The purpose of this proposed new rule is to inform claims administrators of notice requirements to employees when the payment of a compensable medical benefit will be apportioned, pursuant to Section 440.15(5), F.S. The proposed rule clarifies that ...

DEPARTMENT OF FINANCIAL SERVICES
Division of Worker's Compensation

RULE NO.: RULE TITLE:
69L-3.017: Notice of Apportionment of Medical Reimbursement Due to a Pre-Existing Condition(s)
PURPOSE AND EFFECT: The purpose of this proposed new rule is to inform claims administrators of notice requirements to employees when the payment of a compensable medical benefit will be apportioned, pursuant to Section 440.15(5), F.S. The proposed rule clarifies that claims administrators must provide employees with notification of decisions to apply apportionment. The proposed rule provides that compliance with the notice requirements is achieved by mailing Form DFS-F2-DWC-12 (Notice of Denial), or a letter to the employee explaining its apportionment decision to the employee, as specified. The proposed rule also clarifies that compliance with the notice requirements under proposed Rule 69L-3.017, F.A.C., does not satisfy the notification requirement under subsection 69L-7.602(5), F.A.C.
SUMMARY: The proposed new rule addresses the apportionment of benefits by claims administrators under Section 440.15(5), F.S. The proposed rule clarifies that claims administrators are required to provide employees seeking medical services (for dates of injury on or after 10/1/2003) with notification, in cases where the payment of a medical benefit will be subject to apportionment.
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 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: A preliminary economic analysis prepared by the agency estimates the aggregate cost to the subject (418 companies are approved to offer workers’ compensation as an authorized line of business in Florida) carrier community to be $10,450 per year to comply with the sending of the required notices. There is also a one-time cost for each carrier to account for programming costs associated with complying with the new rule. Programming costs are estimated to be $1,125 per company. Therefore, over a 5-year period, the estimated total aggregate cost of compliance to the subject carrier community is $522,500.
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: 440.185(5), 440.20(3), 440.591 FS.
LAW IMPLEMENTED: 440.12(2), 440.14, 440.15(5), 440.192(8), 440.20(2), (4), (9), (15)(f), 440.207(2) 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: Friday, August 3, 2012 (Immediately upon conclusion of the hearing for Rule 69L-7.602, F.A.C., if permissible, otherwise 3:00 p.m.)
PLACE: Room 102, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Eric Lloyd, Program Administrator, Office of Medical Services, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232, [phone] or [e-mail]
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this program, please advise the Department at least 5 calendar days before the program by contacting the person listed above.

THE FULL TEXT OF THE PROPOSED RULE IS:

69L-3.017 Notice of Apportionment of Medical Reimbursement Due to a Pre-Existing Condition(s).

For dates of injury occurring on or after 10/1/2003, if the claims administrator decides to apportion payment of a medical benefit pursuant to Section 440.15(5), F.S., it shall send Form DFS-F2-DWC-12, Notice of Denial, or a letter to the employee explaining its apportionment decision, no later than three (3) business days after the date the claims administrator notified a health care provider that payment of the medical benefit will be apportioned pursuant to subsection 69L-7.602(5), F.A.C, Compliance with this rule is independent of and does not satisfy the notification requirement pursuant to subsection 69L-7.602(5), F.A.C.

Rulemaking Authority 440.185(5), 440.20(3), 440.591 FS. Law Implemented 440.12(2), 440.14, 440.15(5), 440.192(8), 440.20(2), (4), (9), (15)(f), 440.207(2) FS. History–New________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Eric Lloyd, Program Administrator, Office of Medical Services, Division of Workers’ Compensation, Department of Financial Services
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: June 19, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: January 20, 2012