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Government Affairs Albany Update

December 7, 2007

Workers' Comp Medical Guidelines

Staff Contact: Ken Pokalsky

This March, in conjunction with his approval of worker's comp reform legislation, Governor Spitzer directed the Commissioner of Insurance Eric Dinallo to proposed medical treatment guidelines for the comp program by December 1, 2007. This Monday, the Department issued four sets of proposed guidelines, for lower back, neck, shoulder and knee injuries — injuries that account for more than 50 percent of all medical related costs in the workers' comp system. The Commissioner has also issued a draft set of general principals related to application of medical guidelines, and a plan for educating physicians, board employees and others involved with the delivery & review of medical care.

Commissioner Dinallo said that these proposed treatment guidelines “contain quality standards for medical care of injured workers', and should encourage accelerated delivery of quality medical services and reduce disputes and costs.” The Commissioner also said that they expect to develop additional guidelines, including those for chronic pain and wrist injuries (including carpal tunnel syndrome).

The Business Council has long been a proponent of evidence-based treatment guidelines, and has been directly involved with the development of these medical guidelines. Three Business Council representatives are serving on the Department's medical guidelines advisory committee — Dr. James Tacci, Manager of Medical Services for Xerox Corporation; Dr. David Deitz, National Medical Director for Liberty Mutual; and Pam Caggianelli, Corporate Manager of Health Services for Bausch and Lomb.

The Department's advisory committee will be addressing implementation issues when it reconvenes next week. Among its agenda items is development of an implementation plan, which will address issues such as the degree to which compliance is mandated; the weight given to these treatment guidelines in determining medical necessity and payment, consideration of variances, and others.

The advisory committee may also address the issue of impairment guidelines, which will be used in part to determine loss of wage earning capacity the basis for setting permanent partial disability benefits under the reform bill.

Please feel free to contact The Business Council with any questions or comments regarding the Department's proposal guidelines or regarding next steps toward implementation.

State Coalition on Liability Reform

In preparation for the 2008 legislative session, The Business Council, along with other businesses, professional and local government groups, is reorganizing a state-wide coalition to advocate for liability reforms. The group will be calling for the Governor and legislature to reform the State's costly liability laws that help contribute to soaring construction costs, ever-increasing property taxes, and a medical liability crisis that reduces access to quality health care.

Members of the coalition are addressing a number of tort issues, but will focus on the “scaffold law” that imposes absolute liability on building owners, noting that New York's unique Labor Law Section 240 contributes to lost jobs, lower tax revenues and increased costs of doing business.

In addition to focusing on “scaffold law” reform, The Business Council will continue to monitor and oppose trial bar initiatives to expand the state's liability laws. In 2007, The Business Council played a key role in urging Governor Eliot Spitzer to veto a bill that would allow plaintiffs in liability lawsuits obtain a court order to determine before trial the extent of the insurance coverage the defendant is carrying .

Universal Coverage Plan Proposed

Staff Contact: Lev Ginsburg

Assemblyman Richard Gottfried, chair of the Assembly Health Committee, has unveiled a proposal to achieve “universal” health care coverage in New York. Called “New York Health Plus,” the proposal would build on the state's existing Family Health Plus and Child Health Plus programs, which would be merged to form the core of the new program. Every New York State resident would be eligible, regardless of age, income, or work status, and coverage would be delivered through participating health plans. Individuals who choose to enroll would pick their own insurance carrier from those participating in the program, and individuals or employers could opt out and pay for private coverage. Neither employers nor individuals would have to pay premiums, deductibles or co-pays.

New York Health Plus would be publicly funded, and has been estimated to cost as much as $59 billion per year. However, the funding mechanism has not been determined, although Assemblyman Gottfried offered a variety of options including a graduated surcharge on the personal income tax and a surcharge on business income taxes. According to the Assemblyman's office, there are currently no plans to introduce legislation.

State Awards RFP for Universal Coverage Study

Staff Contact: Lev Ginsburg

As the Spitzer administration considers ways to expand access to health coverage as part of its “Partnership for Coverage” initiative, the state has awarded a $470,000 contract to the Urban Institute, a policy research organization, to “model alternative proposals for achieving universal health coverage in New York. According to the state, the analysis will include, but may not be limited to, proposals to provide universal health coverage through public and private health coverage mechanisms.”

A final proposal for universal coverage in New York from the departments of Health and Insurance is due by May 31, 2008.

Berger Commission Status Report Released

Staff Contact: Lev Ginsburg

The NYS Department of Health released a status report on the implementation of the recommendations made November 2006 by the Commission on Health Care Facilities in the 21st Century, known as the Berger Commission. In its final report, the Commission recommended the restructuring of 48 hospitals, the closing of nine hospitals and the downsizing of almost 3,000 nursing home beds as part of an effort to reform and strengthen New York's acute and long term care delivery systems.

According to the Department of Health, the majority of the affected hospitals and nursing homes are taking steps required to meet or exceed the deadlines of the commission's mandates. Facilities subject to the recommendations, which became law on January 1, 2007, must be in full compliance by June 30, 2008.

“Project Sunlight”

The “Project Sunlight” web site, developed by the office of Attorney General, was unveiled this week, provides access to a wide range of data currently maintained by the state legislature, Board of Elections, Commission on Public Integrity, the Department of State and other sources. The web site is available here:

This site allows you to access: