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Regulatory Flexibility Analysis for Small Businesses and Local Governments
Proposed Amendment of Part 324 of 12 NYCRR
(Amendment of the Medical Treatment Guidelines)


  1. Effect of rule:

    Small businesses and local governments whose only involvement with the workers' compensation system is that they are employers and are required to have coverage will not be affected directly by this rule. Small businesses cannot be individually self-insured but must purchase workers' compensation coverage from the State Insurance Fund or a private insurance carrier authorized to write workers' compensation insurance in New York or join a group self-insured trust. It is the entity providing coverage for the small employer that must comply with all of the provisions of this rulemaking, not the covered employer. The impact on the State Insurance Fund and all private insurance carriers is not covered in this document as they are not small businesses. Group self-insured trusts, third party administrators hired by private insurance carriers and group self-insured trusts, independent medical examination (IME) entities, and attorneys may be small businesses who will be impacted by this regulation. All health practitioners authorized by the Chair to treat or conduct independent medical examinations of claimants will have to comply with parts of this rule. Finally, local governments that own and/or operate a hospital will be affected by this rule.

    The approximately 2,500 political subdivisions that are self-insured for workers' compensation coverage in New York State will have to comply with the provisions of this proposal. Those local governments who are not self-insured and do not own and/or operate a hospital will not be affected by this rule.
  2. Compliance requirements:

    The proposed rule modifies existing compliance requirements on the small businesses and local governments described above.

    The proposed amendments should significantly reduce the number of variances requested and thus reduce the reporting and recordkeeping associated with those requests. Adoption of the carpal tunnel syndrome Guidelines will require all medical providers to adhere to those Guidelines and to request a variance to deviate from the Guidelines' recommendations. The forms used to request a variance are already in use, but will be modified slightly. It is not anticipated that the proposed amendments will require any additional staffing or resources by rural employers.
  3. Professional services:

    Small businesses and local governments affected by the rule will not need any new professional services to comply with this rule.
  4. Compliance costs:

    The proposed amendments are intended to improve medical care, reduce administrative costs to all parties including rural participants, and reduce delays in resolution of disputes, and reduce medical costs in workers' compensation. As with the original Guidelines adopted in 2010, the Board will offer support for this implementation through training. The Guidelines will be available on the Board's website and anyone will be able to download and print them free of charge. If an individual or entity requests a hardcopy of one or more of the guidelines, the cost will be $10.00 per guideline or $50.00 for all five. This charge is to cover the Board's cost in making the copies. The charge for one or more of the Guidelines on a compact disc is $5.00.
  5. Economic and technological feasibility:

    It is economically and technologically feasible for small businesses and local governments to comply with the proposed amendments. The proposed amendments rely on existing technology and services already provided to affected payers. The proposed amendments permit the Board to adapt technologies but always allows for use of regular mail when the technology is not available to a participant.
  6. Minimizing adverse impact:

    As stated above, the implementation of the proposed amendments is expected to save money for all participants in the workers' compensation system by prescribing Guidelines for the treatment of CTS, by permitting a fixed number of treatments for maintenance care to relieve chronic pain and eliminating the variance requests associated to such treatment, and by further streamlining the process to eliminate delays and disputes.
  7. Small business and local government participation:

    The Board solicited comments from all stakeholders to the proposed carpal tunnel syndrome Guidelines by Subject Number dated October 4, 2011. The Board's Subject Numbers are emailed to over 3000 subscribers statewide. The Board does not track how many of these subscribers are small businesses or local governments. In addition, the Board posts all Subject Numbers on its website. The Subject Number, "Chair Seeks Comments on Draft Carpal Tunnel Syndrome Treatment Guidelines," invited public comment from all participants.

    The proposed amendments are expected to reduce costs and consume fewer resources for all participants in the workers' compensation system including small businesses and local governments.

    While medical professionals and affected payers who are small businesses will be required to incorporate the Guidelines into their policies, practices, and procedures, the Board will assist in this process by providing training and support to stakeholders. There will be no charge for the training.

Please Note: The Board recommends using the latest version of Adobe Reader Link to External Website which is available as a free download from Adobe's web site.

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