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The NYFAIR Mission: NYFAIR’s goal is to ensure that New Yorkers injured in auto accidents, and their healthcare providers, are treated fairly by insurance companies. NYFAIR is dedicated to bring to light the all too common insurer abuses endured by such claimants. Click here for more information.

The NYFAIR Approach: Through lobbying and advocation efforts, NYFAIR seeks to inform and educate New York State policymakers concerning recurring issues encountered by claimants.

Latest News and Updates:

December 26, 2018

Final Adoption: the Workers’ Compensation Board (WCB) published a Notice of Adoption of updated Medical Fee Schedules.  Click here to read the read the text of the adoption.

We are pleased that the WCB has abandoned proposals to limit physical therapy to 12 visits and physical therapy and chiropractic care to 180 days of the accident.  This is a real victory for accident victims and their health care providers.

The update is scheduled to become effective on April 1, 2019, although it will not apply to No-Fault reimbursement until 18 months later.

Copies of the new Medical Treatment Schedule may be purchased from OptumInsight, by writing to Official New York Workers’ Compensation Fee Schedule, PO Box 88050, Chicago, IL 60680-9920; by telephone at 1-800-464-3649, option 1; or online at www.optum360coding.com keyword New York or https://www.optum360coding.com/Product/40508/.

November 1, 2018

Click here to read our comments to the Workers’ Compensation Board proposal adopt Revised Medical Fee Schedules (I.D. No. WCB-23-18-00005-RP), including our strong opposition to the proposals to limiting Physical Therapy to 12 visits within 180 days and Chiropractic care to 180 days—ending the existing medical necessity standard.

October 30, 2018

Review the comments here from a NYFAIR member about the proposed changes to the Workers Compensation Chiropractic Fee Schedule

October 19, 2018

After two decades without any meaningful rate increase, the Workers’ Compensation Board (“the Board”) has proposed a new medical schedule of fees that increases rates of reimbursement for most services and most providers throughout the healthcare industry.  However, some of the proposals threaten to severely restrict access to healthcare for injured workers and automobile accident victims.

Most troubling are the proposals limiting Physical Therapy to 12 visits within 180 days and Chiropractic care to 180 days—ending the existing medical necessity standard. 

Proposed Ground Rule 2 provides:
     Physical medicine services may not exceed 12 sessions/visits per patient per accident or illness or be
     rendered more than 180 days from the first session/visit.

Chiropractic Physical Medicine Ground Rule 3 also limits treatment to 180 days.

These proposed Ground Rules must be stopped! These rules will have dire consequences for many injured workers and all automobile accident victims.

These arbitrary Ground Rules must not be applied to automobile accident victims!  First, they are arbitrary limitations made without regard to the patient’s needs, and without any examination of the patient or the patient’s records.  These Ground Rules effectively takes medical decision making out of the hands of the medical professionals, without any regard for the needs of the individual patient, or the professional judgment of their health care provider. 

Under the proposed rules, a patient who prudently delayed receiving reconstructive surgery while receiving conservative treatment could easily find herself in a situation where the surgery is covered, but the physical therapy necessary to recover from the surgery is not.  There is no medical justification for such a rule.  In fact, it seems to promote medical malpractice. 

The proposed rules directly contradicts an accident victim’s statutory right to receive “all necessary” No-Fault benefits without time limitation as long as the need for further treatment is identified in the first year.

If Ground Rule 2 were to be applied to an automobile accident victim it would limit physical therapy--the most effective and commonly prescribed recuperative treatment regime--to 12 visits within the first 180 days.

Ironically, the Board continues to characterize the changes as an improvement to the Workers Compensation system.  While there are aspects of the long overdue rate increases that will benefit patients and their healthcare providers, such increases are meaningless if the needed treatment is arbitrarily limited to 12 visits or 180 days.

There are other problematic aspects of the Board’s proposal:

  • A ground rule preventing chiropractors from billing for services they are qualified and licensed to provide, such as manipulation under anesthesia and spinal decompression.
  • Decreased reimbursement for Electrodiagnostic Testing
  • Preventing licensed clinical social workers and licensed mental health counselors from providing health care services under the supervision of a psychologist. A provision that could result in the abandonment of thousands of patients across New York State who are currently in treatment with an LCSW or LMHC under the supervision of an authorized psychologist.

The complete text of the proposed Medical Fee Schedule may be reviewed at http://www.wcb.ny.gov/content/main/hcpp/FeeSchedules.jsp

This proposal is not yet final.  The Board is required by law to consider comments at least until November 1, 2018.

Questions Concerning the Proposed Changes

Can anything be done to prevent or modify these proposed changes?
Fortunately, there is something that can be done.  The Board needs to know how these changes will affect medical providers and their ability to treat workers and automobile accident victims.  There is an opportunity for the public to submit comments to the Board regarding the proposed changes.

Who can submit such comments? 
Any New York State resident, including medical doctors, physical therapists, chiropractors, and other medical providers, injured workers and automobile accident victims.

How can I submit my comment?
Comment may be made directly to the Board to the attention of Heather MacMaster, Workers’ Compensation Board, 328 State Street, Schenectady, NY 12305-2318, (518) 486-9564, email: regulations@wcb.ny.gov

What sort of comment should I submit?
Feel free to write in as many or as few words as you like concerning what you feel about the new proposed change, particularly the Ground Rule 2 limiting physical medicine treatment to 12 visits within the first 180 days and Chiropractic Physical Medicine Ground Rule 3 limiting treatment to 180 days of the accident.  Comments from professionals and professional organizations that are based upon clinical experience or clinical studies would be the most helpful.  Individual statements from injured patients—particularly those that benefited from treatment in excess of 12 visits or physical therapy rendered more than 180 days after the accident may also prove persuasive.  Many unique credible comments are preferable to multiple copies of the same letter or email. If you require assistance drafting your comment, we would be glad to help.

The important thing is that you voice your opinion, share your expertise and tell the Board that you do not approve of the proposed changes. Let them know that these changes will hurt not only you and your patients, but also every person in New York who has been or may be injured at work or in an automobile accident.

When must I submit my comments?
Immediately!  Comments SHOULD be submitted on or before November 1, 2018.

Will my comment make a difference?
Yes.  The Board is required to consider every comment made regarding the proposed changes. Additionally, the more of us who submit comments, the more our collective voice will be heard.  This is our opportunity to stand up to the powerful insurance lobby in New York and tell the Board we do not approve the proposed changes.  Of course, if we do not stand up for our patients and practices, we cannot expect the Board will do so.

Will it help to get my professional associations involved?
Yes!  Comments made by respected professional associations such as the Medical Society of the State of New York, the New State York Osteopathic Medical Society, the New York State Chiropractic Association, the New York Physical Therapy Association can be particularly helpful.

What else is being done?
New Yorkers for Fair Automobile Insurance Reform (NYFAIR), an organization dedicated to ensuring that New Yorkers have continued access to quality medical care after automobile accidents, is working, along with other interested parties and organizations, to convince the Board, governmental entities, professionals, organizations and other stakeholders that the proposal to adopt Ground Rule 2 should be abandoned. (NYFAIR Position Statement)

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