N.Y. Workers' Compensation Law § 13-c: Licensing of compensation medical bureaus and laboratories

§ 13-c. Licensing of compensation medical bureaus and laboratories. 1.

The chairman may, upon the recommendation of the medical society of the

county or of a board as provided in section thirteen-b, authorize and

license compensation medical bureaus in such counties operated by

qualified physicians wholly or principally for the diagnosis and

treatment of industrial injuries or illnesses in respect to which they

are authorized to render medical care under this chapter. The chairman,

however, shall not authorize or license more than two such bureaus

operated by the same physician. The chairman may, upon the

recommendation of the medical society of the county or of a board as

provided in section thirteen-b, authorize and license separate

laboratories and bureaus engaged in X-ray diagnosis or treatment and

clinical diagnosis, or in physiotherapy or other therapeutic procedures,

which participate in the diagnosis or treatment of injured workmen under

this chapter. The chairman, however, shall not authorize or license more

than two such laboratories or bureaus operated by the same physician.

Application for such authorization shall be made on forms to be

furnished by the chairman, and shall disclose in full the nature of the

personnel and equipment of such bureaus. If within sixty days after such

application has been filed the medical society or board refuses or fails

to act or refuses to recommend to the chairman that such license be

granted, the applicant may appeal to the medical appeals unit. Each such

bureau or laboratory which receives such authorization shall:

(a) Make reports on its personnel and equipment in such form and at

such times as may be required by the chairman; and

(b) Be subject to inspection by the chairman or the medical society of

the county in which such bureau or laboratory is located; and

2. No claim for services in connection with x-ray examination,

diagnosis or treatment of any claimant shall be valid or enforceable

except by a laboratory or bureau of a voluntary hospital authorized and

licensed under subdivision one of this section, or except by a physician

duly authorized as a roentgenologist by the chairman for services

performed by such physician or under his immediate supervision.

3. (a) The chairman may authorize a medical center, jointly operated

by labor and management representatives as a non-profit corporation or

as a non-profit benefit trust, approved by and under the supervision of

the New York state department of health, to provide medical, surgical,

dental, optometric, podiatric, or other attendance or treatment,

including X-ray diagnosis or treatment, physiotherapy or other

therapeutic procedures or services, laboratory services and any and all

other services required to be provided for an injured employee under

section thirteen of this chapter, entitled "Treatment and care of

injured employees".

(b) Application for such authorization shall be made on forms to be

furnished by the chairman, and shall disclose in full the nature of the

personnel and equipment of such medical center. Each such medical center

which receives such authorization shall:

(i) Make reports on its personnel and equipment in such form and at

such times as may be required by the chairman;

(ii) Be subject to inspection by the chairman;

(c) All treatment and services provided hereunder shall be provided on

an out-patient basis to employees, who are claimants for workmen's

compensation, eligible to use the medical center pursuant to an

agreement, plan, deed of trust or labor-management collective bargaining

agreement.

(d) (i) A physician rendering medical care at a medical center

authorized hereunder must be authorized to render such care pursuant to

this chapter and he shall limit his professional activities hereunder to

such medical care as his experience and training qualify him to render.

(ii) When para-medical, laboratory or X-ray services or other medical

care is required it shall be rendered, under the active and personal

supervision of an authorized physician, by a registered nurse or other

person trained in laboratory or diagnostic techniques within the scope

of such person's specialized training and qualifications. This

supervision shall be evidenced by signed records of instructions for

treatment and signed records of the patient's condition and progress.

Reports of such treatment and supervision shall be made by such

physician to the chairman on such forms and at such times as the

chairman may require.

(iii) When physical therapy care is required it shall be rendered by a

duly licensed physical therapist upon the referral which may be

directive as to treatment of an authorized physician or podiatrist

within the scope of such physical therapist's specialized training and

qualifications as defined in article one hundred thirty-six of the

education law. Reports of such treatment and records of instruction for

treatment, if any, shall be maintained by the physical therapist and

referring professional and submitted to the chairman on such forms and

at such times as the chairman may require.

(iv) When occupational therapy care is required it shall be rendered

by a duly licensed and registered occupational therapist upon the

prescription or referral of an authorized physician within the scope of

such occupational therapist's specialized training and qualifications as

defined in article one hundred fifty-six of the education law. Reports

of such treatment and records of instruction for treatment, if any,

shall be maintained by the occupational therapist and referring

professional and submitted to the chairman on such forms and at such

times as the chairman may require.

(v) The physician rendering the medical care hereunder shall be in

charge of the care unless, in his judgment, it is necessary to refer the

case to a specially trained and qualified physician, which physician

shall then assume complete responsibility for and supervision of any

further medical care rendered.

(e) Notwithstanding any provision of this chapter to the contrary, a

medical center authorized by the chairman to render medical care and

laboratory services under this section, is authorized and may charge for

any and all services rendered in accordance with such schedule or

schedules prepared and established by the chairman.

(f) Nothing herein contained shall operate to prevent such employee

from selecting for rendering or continuance of any medical treatment or

care required, any physician authorized by the chairman to render

medical care as hereinabove provided, in accordance with section

thirteen-a, of this chapter.

