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Subject Number 046-1058 Proposals to Improve Medical Care for Injured Workers

Board Bulletins and Subject Numbers

April 17, 2018

To increase provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) is proposing an increase to provider fees and adoption of the universal CMS-1500 form to reduce administrative burden, among other measures.

Access to quality medical care for injured workers is of utmost importance for a healthy workers' compensation system. When an injured worker has ready access to medical treatment, the worker heals and is restored to function more quickly and completely. This benefits not only the worker, but the employer as well.

Today the Board announces a multipronged approach to address provider concerns around participating in the workers' compensation system and expand injured workers' access to medical care.

Proposal to Increase Medical Fees for All Medical Providers

The Board's current medical fee schedule has remained relatively unchanged since 1996 and remains a significant obstacle to attracting new providers and retaining existing ones. Therefore, the Board will be advancing a regulatory proposal in June to raise provider fees; this will be effective for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. These new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.

Proposal to Reduce Paperwork

Providers have indicated that the unique paperwork requirements in the workers' compensation system result in significant additional administrative costs. Therefore, the Board will be consolidating and eliminating forms, including converting to the use of the CMS-1500 form. The CMS-1500 is the universal claim form used by medical providers to bill health insurers. Careful review and discussion with different stakeholders confirms that the CMS-1500 is easy to use and provides the necessary information. The Board proposes replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. As the CMS-1500 is already used by medical providers and insurance carriers to process claims, the Board anticipates an easy transition to the CMS-1500 and will be working towards a January 1, 2019, implementation date.

Other Enhancements to Improve Access to Quality Medical Care

The Board is also committed to other improvements that will increase access to quality medical care and reduce administrative burdens.

Medical Portal. The first phase of the Medical Portal, an important Business Process Re-engineering initiative, will be coming this year. This electronic medical portal will allow providers to quickly and easily identify whether their course of treatment is consistent with the Board's medical treatment guidelines and, if not, advise them that a variance is needed. The Medical Portal is an important step toward an easy-to-use, paperless system.

Access to Different Medical Providers Types. The Board is also exploring options that will increase access to medical care providers. This will afford injured workers access to expanded provider types and medical providers flexibility in the delivery of medical care.

Governor Cuomo continues to support a comprehensive legislative solution that expands the types of providers that may treat injured workers. Currently only physicians, chiropractors, podiatrists, and psychologists can be authorized. The proposed legislation would amend the Workers' Compensation law to conform with the Education law by permitting medical providers who are licensed in New York State to become authorized, opening participation to nurse practitioners, physician's assistants, licensed clinical social workers, and other providers. In most instances, injured workers would be able to seek treatment for their workers' compensation illness and injuries with the same providers they use for non-work related illness and injuries.

The proposals announced today come in direct response to claimants' challenges in finding treating providers, and concerns from health care providers around low fees and complexity that keep some from participating. By addressing these concerns and bringing more providers into the workers' compensation system, injured workers can more readily access the care they need.

Clarissa M. Rodriguez