Effective March 1, 2013, the New York State Workers’ Compensation Board will implement changes to the Low Back, Knee, Shoulder and Cervical Spine Medical Treatment Guidelines (MTGs), as well as add guidelines for Carpal Tunnel Syndrom. Below are the changes that will be taking effect on March 1st that will impact physical therapy services:
- Summary of Carpal Tunnel Syndrome Medical Treatment Guidelines.
- Adoption of a new maintenance care program for chronic pain for existing guidelines (back neck, shoulder and knee).
The revised MTGs for those body parts listed above will include up to 10 visits for maintenance care per year for those injured workers with chronic pain who have reached maximum medical improvement (MMI), have a permanent disability and meet the requirements of the maintenance program. No variance is allowed from the 10 visit annual maximum. This change will apply to all claims on or after March 1st regardless of the date of accident or disablement.
- The knee, shoulder and back MTGs will now state that kinesiotaping, taping or strapping, other than for acute joint immobilization (ex: acute ankle sprain) is not recommended for acute, subacute or chronic pain.
- Because of the regulation on timing of the variance signature and fax transmissions, which required that a medical provider certify that they served a copy of the variance request on the insurance carrier the same day the form was sent to the Board (some forms were being faxed to the insurance carrier and the Board the day after the physician signed it), some requests were being rejected. The revised regulations and form allows for the simultaneous submission to the insurance carrier and the Board within two business days of the physician signing the request.
- Due to frequent duplicate submissions of identical variance request forms (same treatment for the same patient) without justification, the new regulations will require the provider to certify that they have not submitted a similar request without a clinical change or meaningful new information. Duplicate requests will no longer be permitted and will not qualify for an order of the chair. Anyone who repeatedly violates this provision may be subject to sanction by the Board.
- Current regulations and forms do not allow an insurance carrier to approve only a portion of the variance request (ex: approve and additional 8 weeks of treatment instead of 16 weeks). The revised regulations will allow the insurance carrier to partially grant the variance and give the provider and injured worker the right to request review of any portion that was denied.
- The definition of Maximum Medical Improvement has been slightly changed and now reads:
“Maximum Medical Improvement (MMI)” means a medical judgment that (a) claimant has recovered from the work injury to the greatest extent that is expected and (b) no further improvement in his or her condition is reasonably expected. The need for palliative or symptomatic treatment does not preclude a finding of MMI. In cases that do not involve surgery or fractures, MMI cannot be determined prior to 6 months from the date of injury or disablement, unless otherwise agreed to by the parties.
- Language was added to allow for electronic submission of variance requests and response, should the technology become available.