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Workers' Compensation Board

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Adoption of the Addition of Part 324 and §325-1.25, the Amendment of
§§ 300.23 (d), 325-1.2, 325-1.3, 325-1.4, and 325-1.24,
and the Repeal of §325-1.6 of 12 NYCRR

Adoption and Implementation of the Medical Treatment Guidelines

On March 13, 2007, former Governor Spitzer signed into law comprehensive workers' compensation reform legislation (Chapter 6 of the Laws of 2007). The purpose of the workers' compensation reform was to increase benefits and improve delivery of services to injured and ill employees (claimants), while at the same time reducing costs. One of the changes to improve the delivery of services to claimants was the amendment to WCL § 13-a (5) to increase the prior authorization threshold and require the establishment of a list of pre-authorized procedures. The Memorandum in Support of the 2007 workers' compensation reform legislation describes the purpose of these changes as follows, "to remove impediments to prompt diagnostic and treatment measures and to better reflect current medical service costs. The provision permitting the creation of a pre-authorized list allows the Board appropriate regulatory flexibility to add or remove procedures depending on best practices, increases or decreases in costs, or opportunities presented by managed care approaches."

In addition to the legislative reforms, by letter dated March 13, 2007, former Governor Spitzer directed The Superintendent of Insurance, with assistance from the Chair of the Workers' Compensation Board (Board) and the Commissioner of Labor to undertake administrative and regulatory reforms. One such direction was to develop medical guidelines to account for modern diagnostic and treatment techniques and evidence-based standards of medical treatment and care. An advisory committee comprised of highly qualified and respected medical professionals selected by labor, business, and the Insurance Department assisted the Superintendent. On December 3, 2007, the Superintendent of Insurance submitted recommended medical treatment guidelines for the neck, back, shoulder, and knee (Guidelines) to the Chair, along with a recommended education plan, based upon the recommendations of the Advisory Committee. In June 2008, the Superintendent, again based upon the recommendations of the Advisory Committee, submitted to the Chair implementation standards for the Guidelines.

Between August 13, 2009, and September 9, 2009, the Board solicited comments based upon medical evidence on the Guidelines recommended by the Superintendent. The comments and the supporting evidence were reviewed by the Board's Interim Medical Director and on January 19, 2010, revised guidelines were released. Additional revisions were made between January and June.

The Notice of Proposed Rule Making was published in the June 30, 2010, edition of the State RegisterLink to External Website and posted on the Board's website. The 45 day public comment period expired on August 16, 2010. The comments were carefully reviewed and non-substantial changes were made to the regulation text to correct typographical errors and clarify text. The changes are listed at the end of the Assessment of Public Comment. Minor edits were made to the guidelines to correct errors. The final guidelines are:

The Notice of Adoption will be published in the November 3, 2010, edition of the State Register. The regulations and guidelines will be effective on December 1, 2010. All treatment for the mid and low back, neck, knee, and shoulder provided on and after December 1, 2010, must be consistent with the guidelines.