(g) The chairman shall have full power and authority and it shall be

his duty to investigate instances of misconduct, or violations of the

provisions of this chapter or violations of the rules promulgated by the

chairman under the provisions of this chapter, or failure to submit full

and truthful medical reports directly to the chairman within the time

limits provided under subdivision four of section thirteen-a of this

chapter; and, after a hearing, to temporarily suspend or revoke the

license of any such medical center. The chairman may also temporarily

suspend or revoke the license of any such medical center upon finding,

after a hearing, that such medical center has been guilty of

professional or other misconduct or that the personnel of such center is

not properly qualified under this chapter or the equipment of such

medical center is inadequate for the proper rendering of medical care.

(h) The chairman may adopt such reasonable rules and regulations for

the authorization and continued supervision of medical centers under

this section, as he may deem necessary and proper.

4. (a) The chairman may authorize a hospital as defined in article

twenty-eight of the public health law or a health maintenance

organization holding a valid certificate of authority issued pursuant to

article forty-four of the public health law or operating under the

provisions of article forty-three of the insurance law to provide

out-patient medical care under this chapter.

(b) Application for such authorization shall be made on forms to be

furnished by the chairman, and shall disclose in full the nature of the

personnel and equipment of such hospital or health maintenance

organization. Each such hospital or health maintenance organization

which receives such authorization shall:

(i) Make reports on its personnel and equipment in such form and at

such times as may be required by the chairman; and

(ii) Be subject to inspection and investigation as provided hereunder.

(c) All treatment and services provided hereunder shall be provided on

an out-patient basis to workers' compensation claimants.

(d) (i) A physician rendering medical care at a hospital or health

maintenance organization authorized hereunder must be authorized to

render such care pursuant to this chapter and he or she shall limit his

or her professional activities hereunder to such medical care as his or

her experience and training qualify him or her to render. The physician

rendering the medical care shall sign and submit all forms and reports

as the chairman may require.

(ii) When para-medical, laboratory or X-ray services or other medical

care is required it shall be rendered, under the active and personal

supervision of an authorized physician, by a registered nurse or other

person trained in laboratory or diagnostic techniques within the scope

of such person's specialized training and qualifications. This

supervision shall be evidenced by signed records of instructions for

treatment and signed records of the patient's condition and progress.

Reports of such treatment and supervision shall be made by such

physician to the chairman on such forms and at such times as the

chairman may require.

(iii) When physical therapy care is required it shall be rendered by a

duly licensed physical therapist upon the referral which may be

directive as to treatment of an authorized physician or podiatrist

within the scope of such physical therapist's specialized training and

qualifications as defined in article one hundred thirty-six of the

education law. Reports of such treatment and records of instruction for

treatment, if any, shall be maintained by the physical therapist and

referring professional and submitted to the chairman of such forms and

at such times as the chairman may require.

(iv) When occupational therapy care is required it shall be rendered

by a duly licensed and registered occupational therapist upon the

prescription or referral of an authorized physician within the scope of

such occupational therapist's specialized training and qualifications as

defined in article one hundred fifty-six of the education law. Reports

of such treatment and records of instruction for treatment, if any,

shall be maintained by the occupational therapist and referring

professional and submitted to the chairman on such forms and at such

times as the chairman may require.

Reports of such treatment and supervision shall be made by such

physician to the chairman on such forms and at such times as the

chairman may require.

(v) The physician rendering the medical care hereunder shall be in

charge of the care unless, in his or her judgment, it is necessary to

refer the case to a specially trained and qualified authorized

physician, which physician shall then assume complete responsibility for

and supervision of any further medical care rendered.

(e) Notwithstanding any provision of this chapter to the contrary, a

hospital or health maintenance organization authorized by the chairman

to render medical care and laboratory services under this section, is

authorized and may charge for any and all services rendered in

accordance with such schedule or schedules prepared and established by

the chairman.

(f) Nothing herein contained shall operate to prevent such employee

from selecting for rendering or continuance of any medical treatment or

care required, any physician authorized by the chairman to render

medical care as hereinabove provided, in accordance with section

thirteen-a of this chapter.

(g) (i) The department of health shall conduct inspections and

investigations and make recommendations with respect to charges of

professional or other misconduct or that the personnel of an authorized

hospital or health maintenance organization are not properly qualified

under this chapter or that the equipment of such hospital or health

maintenance organization is inadequate for the proper rendering of

medical care. After such inspection and investigation the department of

health shall refer its report and recommendations to the chairman, who

shall have full power and authority to temporarily suspend or revoke the

authorization under this subdivision of any such hospital or health

maintenance organization upon finding, after a hearing, that such

hospital or health maintenance organization has been guilty of

professional or other misconduct, or that the personnel of such hospital

or health maintenance organization are not properly qualified under this

chapter or the equipment of such hospital or health maintenance

organization is inadequate for the proper rendering of medical care. The

recommendations of the department of health shall be advisory to the

chairman only and shall not be binding or conclusive upon him.

(ii) The chairman shall have full power and authority and it shall be

his duty to investigate violations of the provisions of this chapter or

violations of the rules promulgated by the chairman under the provisions

of this chapter, or failure to submit full and truthful medical reports

directly to the chairman within the time limits provided under

subdivision four of section thirteen-a of this article, and, after a

hearing, to temporarily suspend or revoke the authorization under this

subdivision of any such hospital or health maintenance organization.

(h) The chairman may adopt such reasonable rules and regulations for

the authorization and continued supervision of hospitals and health

maintenance organizations under this section as he may deem necessary

and proper.