The purpose and effect of the proposed rule development is to amend the rule to adopt by reference the 2012 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-7.501: Florida 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 2012 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 2012 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals will incorporate a fee schedule for certain hospital outpatient services within defined geographic areas in Florida utilizing Current Procedural Terminology® (CPT) line level charge data. The methodology for the incorporated fee schedule establishes criteria to evaluate 18 months of hospital outpatient bill data. The 2012 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals also makes technical changes to include a new manual format, an expanded table of contents and chapters by topic.

SUMMARY: Rule amendment to adopt the 2012 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The Manual incorporates a fee schedule reimbursement methodology for certain hospital services based on CPT line level charge data obtained from defined geographic areas in Florida and establishes criteria to evaluate 18 months of hospital outpatient data.

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 statement of estimated regulatory costs (SERC) will be prepared by the Department.

Based on its own preliminary analysis, the Department estimates that the proposed rule will result in new costs of $2000 per carrier or claims administrator for expenses associated with the loading and installation of the proposed outpatient fee schedule into their medical claims payment software. There are 418 subject carriers (as of 9/26/2011) impacted by the proposed rule, thus, the aggregate, one-time cost to the carrier community for updated software is $836,000. Additionally, an analysis of the proposed revision to the Florida outpatient fee schedule performed by the National Council on Compensation Insurance (NCCI) estimates that implementing the proposed fee schedule for Category 2 and Category 3 hospital services would result in an impact of between -0.5% ($-14M) and -0.6% ($-17M) on overall workers’ compensation system costs in Florida. The Department 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 on and described herein: Based on the preliminary economic analysis conducted by the Department and the analysis that was prepared by NCCI, the Department has determined that the proposed rule is likely to increase regulatory costs, including any transactional costs, in excess of $1 million in aggregate within 5 years after implementation of the rule.

Any person who wishes to provide information regarding the statement of estimated regulatory costs, or to 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 IN WRITING WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A RULE HEARING WILL BE HELD AT THE TIME, DATE, AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Wednesday, August 8, 2012, 2:00 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, Office of Medical Services, Program Administrator, 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-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals.

(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2012 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 Section 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.myfloridacfofldfs.com/wc/publications.html.

(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual [HCP RM], 2011 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, 2012 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.myfloridacfofldfs.com/wc/publications/html.

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, Office of Medical Services, Program Administrator, 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