The proposed rules incorporate updated versions of currently adopted resource materials utilized in the determination and reimbursement of the costs of medical care provided to Florida’s injured employees. The proposed rules promote the efficient ...

Notice of Proposed Rule

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Workers’ Compensation

RULE NO:RULE TITLE:

69L-8.071   Materials for use with the Florida Workers’ Compensation Health Care Provider Reimbursement Manual

69L-8.074     Materials for Use throughout Rule Chapter 69L-7, F.A.C.

PURPOSE AND EFFECT: The proposed rules incorporate updated versions of currently adopted resource materials utilized in the determination and reimbursement of the costs of medical care provided to Florida’s injured employees. The proposed rules promote the efficient delivery of appropriate medical care to Florida’s injured employees by reducing the potential for errors and delays resulting from the use of dated materials.

SUMMARY: The proposed rules update resource materials utilized in the determination and efficient delivery of appropriate medical care to injured employees and the provision of timely reimbursement to health care providers under Florida’s workers’ compensation system. 

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 exceeding $200,000 in the aggregate within one year after the implementation of the rule.  SERCs for the proposed rules have not been prepared by the Agency.

The Department has determined that neither 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: The Agency conducted a preliminary analysis on each of the proposed rules and, based on economic criteria set forth under section 120.541, F.S., has determined that SERCs are not required. 

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(4), 440.15(3)(b), (d), (f), 440.185(5), 440.20(6)(b), 440.525(2), 440.591, 440.593(5), F.S.

LAW IMPLEMENTED: 440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (14), (16), 440.15(3)(b), (d), (f), (5), 440.185(5), (9), 440.20(6), 440.525(2), 440.593, F.S.

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, September 8, 2017, 2:00 p.m. to 3:00 p.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: 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: Theresa Pugh, Program Administrator, Medical Services Section, Bureau of Monitoring and Audit, Division of Workers’ Compensation, Department of Financial Services, address: 200 East Gaines Street, Tallahassee, Florida 32399-4228, telephone: [phone], email: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-8.071, F.A.C., Materials for use with the Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

(1) The following materials are incorporated by reference:

(a) through (i) No change.

(j) The 2015 ICD-10-PCS: The Complete Official Draft Codebook, American Medical Association, Copyright 2014, OptumInsight, Inc.; and,

(k) The 2015 CPT® Assistant, Copyright American Medical Association.

(2) No change.

Rulemaking Authority 440.13(13)(b), 440.591 FS. Law Implemented 440.13(12), (13)(b) FS. History–New 2-18-16, Amended_______.

 

69L-8.074, F.A.C., Materials for use throughout Rule Chapter 69L-7, F.A.C.

(1) The following materials are incorporated by reference:

(a) through (c) No change.

(d) The ICD-9-CM  Professional Edition for Physicians, Volumes 1 & 2, as adopted in Rules 69L-8.071, 69L-8.072 and 69L-8.073, F.A.C.

(e) through (i) No change.

(j) The National Uniform Billing Committee, Official UB-04 Data Specifications Manual 2017 2016, version 11.00 10.00, July 2016 2015, as adopted by the National Uniform Billing Committee. (A copy of this manual can be obtained from the National Uniform Billing Committee website at http://www.nubc.org/subscriber/.)

(k) and (l) No change.

(m) The ICD-10-PCS: The Complete Official Codebook, American Medical Association, as adopted in Rules 69L-8.072, and 69L-8.073, F.A.C.

(n) The CPT® Assistant, Copyright American Medical Association, as adopted in Rules 69L-8.071, 69L-8.072, and 69L-8.073.

(2) No change.

Rulemaking Authority 440.13(4), 440.15(3)(b), (d), (f), 440.185(5), 440.20(6)(b), 440.525(2), 440.591, 440.593(5) FS. Law Implemented 440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (13), (16), 440.15(3)(b), (d), (f), (5), 440.185(5), (9), 440.20(6), 440.525(2), 440.593 FS. History–New 2-18-16, Amended_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Theresa Pugh, Program Administrator, Medical Services Section, Bureau of Monitoring and Audit, Division of Workers’ Compensation, Department of Financial Services.

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE:

Jimmy Patronis, Chief Financial Officer, Department of Financial Services

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 16, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: April 14, 2017.