Note: The Division has scheduled (1) Rule Workshops or Rule Hearings.
|Rule Development Workshop||Chapter 69L-31, F.A.C.||Tuesday, January 12, 2016, 9:30 a.m.||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
|Summary: Rules are being amended which govern the process for resolution of disputes between workers’ compensation carriers and health care providers. Revised forms are adopted. Rule 69L-31.005, F.A.C., is amended to provide greater detail regarding materials required to be included in a petition for dispute resolution. Rule 69L-31.008, F.A.C., is revised to provide clarity regarding computation of the time period to submit a petition for dispute resolution. The time period in Rule 69L-31.009, F.A.C., for a carrier to respond to a petition is expanded from 10 to 30 days. New Rule 69L-31.016, F.A.C., is proposed to limit the scope of the dispute resolutions to compliance with standards under Chapter 440, F.S., and exclude issues of contract interpretation. Changes are also made to provide several minor edits, primarily for the purpose of clarity.
A copy of the notice and link to the proposed Rules may be found through the following link. https://www.flrules.org/Gateway/View_notice.asp?id=16896544
Past Workshops & Hearings
|Rule Hearing||Chapters 69L-7.710, 69L-7.720, 69L-7.730, 69L-7.740, 69L-7.750, 69L-8.071, 69L-8.072, 69L-8.073, 69L-8.074||Tuesday, June 2, 2015 at 9:30 a.m.||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
|Summary for 69L-7 series Rules: The proposed rulemaking represents a substantial rewrite and reorganization of existing Rule 69L-7.710, F.A.C., which is divided into five rule sections. The rulemaking also incorporates and adopts the ICD-10 medical code sets for use in conjunction with the Florida Medical EDI Implementation Guide ("MEIG"). The proposed rules also include revised billing forms and accompanying instructions.
Summary for 69L-8 series Rules: 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." A copy of the notices may be found through the following links.
Notice for 69L-7 Series
Notice for 69L-8 Series
Documents referenced in the proposed Rules (Instructions updated 09/24/2015):
||Chapter 69L-30, Expert Medical Advisors||Tuesday, April 14, 2015 at 10:00 a.m.||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
|Summary: The proposed rulemaking represents a significant rewrite of all rules listed under Rule Chapter 69L-30, F.A.C. The proposed rules clarify and streamline the process through which a physician becomes certified as an Expert Medical Advisor (EMA), pursuant to subsection 440.13(9), Florida Statutes. The proposed rulemaking includes the addition of an online application and certification process, tutorial and a list of certified EMAs through which each physician is responsible for updating their profile to reflect any changes to the physician’s current information. The proposed rulemaking also provides a website address to access the on-line certification and certificate issuance process, the tutorial, and the list of certified EMAs.
Notice and Draft Rules 69L-30
Notice of Correction
|Rule Hearing||Chapter 69L- 7.020, Chapter 69L-7.100||Thursday, February 26, 2015 at 9:00 a.m.||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
|Summary: The Florida Workers’ Compensation Health Care Provider Reimbursement Manual incorporated in Rule 69L-7.020, F.A.C. and the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers incorporated in Rule 69L-7.100, F.A.C., are updated to conform to the mandate in paragraph 440.13(12)(b), F.S., limiting workers’ compensation healthcare provider reimbursements to 110% of Medicare reimbursement allowances. Manuals containing updated billing codes are also updated.
Notice and Draft Rules 69L-7.020 and 69L-7.100
Draft FL Workers’ Comp Reimbursement Manual for Ambulatory Surgical Centers 2015
Draft FL Workers’ Comp Health Care Provider Reimbursement Manual 2015
Note: This tab reflects Rules adopted within the past 6 months.
|Rule Adoption||69L-7.100 Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)||September 28, 2015|
|Summary: The rule adopts* a revised manual listing reimbursement rates for various medical services provided by ambulatory surgical centers.
*Please take note that the reimbursement manual does not go into effect until January 1, 2016 (as provided in the rule text)
Reimbursement Manual for Ambulatory Surgical Centers, 2015 Edition (Effective 01/01/2016)
|Rule Adoption||69L-6.015 - Record Maintenance and Production Requirements for Employers
69L-6.025 - Conditional Release of Stop-Work Order and Periodic Payment Agreement
|September 6, 2015|
|Summary: These rules are amended to conform to applicable provisions of Section 440.107, F.S., as revised under Chapter No. 2014-109, Laws of Florida. Rule 69L-6.015, F.A.C., reduces the business record retention period requirements for employers under Florida’s Workers’ Compensation law to a period consisting of an employer’s two, rather than three, years of employment activity. Rule 69L-6.025, F.A.C., modifies the terms and conditions under which the Department’s Division of Workers’ Compensation is authorized to issue an Agreed Order of Conditional Release from Stop-Work Order to employers who violate Chapter 440, F.S., as well as the circumstances under which such orders will be reinstated and rescinded. The proposed rule also incorporates a new form, and revises existing forms.
|January 11, 2016||69L-22.006 Screening Process
69L-22.008 Reemployment Services and Programs
69L-22.009 Employee Responsibilities
69L-22.011 List of Forms
|The Florida Division of Workers' Compensation submitted a Notice of Development for Chapters 69L-22 of the Florida Administrative Code. The proposed rules are amended to clarify the process injured employees must follow when seeking to obtain Department-sponsored reemployment services. The proposed rules provide injured employees with information and guidance regarding available reemployment services and the terms, conditions, and responsibilities associated with receiving such services. Additionally, the proposed rulemaking incorporates two new forms and revises two existing forms.
