The purpose and effect of the proposed rule development is to amend the rule to adopt by reference the 2014 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals, replacing the 2006 Edition of the Florida Workers’ ...

 

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 and effect of the proposed rule development is to amend the rule to adopt by reference the 2014 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals, replacing the 2006 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals in the existing rule. The 2014 Edition of the Florida Workers’ Compensation Reimbursement Manual will incorporate a fee schedule for certain hospital outpatient services utilizing current procedural terminology (CPT) line level charge data. The proposed outpatient fee schedule includes adjustment of the reimbursement amount depending upon the geographic location of the service provider. In addition, the manual increases the current inpatient surgical and non-surgical per diem amounts by 16.5% and raises the current stop-loss threshold by 16.5%. Technical changes incorporated into the 2014 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals include a new manual format and an expanded table of contents, with chapters organized by topic.

SUMMARY: Rule amendment to adopt the 2014 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The Manual incorporates a fee schedule reimbursement methodology for certain hospital outpatient services based on CPT line level charge data including an adjustment based upon defined geographic areas in Florida.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not 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 not 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 has conducted an economic analysis of the proposed rule and determined that there is no adverse impact or potential regulatory cost associated with the proposed rule that exceeds any of the criteria under paragraph 120.541(1)(b) or 120.541(2)(a), F.S. The Department based its analysis on its experience in estimating operating costs within the rulemaking process, as well as data provided to it by the National Council on Compensation Insurance, Inc. (“NCCI”). The Department also utilized information that was gathered through survey and consultation with regulated entities and industry representatives.

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(12), (14), 440.591 FS.

LAW IMPLEMENTED: 440.13(7), (12), (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, March 4, 2014, 10:00 a.m.

PLACE: Room 102, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida

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: Eric Lloyd @ [phone] or [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: Eric Lloyd, Program Administrator, Medical Services Section, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232, [phone] or [e-mail]

 

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, 2014 2006 Edition, is adopted by reference as part of this rule. The Hospital Manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to subsection 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 Manual are in addition to the requirements established by the Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.602, 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/provider/reimbursement-manuals.htm http://www.fldfs.com/wc.

(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual [HCP RM], 2006, incorporated by reference into Rule 69L-7.020, F.A.C.; and the Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.602, F.A.C., are recognized for use in conjunction with the Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2014 Edition also incorporated by reference into this rule. Both rules and the HCP RM are 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 via the Department’s web site at http://www.myfloridacfo.com/Division/WC/provider/reimbursement-manuals.htm http://www.fldfs.com/wc.

Rulemaking Specific Authority 440.13(12), (14), 440.591 FS. Law Implemented 440.13(7), (12), (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,_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Eric Lloyd, Program Administrator, Medical Services Section, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232, [phone] or [e-mail]

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jeff Atwater, Chief of Financial Officer, Department of Financial Services

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 28, 2014

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 30, 2013