Florida Division of Workers’ Compensation Reviews Ambulatory Surgical Centers, Workers’ Compensation Health Care Provider Reimbursement Manuals
Jul 14, 2011
On Wednesday, July 13, 2011, the Florida Department of Financial Services Division of Workers’ Compensation (“Division”) held a Rule Hearing on proposed Rule 69L-7.020, entitled “Florida Workers’ Compensation Health Care Provider Reimbursement Manual” and Proposed Rule 69L-7.100, entitled “Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers.”
The proposed Rules adopt the 2010 versions of these Manuals, which include the Maximum Reimbursement Allowances determined by the Three-Member Panel. The Manuals also establish reimbursement policies, guidelines, and codes, as well as new formatting that is expected to be more efficient.
Eric Lloyd, Lynn Metz and Sam Willis presided over the Hearing on behalf of the Division.
Mr. Lloyd briefly explained Proposed Rule 69L-7.020, noting that format changes were made to the Florida Workers’ Compensation Health Care Provider Reimbursement Manual (“Health Care Provider Reimbursement Manual”) so that revisions would be highlighted. No significant substantive changes had been made to the Health Care Provider Reimbursement Manual since it was presented during the initial Rule Development Workshop. Mr. Lloyd advised that the rate impact is plus seven-tenths of a percent as established by the Three-Member Panel.
Following these comments, Mr. Lloyd opened the hearing up for public testimony.
Various carriers and other interested parties, such as chiropractors and athletic trainers, provided oral, as well as written comments that will become part of the record.
Regarding the Health Care Provider Reimbursement Manual adopted by proposed Rule 69L-7.020, it was suggested that the dispensing fee language should be clarified in relation to the reimbursement for compound drugs in order to ensure the fee is being charged multiple times.
Concerns also were raised that the changes could be interpreted as expanding athletic trainers’ scope of practice. However, the Division officials assured the changes did not include such expansion.
In response to a question about the mechanism for securing a fraud statement, Mr. Lloyd said that one statement per carrier, per year is required, but there is not an applicable Division form. The language in the statute should be applied, he explained.
Discussion also took place on the recent legislative changes to the rulemaking process that require legislative review if a Rule is determined to have an economic impact. According to Mr. Lloyd, proposed Rule 69L-7.020 will trigger the need for such a review, but that the statutes are ambiguous as to the process by which the Legislature would perform the review. Therefore, the Division will submit the proposed Rule to the Legislature prior to the 2012 Session, although it is unclear how the Legislature will act.
Mr. Lloyd briefly explained proposed Rule 69L-7.100, noting there were changes made to the Maximum Reimbursement Allowance table in the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers. Since the proposed Rule does not effect a significant rate impact, there will be no need for it to be submitted to the Legislature for review, he said.
Ambulatory surgical center representatives provided extensive comments and suggestions on the proposed Rule. However, Mr. Lloyd advised them to steer clear of discussion on any policy issues, since these have been considered during previous workshops. Instead, he guided them to focus on legal or sufficiency issues. Nevertheless, concerns were raised about the “unnecessary and burdensome” duty to produce itemized statements and conduct an onsite paper audit.
The Division officials stated they would strongly consider these concerns in a potential redraft of the proposed Rules. Mr. Lloyd indicated that he anticipates substantive changes to be made to each.
The record will remain open until July 25, 2011 for additional written comments.
The meeting materials and texts of the proposed Rules are attached for review.
Should you have any questions or comments, please contact Colodny Fass.
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