The purpose of the changes being made to Rule 69L-7.100, F.A.C., is to incorporate the 2017 version of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs). The manual contains the updated lists of Maximum ...

 

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 purpose of the changes being made to Rule 69L-7.100, F.A.C., is to incorporate the 2017 version of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs). 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 Reimbursement Manual for Ambulatory Surgical Centers (ASCs).

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-7.100, F.A.C., indicates that the proposed rule will result in an estimated overall increase in Florida workers’ compensation system costs of +1.1% (+$40M).

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(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, 10:30 a.m. – 12:00 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, 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-7.100 Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs).

(1) The Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASC RM), 2017 2015 Edition, to become effective July 1, 2018, or upon the rule’s ratifying legislation becoming law, whichever date occurs later, 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 RM Reimbursement 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 maximum reimbursement allowances (MRAs) for items and services provided to an injured worker in connection with a surgical procedure performed in an Ambulatory Surgical Center. The policies, procedures, principles, and standards in the ASC 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 ASC RM 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 RM Reimbursement Manual, the Ambulatory Surgical Center shall refer to the Current Procedural Terminology (CPT®), 2017 2015 Professional Edition, Copyright 2016 2014, American Medical Association, which is hereby incorporated by reference as part of this rule. The CPT® Assistant, American Medical Association, Copyright 2016 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 2017 2015 ICD-10-CM: The Complete Official Draft Codebook, American Medical Association, Copyright 2016, Optum360, LLC 2014 OptumInsight, Inc.; and the 2017 2015 ICD-10-PCS: The Complete Official Draft Codebook, American Medical Association, Copyright 2016, 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 National Uniform Billing Committee, Official UB-04 Data Specifications Manual 2017, version 11.00, July 2016, 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)(3) The CDT 2017 2015, Dental Procedure Codes, Copyright 2016 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.

(5)(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 RM Reimbursement Manual and copies of materials incorporated by reference in this rule are 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)(b), 440.591 FS. Law Implemented 440.13(7), (12), (13), (14) 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: Theresa Pugh

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: October 26, 2017

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