The proposed rule incorporates and adopts for use the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASC Reimbursement Manual), as approved by the Three-Member Panel on April 20, 2016, ...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker’s Compensation

RULE NO.:RULE TITLE:

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

PURPOSE AND EFFECT: The proposed rule incorporates and adopts for use the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASC Reimbursement Manual), as approved by the Three-Member Panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the ASC Reimbursement Manual contains an updated list of the Maximum Reimbursement Allowances (MRAs) for various medical services provided to Florida’s injured workers.

SUMMARY: The proposed rule adopts for use and incorporates by reference the 2016 Edition of the ASC Reimbursement Manual and updated reference materials, reflecting changes to certain reimbursement levels and policy instructions, as authorized by Florida’s Three-Member Panel.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will 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.

The Agency has determined that the proposed 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 Department conducted a preliminary SERC analysis of the proposed rule utilizing a cost analysis of estimated regulatory costs prepared by the National Council on Compensation Insurance, Inc. (NCCI). NCCI’s cost analysis of proposed Rule 69L-7.100, F.A.C., indicates that the proposed rule will result in an estimated overall increase in Florida workers’ compensation system costs of +0.6% (+$22M).

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(4), (13), 440.591, FS.

LAW IMPLEMENTED: 440.13(7), (12), (13), 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 at 10:30 a.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-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2016 2015 Edition, effective January 1, 2016, http://www.flrules.org/Gateway/reference.asp?No=Ref-05794 (ASC Reimbursement Manual) is incorporated by reference as part of this rule. The ASC Reimbursement Manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to subsection 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes and maximum reimbursement alowances (MRAs) for items and services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center.

(2) The ASC 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 Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2016 2015 Professional Edition, Copyright 2015 2014, American Medical Association, which is hereby incorporated by reference as part of this rule. The CPT® Assistant, American Medical Association, Copyright 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 2016 2015 ICD-10-CM: The Complete Official Draft Codebook, American Medical Association, Copyright 2015 Optum360, LLC 2014 OptumInsight, Inc.; and the 2016 2015 ICD-10-PCS: The Complete Official Draft Codebook, American Medical Association, Copyright 2015 Optum360, LLC, 2014 OptumInsight, Inc. are also incorporated 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 CDT 2016 2015, Dental Procedure Codes, Copyright 2015 2014, American Dental Association, is incorporated 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.

(4) 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 ASC Reimbursement Manual and copies of materials incorporated by reference in this rule are is available for inspection during normal business hours at the Florida Department of Financial Services, Division of Workers’ Compensation, Bureau of Monitoring and Audit, Hartman Building, 2012 Capital Circle Southeast, 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 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: 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