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Friday, November 16, 2012

NY Worker's Compensation Board Proposes New Medical Treatment Guidelines

New York Worker’s Compensation Board’s proposed new medical treatment guidelines that will modify 2010 previously implemented.

  1. Adopt the new carpal tunnel syndrome (CTS) medical treatment guidelines (MTG) as the standard of care for the treatment of injured workers with carpal tunnel syndrome;
  2. Modify current MTGs to include new maintenance care recommendations; and
  3. Implement consensus changes to simplify the process, reduce litigation and speed dispute resolution.

Carpal Tunnel Syndrome (CTS)
The new CTS MTG provide evidence based guidelines for the treatment of carpal tunnel syndrome, the most common occupational disease experienced in the workers’ compensation system. Like the other MTGs, the CTS MTG should improve the quality of care, speed access to the most beneficial treatment, and control the use of ineffective treatment.

Maintenance Care
The original four MTGs primarily address treatment for the acute and sub-acute phases of injury, with limited recommendations for the management of chronic conditions and chronic pain. As part of its effort to develop chronic pain guidelines, the MAC re-evaluated those recommendations that relate to maintenance care, recognizing that in certain situations maintenance care (chiropractic and occupational/physical therapy) should be available. The revised MTGs will authorize an ongoing maintenance program that can include up to 10 visits per year for those who have a previously observed and documented objective deterioration in functional status without the identified treatment. To be eligible for maintenance care, injured workers with chronic pain must have reached maximum medical improvement (MMI), have a permanent disability, and meet the requirements of the maintenance care program. No variance is allowed from the 10 visit annual maximum.

The new recommendations address a major concern of both providers and payers: the high number of variance requests. To date, more than three quarters of the variance requests are for maintenance care for those with chronic pain. Injured workers will now have access to important maintenance care while payers and providers will be relieved from the administrative burden of handling individual variance requests for this care. The remainder of the chronic pain guidelines is expected to be completed by early 2013.

Process Changes
The regulations also include several changes to simplify the process, reduce conflict, and speed dispute resolution. These consensus changes are the result of suggestions from stakeholders. The changes will achieve the following:

  • enable parties to more easily choose resolution by the Medical Director’s Office, which provides faster and less costly dispute resolution;
  • clarify and simplify transmission requirements that were resulting in rejection of thousands of variance requests for technical violations;
  • allow carriers to partially grant variance requests, thereby expediting care and reducing litigation;
  • eliminate submission of duplicate variance requests;
  • reduce the number of procedures requiring C-4 Authorization, and
  • authorize submission of variance requests through a web-based portal or other technology in the future, should it become available.
In addition, several changes to the Forms C-4 AUTH, C-8.1, MG-1 and MG-2 forms that have been agreed upon with stakeholders will be implemented.  Comments on the draft forms may be sent to and will be considered if received by Monday, November 26, 2012. Final versions of the forms will be posted in early December. The parties will be expected to begin using the new forms after February 1, 2013. Old forms cannot be used to initiate new requests after March 15, 2013.

Complete copies of the proposed regulations, new and revised guidelines, complete description of the process changes, draft versions of the new forms, and other information are available on the Proposed Changes to New York Medical Treatment Guidelines page of the Board’s website. The regulations will be published in the November 21, 2012 State Register.

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