The proposed rulemaking will incorporate the 2020 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The manual contains the updated Maximum Reimbursement Allowances for various medical services ....

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Workers’ Compensation

RULE NO.:RULE TITLE:

69L-7.501Florida Workers' Compensation Reimbursement Manual for Hospitals

PURPOSE AND EFFECT: The proposed rulemaking will incorporate the 2020 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. 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 316 hospitals.

• 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 10:00 a.m.

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

https://meet.goto.com/935046997

You can also dial in using your phone.

Access Code:

935-046-997

United States (Toll Free):

1 866 899 4679

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 days 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-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals.

(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, (Hospital RM), 2020 (“Manual”), 2014 Edition, http://www.flrules.org/Gateway/reference.asp?No=Ref-04109, effective MM/YY January 1, 2015, is incorporated herein 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 Hospital RM Manual supplement are in addition to the requirements and responsibilities established throughout Rule Chapter 69L-7, F.A.C. Workers’ Compensation Medical Reimbursement and Utilization Review. by the Florida Worker’s Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.710, 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 of download from the Department’s website at http://www.myfloridacfo.com/division/wc/publications.html.

(2) The Current Procedural Terminology (CPT®), 2020 Professional Edition, Copyright 2019, American Medical Association; the CPT®  Assistant 2020, American Medical Association, Copyright 2019; the ICD-10-CM 2020: The Complete Official Codebook, American Medical Association, Copyright 2019, Optum360, LLC; the ICD-10-PCS 2020: The Complete Official Codebook, American Medical Association, Copyright 2019, Optum360, LLC; the 2020 HCPCS Level II Professional Edition, American Medical Association, Copyright 2020, Elsevier Inc.; and the CDT 2020, Dental Procedure Codes, Copyright 2020, American Dental Association, are incorporated herein by reference. A copy of the American Medical Association’s reference materials may be obtained from the American Medical Association’s website at https://commerce.ama-assn.org/store/ui. A copy of the CDT reference material may be obtained from the American Dental Association’s website at https://www.ada.org/en/publications/ada-catalog.

(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)(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual (“HCP RM”), incorporated by reference into Rules Rule 69L-7.020, F.A.C.; and Rules 69L-7.100 through 7.750, F.A.C. which inform Health Care Providers and Insurers of their respective responsibilities in the billing, filing, reporting and review of worker’s compensation medical  claims the Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.710, F.A.C., are recognized for use in conjunction with the Hospital RM. Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2014 Edition, effective January 1, 2015. 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 website at http://www.myfloridacfo.com/division/wc/publications.html.

(5) The Department has determined that posting the documents referenced in subsections (1), (2), and (3) 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.

Rulemaking 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, 1-1-15,__________.

 

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