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Division Director

Tanner Holloman

Assistant Director

Andrew Sabolic


Workers' Compensation
200 East Gaines Street
Tallahassee, FL 32399-0318
Workers' Compensation Claims
(800) 342-1741
Workers' Compensation Exemption/ Compliance
(850) 413-1609

Rule Changes & Notices

Draft Rules

Note: The Division has scheduled (3) Rule Workshops or Rule Hearings.

Type Rules Date Location
Rule Workshop 69L-6.028, F.A.C.
69L-6.035, 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

Proposed Rules
 
Type Rules Date Location
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.

https://www.flrules.org/gateway/ruleNo.asp?id=69L-31.003

Proposed Rules
 

Past Workshops & Hearings

Type Rule Date Location
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

 

New Rules

Note: This tab reflects Rules adopted within the past 6 months.

Type Rule Effective Date
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.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-30

 

Notices

 
Date Subject
Wednesday, April 20, 2016 Three-Member Panel Meeting
The Florida Department of Financial Services, Division of Workers' Compensation announces a public meeting of the Three-Member Panel that will be held on Wednesday, April 20, 2016, beginning at 10:00 a.m. in room 116 of the J. Edwin Larson Building located at 200 East Gaines Street, Tallahassee, Florida. Notice of this public meeting appears in the Monday, April 4, 2016, issue of the Florida Administrative Register. To view the official (published) notice click on the following link: http://www.FLRules.org/gateway/View_Notice.asp?id=17373396

Meeting Packet Materials:
- Agenda
- Draft 2016 Health Care Provider Reimbursement Manual
- Draft 2016 Ambulatory Surgical Center Reimbursement Manual
- Draft 2016 Hospital Reimbursement Manual
- Annual Report on Reimbursement Disputes and Overutilization

 
Type Rule Effective Date
Rule Adoption Selected Materials Incorporated By Reference
Rules 69L-8.071, 69L-8.072, 69L-8.073, 69L-8.074, Florida Administrative Code
Thursday, February 18, 2016
Summary for 69L-8 series Rules: The rules within this new chapter organize incorporated materials that are utilized in conjunction with DWC medical reimbursement manuals and throughout Rule Chapter 69L-7, F.A.C.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-8
 
Type Rule Effective Date
Rule Adoption Workers' Compensation Medical Reimbursement and Utilization Review
Rules 69L-7.710, 69L-7.720, 69L-7.730, 69L-7.740, and 69L-7.750, Florida Administrative Code
Thursday, February 18, 2016
Summary for 69L-7 series Rules: The rules within this chapter represent a substantial rewrite and reorganization of the previous Rule 69L-7.710, F.A.C. It is now 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.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-7
 
Date Subject
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:
https://www.flrules.org/gateway/ruleNo.asp?id=69L-22.006
 
Date Subject
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.
 
Date Subject
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.

DFS-04-2015 PDF
 
Date Subject
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:
http://www.FLRules.org/gateway/View_Notice.asp?id=16732711
http://www.FLRules.org/gateway/View_Notice.asp?id=16732905
 
Type Rule Date Location
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

http://www.FLRules.org/gateway/View_Notice.asp?id=16268954
 
Date Subject
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.