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New York State
Workers' Compensation Board
OFFICE OF THE CHAIR
328 State Street  Schenectady, New York 12305
Governor Andrew M. Cuomo


Subject No. 046-464

Upcoming Deadlines Regarding the Medical Treatment Guidelines

Date: March 18, 2011

ATTENTION: This Subject Number contains critical time-sensitive information.

This Subject Number serves as a reminder of two important upcoming dates related to the Board's Medical Treatment Guidelines program.

Carrier Medical Treatment Guidelines Certification

Board regulations require each carrier and self-insured employer to certify to the Chair, by April 1, 2011, that they have incorporated the Medical Treatment Guidelines into their policies, procedures and practices. Any utilization review and management criteria must be consistent with the Medical Treatment Guidelines. Carriers and self-insured employers must also re-certify to the incorporation of the Medical Treatment Guidelines and the regulatory provisions within 60 days of any changes to their policies, procedures, and practices.

The certification can be completed by the company's designated administrator on the administrator page of the Board's website.

Waiving Carrier's Right to Expedited Hearings

Starting June 1, 2011, a carrier or self-insured employer may no longer decide on a case by case basis whether to waive its right to expedited hearings and request resolution by the medical arbitrator. Instead, the company must select either the hearing process or the medical arbitrator for all claims involving variance requests. No action is required if the carrier/self-insured employer wants to select resolution through the hearing process. To select the medical arbitrator, the administrator must check the appropriate box waiving the right to hearing on the administrator page of the Board's website. Any selection to waive rights to expedited hearings made before June 1 will not become effective until June 1, 2011. The waiver, or withdrawal of the waiver made after June 1, will be effective 30 days after the date the administrator notifies the Board.

The administrator page is found under the Medical Treatment Guidelines section on the Board's website.

Please contact the Board at 1-800-781-2362 with any questions regarding Medical Treatment Guidelines. Thank you for your cooperation.

 

Robert E. Beloten
Chair