The purpose of the changes being made to Rule 69L-7.501, F.A.C., is to incorporate the 2018 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. This manual contain the updated list of Maximum Reimbursement Allowances for ...

 

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 purpose of the changes being made to Rule 69L-7.501, F.A.C., is to incorporate the 2018 version of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. This manual contain the updated list of Maximum Reimbursement Allowances for various medical services, pursuant to section 440.13(12)(a), Florida Statutes.

SUBJECT AREA TO BE ADDRESSED: Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2018 Edition.

RULEMAKING AUTHORITY: 440.13(7), (13), 440.591, FS.

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

IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: November 27, 2018, 1:00 p.m. – 2:00 p.m.

PLACE: Hartman Building, Room 102, 2012 Capital Circle SE, Tallahassee, FL 32301

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: Theresa Pugh at [phone], or via email at [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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Theresa Pugh, Program Administrator, address: Medical Services Section, Division of Workers’ Compensation, 200 East Gaines Street, Tallahassee, FL 32399, telephone: [phone], email: [e-mail].

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

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

(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, (“Hospital RM Manual”), 2018 2014 Edition, effective July 1, 2019, or upon the rule’s ratifying legislation becoming law, whichever date occurs later, http://www.flrules.org/Gateway/reference.asp?No=Ref-04109, effective January 1, 2015, is incorporated adopted by reference as part of this rule. The Hospital RM Manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and establishes policy, and 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, and procedures, principles, and standards in the Hospital RM Manual are in addition to the requirements and responsibilities established throughout by the Rule Chapter 69L-7, F.A.C., Workers’ Compensation Medical Reimbursement and Utilization Review. Florida Workers’ 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 or download from the Department’s website at http://www.myfloridacfo.com/division/wc/. http://www.myfloridacfo.com/division/wc/publications.html.

(2) The Current Procedural Terminology (CPT®), 2018 Professional Edition, Copyright 2017, American Medical Association; the CPT® Assistant, American Medical Association, Copyright 2017; the 2018 ICD-10-CM: The Complete Official Codebook, American Medical Association, Copyright 2017, Optum360, LLC; the 2018 ICD-10-PCS: The Complete Official Codebook, American Medical Association, Copyright 2017, Optum360, LLC; the 2018 HCPCS Level II Professional Edition, American Medical Association, Copyright 2018, Elsevier Inc.; and the CDT 2018, Dental Procedure Codes, Copyright 2017, American Dental Association, are incorporated by reference as part of this rule. 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/. 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.

(3) The National Uniform Billing Committee, Official UB-04 Data Specifications Manual 2018, version 12.00, July 2017, as adopted by the National Uniform Billing Committee, is incorporated by reference as part of this rule. A copy of this manual can be obtained from the National Uniform Billing Committee’s website at http://www.nubc.org/subscriber/.

(4)(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual (“HCP RM”), incorporated by reference into Rule 69L-7.020, F.A.C.; and Rules 69L-7.710-7.750, F.A.C., which inform Health Care Providers and Insurers of their respective responsibilities in the billing, filing, reporting, and review of workers’ 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.

(5) The Both rules, the Hospital RM, and the HCP RM, and all incorporated resource materials are available for public inspection and examination 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 32301, 32399-0311 or via the Department’s website web site at http://www.myfloridacfo.com/division/wc/ http://www.myfloridacfo.com/division/wc/publications.html. The copying or posting of any of the preceding copyrighted materials on the Internet would constitute a violation of the federal copyright law. The preceding non-copyrighted materials may be accessed online via the Division of Workers’ Compensation website at http://www.myfloridacfo.com/division/wc/.

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, ________.