Florida Workers' Compensation Reimbursement Manual for Hospitals

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker's Compensation

RULE NO.:RULE TITLE:

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

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 40, No. 183, September 19, 2014 issue of the Florida Administrative Register.

Pursuant to written comments received from the Joint Administrative Procedures Committee in a letter dated March 5, 2014, the Department has changed certain statutory citations and rule references contained in proposed Rule 69L-7.501, Florida Administrative Code, and in the proposed 2014 Edition of the  Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Manual”), which the proposed rule incorporates by reference. The statement, “A SERC has been prepared by the Agency,” was included under the “Summary of Statement of Regulatory Costs and Legislative Ratification,” section of the above-cited notice. That statement should have stated that “A SERC has not been prepared by the Agency.” However, as stated in the Notice of Proposed Rule, an economic analysis was conducted, as required.  Additional changes to the proposed rule and Manual, which is incorporated by reference, reflect the terms of a Settlement Agreement between the Petitioners in rule challenge litigation and the Department of Financial Services, as Respondent.

The proposed 2014 Edition of the Manual includes a fee schedule reimbursement methodology for hospital outpatient services based on Current Procedural Terminology (“CPT”) line level charge data held by the Division of Workers’ Compensation, which is then adjusted based on a modification factor specified for defined geographic areas in Florida. The aforementioned Settlement Agreement requires the Department to increase the threshold number of bills used to determine the “Base Rate” of the applicable CPT procedure codes from no less than twenty (20) bills, to no less than forty (40) bills. Certain of the “Base Rates” listed under Appendices “B” and “C” of the proposed 2014 edition of the Manual have been changed to reflect a recalculation of values based on the increase in the number of bills, as discussed above.  Proposed Rule 69L-7.501, Florida Administrative Code, is also changed to provide the proposed 2014 Edition of the Manual with an effective date of January 1, 2015. The proposed rule is changed to read as follows:

 

69L-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals.

(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Manual”), 2014 2006 Edition, effective  January 1, 2015, 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 subsection 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-7.710 602, 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/division/wc/publications.html.

(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual (“HCP RM”) [HCP RM], 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-7.710 602, F.A.C., are recognized for use in conjunction with the Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2014 Edition, effective January 1, 2015 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/division/wc/publications/html.

Consistent with the description above, the 2014 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals, which is incorporated by reference into Rule 69L-7.501, has been changed.

 

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Pamela Macon, Chief, Bureau of Monitoring and Audit, Division of Workers’ Compensation, Department of Financial Services,  200 East Gaines Street, Tallahassee, Florida, 32399-4232, [phone] or Pamela [e-mail]