The proposed rule is necessary in order to comply with federal mandates that will become effective on July 1, 2009. Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Section 1862(b) of the Social Security Act (42 U.S.C. 1395(y)(...

 

DEPARTMENT OF FINANCIAL SERVICES
Division of Risk Management

RULE NO: RULE TITLE
69H-2.008: Other Forms Adopted
PURPOSE, EFFECT AND SUMMARY: The proposed rule is necessary in order to comply with federal mandates that will become effective on July 1, 2009. Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Section 1862(b) of the Social Security Act (42 U.S.C. 1395(y)(b)) adds mandatory reporting requirements with respect to Medicare beneficiaries who receive settlements, judgments, awards, or other payments from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation. The Division of Risk Management, as a required reporting entity, must identify any Medicare beneficiaries that have existing claims with the Division of Risk Management and collect certain data that will be reported to the Center for Medicare and Medicaid Services (CMS). The data collected under federal law will be used by CMS in processing claims billed to Medicare for reimbursement of items and services furnished to Medicare beneficiaries and for Medicare as a Secondary Payer recovery effort, as appropriate.

The simplest and most effective means to collect this data is to promulgate a form that will be sent to all applicable claimants.

SPECIFIC AUTHORITY: 284.17, 284.39 FS.
LAW IMPLEMENTED: 284.30, 284.40, 284.41 FS.

THIS RULEMAKING IS UNDERTAKEN PURSUANT TO SECTION 120.54(6), F.S. WRITTEN COMMENTS MAY BE SUBMITTED WITHIN 14 DAYS OF THE DATE OF THIS NOTICE TO: George Rozes, Senior Management Analyst II, Division of Risk Management, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-0336.

SUBSTANTIALLY AFFECTED PERSONS MAY WITHIN 14 DAYS OF THE DATE OF THIS NOTICE, FILE AN OBJECTION TO THIS RULEMAKING WITH THE AGENCY. THE OBJECTION SHALL SPECIFY THE PORTIONS OF THE PROPOSED RULE TO WHICH THE PERSON OBJECTS AND THE SPECIFIC REASONS FOR THE OBJECTION.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

69H-2.008 Other Forms Adopted.

(1) The following forms are hereby adopted and incorporated by reference. These forms shall be used to aid the Division in the performance of its administrative duties by securing pertinent facts and information on claims filed against the Fund, as the circumstances of particular cases may require.

(a) DFS-D0-261, “Automobile Accident Report,” rev. 11/05;

(b) DFS-D0-866, “Mileage Reimbursement,” rev. 11/05;

(c) DFS-D0-1403, “General Liability Loss Report”, rev. 11/05;

(d) DFS-D0-1404, “Lien Disclosure Statement”, rev. 11/05;

(e) DFS-D0-1406, “Insurer’s Disclosure Statement Pursuant to Section 627.4137, F.S.”, rev. 11/05;

(f) DFS-D0-1407, “Medical Authorization”, rev. 11/05; and

(g) DFS-D0-1410, “Substitute Form W9”, new 11/05;.

(i) DFS-D0-1990, “Medicare Secondary Payer Reporting Questionnaire”, new 5/09; and

(h) DFS-D0-1991, “Medicare Beneficiary/Eligibility Information”, new 5/09.

(2) Copies of each form adopted and incorporated by reference in this rule are available from the Division of Risk Management, Department of Financial Services, Larson Building, Tallahassee, Florida 32399-0336.

Rulemaking Specific Authority 284.17, 284.39 FS. Law Implemented 284.30, 284.40, 284.41 FS. History–New 1-7-92, Amended 6-28-01, Formerly 4H-2.008, Amended 7-4-04, 5-4-05,________.