The official Notices of Change appeared in the Volume 42, Number 04 of the Florida Administrative Weekly, published on January 7, 2016. If you have questions about the Notice, please contact Stephen Yon, Chief, Bureau of Employee Assistance and Ombudsman Office, Division of Workers' Compensation at (850) 413-1786 or Stephen.Yon@myfloridacfo.com.
If requested in writing and not deemed unnecessary by the agency head, a rule development workshop will be held Thursday, February 4, 2016, 9:00 a.m. in Room 102, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida.
A copy of the Notice may be found via the following link:
|December 21, 2015||69L-7, F.A.C. Workers' Compensation Medical Reimbursement and Utilization and Review
|This summary notice is being posted by the Florida Division of Workers' Compensation for all Self-Insurers, Insurers, Claims Administrators and Medical Providers. The Florida Division of Workers' Compensation submitted a Notice of Change for Chapter 69L-7.720 of the Florida Administrative Code. The official notice appeared on December 21, 2015 in Volume 41, No. 245 of the Florida Administrative Register.
The form completion instructions for the DFS-F5-DWC-90 (UB-04) located in the headers of incorporated forms are changed as follows:
Edition ("2015") and copyright ("July 2014") date references to the NATIONAL UNIFORM BILLING COMMITTEE OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL (UB-04 MANUAL) are deleted from the form completion instructions headers.
Language requiring insurer/claim administrator information to be entered in the blank area at the top of the DFS-F5-DWC-90 (UB-04) billing form is deleted.
In addition to the above referenced changes, the form completion instructions for the Form DFS-F5-DWC-90-B (Completion Instructions for Ambulatory Surgical Centers) are also revised.
A copy of the Notice and a complete list of the changes may be found via the following link: https://www.flrules.org/Gateway/View_notice.asp?id=16919630
If you have questions about the Notice, please contact Pam Macon, Chief, Bureau of Monitoring and Audit, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com.
|December 7, 2015||Maximum Workers' Compensation Rate, Effective January 1, 2016
|The Florida Department of Economic Opportunity has determined the statewide average weekly wage paid by employers subject to the Florida Reemployment Assistance Program Law to be $862.51 for the four calendar quarters ending June 30, 2015.
Section 440.12(2), Florida Statutes (2015), expressly provides that, for injuries occurring on or after August 1, 1979, the weekly compensation rate shall be equal to 100 percent of the statewide average weekly wage, adjusted to the nearest dollar, and that the average weekly wage determined by the Department of Economic Opportunity for the four calendar quarters ending each June 30 shall be used in determining the maximum weekly compensation rate with respect to injuries occurring in the calendar year immediately following.
Accordingly, the maximum weekly compensation rate for work-related injuries and illnesses occurring on or after January 1, 2016 shall be $863.00.
|November 5, 2015||69L-7, F.A.C. Workers’ Compensation Medical Reimbursement and Utilization Review
69L-8, F.A.C. Selected Materials Incorporated by Reference
| The Florida Division of Workers' Compensation submitted a Notice of Change for Chapters 69L-7 and 69L-8 of the Florida Administrative Code. The changes to the proposed rules are being made to address public comments and comments submitted by the Joint Administrative Procedures Committee. Completion instructions for incorporated forms DFS-F5-DWC-9-A, DFS-F5-DWC-9-B, and DFS-F5-DWC-9-C are changed to clarify the dates of use for the ICD-9 and the required use of the ICD-10 upon federal implementation. The proposed rules also include certain technical changes.
The official Notices of Change appeared in the Volume 41, Number 216 of the Florida Administrative Weekly, published on November 5, 2015. If you have questions about the Notices, please contact Pam Macon, Chief, Bureau of Monitoring and Audit, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com.
A copy of each Notice may be found via the following links:
|Rule Hearing||69L-3.018, 69L-3.019, 69L-3.0191, 69L-3.0192, and 69L-3.0193, Florida Administrative Code||Tuesday, August 18, 2015 at 8:00 a.m., Eastern Time||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
|Summary: Repeal of Unnecessary Rules
|July 23, 2015||69L-7.020, F.A.C. - Florida Workers' Compensation Health Care Provider Reimbursement Manual|
|Summary: On July 20, 2015, the Florida Department of Financial Services, Division of Workers' Compensation adopted the Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2015 Edition (Rule Chapter 69L-7.020, Florida Administrative Code). However, the policies and reimbursement allowances identified in the Health Care Provider Reimbursement Manual will not go into effect until the manual has been ratified by the legislature.
The purpose and effect of the rule is to update the schedule of maximum reimbursement allowances to 2014 Medicare reimbursement rates as adopted by the Three Member Panel on 01/22/2015.