69L-7.501: Florida Workers' Compensation Reimbursement Manual for Hospitals
PURPOSE AND EFFECT: The purpose and effect of the proposed rule development is to amend the rule to adopt by reference the 2009 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. The 2009 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals will incorporate Medicare’s Hospital Outpatient Prospective Payment System payment methodology for reimbursing hospitals for outpatient bills, with payment adjustment factors of 1.74 times the Medicare allowed amount for scheduled surgeries and 3.95 times the Medicare allowed amount for other specified compensable charges, as approved by the Three Member Panel at its November 20, 2008 meeting. The 2009 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals also incorporates a definition for the Medicare Hospital Outpatient Prospective Payment System, recognizes the Integrated Outpatient Code Editor and the National Correct Coding Initiative (NCCI) edits and their updates from the Centers for Medicare and Medicaid Services (CMS) in the Medicare Hospital Outpatient Prospective Payment System, and makes technical changes to include a new manual format, an expanded table of contents and a listing of chapters by topic.
SUMMARY: Rule amendment to change the Florida Workers’ Compensation Manual for Hospitals to incorporate Medicare’s Hospital Outpatient Prospective Payment System for reimbursing hospitals for outpatient bills, with payment adjustment factors of 1.74 times the Medicare allowed amount for scheduled surgeries and 3.95 times the Medicare amount for other specified compensable charges. Additional changes to the manual include recognition of the Integrated Outpatient Code Editor and the National Correct Coding Initiative edits and their updates from the Centers for Medicare and Medicaid Services in the Medicare Hospital Outpatient Prospective Payment System, and technical formatting changes to the manual.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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 in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 440.13(12),(14), 440.591 FS.
LAW IMPLEMENTED: 440.13(7), (12), (14) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Wednesday, December 2, 2009, 1:30 p.m.
PLACE: 104J Hartman Bldg., 2012 Capital Circle Southeast, Tallahassee, Florida
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Samuel Willis III, (850)413-1898. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Samuel Willis, III, Operations Management Consultant II, Office of Medical Services, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232, (850)413-1898
THE FULL TEXT OF THE PROPOSED RULE IS:
69L-7.501 Florida Workers’ Compensation Reimbursement Manual for Hospitals.
(1) The Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2009 2006 Edition, (effective:_______,) is adopted by reference as part of this rule. The Hospital Manual contains the Maximum Reimbursement Allowances (MRAs) determined by the Three Member Panel, pursuant to Section 440.13(12), F.S., and establishes policy, procedures, principles and standards for implementing statutory provisions regarding reimbursement for medically necessary services and supplies provided to injured workers in a hospital setting. The policy, procedures, principles and standards in the Manual are in addition to the requirements established by the Florida Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.602, F.A.C. The Reimbursement Manual for Hospitals 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 may be obtained free of charge by print or download from the Department’s website at http://www.myfloridacfofldfs.com/wc/publications.html.
(2) The Florida Workers’ Compensation Health Care Provider Reimbursement Manual [HCP RM], 2008 2006, incorporated by reference into Rule 69L-7.020, F.A.C.; and the Workers’ Compensation Medical Services Billing, Filing and Reporting Rule, Rule 69L-7.602, F.A.C., are recognized for use in conjunction with the Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2009 Edition also incorporated by reference into this rule. Both rules and the HCP RM are 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.myfloridacfofldfs.com/wc/publications/html.
Rulemaking Specific Authority 440.13(12), (14), 440.591 FS. Law Implemented 440.13(7), (12), (14) FS. History–New 6-9-87, Amended 6-1-92, 10-27-99, 7-3-01, Formerly 38F-7.501, 4L-7.501, Amended 12-4-03, 1-1-04, 7-4-04, 10-1-07,________.