The purpose of the proposed new rule chapter and rule sections is to create a more efficient and transparent means of identifying, organizing and updating the incorporated resource materials utilized in conjunction with rule sections listed under ...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker’s Compensation

RULE NOS.:RULE TITLES:

69L-8.071Materials for use with the Workers’ Compensation Health Care Provider Reimbursement Manual

69L-8.072Materials for use with the Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers

69L-8.073Materials for use with the Workers’ Compensation Hospital Reimbursement Manual

69L-8.074Materials for use throughout Rule Chapter 69L-7, F.A.C.

PURPOSE AND EFFECT: The purpose of the proposed new rule chapter and rule sections is to create a more efficient and transparent means of identifying, organizing and updating the incorporated resource materials utilized in conjunction with rule sections listed under Rule Chapter 69L-7, F.A.C., entitled, “Workers’ Compensation Medical Reimbursement and Utilization Review.” The proposed new rule chapter and rule sections will assist the Department in providing timely updates to the manuals, forms and other materials utilized by the rules listed above.

SUMMARY: The proposed rules reorganize incorporated materials that are utilized in conjunction with DWC medical reimbursement manuals and throughout Rule Chapter 69L-7, F.A.C., entitled, “Workers’ Compensation Medical Reimbursement and Utilization Review.”

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 performed an analysis of the economic impact or regulatory costs for each of the proposed rules and determined that none of the proposed rules will result in costs exceeding the economic analysis criteria set for in paragraphs 120.541(1)(b) or (2)(a), F.S.

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), 440.15(3)(b), (d), (f), 440.185(5), 440.20(6)(b), 440.525(2), 440.591, 440.593(5) FS.

LAW IMPLEMENTED: 440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (14), (16), 440.15(3)(b), (d), (f), (5), 440.185(5), (9), 440.20(6), 440.525(2), 440.593 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: Tuesday, June 2, 2015 (immediately following the 9:30 AM hearing of Rule Chapter 69L-7, F.A.C.)

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: Pamela Macon, [phone] or [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: Pamela Macon, Chief, Bureau of Monitoring and Audit, Division of Workers’ Compensation, Department of Financial Services, 200 E. Gaines Street, Tallahassee, Florida 32399-4232, [phone] or [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-8.071 Materials for use with the Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

 

(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2015 Edition (HCP RM), as formerly incorporated by reference in Rule 69L-7.020, F.A.C., adopts all reference materials, as incorporated by reference herein. The incorporated reference materials are as follows:

(a) The CPT® 2014 Current Procedural Terminology Professional Edition, Copyright 2013, American Medical Association;

(b) The Current Dental Terminology, CDT-2014, Copyright 2013, American Dental Association;

(c) The Healthcare Common Procedure Coding System, 2014 HCPCS Level II, Professional Edition, Twenty-fourth Edition, Copyright 2013, Elsevier Inc.(American Medical Association);

(d) The Physician ICD-9-CM®, Volumes 1 & 2, International Classifications of Disease, 9th Revision, Clinical Modification (ICD-9); Copyright 2009, Ingenix, Inc. (American Medical Association);

(e) The 2014 ICD-10-CM: The Complete Official Draft Code Set, Copyright 2013, OptumInsight, Inc., and

(f) The 2014 ICD-10-PCS: The Complete Official Draft Code Set, Copyright 2013, OptumInsight, Inc

(2) When a health care provider performs a procedure or provides a service which is not listed in the HCP RM, 2015 Edition, formerly incorporated by reference as part of Rule 69L-7.020, F.A.C., the provider must use a code contained in materials listed in Rule 69L-8.071(1), F.A.C.

Rulemaking Authority 440.13(13)(b), 440.591 FS. Law Implemented 440.13(12), (13)(b) FS. History – New______.

 

Editorial Note: Materials were formerly incorporated in Rule 69L-7.602 and 69L-7.710, F.A.C.

 

69L-8.072 Materials for use with the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers.

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2015 Edition, as formerly incorporated by reference in Rule 69L-7.100, F.A.C., adopts all reference materials, as incorporated by reference herein. The incorporated reference materials are as follows:

(a) The CPT® 2010 Current Procedural Terminology Professional Edition, Copyright 2009, American Medical Association;

(b) The Current Dental Terminology, CDT-2009/2010, Copyright 2008, American Dental Association;

(c) The HCPCS Level II, A resourceful compilation of HCPCS codes 2010, Copyright 2009, Ingenix Publishing Group;

(d) The 2010 ICD-9-CM for Hospitals, Volumes 1, 2 and 3, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc;

(e) The Physician ICD-9-CM 2010, Volumes 1 & 2, International Classification of Diseases, 9th Revision, Clinical Modification, Copyright 2009, Ingenix, Inc.; and

(f) CPT® Assistant, Copyright American Medical Association.

Rulemaking Authority 440.13(4), (13), 440.591, FS. Law Implemented 440.13(12), (13) FS. History – New______.

