Provides that the list of pre-authoized procedures is to be used only as a list of treatment that does not require insurance carrier approval

• Republican2

◆ The sponsor's argument

Why Steve Rhoads says this is needed

In 2007 the Legislature amended Workers' Compensation Law Section 13-a(6) to direct the chair of the Workers' Compensation Board to adopt a list of pre-authorized procedures. The Legislature's intent was to expedite the delivery of medical care to injured workers in order to improve outcomes and reduce periods of disability and the extent of permanent injury. In 2010, the Board adopted Medical Treatment Guidelines and associated regulations that, instead of merely pre-authorizing treatment as directed by the statute, deem any treatment that is not pre-authorized to be pre- denied. Despite the statutory threshold of $1,000 for prior authorization, the Guidelines and regulations have been employed to deny to provision of any medical care, regardless of cost, that is not authorized by the Guidelines. The Board has subsequently developed a complex process which the burden is placed on treating physicians to seek a "variance" from the Guide- lines in order to obtain prior authorization. Injured workers and attor- neys are excluded from this process, thus imposing a burden upon health care providers to act as both doctors and patient advocates. There are widespread reports that his system has resulted in the routine delay and denial of needed medical treatment, as well as of significant backlogs in the final stage of the medical appeal process to the Board's medical director. The system in place also imposes significant burdens on employers and insurers to receive, review, and respond to variance requests. This amendment is intended to clarify existing law that prior authori- zation is not required for treatments under $1,000 regardless of such treatment's status in the Medical Treatment Guidelines promulgated by the Board.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.