Medical Provider Authorization
NY-ADR
6/19/19 N.Y. St. Reg. WCB-25-19-00019-P
NEW YORK STATE REGISTER
VOLUME XLI, ISSUE 25
June 19, 2019
RULE MAKING ACTIVITIES
WORKERS' COMPENSATION BOARD
PROPOSED RULE MAKING
NO HEARING(S) SCHEDULED
I.D No. WCB-25-19-00019-P
Medical Provider Authorization
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:
Proposed Action:
Addition of Part 323 to Title 12 NYCRR.
Statutory authority:
Workers' Compensation Law, sections 117 and 141
Subject:
Medical Provider Authorization.
Purpose:
Describe the process for providers to become authorized by the Board and maintain authorization.
Text of proposed rule:
Part 323, Section 323.1 of Subchapter C of Title 12 NYCRR is hereby added to read as follows:
Part 323. Medical Provider Authorization
Section 323.1 Application for New York Workers’ Compensation Authorization
(a) Providers who can apply to become authorized. A duly New York State licensed acupuncturist, chiropractor, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant, podiatrist, psychologist or social worker as defined in section 13-b of the Workers’ Compensation Law may apply to become an authorized provider under the Workers’ Compensation Law by complying with the provisions of this section.
(b) Providers listed in subdivision (a) of this section who wish to be authorized by the Chair shall submit their application in the electronic format prescribed by the Chair. A hospital, as that term is defined in Article 28 of the Public Health Law, may submit a single collective application for each provider type employed by such hospital when such employer hospital affirms that the providers listed in the collective application are currently employed and meet the qualifications required to become Board authorized.
(c) Affirmations. Such application shall contain an affirmation that the information provided by the applicant(s) is correct and complete, and that all bills, variances, medical reports, and request for review of billing disputes will be submitted in the electronic format prescribed by the Chair.
(d) Required license and certification information. An application for authorization under this section must also provide the provider’s license information and certification of completion of the required training, including:
(1) For acupuncturists, New York State licensed and having completed a formal course of study and having passed an examination in accordance with the education law, the regulations of the commissioner of education, and the requirements of the Board of regents.
(2) For chiropractors, New York State licensed and having completed two years of preprofessional college study and a four-year resident program in chiropractic in accordance with the education law, and consistent with the licensing requirements of the commissioner of education.
(3) For nurse practitioners, certification of licensure as a registered professional nurse (certified pursuant to section sixty-nine hundred ten of the education law) acting within their lawful scope of practice.
(4) For occupational therapists, New York State licensed and having at least a bachelor’s or master’s degree in occupational therapy from a registered program with the education department or receipt of a diploma or degree resulting from completion of not less than four years of postsecondary study, which includes the professional study of occupational therapy in accordance with the education law and the regulations of the commissioner of education.
(5) For physical therapists, New York State licensed in accordance with the education law and licensing requirements of the commissioner of education.
(6) For physicians, New York State licensed with a degree of doctor of medicine, M.D., or doctor of osteopathic medicine, D.O., or an equivalent degree in accordance with the education law and the licensing requirements of the state board of medicine and the regulations of the commissioner of education.
(7) For physician assistants, New York State licensed as a physician assistant pursuant to section sixty-five hundred forty-one of the education law. In order to become authorized to practice under the Workers’ Compensation Law, such physician assistants’ supervising physician must have an active Board authorization to treat injured workers.
(8) For podiatrists, New York State licensed and having received a doctoral degree in podiatric medicine in accordance with the regulations of the commissioner of education and the education law, and satisfactorily meeting all other requirements of the state board for podiatric medicine.
(9) For psychologists, New York State licensed and having received a doctoral degree in psychology from a program of psychology.
(10) For social workers, New York State licensed as a clinical social worker having completed a master’s degree of social work that includes completion of a core curriculum of at least twelve credit hours of clinical courses or the equivalent post-graduate clinical coursework, in accordance with the education law and the regulations of the commissioner of education.
(e) Receipt of application. The date and time of an application shall be the time a completed and electronically signed application is received by the Board. For the purposes of this section, electronically signed shall mean submitted using a valid NY.gov ID business account in the applicant’s name. Receipt of the completed application by the Board does not indicate that a provider has been authorized.
