A Guide to Navigating New York State Medical Treatment Guidelines: 2022

Established in 2010 by the New York State Workers’ Compensation Board as a single standard of medical care for the treatment of injured workers, the New York State Medical Treatment Guidelines continue to evolve with the rapidly shifting industry.

New York has a more formalized and complex medical treatment process than most other states. With strict deadlines and steep penalties and fines, it’s crucial that employers, providers, carriers and injured workers have the most up-to-date information about forms, deadlines and updates to the guidelines. Here, we’ve compiled everything you need to know to navigate the NY WC MTG in 2022.

NY WC MTG: A Brief History
The Medical Treatment Guidelines were an important component of New York State’s 2007 Workers' Compensation Reform. They were initially developed by the Workers' Compensation Reform Task Force and its Advisory Committee.

The goal of the task force was to develop modern diagnostic and treatment techniques along with evidence-based standards of care that would ensure injured workers in New York State receive the most efficacious care available for their injuries.

The task force started with the back, neck, shoulder and knee since injuries to those areas were, at the time, the most common in the workplace. When the Treatment Guidelines were first being drafted, forty percent of all claims and sixty percent of system medical costs were due to back, neck, shoulder and knee injuries.

In 2008, once the guidelines were created, the WCB posted the proposed Guidelines on their website and asked for feedback from stakeholders. At the same time, the WCB began an extensive and lengthy review of the Treatment Guidelines. They were amended and then finally adopted and implemented by the Board in 2010.

The Treatment Guidelines are significant because they set a single standard of medical care for injured workers. Before the Treatment Guidelines existed, the Workers’ Comp Board set a monetary threshold. Any test or treatment that exceeded that threshold needed to be approved.

This caused an enormous number of tests and treatments to get stalled while injured workers sought approval, which led to confusion and delays for the injured worker, and lots of headaches for the employers, carriers, doctors, medical management teams and third party administrators working to get the injured worker treated and back to work.

The purpose of the New York Workers’ Comp MTG is to provide a playbook for how certain injuries should be treated and what is and isn’t pre-authorized by the carrier. The six main benefits of the Treatment Guidelines are:

They expedite quality care for injured workers
They improve the medical outcomes for injured workers
They get injured workers back to work more quickly
They reduce disputes between carriers and the medical providers treating the injured worker over treatment issues
They increase timely payments to medical providers
They reduce overall system costs

NY WC MTG: What’s Covered?
Since their adoption in 2010, the Workers’ Compensation Board has added additional injury sites to the Treatment Guidelines beyond the initial back, neck, shoulder and knee injuries.

Since then:

carpal tunnel syndrome and non-acute pain have been added.
On May 2, 2022, the following will go into effect:
- Ankle and Foot Disorders
- Elbow Injuries, Hand, Wrist and Forearm Injuries (including Carpal Tunnel Syndrome),
- Hip and Groin Disorders
- Occupational Interstitial Lung Disease
- Occupational/Work-Related Asthma
- Post-Traumatic Stress Disorder and Acute Stress Disorder
- Work-Related Depression and Depressive Disorders
- Eye Disorders
- Traumatic Brain Injury
- Complex Regional Pain Syndrome

PARS: Prior Authorization Requests
As of May 2, 2022, the traditional forms we’ve used for years in workers’ compensation—the MG-1, MG-2 and C4-Auth—will be obsolete as we move to OnBoard, the WCB’s new web-based claims system.

The forms will be replaced by PARs, or prior authorization requests. The WCB defines a PAR as “a request by an injured worker's health care provider to obtain prior approval from the payer (e.g., insurance carrier) to cover the costs associated with a specific treatment under workers' compensation insurance.”

There are currently seven PAR types:

Medication: The request used for prescribing non-formulary medications. It replaces the Drug Formulary Prior Authorization application. Insurers must respond within four calendar days.
MTG Confirmation: Replaces the MG-1 form and confirms that the proposed treatment or test is based on the correct utilization of the MTGs. Insurers must respond within eight business days. Health care providers do not have to submit MTG Confirmations, but a response from payers is mandatory.
MTG Variance: Used to request treatments and tests that vary from what’s included in the MTGs. The MTG Variance replaces the MG-2 form. Insurers must respond within 15 calendar days, in accordance with General Construction Law, of receiving the request. If they decide to request an independent medical examination (IME), the insurer must notify both the healthcare provider and the Chair within five business days of the decision and respond within 30 calendar days, in accordance with General Construction Law, of receiving the request.
Non-MTG Over $1,000: Used to request treatment or tests costing more than $1,000 with no applicable MTGs. It replaces the C4-Auth. The insurer must respond within 30 calendar days in accordance with General Construction Law.
Non-MTG Under or =$1,000: Used to request treatment or tests costing $1,000 or less with no applicable MTGs. The insurer must respond within eight business days.
MTG Special Services: Used to request special services. The insurer must respond within the same timeframe as the MTG Variance outlined above.
Durable Medical Equipment: Used to request durable medical equipment not listed on the Durable Medical Equipment Fee Schedule or one that is listed on the schedule but requires prior authorization. The insurer must respond within four calendar days in accordance with General Construction Law.

Per the WCB, “General Construction Law (GCL) 25a states: ‘When any period of time, computed from a certain day, within which or after which or before which an act is authorized or required to be done, ends on a Saturday, Sunday or a public holiday, such act may be done on the next succeeding business day…’”

OUT OF STATE (OOS) TREATMENT REQUIREMENTS
Per the Workers’ Compensation Board panel decision from May 24, 2017, “the Medical Treatment Guidelines and the various Guidelines processes apply if the claimant both resides out of state and receives medical treatment out of state.”

This means a few important things:

Requests for treatment by out-of-state providers are no longer considered moot
Starting May 2, 2022, out-of-state providers will also have access to submit requests through OnBoard
If the determination is made that treatment should be denied, a carrier should fill out a C8.1

For more information on the New York State Medical Treatment Guidelines, visit http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/MTGOverview.jsp.