The purpose of the changes being made to Rule 69L-7.020, F.A.C., is to incorporate the 2017 version of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual. The manual contains the updated lists of Maximum Reimbursement ...

 

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 purpose of the changes being made to Rule 69L-7.020, F.A.C., is to incorporate the 2017 version of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual. The manual contains the updated lists of Maximum Reimbursement Allowances for various medical services, as approved by the Three-Member Panel on April 19, 2017, pursuant to section 440.13(12)(a), Florida Statutes.

SUMMARY: The proposed rule amends the existing rule to adopt and incorporate by reference the 2017 version of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

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 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-7.020, F.A.C., indicates that the proposed rule will result in an estimated overall increase in Florida workers’ compensation system costs 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(4), (13)(b), 440.591, FS.

LAW IMPLEMENTED: 440.13(3), (7), (12), (13), (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):

DATE AND TIME: Tuesday, November 21, 2017, 1:00 p.m. – 2:30 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, 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: Theresa Pugh, Program Administrator – Medical Services Section, Bureau of Monitoring and Auditing, Division of Workers’ Compensation, Department of Financial Services, telephone: [phone], email: [e-mail]. The text of the proposed rule is also available on the Department's website at http://www.myfloridacfo.com/Division/GeneralCounsel/RuleWorkshopMeetings/default.asp.

 

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 (HCP RM), 2017 2016 Edition, to become effective July 1, 2018, or upon the rule’s ratifying legislation becoming law, whichever date occurs later, to become effective on July 1, 2017, http://www.flrules.org/Gateway/reference.asp?No=Ref-07685, is incorporated adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three-Member Panel, pursuant to Section subsection 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes, and MRAs 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. The policies, procedures, principles, and standards in the HCP RM are in addition to the requirements and responsibilities established throughout Rule Chapter 69L-7, F.A.C., Workers’ Compensation Medical Reimbursement and Utilization Review.

(2) The CPT® 2017 2016 Current Procedural Terminology Professional Edition, Copyright 2016 2015, American Medical Association; the CDT-2017 2016, Dental Procedure Codes, Copyright 2016 2015, American Dental Association; and, in part, for D codes and for injectable J codes, and for other medical services and supply codes, the “2017 2016 HCPCS Level II Professional Edition,” American Medical Association, Copyright 2017 2016, Elsevier Inc.;, 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 Edition, incorporated above, the provider must use a code contained in the CPT®-2016, CDT-2016 or HCPCS-2016 as specified in this section. tThe CPT® Assistant, American Medical Association, Copyright 2016; 2015, and the 2017 2016 ICD-10-CM: The Complete Official Codebook, American Medical Association, Copyright 2016 2015, Optum360, LLC, are also adopted by reference as part of this rule. A copy of the American Medical Association 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, 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, Tallahassee, Florida. The preceding non-copyrighted materials may be accessed online via the Department’s Division of Workers’ Compensation website at http://www.myfloridacfo.com/Division/wc/.

Rulemaking Authority 440.13(4), (13)(b), 440.591 FS. Law Implemented 440.13(3), (7), (12), (13)(b), (14) 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, 7-1-17,   .

Editorial Note: Ratified by Ch. 2016-203, LOF.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Theresa Pugh

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: CFO Jimmy Patronis

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 10/26/2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 08/11/2017