RULE NO.: RULE TITLE:
69L-7.020: Florida Workers' Compensation Health Care Provider Reimbursement Manual

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 37 No. 24, June 17, 2011 issue of the Florida Administrative Weekly.

These changes are being made in response to comments received as part of the record for the public hearing held on Wednesday, July 13, 2011, and to add clarity to the rule. This notice also includes technical changes that have been made to the proposed rule. Changes made to the text of the incorporated reimbursement manual can be reviewed on the Department of Financial Services, Division of Workers’ Compensation webpage: http://www.myfloridacfo.com/WC/draft-rules.html.

To comply with the requirements of Chapter 2011-255, Laws of Florida, the Summary of Statement of Estimated Regulatory Costs is amended to read as follows: The Department has determined that the proposed rule will directly or indirectly increase regulatory costs, including transactional coasts, in excess of $1million in the aggregate within 5 years after the implementation of the rule. Accordingly, the Department has determined that the proposed rule will require legislative ratification.

Text of proposed rule with changes:

69L-7.020 Florida Workers’ Compensation Health Care Provider Reimbursement Manual.

(1) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 20110 Edition, is adopted by reference as part of this rule. The manual contains the Maximum Reimbursement Allowances determined by the Three-Member Panel, pursuant to Section 440.13(12), F.S., and establishes reimbursement policies, guidelines, codes and maximum reimbursement allowances for services and supplies provided by health care providers. Also, the manual includes reimbursement policies and payment methodologies for pharmacists and medical suppliers.

(2) The CPT^® 2010 Current Procedural Terminology Professional Edition, Copyright 20109, American Medical Association; the Current Dental Terminology, CDT-2009/2010, Copyright 2008, American Dental Association; and in part for D codes and for injectable J codes, and for other medical services and supply codes, the “HCPCS Level II, A resourceful compilation of HCPCS codes Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2010”, American Medical Association, Copyright 2009, Ingenix Publishing Group, are adopted by reference as part of this rule. When a health care provider performs a procedure or service which is not listed in the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 20110 Edition incorporated above, the provider must use a code contained in the CPT^®-2010, CDT-2009/2010 or HCPCS Level II as specified in this section.

(3) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 20110 Edition incorporated above, is available for inspection during normal business hours at the Florida Department of Financial Services, Document Processing Section, 200 East Gaines Street, Tallahassee, Florida 32399-0311, or via the Department’s web site at: http://www.myfloridacfo.com/wc/provider/reimbursement-manuals.html. Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so within 21 days of this notice.

The remainder of the rule reads as previously published.