The Workers' Compensation Board (Board) received comments from one organization in regard to the amendments to Subchapters C, D and E of Title 12 NCRR, specifically Parts 325, 326, 329, 330, 331, 333, 340, 341 and 343. The organization provided comments about five sections, as well as noted some potential violations of the regulations. The organization did not object to the proposed rule making.
First, the organization noted that the amendment to 12 NYCRR §325-1.4 did not include mention of or a list of procedures costing more than $1,000 that were pre-authorized pursuant to Workers' Compensation Law (WCL) §13-a(5). In a conversation with the organization about this comment, it was agreed that when the Board received the recommended list from the Advisory Committee on Medical Guidelines to the Department of Insurance's Workers' Compensation Reform Task Force a rule specific to the list would be proposed.
Second, the organization noted a concern regarding the amendment to 12 NYCRR §325-1.5 regarding a claimant's right to choose a physician except if the insurance carrier or self-insured employer has contracted with a provider network or networks for the performance of diagnostic tests pursuant to WCL §13-a(7). The organization felt the language in the proposed rule did not make clear that the claimant's right to choose a physician is limited only to the extent that the claimant is required by §13-a(7) to use a diagnostic network or networks with which his or her employer or its insurance carrier has contracted. To ensure the regulation is entirely clear, the Board made a non-substantial revision to this section.
Third, the organization questioned why health providers where not included in the amendments to 12 NYCRR §325-5.6, which clarifies the health insurer matching program. The organization has been advised that the statutory authority for the health insurer matching program does not include notice to health providers, so they would not be provided notice in the regulation which implements the statute. However, the Board will work with the organization so its members receive the notice in accordance with the provisions of the WCL that apply to them.
Fourth, with respect to the amendments to 12 NYCRR §325-8.4, the organization asked the Board to examine ways to provide the information required by the amendments to the medical providers who treat injured workers. The Board has agreed to discuss this request with the organization.
Fifth, the organization noted that the reference to Doctors of Osteopathy and the State association of osteopaths were not correctly worded in the amendments to 12 NYCRR §326-1.1. The organization proposed non-substantial revisions to correct the technical inaccuracies. The Board has incorporated the suggestions. The suggestions were non-substantial so a revised rule making is not necessary.
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