This rulemaking will incorporate the 2020 version of the Ambulatory Surgical Centers (ASCs) Reimbursement Manual. The manual contains the updated Maximum Reimbursement Allowances for various medical services based upon the ....

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Workers’ Compensation

RULE NO.:RULE TITLE:

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

PURPOSE AND EFFECT: This rulemaking will incorporate the 2020 version of the Ambulatory Surgical Centers (ASCs) Reimbursement Manual. The manual contains the updated Maximum Reimbursement Allowances for various medical services based upon the methodology approved by the Three-Member Panel on April 27, 2022, pursuant to section 440.13(12)(a), Florida Statutes. This rulemaking will also update other incorporated materials referenced in the rule and make other necessary changes to the rule text.

SUMMARY: Updating the above-referenced reimbursement manual, incorporated materials, and rule text.

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.

A summary of the SERC follows:

• The rule is not likely to directly or indirectly have an adverse impact on economic growth, private-sector job creation or employment, or private-sector investment in excess of $1 million in the aggregate within 5 years after the implementation of the rule.

• The rule is not likely to directly or indirectly have an adverse impact on business competitiveness, including the ability of persons doing business in the state to compete with persons doing business in other states or domestic markets, productivity, or innovation in excess of $1 million in the aggregate within 5 years after the implementation of the rule.

• The rule is not likely to directly or indirectly increase regulatory costs, including any transaction costs, in excess of $1 million in the aggregate within 5 years after the implementation of the rules.

• The number of individuals and entities likely to be required to comply with the rule is approximately 891 administrators and 496 Ambulatory Service Centers.

• The Department will not incur costs for implementing or enforcing the proposed rule.

• The cost to any other state and local government entities of implementing the proposed rule and the anticipated effect on state and local revenues is anticipated to be none.

• The total estimated transactional costs to the individuals and entities that are required to comply with the rule is minimal.

• Impacts on small businesses, small counties, and small cities are likely minimal and may vary by the size of the entity.

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 Department’s economic review for this rulemaking.

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, 440.591 FS.

LAW IMPLEMENTED: 440.13 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: August 30, 2022 at 2:00 p.m.

PLACE: Please join the meeting from your computer, tablet or smartphone.

https://meet.goto.com/445433517

You can also dial in using your phone.

Access Code:

445-433-517

United States (Toll Free):

1 877 309 2073

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 7 hours before the workshop/meeting by contacting: Charlene Miller, Bureau Chief, Division of Workers’ Compensation, 200 East Gaines Street, Tallahassee, FL 32399, [phone], [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: Charlene Miller, Bureau Chief

 

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 (ASC RM), 2020 2015 Edition, effective MM/YY January 1, 2016, http://www.flrules.org/Gateway/reference.asp?No=Ref-05794, (ASC Reimbursement Manual) is incorporated herein by reference as part of this rule. The ASC Reimbursement Manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes and MRAs 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. The policy, procedures, principles, and standards in the ASC RM supplement the requirements and responsibilities established throughout Rule Chapter 69L-7, F.A.C., Workers’ Compensation Medical Reimbursement and Utilization Review.

(2) The ASC RM 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 RM Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2020 2015 Professional Edition, Copyright 2019 2014, American Medical Association, which is hereby incorporated herein by reference as part of this rule. The CPT® Assistant 2020, American Medical Association, Copyright 2019 2015; 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 2020: The Complete Official Draft Codebook, American Medical Association, Copyright 2019, 2014 Optum360, LLC OptumInsight, Inc.; and the 2015 ICD-10-PCS 2020: The Complete Official Draft Codebook, American Medical Association, Copyright 2019 2014 Optum360, LLC, OptumInsight, Inc. are also incorporated herein 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/.

(3) The National Uniform Billing Committee (NUBC), Official UB-04 Data Specifications Manual 2021, version 15.00, July 2020, American Hospital Association, is incorporated herein by reference.  A copy of this manual can be obtained from the National Uniform Billing Committee’s website at https://www.nubc.org/.

(4)(3) The CDT 2020 2015, Dental Procedure Codes, Copyright 2020 2014, American Dental Association, is incorporated herein by reference as part of this rule, for dental D codes. A copy of the CDT reference material may be obtained from the American Dental Association’s website at http://www.ada.org/en/publications/ada-catalog.

(5)(4) The Department has determined that posting the publications referenced in subsections (1), (2), (3) and (4) on the Internet for purposes of public examination and inspection would constitute a violation of federal copyright law. These copyrighted materials may be viewed, during regular business hours, at the offices of:

1. Division of Workers’ Compensation, Bureau of Monitoring and Audit, 1579 Summit Lake Drive, Tallahassee, Florida, 32317; or

2. The Florida Administrative Code and Register, R.A. Gray Building, 500 South Bronough Street, Tallahassee, Florida, 32399-0250.

(4) The ASC Reimbursement Manual and copies of materials incorporated by reference in this rule 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 website at http://www.myfloridacfo.com/Division/wc/.

Rulemaking Authority 440.13(4), (13), 440.591 FS. Law Implemented 440.13(7), (12), (13) 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, 9-28-15,_______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Charlene Miller, Bureau Chief

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jimmy Patronis, Chief Financial Officer

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 18, 2022

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 22, 2022