The purpose of the changes being made to Rules 69L-7.020, 69L-7.100, and 69L-7.501, F.A.C., is to incorporate the 2017 versions of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, the Florida Workers’ Compensation ...
DEPARTMENT OF FINANCIAL SERVICES
Division of Workers’ Compensation
RULE NOS:RULE TITLES:
69L-7.020, Florida Workers’ Compensation Health Care Provider Reimbursement Manual
69L-7.100.Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)
69L-7.501Florida Workers’ Compensation Reimbursement Manual for Hospitals
PURPOSE AND EFFECT: The purpose of the changes being made to Rules 69L-7.020, 69L-7.100, and 69L-7.501, F.A.C., is to incorporate the 2017 versions of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), and the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The manuals contain 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.
SUBJECT AREA: Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2017 Edition; Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2017 Edition; Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2017 Edition.
RULEMAKING AUTHORITY: 440.13(4), 440.13(12), 440.13(13), 440.13(13)(b), 440.13(14), 440.59, 440.591, FS.
LAW IMPLEMENTED: 440.13(7), (12), (13), (13)(b), (14), FS.
A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE TIME, DATE, AND PLACE SHOWN BELOW:
DATE AND TIME: Friday, August 25, 2017, 9:00 a.m. – 10:30 a.m. (Hospitals – 69L-7.501), 10:30 a.m. – 12:00 p.m. (Ambulatory Surgical Centers – 69L-7.100), 1:00 p.m. – 2:30 p.m. (Health Care Providers – 69L-7.020).
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: (850)413-1721, email: Theresa.Pugh@myfloridacfo.com.
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: Theresa Pugh, Program Administrator – Medical Services Section, Bureau of Monitoring and Auditing, Division of Workers’ Compensation, Department of Financial Services, address: 2012 Capital Circle SE, Tallahassee, FL 32399-4229, telephone: (850)413-1721, email: Theresa.Pugh@myfloridacfo.com. The text of the proposed rules is also available on the Department's website at http://www.myfloridacfo.com/Division/GeneralCounsel/RuleWorkshopMeetings/default.asp
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT
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, eff. mm-yy 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 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(13)(b), 440.591 FS. Law Implemented 440.13(7), (12), (13)(b) 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.
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, eff. mm-yy, 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 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), 440.591 FS. Law Implemented 440.13(7), (12), (13) 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, ______.
69L-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals.
(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, (“Hospital RM Manual”), 2017 2014 Edition, eff. mm-yy 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 subsection Section 440.13(12), F.S., and establishes policy, 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, 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®), 2017 Professional Edition, Copyright 2016, American Medical Association; the CPT® Assistant, American Medical Association, Copyright 2016; the 2017 ICD-10-CM: The Complete Official Codebook, American Medical Association, Copyright 2016, Optum360, LLC; the 2017 ICD-10-PCS: The Complete Official Codebook, American Medical Association, Copyright 2016, Optum360, LLC; the 2017 HCPCS Level II Professional Edition, American Medical Association, Copyright 2017, Elsevier Inc.; and the CDT 2017, Dental Procedure Codes, Copyright 2016, 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 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)(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 32399-0311 32301, 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, ________.
