The purpose and effect of the proposed rule is to update the Health Care Provider Reimbursement Manual (HCP RM) and other incorporated materials. The HCP RM contains the updated lists of Maximum Reimbursement Allowances ....

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Workers' Compensation

RULE NO.:RULE TITLE:

69L-7.020Florida Workers' Compensation Health Care Provider Reimbursement Manual

PURPOSE AND EFFECT: The purpose and effect of the proposed rule is to update the Health Care Provider Reimbursement Manual (HCP RM) and other incorporated materials. The HCP RM contains the updated lists of Maximum Reimbursement Allowances for various medical services, as approved by the Three-Member Panel on December 17, 2020, pursuant to section 440.13(12)(a), Florida Statutes.

SUMMARY: The proposed rule will update the HCP RM and other incorporated materials.

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.

A summary of the SERC follows:

• The rule is not likely to directly or indirectly have an adverse impact on economic growth, private-sector job creation or employment, or private-sector investment in excess of $1 million in the aggregate within 5 years after the implementation of the rule.

• The rule is not likely to directly or indirectly have an adverse impact on business competitiveness, including the ability of persons doing business in the state to compete with persons doing business in other states or domestic markets, productivity, or innovation in excess of $1 million in the aggregate within 5 years after the implementation of the rule.

• The rule is likely to directly or indirectly increase regulatory costs, including any transaction costs, in excess of $1 million in the aggregate within 5 years after the implementation of the rules.

• The number of individuals and entities likely to be required to comply with the rule is approximately 83,868.

• The agency will incur no costs for implementing or enforcing the proposed rule.

• The cost to any other state and local government entities of implementing the proposed rule and the anticipated effect on state and local revenues is anticipated to be none.

• The total estimated transactional costs to the individuals and entities that are required to comply with the rule is minimal.

• Impacts on small businesses, small counties, and small cities are likely minimal and may vary by the size of the entity.

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: Not applicable (see SERC).

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(13)(b), 440.591, FS.

LAW IMPLEMENTED: 440.13(7), (12), (13)(b), 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: March 4, 2021, 9:30 a.m. ET

PLACE: Please join the meeting from your computer, tablet or smartphone, https://global.gotomeeting.com/join/822492709.

You can also dial in using your phone. United States (Toll Free): 1(866)899-4679; United States: [phone], Access Code: 822-492-709.

Join from a video-conferencing room or system. Dial in or type: 67.217.95.2 or inroomlink.goto.com, Meeting ID: 822 492 709, Or dial directly: 822492709@67.217.95.2 or 67.217.95.2##822492709.

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: Charlene Miller, Bureau Chief, Division of Workers’ Compensation, 200 East Gaines Street, Tallahassee, FL 32399, [phone], [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-7.020 Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual (HCP RM), 2020 2016 Edition, to become effective July 1, 2021, 2017, http://www.flrules.org/Gateway/reference.asp?No=Ref-07685, is incorporated adopted by reference as part of this rule. The HCP RM manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to section subsection 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes, and MRAs maximum reimbursement allowances for services and supplies provided by health care providers. Also, the HCP RM manual includes reimbursement policies and payment methodologies for pharmacists and medical suppliers. The policies and procedures in the HCP RM are in addition to the requirements and responsibilities established throughout Rule Chapter 69L-7, F.A.C., Workers’ Compensation Medical Reimbursement and Utilization Review.

(2) The CPT® 2016 Current Procedural Terminology (CPT®), 2020 Professional Edition, Copyright 2019 2015, American Medical Association; the CDT 2020 2016, Dental Procedure Codes, Copyright 2020 2015, American Dental Association; and, in part, for D codes and for injectable J codes, and for other medical services and supply codes, the “2016 HCPCS Level II, Professional 2020 eEdition,” American Medical Association, Copyright 2020 2016, Elsevier Inc.;, are adopted by reference as part of this rule. When a health care provider performs a procedure or service which is not listed in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition, incorporated above, the provider must use a code contained in the CPT® 2016, CDT 2016 or HCPCS 2016 as specified in this section. tThe CPT® Assistant 2020, American Medical Association, Copyright 2019; 2015, and the 2016 ICD-10-CM 2020: The Complete Official Codebook, American Medical Association, Copyright 20192015, Optum360, LLC, are incorporated also adopted by reference as part of this rule. A copy of the American Medical Association these reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/. A copy of the CDT CDP reference material may be obtained from the American Dental Medical Association’s website at https://www.ada.org/en/publications/ada-catalog http://www.ada.org/en/publications/ada-catalog. A copy of the HCPCS Legel II reference material may be obtained from the American Medical Association’s webiste at http://commerce.ama-assn.org/store/.

(3) The Pposting of the preceding copyrighted materials in subsection (2) above and the HCP RM on the Iinternet would constitute a violation of the federal copyright law. The preceding copyrighted These materials are available for public inspection and examination, but may not be copied, during normal business hours at: (a) the Florida Department of Financial Services, Division of Workers’ Compensation, Bureau of Monitoring and Audit, 1579 Summit Lake Drive, Tallahassee, Florida 32317, or (b) the Florida Department of State, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida 32399. In addition, the HCP RM may be obtained via the Department’s Division of Workers’ Compensation website at https://www.myfloridacfo.com/Division/wc/.  The preceding non-copyrighted materials may be accessed online via the Department’s Division of Workers’ Compensation website at http://www.myfloridacfo.com/Division/wc/.

PROPOSED EFFECTIVE DATE: Upon ratification ratification by the Legislature

Rulemaking Authority 440.13(13)(b), 440.591 FS. Law Implemented 440.13(7), (12), (13)(b) FS. History–New 10-1-82, Amended 3-16-83, 11-6-83, 5-21-85, Formerly 38F-7.20, Amended 4-1-88, 7-20-88, 6-1-91, 4-29-92, 2-18-96, 9-1-97, 12-15-97, 9-17-98, 9-30-01, 7-7-02, Formerly 38F-7.020, 4L-7.020, Amended 12-4-03, 1-1-04, 7-4-04, 5-9-05, 9-4-05, 11-16-06, 10-18-07, 2-4-09, 7-1-16, 7-1-17,______.

Editorial Note: Ratified by Ch. 2016-203, LOF.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Charlene Miller, Bureau Chief

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jimmy Patronis, Chief Financial Officer

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 29, 2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: February 4, 2021