Note: The Division has scheduled (3) Rule Workshops or Rule Hearings.
|Rule Development Workshop||69L-7.501, F.A.C.
|Thursday, July 28, 2016, at 9:00 A.M.
Thursday, July 28, 2016, at 10:30 A.M.
Thursday, July 28, 2016, at 1:00 P.M.
|Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
69L-7.501: The proposed rule is amended to adopt 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.
69L-7.100: The proposed rule amendment incorporates and adopts for use the 2016 Edition of the Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (“ASC Reimbursement Manual”), as approved by the Three-Member Panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the ASC Reimbursement Manual contains an updated list of the Maximum Reimbursement Allowances ("MRAs") for various medical services provided to Florida’s injured workers.
69L-7.020: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers' Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The aforementioned manual is updated to incorporate the 2016 Medicare Conversion Factor and Resource Based Relative Value Scale ("RBRVS") geographic-specific reimbursement levels used to determine Maximum Reimbursement Allowances ("MRAs") for physician’s services and non-surgical hospital outpatient services provided to Florida's injured workers.
A copy of the notice regarding the proposed Rules may be found through the following links
A copy of the draft manuals may be found through the following links:
Draft 69L-7.501 Workshop 2016HRM 07_15_2016
Draft 69L-7.100 Workshop 2016ASCRM 07_15_2016
Draft 69L-7.020 Workshop 2016HCPRM 07_19_2016
Past Workshops & Hearings
|Rule Workshop||69L-31, Utilization and Reimbursement Dispute Rule
||Friday, June 10, 2016, 9:30 a.m.||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL
|The Rules of 69L-31, F.A.C. 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, including expanding the time period for submitting petitions for dispute resolution from 30 to 45 days. 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, FS., and exclude issues of contract interpretation. New Rule 69L-31.017, F.A.C. is proposed to stipulate the consequences for failure to comply with Department Determinations. Minor edits to enhance clarity and additional technical changes are also included. The proposed rules have been renumbered accordingly.
|Rule Workshop||69L-6.028, F.A.C.
|Tuesday, June 7, 2016, 2:00 p.m.||Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL|
|Proposed Rule 69L-6.028, F.A.C., clarifies time periods of employer non-compliance for penalty calculation purposes, and provides that the Department may impute the employer’s payroll 10 business days following the employer’s receipt of the Department’s request to produce business records. The amendment to Rule 69L-6.035, F.A.C., further defines remuneration to employees, adding language to address the validation of expense reimbursements; remuneration occurring on the day a stop-work order is issued; and employee classification code assignments for payroll calculation purposes. The proposed rules also delete obsolete language and include additional technical changes.
https://www.flrules.org/gateway/RuleNo.asp?title=WORKERS'' COMPENSATION COMPLIANCE&ID=69L-6.028
https://www.flrules.org/gateway/RuleNo.asp?title=WORKERS'' COMPENSATION COMPLIANCE&ID=69L-6.035
Note: This tab reflects Rules adopted within the past 6 months.
|Rule is Effective||69L-30 Expert Medical Advisors||March 1, 2016|
|Summary: The rule dictates how to qualify, apply to become, be selected, and be recertified as an Expert Medical Advisor (EMA). This Rule also dictates how to bill for and receive reimbursement for EMA services. Finally, this Rule states circumstances under which previously certified EMAs can become decertified.
|August 24, 2016||2016 WCI Conference - DWC Breakout Presentation|
The Florida Division of Workers' Compensation recently participated in the 71st Annual Workers' Compensation Educational Conference with the Workers' Compensation Institute, in Orlando, Florida. The Division's breakout session included the following topics: Legislative and Rule Updates, Audits and Carrier Compliance, Medical Services and EDI Updates. Please contact Brittany O'Neil at 850-413-1927 with any questions.
DWC Breakout Presentation