(1) An applicant, if approved for authorization, shall receive a separate notification informing them of their authorization.
(2) Pursuant to section thirteen-b of the Workers’ Compensation Law, a physician applicant must submit an authorization application to the medical society of the county in which the physician’s office is located or to a board designated by such county society or to a board representing duly licensed physicians of any other school of medical practice in such county together with submission of his or her application to the Board. Such simultaneous submission to the applicable county medical society and the Board shall be done in a single transaction using the electronic method and format prescribed by the Chair and available to all parties. Every county medical society shall individually or through a delegate provide the Board with the email address for application submission. Following review of the application, a county medical society shall submit their recommendation to the Board. In the event such county society or board fails to take action upon a physician’s completed and electronically signed application within forty-five days, the chair may complete review of the application without such approval.
(f) The Board may reject applications for authorization or remove a provider from the list of authorized providers if information in the application is omitted, inaccurate or false.
(g) Every authorized provider, regardless of their date of authorization, shall reregister with the Board within sixty days of their license renewal with the New York State Education Department. Such reregistration shall include updated professional information and certification that any mandatory training required by the Chair has been completed. The Board may remove a provider from the list of authorized providers if the reregistration is not filed, or is incomplete, inaccurate, or falsifies any information.
(h) Upon approval of an authorization application, the provider may treat injured workers within the scope of their practice and as set forth in section thirteen-b of the Workers’ Compensation Law. Authorized providers billing for workers’ compensation injuries, including treatment rendered after a case is closed, must bill at the provider’s appropriate New York State Workers’ Compensation medical fee schedule rate.
(i) Unless otherwise permitted by law, a provider permitted to seek authorization, must obtain such authorization prior to treating injured workers under the workers’ compensation law.
(1) Such provider may not treat an injured worker under subdivision (2)(b) of section thirteen-b of the workers’ compensation law.
(2) A provider permitted to treat injured workers upon prescription or referral of an authorized provider or under the supervision of an authorized provider prior to January 1, 2020, may continue to treat in such capacity when such provider has submitted an application for authorization on or before January 1, 2020, but such application has not yet been acted upon by the chair or chair’s designee.
Text of proposed rule and any required statements and analyses may be obtained from:
Heather MacMaster, Workers' Compensation Board, 328 State Street, Office of General Counsel, Schenectady, NY 12305, (518) 486-9564, email: [email protected]
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
60 days after publication of this notice.
This rule was not under consideration at the time this agency submitted its Regulatory Agenda for publication in the Register.
Regulatory Impact Statement
1. Statutory Authority
The statutory authority for this rule comes from §§ 117(1) and 141 of the Workers’ Compensation Law, which allows the Chair to adopt reasonable rules to supplement the provisions of the chapter and the labor law.
2. Legislative Objectives
In April 2019, the amendments to section 13-b of the workers’ compensation law were enacted. The new law expanded the categories of providers who may become authorized to treat injured workers to include nurse practitioners, physician assistants, licensed clinical social workers, physical and occupational therapists and acupuncturists.
The proposed amendments describe the process for becoming authorized to treat injured workers.
3. Needs and Benefits
The bill expanding the list of providers who can become authorized to treat injured workers under the Workers’ Compensation Law will provide more access to different types of providers, and more types of medical care for injured workers.
The bill provides a basic framework, but the proposed regulations provide further context and clarity in implementing these changes. For example, clarity about how to apply for authorization, and the contents of such applications, as well as further detail about how an expanded list of providers will work in the context of the workers’ compensation system is addressed by the proposal. These regulations are required to reflect the changes to the workers’ compensation system introduced by the statute.
4. Costs
The proposed amendments should not impose significant costs. The proposal provides guidance and clarity to implement the statute, while avoiding costs outside what the law requires. The updates implement what the statute requires, and the proposal does not impose any independent additional costs.
5. Local Government Mandates
There are no specific mandates on local governments as a result of this proposal.
6. Paperwork
The proposal requires an application for providers who wish to become authorized, and sets forth guidance about what that application must include. The Board will prescribe the method of application, and makes provision for electronic filing of applications. Thus, paperwork should be diminished as a result of these regulations.
