18083630, 69L-7.501 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 18083630

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

WORKERS' COMPENSATION MEDICAL REIMBURSEMENT AND UTILIZATION REVIEW

Overview

RULE:

69L-7.501

Florida Workers' Compensation Reimbursement Manual for Hospitals

PURPOSE:

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.

RULEMAKING AUTHORITY:

440.13(12), (14), 440.591, FS.

LAW:

440.13(7), (12), (14), FS.

PRINT PUBLISH DATE:

9/30/2016 Vol. 42/191

COMMENTS:

From 9/30/2016 To 10/21/2016 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

Ref-04109 Hospital Manual

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