Office of Medical Services

The Florida Division of Workers' Compensation has submitted a Notice of Proposed Rule Making for the Florida Workers' Compensation Reimbursement Manual for Hospitals Rule (Rule Chapter 69L-7.501, Florida Administrative Code). The notice provides that, if requested in writing within 21 days of the publication of the official notice, a rule hearing will be held on Wednesday, August 8, 2012 at 2:00 p.m., eastern daylight time (EDT) in room 102 of the Hartman Building. The purpose of the proposed rule making is to amend the rule to adopt by reference the 2012 Edition of the Florida Workers' Compensation Reimbursement Manual for Hospitals, replacing the 2006 Edition of the Florida Workers' Compensation Reimbursement Manual for Hospitals in the existing rule. In addition, the 2012 Edition of the Florida Workers' Compensation Reimbursement Manual for Hospitals will incorporate a fee schedule for certain hospital outpatient services within defined geographic areas in Florida utilizing Current Procedural Terminology® (CPT) line level charge data. The proposed manual makes technical changes to include a new manual format, an expanded table of contents and chapters by topic. The official Notice of Proposed Rule appears in Volume 38, Number 27, of the Florida Administrative Weekly, which was published on July 6, 2012. If you have questions about the contents of this notice, please contact Eric Lloyd, Program Administrator, Office of Medical Services, at (850) 413-1689 or Eric.Lloyd@myfloridacfo.com.

• Proposed Draft 2012 Hospital Reimbursement Manual
  

The Florida Division of Workers' Compensation has submitted a Notice of Proposed Rule Making for the Notice of Apportionment of Medical Reimbursement Due to a Pre-Existing Condition(s) Rule (Rule Chapter 69L-3.017, Florida Administrative Code). The notice provides that, if requested in writing within 21 days of the publication of the official notice, a rule hearing will be held on Friday, August 3, 2012 at 3:00 p.m., eastern daylight time (EDT) in room 102 of the Hartman Building. The purpose of this proposed new rule is to inform claims administrators of notice requirements to employees when the payment of a compensable medical benefit will be apportioned, pursuant to Section 440.15(5), F.S. The proposed rule clarifies that claims administrators must provide employees with notification of decisions to apply apportionment. The proposed rule provides that compliance with the notice requirements is achieved by mailing Forms DFS-F2-DWC-12 (Notice of Denial), or a letter to the employee explaining its apportionment decision to the employee, as specified. The proposed rule also clarifies that compliance with the notice requirements under proposed Rule 69L-3.017, F.A.C., does not satisfy the notification requirements under Rule 69L-7.602(5), F.A.C. The official Notice of Proposed Rule appears in Volume 38, Number 27, of the Florida Administrative Weekly, which was published on July 6, 2012. If you have questions about the contents of this notice, please contact Eric Lloyd, Program Administrator, Office of Medical Services, at (850) 413-1689 or Eric.Lloyd@myfloridacfo.com.

The Florida Division of Workers' Compensation has submitted a Notice of Proposed Rule Making for the Florida Workers' Compensation Medical Services Billing, Filing and Reporting Rule (Rule Chapter 69L-7.602, Florida Administrative Code). The notice provides that, if requested in writing within 21 days of the publication of the official notice, a rule hearing will be held on Friday, August 3, 2012 at 2:00 p.m., eastern daylight time (EDT) in room 102 of the Hartman Building. The purpose of the proposed rule making is to amend the rule (which applies to dates of injury occurring on or after October 1, 2003) to clarify that an insurer must provide health care providers with notification of a decision to apply apportionment in the payment of reimbursement for medical services. The amendment provides that an insurer shall, at the time of authorization or following authorization and prior to the rendering of medical service(s) if the decision to so apportion the reimbursement is made by the carrier following authorization but prior to the rendering of services, provide each health care provider with written or electronic notification of its decision to apply apportionment in the payment of reimbursement for medical service(s). Subsection (7) of the rule is deleted, as the penalty provisions are transferred to Rule Chapter 69L-24, F.A.C. The official Notice of Proposed Rule appears in Volume 38, Number 27, of the Florida Administrative Weekly, which was published on July 6, 2012. If you have questions about the contents of this notice, please contact Eric Lloyd, Program Administrator, Office of Medical Services, at (850) 413-1689 or Eric.Lloyd@myfloridacfo.com.

The Florida Division of Workers' Compensation has submitted a Notice of Proposed Rule Making for the Health Care Provider Certification Rule (Rule Chapter 69L-29, Florida Administrative Code). The notice provides that, if requested in writing within 21 days of the publication of the official notice, a rule hearing will be held on Friday, August 3, 2012 at 10:00 a.m., eastern daylight time (EDT) in room 102 of the Hartman Building. The purpose of this proposed rule is to amend the current rule chapter to revise the process by which health care providers meet the minimum criteria for certification pursuant to section 440.13(3)(a), F.S. The proposed amendment also introduces the "Florida Workers' Compensation Health Care Provider Certification Tutorial", a no-cost, on-line resource that implements an electronic certification process for health care providers that will improve the efficiencies in the certification process. The tutorial ensures participation only by statutorily defined providers and provides a learning tool that allows providers to progress at their own pace and to create and maintain their provider profile. The tutorial consists of an overview of the Florida Workers’ Compensation System and the general administrative policies with which a health care provider must become familiar to be certified and successfully participate under the system. The proposed rule amendment also deletes existing Rule(s) 69L-29.004, 69L-29.006, 69L-29.007, 69L-29.009 and 69L-29.011, F.A.C. The official Notice of Proposed Rule appears in Volume 38, Number 27, of the Florida Administrative Weekly, which was published on July 6, 2012. If you have questions about the contents of this notice, please contact Eric Lloyd, Program Administrator, Office of Medical Services, at (850) 413-1689 or Eric.Lloyd@myfloridacfo.com.