7. Duplication
There is no duplication of state or federal regulations or standards.
8. Alternatives
An alternative to the regulation would be to simply update references to provider to include the other provider types. However, without regulations in place to provide guidance and clarity, the statute expanding provider types would be difficult to implement, would increase paperwork, and lack of clarity could result in additional litigation.
9. Federal Standards
There are no applicable federal standards or regulations related to the proposed amendments.
10. Compliance Schedule
The statute becomes takes effect January 1, 2020.
Regulatory Flexibility Analysis
1. Effect of rule
The statute expands the list of providers that may become authorized to treat injured workers under the NYS Workers’ Compensation Law. This may mean that new provider types added in the statute that operate as small businesses will now be able to apply for authorization.
2. Compliance requirements
The proposal requires an application process (and reregistration process) for providers who wish to become authorized to treat injured workers under the NYS Workers’ Compensation Law. The proposal implements the statute and provides guidance and clarity about the application process and role of authorized providers under the NYS Workers’ Compensation Law.
Authorized providers must comply with the application and reregistration processes as well as the education requirements, etc. listed in the proposal to implement the statute.
3. Professional services
It is believed that no professional services will be needed by small businesses or local governments to comply with the proposed regulation.
4. Compliance costs
Compliance with the proposed regulations should not impose significant compliance costs on small businesses or local governments. The proposal seeks to implement the statute smoothly, and does not impose additional costs beyond what the statute would require.
5. Economic and technological feasibility
Compliance with the proposed regulations is technologically and economically feasible for small business and local government. The proposed regulations lay out how to apply for authorization and reregister, and no additional technology beyond what most medical providers already use will be required.
6. Minimizing adverse impact
The proposed regulations were written to provide a framework to implement the statute expanding the list of providers in accordance with the statute, in the clearest, smoothest way possible. To further minimize any impact, the regulations are being proposed now, and the statute takes effect on 1/1/20.
7. Small business and local government participation
The Board will duly consider all public comments received from small businesses or local governments during the public comment period.
Rural Area Flexibility Analysis
1. Types and estimated numbers of rural areas
The proposed regulations implement the statute expanding provider types who can be authorized to treat injured workers across NYS. Any licensed provider type in the statute can apply to become authorized, including those in rural areas.
2. Reporting, recordkeeping and other compliance requirements; and professional services
The same compliance and application requirements apply to providers in rural areas as in metropolitan areas. The application process (and reregistration process) will be prescribed by the Board, and no special professional services should be required by rural or any other areas. The regulations seek to implement the statute.
3. Costs
The proposed amendments should not impose costs. The proposal provides guidance and clarity to implement the statute, while avoiding costs outside what the law requires.
4. Minimizing adverse impact
The proposed regulations were written to provide a framework to implement the statute expanding the list of providers in accordance with the statute, in the clearest, smoothest way possible. To further minimize any impact, the regulations are being proposed now, and the statute takes effect on 1/1/20.
5. Rural area participation
The Board will duly consider all public comments received from rural areas during the public comment period.
Job Impact Statement
1. Nature of Impact
It is expected that the proposed regulations (as a result of the statute they are implementing) could have a positive impact on jobs in New York State. It expands the list of providers who may become authorized to treat injured workers under the Workers’ Compensation Law, and provides guidance about how to do it. The expanded list of providers offers injured workers’ more choices and access to medical care with an increased number and types of providers, as well.
2. Categories and Numbers Affected
Any NYS licensed provider as defined in the statute and fleshed out in the proposed regulations can apply to become authorized under the Workers’ Compensation Law.
3. Regions of Adverse Impact
The statute and its supporting proposed regulations will be implemented state-wide. The increased number of provider types applies state-wide, and accordingly there are no specific regions of adverse impact. More health care providers can apply to become authorized, and injured workers will have more access to providers throughout the state.
4. Minimizing Adverse Impact
The statute does not take effect until 1/1/20, which minimizes adverse impact that might be felt by lack of awareness – the proposed regulations are being published now, with several months before the statute takes effect, in order to receive public comments and implement the statute as smoothly as possible.
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