 

Editorial Note: Materials were formerly incorporated in Rule 69L-7.602 and 69L-7.710, F.A.C.

 

69L-8.073 Materials for use with the Florida Workers’ Compensation Hospital Reimbursement Manual.

(1) The Florida Workers’ Compensation Hospital Reimbursement Manual, 2014 Edition (HRM), as formerly incorporated by reference in Rule 69L-7.501, F.A.C., adopts all of the reference materials listed below and incorporated by reference herein. The incorporated reference materials are as follows:

(a) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2015 Edition (HCP RM), a s formerly incorporated by reference into Rule 69L-7.020, F.A.C.;

(b) Rule 69L-7.710, F.A.C; 

(c) Rule 69L-7.720, F.A.C.;

(d) Rule 69L-7.730, F.A.C.;

(e) Rule 69L-7.740, F.A.C.;

(f) Rule 69L-7.750, F.A.C.;

(g) The 2014 ICD-9-CM for Hospitals, Volumes 1, 2 & 3, Professional Edition, Copyright 2014, Elsevier Saunders, American Medical Association;

(h) The 2014 ICD-10-CM: The Complete Official Draft Code Set, American Medical Association, Copyright 2013, OptumInsight, Inc.;

(i) The 2014 ICD-10-PCS: The Complete Official Draft Code Set, Americn Medical Association, Copyright 2013, OptumInsight, Inc.;

(j) The CPT® 2014 Current Procedural Terminology Professional Edition, Copyright 2013, American Medical Association;

(k) The Current Dental Terminology, CDT-2014, Copyright 2013, American Dental Association; and

(l) The “2014 HCPCS Level II Professional Edition”, American Medical Association, Copyright 2014, Elsevier Saunders.

Rulemaking Authority 440.13(12), (13), 440.591 FS., Law Implemented  440.13(12), (13) FS. History – New______.

 

Editorial Note: Materials were formerly incorporated in  Rule 69L-7.602 and 69L-7.710, F.A.C.

 

69L-8.074 Materials for use throughout Rule Chapter 69L-7, F.A.C.

(1) The Workers’ Compensation Medical Reimbursement and Utilization Review, Chapter Rule 69L-7, adopts all reference materials that are incorporated by reference herein. The incorporated reference materials are as follows:

(a) The American Medical Association Healthcare Common Procedure Coding System, Medicare’s National Level II Codes (HCPCS), as adopted in Rules 69L-8.071, 69L-8.072 and 69L-8.073, F.A.C.

(b) The Current Procedural Terminology (CPT®), as adopted in Rules 69L-8.071, 69L-8.072 and 69L-8.073, F.A.C.

(c) The Current Dental Terminology (CDT), as adopted in Rules 69L-8.071, 69L-8.072 and 69L-8.073, F.A.C.

(d) The Physician ICD-9-CM,  as adopted in Rules 69L-8.071, 69L-8.072 and 69L-8.073, F.A.C.

(e) The ICD-9-CM for Hospitals, as adopted in Rules 69L-8.072 and 69L-8.073, F.A.C.

(f) The American Medical Association’s Guide to the Evaluation of Permanent Impairment, as adopted in Rule 69L-7.604, F.A.C.

(g) The Minnesota Department of Labor and Industry Disability Schedule, as adopted in Rule 69L-7.604, F.A.C.

(h) The Florida Impairment Rating Guide, as adopted in Rule 69L-7.604, F.A.C.

(i) The 1996 Florida Uniform Permanent Impairment Rating Schedule, as adopted in Rule 69L-7.604, F.A.C.

(j) National Uniform Billing Committee Official UB-04 Data Specifications Manual 2015, version 9.00, July 2014, as adopted by the National Uniform Billing Committee. A copy of this manual can be obtained from the National Uniform Billing Committee web site: http://www.nubc.org/subscriber/index.dhtmll.

(k) The Florida Medical EDI Implementation Guide (MEIG), 2015. The MEIG, 2015 can be obtained from the DFS/DWC web site: http://www.myfloridacfo.com/WC/edi_med.html.

(l) The 2014 ICD-10-CM, as adopted in Rules 69L-8.071 and 69L-8.073, F.A.C.; and

(m) The 2014 ICD-10-PCS, as adopted in Rules 69L-8.071 and 69L-8.073, F.A.C.

Rulemaking Authority 440.13(4), 440.15(3)(b), (d), (f), 440.185(5), 440.20(6)(b), 440.525(2), 440.591, 440.593(5) FS. Law Implemented  440.09, 440.13(2)(a), (3), (4), (6), (11), (12), (13), (16), 440.15(3)(b), (d), (f), (5), 440.185(5), (9), 440.20(6), 440.525(2), 440.593 FS. History – New______.

 

Editorial Note: Materials were formerly incorporated in Rule 69L-7.602 and 69L-7.710, F.A.C.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Pamela Macon, Chief, Bureau of Monitoring and Audit, 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: April 30, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: June 3, 2014