITHIN THE LAWFUL SCOPE OF CHIROPRACTIC PRACTICE, IN HOSPITAL FACILITIES ON
STAFF OR EMPLOYEE BASIS.
(B) EVERY POLICY WHICH INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A
PHYSICIAN'S OFFICE, OTHER THAN A POLICY THAT PROVIDES MANAGED CARE COVERAGE,
SHALL PROVIDE COVERAGE FOR CARE PROVIDED IN THE PRACTICE OF CHIROPRACTIC, AS
DEFINED IN SECTION SIXTY-FIVE HUNDRED FIFTY-ONE OF THE EDUCATION LAW,
PROVIDED BY A DOCTOR OF CHIROPRACTIC LICENSED PURSUANT TO ARTICLE ONE HUNDRED
THIRTY-TWO OF THE EDUCATION LAW, IN CONNECTION WITH THE DETECTION OR
CORRECTION BY MANUAL OR MECHANICAL MEANS OF STRUCTURAL IMBALANCE, DISTORTION
OR SUBLUXATION IN THE HUMAN BODY FOR THE PURPOSE OF REMOVING NERVE
INTERFERENCE, AND THE EFFECTS THEREOF, WHERE SUCH INTERFERENCE IS THE RESULT
OF OR RELATED TO DISTORTION, MISALIGNMENT OR SUBLUXATION OF OR IN THE
VERTEBRAL COLUMN. CHIROPRACTIC CARE AND SERVICES MAY BE SUBJECT TO REASONABLE
FEE SCHEDULES AND REASONABLE UTILIZATION REVIEW, PROVIDED THAT ANY SUCH
SCHEDULES AND REVIEW: (I) SHALL NOT DISCRIMINATE AGAINST CHIROPRACTIC CARE,
AND (II) INDIVIDUALLY AND COLLECTIVELY SHALL BE NO MORE RESTRICTIVE THAN
THOSE APPLICABLE UNDER THE SAME POLICY TO CARE OR SERVICES PROVIDED BY
PHYSICIANS IN THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF THE SAME OR SIMILAR
CONDITIONS, INJURIES, COMPLAINTS, DISORDERS OR AILMENTS, EVEN IF DIFFERING
NOMENCLATURE IS USED TO DESCRIBE THE CONDITION, INJURY, COMPLAINT, TREATMENT
OR SERVICE. NOTHING IN THIS SUBDIVISION SHALL BE CONSTRUED AS IMPEDING OR
PREVENTING EITHER THE PROVISION OR COVERAGE OF CHIROPRACTIC CARE AND SERVICES
BY DULY LICENSED DOCTORS OF CHIROPRACTIC, WITHIN THE LAWFUL SCOPE OF
CHIROPRACTIC PRACTICE, IN HOSPITAL FACILITIES ON A STAFF OR EMPLOYEE BASIS.
(C) THE COVERAGE REQUIRED BY THIS SUBDIVISION SHALL NOT BE ABRIDGED BY
ANY REGULATION PROMULGATED BY THE CHAIR, THE BOARD OR THE SUPERINTENDENT OF
INSURANCE.
Section 3. The workers' compensation law is amended by adding a new
section 356 to read as follows:
Section 356. PREFERRED PROVIDER ORGANIZATIONS; CHIROPRACTIC TREATMENT.
1. EACH PREFERRED PROVIDER ORGANIZATION SHALL PROVIDE COVERAGE FOR CARE AND
TREATMENT PROVIDED IN THE COURSE OF THE PRACTICE OF CHIROPRACTIC, AS DEFINED
IN SECTION SIXTY-FIVE HUNDRED FIFTY-ONE OF THE EDUCATION LAW, PROVIDED BY A
DOCTOR OF CHIROPRACTIC LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-TWO OF
THE EDUCATION LAW, IN CONNECTION WITH THE DETECTION OR CORRECTION BY MANUAL
OR MECHANICAL MEANS OF STRUCTURAL IMBALANCE, DISTORTION OR SUBLUXATION IN THE
HUMAN BODY FOR THE PURPOSE OF REMOVING NERVE INTERFERENCE, AND THE EFFECTS
THEREOF, WHERE SUCH INTERFERENCE IS THE RESULT OF OR RELATED TO DISTORTION,
MISALIGNMENT OR SUBLUXATION OF OR IN THE VERTEBRAL COLUMN. CHIROPRACTIC CARE
AND TREATMENT MAY BE SUBJECT TO REASONABLE FEE SCHEDULES, AND REASONABLE
UTILIZATION REVIEW, PROVIDED THAT ANY SUCH SCHEDULES AND REVIEW: (A) SHALL
NOT DISCRIMINATE AGAINST CHIROPRACTIC CARE; AND (B) INDIVIDUALLY AND
COLLECTIVELY SHALL BE NO MORE RESTRICTIVE THAN THOSE APPLICABLE WITHIN THE
PREFERRED PROVIDER ORGANIZATION TO CARE OR TREATMENT PROVIDED BY PHYSICIANS
IN THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF THE SAME OR SIMILAR CONDITIONS,
INJURIES OR COMPLAINTS, EVEN IF DIFFERING NOMENCLATURE IS USED TO DESCRIBE
THE CONDITION, INJURY, COMPLAINT, TREATMENT OR SERVICE. NOTHING IN THIS
SECTION SHALL BE CONSTRUED AS IMPEDING OR PREVENTING EITHER THE PROVISION OR
COVERAGE OF CHIROPRACTIC CARE AND TREATMENT BY DULY LICENSED DOCTORS OF
CHIROPRACTIC, WITHIN THE LAWFUL SCOPE OF CHIROPRACTIC PRACTICE, IN HOSPITAL
FACILITIES ON A STAFF OR EMPLOYEE BASIS.
2. EACH PREFERRED PROVIDER ORGANIZATION SHALL INCLUDE A SUFFICIENT
NUMBER OF CHIROPRACTORS WITHIN EACH GEOGRAPHIC AREA TO ASSURE ACCESS TO
CHIROPRACTIC TREATMENT THAT IS EQUAL TO THAT AVAILABLE TO MEDICAL TREATMENT
WITHIN THE SAME PREFERRED PROVIDER ORGANIZATION.
3. AN EMPLOYEE MAY SEEK CHIROPRACTIC TREATMENT FROM OUTSIDE THE
PREFERRED PROVIDER ORGANIZATION THIRTY DAYS AFTER HIS OR HER VISIT TO A
PREFERRED PROVIDER ORGANIZATION PROVIDER. IN THE EVENT THAT SUCH EMPLOYEE
SEEKS CHIROPRACTIC TREATMENT OUTSIDE THE PREFERRED PROVIDER ORGANIZATION, THE
EMPLOYER MAY REQUIRE A SECOND OPINION FROM A PROVIDER WITHIN THE PREFERRED
PROVIDER ORGANIZATION.
4. AN EMPLOYEE MAY SEEK A SECOND OPINION WITH RESPECT TO SUCH
CHIROPRACTIC TREATMENT FROM ANOTHER PROVIDER WITHIN THE PREFERRED PROVIDER
ORGANIZATION AT ANY TIME.
5. THE COVERAGE REQUIRED BY THIS SECTION SHALL NOT BE ABRIDGED BY ANY
REGULATION PROMULGATED BY THE CHAIR OR THE BOARD.
Section 4. This act shall take effect January 1, 2010 and shall apply to
policies and contracts issued, renewed, modified, altered or amended on or
after such effective date.