The proposed rule incorporates the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals (Manual), as approved by the Three-Member Panel during a scheduled meeting held on April 20, 2016, pursuant to paragraph 440.13(...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker’s Compensation

RULE NO.:RULE TITLE:

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

PURPOSE AND EFFECT: The proposed rule incorporates the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals (Manual), as approved by the Three-Member Panel during a scheduled meeting held on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the Manual increases the per diem reimbursement rates for surgical and non-surgical hospital inpatient services and the threshold dollar amount triggering Stop-Loss reimbursement above reimbursement allowances specified in the 2014 Edition of the Manual, as adopted by the existing rule. The 2016 Edition of the Manual also provides an updated fee schedule for various categories of hospital outpatient services based on the Current Procedural Terminology (CPT) line level charge data, with an adjustment of the Maximum Reimbursement Allowance (MRA) based on the geographic location of the service provider.

SUMMARY: The proposed rule incorporates the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals. The Manual provides for increases in per diem reimbursement rates for surgical and non-surgical hospital inpatient services, increases Stop-Loss reimbursement allowances, and incorporates an updated CPT-based fee schedule.

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’s preliminary SERC utilizes an economic analysis prepared by the National Council on Compensation Insurance, Inc., that indicates the proposed rule will result in an estimated economic impact of +2.2% (+$80M) on overall workers’ compensation system costs in Florida.

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(12), (14), 440.591, FS.

LAW IMPLEMENTED: 440.13(7), (12), (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: Monday, October 24, 2016 @ 9:00 a.m.

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: Brittany O’Neil, 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: Brittany O’Neil, Policy Coordinator, Division of Workers’ Compensation, Department of Financial Services, address: 200 East Gaines Street, Tallahassee, Florida 32399-4220, telephone: [phone], email: [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

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

(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, (“Manual”), 2016 2014 Edition http://www.flrules.org/Gateway/reference.asp?No=Ref-04109, effective January 1, 2015, is adopted by reference as part of this rule. The Hospital 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 Manual are in addition to the requirements and responsibilities established throughout by Rule Chapter 69L-7, F.A.C., the 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, 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, or may be obtained free of charge by print or download from the Department’s website at http://www.myfloridacfo.com/division/wc/.

(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 Florida Workers’ Compensation Reimbursement Manual for Hospitals, adopted by reference herein 2014 Edition, effective January 1, 2015. These Both rules, and both manuals, and all incorporated resource materials the HCP RM 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, or via The copying of or the 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 Department’s Division of Workers’ Compensation website web site at http://www.myfloridacfo.com/division/wc/ http://www.myfloridacfo.com/division/wc/publications/html.

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,________.

 

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Brittany O’Neil, Policy Coordinator, 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: September 27, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 7, 2016