To adopt the new version of the Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2006 Edition, to implement the reimbursement rates authorized by the Three Member Panel pursuant to Section 440.13(12) F.S., at its meeting on ...

DEPARTMENT OF FINANCIAL SERVICES
Divsion of Worker's Compensation

RULE NO: RULE TITLE
69L-7.020: Florida Workers' Compensation Health Care Provider Reimbursement Manual
PURPOSE AND EFFECT: To adopt the new version of the Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2006 Edition, to implement the reimbursement rates authorized by the Three Member Panel pursuant to Section 440.13(12) F.S., at its meeting on April 11, 2006. In addition, the proposed rule 69L-7.020 will adopt updated versions of the Physicians’ Current Procedural Terminology Manual and the American Medical Association “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes Manual.”
SUMMARY: Proposed revisions to the Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2006 Edition, incorporated by reference into the rule, including amendments to the uniform schedules of maximum reimbursement allowances.
SUMMARY OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC AUTHORITY: 440.13(14)(b), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14) 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):
TIME AND DATE: Tuesday, October 3, 2006, 9:30 AM
PLACE: 104J, Hartman Building, 2012 Capital Circle, 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: Don davis @ [phone]. 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: Don Davis, Division of Workers' Compensation, Office of Data Quality and Collection, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4226, phone [phone].

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, 20062005 Second Edition, is adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13 (12), Florida Statutes 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 Physicians’ Current Procedural Terminology (CPT®), 2006 Current Procedural Terminology 2005 Professional Edition, Copyright 20052004, American Medical Association; the Current Dental Terminology, CDT-2005, Copyright 2004, American Dental Association; and in part for D codes and for injectable J codes, and for other medical services and supply codes, the American Medical Association “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 20062005”, American Medical Association, Eighteenth SeventeenthEdition, Copyright 20052004, Ingenix Publishing Group, 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, 20062005 Second Edition incorporated above, the provider must use a code contained in the CPT®-2006, CDT-2005 or HCPCS-2006 as specified in this section.

(3) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 20062005 Second Edition incorporated above, 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 web site at http://www.fldfs.com/wc.

Specific Authority 440.13(14)(b), 440.591 FS. Law Implemented 440.13(7), (12), (14) FS. History–New 10-1-82, Amended 3-16-83, 11-6-83,5-21-85, Formerly 38F-7.020, 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, ________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Don Davis, Office of Data Quality and Collection, Division of Workers’ Compensation.
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Dan Sumner, Assistant Director, Division of Workers’ Compensation.
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 22, 2006
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: April 28, 2006