The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member panel on April 20, 2016, pursuant to ...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker’s Compensation

RULE NO.:RULE TITLE:

69L-7.020Florida Workers’ Compensation Health Care Provider Reimbursement Manual

PURPOSE AND EFFECT: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The aforementioned manual is updated to incorporate the 2016 Medicare Conversion Factor and Resource Based-Relative Value Scale (RBRVS) geographic-specific reimbursement levels used to determine Maximum Reimbursement Allowances (MRAs) for physician’s services and non-surgical hospital outpatient services provided to Florida’s injured workers.

SUMMARY: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers’ Compensation Health Care Provider Manual which incorporates the 2016 Medicare Conversion Factor and RBRVS geographic-specific reimbursement levels used to determine MRAs for physician’s services and non-surgical hospital outpatient services provided to Florida’s injured employees.

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 not been prepared by the Agency.

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 has conducted an economic analysis of the proposed rule and has determined that there is no adverse impact or potential regulatory cost associated with the proposed rule that exceeds any of the criteria under paragraphs 120.541(1)(b) or 120.541(2)(a), F.S. The Department based its determination on its experience in estimating operating costs within the rulemaking process, information gathered through survey and consultation with representatives of regulated entities, and on an economic analysis prepared for it by the National Council on Compensation Insurance, Inc., which estimates that the proposed rule will result in an overall Florida workers’ compensation system cost impact of - 0.1% (-$4M).

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(13)(b), 440.591, FS.

LAW IMPLEMENTED: 440.13(7), (12), (13)(b), FS.

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: Monday, October 24, 2016 @ 1:00 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: Brittany O’Neil, 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: Brittany O’Neil, Policy Coordinator, Division of Workers’ Compensation, Department of Financial Services, address: 200 East Gaines Street, Tallahassee, Florida 32399-4220, telephone: [phone], email: [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-7.020 Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 2015 Edition, http://www.flrules.org/Gateway/reference.asp?No=Ref-05618, is adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to subsection 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes, and maximum reimbursement allowances for services and supplies provided by health care providers. Also, the manual includes reimbursement policies and payment methodologies for pharmacists and medical suppliers.

(2) The CPT® 2016 2014 Current Procedural Terminology Professional Edition, Copyright 2015 2013, American Medical Association; the CDT 2016 -2014, Dental Procedure Codes, Copyright 2015 2013, American Dental Association; and, in part, for D codes and for injectable J codes, and for other medical services and supply codes, the “2016 2014 HCPCS Level II Professional Edition,” American Medical Association, Copyright 2016 2014, Elsevier Inc. Saunders, are adopted by reference as part of this rule. When a health care provider performs a procedure or service which is not listed in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 2015 Edition, incorporated above, the provider must use a code contained in the CPT®- 2016 2014, CDT- 2016 2014 or HCPCS - 2016 2014 as specified in this section. The CPT® Assistant, Copyright American Medical Association, the 2014 ICD-9-CM Professional Edition for Physicians, Volumes 1 & 2, American Medical Association, Copyright 2013, and the 2016 2014 ICD-10-CM: The Complete Official Codebook Draft Code Set, American Medical Association, Copyright 2015 2013, Optum360, LLC OptumInsight, Inc., are also adopted 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/. 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.

A copy of the HCPCS Level II reference material may be obtained from the American Medical Association’s’ website at http://commerce.ama-assn.org/store/.

(3) The posting of the preceding copyrighted materials on the Internet would constitute a violation of the federal copyright law.The preceding copyrighted materials are available for public inspection and examination, but may not be copied, The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2015 Edition and copies of other materials incorporated by reference in this rule are available for inspection during normal business hours at the Florida Department of Financial Services, Division of Workers’ Compensation, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida, 32399-0311,. The preceding non-copyrighted materials may be accessed online or via the Department’s Division of Workers’ Compensation website at http://www.myfloridacfo.com/Division/wc/.

Rulemaking Authority 440.13(13)(b), 440.591 FS. Law Implemented 440.13(7), (12), (13)(b) FS. History–New 10-1-82, Amended 3-16-83, 11-6-83, 5-21-85, Formerly 38F-7.20, Amended 4-1-88, 7-20-88, 6-1-91, 4-29-92, 2-18-96, 9-1-97, 12-15-97, 9-17-98, 9-30-01, 7-7-02, Formerly 38F-7.020, 4L-7.020, Amended 12-4-03, 1-1-04, 7-4-04, 5-9-05, 9-4-05, 11-16-06, 10-18-07, 2-4-09, 7-1-16,        .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Brittany O’Neil, Policy Coordinator, Division of Workers’ Compensation, Department of Financial Services

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jeff Atwater, Chief Financial Officer, Department of Financial Services

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: September 27, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 7, 2016