The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers incorporated in Rule 69L-7.100, F.A.C., is to establish reimbursement rates for services provided by ambulatory surgical centers.

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker's Compensation

RULE NO.:RULE TITLE:

69L-7.100Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)

PURPOSE AND EFFECT: The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers incorporated in Rule 69L-7.100, F.A.C., is to establish reimbursement rates for services provided by ambulatory surgical centers.

SUMMARY: The rule adopts a revised manual listing reimbursement rates for various medical services provided by ambulatory surgical centers.

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 rule is anticipated to create a cost savings. The Department’s analysis indicates that no adverse impact on small businesses and aggregate costs in excess of $200,000 in one year will not occur.

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), (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:

DATE AND TIME: Wednesday, May 27, 2015, 9:30 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: Pam Macon, [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: Pam Macon, Chief, Bureau of Monitoring and Audit, 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-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2015 2011 Edition, http://www.flrules.org/Gateway/reference.asp?No=Ref-00686 (ASC Reimbursement Manual) is incorporated by reference as part of this rule. The ASC Reimbursement Manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to subsection Section 440.13(12), F.S. and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances (MRAs) for items and services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center.

(2) The ASC Reimbursement Manual refers to a number of procedure codes and modifiers that are consistent with the Current Procedural Terminology (CPT®), developed and published by the American Medical Association. When a service or procedure is performed that does not have a code listed in the ASC Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2015 2010 Professional Edition, Copyright 2014 2009, American Medical Association, which is hereby incorporated by reference as part of this rule. The CPT® Assistant, Copyright American Medical Association, the 2015 ICD-9-CM Professional Edition for Hospitals, Volumes 1, 2 & 3, American Medical Association, Copyright 2015, the 2015 ICD-9-CM Professional Edition for Physicians, Volumes 1 & 2, American Medical Association, Copyright 2015, the 2015 ICD-10-CM: The Complete Official Draft Codebook, American Medical Association, Copyright 2014 OptumInsight, Inc., the 2015 ICD-10-PCS: The Complete Official Draft Codebook, American Medical Association, Copyright 2014 OptumInsight, Inc., are also adopted by reference as part of this rule. A copy of these reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/. In addition, the rule incorporates the 2010 ICD-9-CM for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc.; the Physician ICD-9-CM 2010, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc.

(3) The Current Dental Terminology (CDT-2015 2009/2010), Copyright 2014 2008, American Dental Association, and the HCPCS Level II, A resourceful complication of HCPCS codes 2010, Copyright 2009, Ingenix Publishing Group, are is incorporated by reference as part of this rule, for dental D codes, injectable J codes, and other medical services or supply codes as specified in the ASC Reimbursement Manual. A copy of the CDT reference material may be obtained from the American Dental Association’s web site at http://www.ada.org/en/publications/ada-catalog.

(4) The ASC Reimbursement Manual 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 via the Department’s web site at http://www.myfloridacfo.com/Division/wc/ http://www.myfloridacfo.com/wc/provider/reimbursement-manuals.html.

Rulemaking Authority 440.13(4),(13) (14), 440.591 FS. Law Implemented 440.13(7), (12),(13) (14) FS. History–New 8-7-91, Amended 12-31-92, Formerly 38F-7.100, 4L-7.100, Amended 9-4-05, 8-19-07, 11-13-11, ___________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Pam Macon, Chief, Bureau of Monitoring and Audit, Division of Workers’ Compensation, Department of Financial Services

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: April 30, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: December 24, 2014