The purpose of the changes being made to Rule 69L-7.501, F.A.C., is to incorporate the 2017 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The manual contains the updated lists of Maximum Reimbursement Allowances ...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker’s Compensation

RULE NO.:RULE TITLE:

69L-7.501Florida Workers’ Compensation Reimbursement Manual for Hospitals

PURPOSE AND EFFECT: The purpose of the changes being made to Rule 69L-7.501, F.A.C., is to incorporate the 2017 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The manual contains the updated lists of Maximum Reimbursement Allowances for various medical services, as approved by the Three-Member Panel on April 19, 2017, pursuant to section 440.13(12)(a), Florida Statutes.

SUMMARY: The proposed rule amends the existing rule to adopt and incorporate by reference the 2017 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has been prepared by the Agency.

The Agency has determined that the proposed rule is expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department conducted a SERC analysis of the proposed rule utilizing a cost analysis of estimated regulatory costs prepared by the National Council on Compensation Insurance, Inc. (NCCI). NCCI’s cost analysis of proposed Rule 69L-7.501, F.A.C., indicates that the proposed rule will result in an estimated overall increase in Florida workers’ compensation system costs of +2.2% (+$80M).

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 440.13(4), (12), (13)(b), 440.591, FS.

LAW IMPLEMENTED: 440.13(7), (12), (13), (14), FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Tuesday, November 21, 2017, 9:00 a.m. – 10:30 a.m.

PLACE: Hartman Building, Room 102, 2012 Capital Circle SE, Tallahassee, FL 32301

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Theresa Pugh, telephone: [phone], email: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Theresa Pugh, Program Administrator – Medical Services Section, Bureau of Monitoring and Auditing, Division of Workers’ Compensation, Department of Financial Services, telephone: [phone], email: [e-mail]. The text of the proposed rule is also available on the Department's website at http://www.myfloridacfo.com/Division/GeneralCounsel/RuleWorkshopMeetings/default.asp.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals.

(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, (“Hospital RM Manual”), 2017 2014 Edition, to become effective July 1, 2018, or upon the rule’s ratifying legislation becoming law, whichever date occurs later, http://www.flrules.org/Gateway/reference.asp?No=Ref-04109, effective January 1, 2015, is incorporated adopted by reference as part of this rule. The Hospital RM Manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and establishes policy, procedures, principles, and standards for implementing statutory provisions regarding reimbursement for medically necessary services and supplies provided to injured workers in a hospital setting. The policy, procedures, principles, and standards in the Hospital RM Manual are in addition to the requirements and responsibilities established throughout by the Rule Chapter 69L-7, F.A.C., Workers’ Compensation Medical Reimbursement and Utilization Review. Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.710, F.A.C. The Reimbursement Manual for Hospitals is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or may be obtained free of charge by print or download from the Department’s website at http://www.myfloridacfo.com/division/wc/. http://www.myfloridacfo.com/division/wc/publications.html.

(2) The Current Procedural Terminology (CPT®), 2017 Professional Edition, Copyright 2016, American Medical Association; the CPT® Assistant, American Medical Association, Copyright 2016; the 2017 ICD-10-CM: The Complete Official Codebook, American Medical Association, Copyright 2016, Optum360, LLC; the 2017 ICD-10-PCS: The Complete Official Codebook, American Medical Association, Copyright 2016, Optum360, LLC; the 2017 HCPCS Level II Professional Edition, American Medical Association, Copyright 2017, Elsevier Inc.; and the CDT 2017, Dental Procedure Codes, Copyright 2016, American Dental Association, are incorporated by reference as part of this rule. A copy of the American Medical Association’s reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/. A copy of the CDT reference material may be obtained from the American Dental Association’s website at http://www.ada.org/en/publications/ada-catalog.

(3) The National Uniform Billing Committee, Official UB-04 Data Specifications Manual 2017, version 11.00, July 2016, as adopted by the National Uniform Billing Committee, is incorporated by reference as part of this rule. A copy of this manual can be obtained from the National Uniform Billing Committee’s website at http://www.nubc.org/subscriber/.

      (4)(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual (“HCP RM”), incorporated by reference into Rule 69L-7.020, F.A.C.; and Rules 69L-7.710-7.750, F.A.C., which inform Health Care Providers and Insurers of their respective responsibilities in the billing, filing, reporting, and review of workers’ compensation medical claims the Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.710, F.A.C., are recognized for use in conjunction with the Hospital RM Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2014 Edition, effective January 1, 2015.

(5) The Both rules, the Hospital RM, and the HCP RM, and all incorporated resource materials are available for public inspection and examination during normal business hours at the Florida Department of Financial Services, Division of Workers’ Compensation, Bureau of Monitoring and Audit, Hartman Building, 2012 Capital Circle Southeast, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311 32301, or via the Department’s website web site at http://www.myfloridacfo.com/division/wc/ http://www.myfloridacfo.com/division/wc/publications.html. The copying or posting of any of the preceding copyrighted materials on the Internet would constitute a violation of the federal copyright law. The preceding non-copyrighted materials may be accessed online via the Division of Workers’ Compensation website at http://www.myfloridacfo.com/division/wc/.

Rulemaking Authority 440.13(4), (12), (13)(b) (14), 440.591 FS. Law Implemented 440.13(7), (12), (13), (14) FS. History–New 6-9-87, Amended 6-1-92, 10-27-99, 7-3-01, Formerly 38F-7.501, 4L-7.501, Amended 12-4-03, 1-1-04, 7-4-04, 10-1-07, 1-1-15, ________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Theresa Pugh

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: CFO Jimmy Patronis

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 10/26/2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 08/11/2017