Rule Changes & Notices

Draft Rules

Note: The Division has scheduled (2) Rule Workshops or Rule Hearings.

Type	Rule	Date	Location
Rule Hearing The Hearing will be held.	Chapter 69L-7.100, FL Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)	Wednesday, May 27, 2015 at 9:30 a.m.	Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL
Summary: The rule adopts a revised manual listing reimbursement rates for various medical services provided by ambulatory surgical centers. Notice and Draft Rule 69L-7.100 Draft Reimbursement Manuals for Ambulatory Surgical Centers

Type	Rule	Date	Location
Rule Hearing	Chapters 69L-7.710, 69L-7.720, 69L-7.730, 69L-7.740, 69L-7.750, 69L-8.071, 69L-8.072, 69L-8.073, 69L-8.074	Tuesday, June 2, 2015 at 9:30 a.m.	Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL
Summary for 69L-7 series Rules: The proposed rulemaking represents a substantial rewrite and reorganization of existing Rule 69L-7.710, F.A.C., which is divided into five rule sections. The rulemaking also incorporates and adopts the ICD-10 medical code sets for use in conjunction with the Florida Medical EDI Implementation Guide ("MEIG"). The proposed rules also include revised billing forms and accompanying instructions. Summary for 69L-8 series Rules: The proposed rules reorganize incorporated materials that are utilized in conjunction with DWC medical reimbursement manuals and throughout Rule Chapter 69L-7, F.A.C., entitled, "Workers' Compensation Medical Reimbursement and Utilization Review." A copy of the notices may be found through the following links. Notice for 69L-7 Series Notice for 69L-8 Series Documents referenced in the proposed Rules: Form DFS-F5-DWC-9 CMS-1500 Rev 02.12 Form DFS-F5-DWC-9-A Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-9-B Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-9-C Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-10 Rev 1-1-15 Form DFS-F5-DWC-10-A Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-11 Rev 2012 Form DFS-F5-DWC-11-A Instructions Rev 01.01.15 (11 17 14) Form DFS-F5-DWC-25 Rev 01.31.08 Form DFS-F5-DWC-25-A Instructions Rev 01.01.15 (11.21.14) Form DFS-F5-DWC-90 Rev 11-3-2006 Form DFS-F5-DWC-90-A Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-90-B Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-90-C Instructions Rev 01.01.15 (11 14 14) Form DFS-F5-DWC-90-D Instructions Rev 01.01.15 (11 14 14) MEIG Rev F 2015 01-21-2015

Past Workshops & Hearings

Type	Rule	Date	Location
Rule Hearing	Chapter 69L-30, Expert Medical Advisors	Tuesday, April 14, 2015 at 10:00 a.m.	Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL
Summary: The proposed rulemaking represents a significant rewrite of all rules listed under Rule Chapter 69L-30, F.A.C. The proposed rules clarify and streamline the process through which a physician becomes certified as an Expert Medical Advisor (EMA), pursuant to subsection 440.13(9), Florida Statutes. The proposed rulemaking includes the addition of an online application and certification process, tutorial and a list of certified EMAs through which each physician is responsible for updating their profile to reflect any changes to the physician’s current information. The proposed rulemaking also provides a website address to access the on-line certification and certificate issuance process, the tutorial, and the list of certified EMAs. Notice and Draft Rules 69L-30 Notice of Correction

Type	Rule	Date	Location
Rule Hearing	Chapter 69L- 7.020, Chapter 69L-7.100	Thursday, February 26, 2015 at 9:00 a.m.	Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL
Summary: The Florida Workers’ Compensation Health Care Provider Reimbursement Manual incorporated in Rule 69L-7.020, F.A.C. and the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers incorporated in Rule 69L-7.100, F.A.C., are updated to conform to the mandate in paragraph 440.13(12)(b), F.S., limiting workers’ compensation healthcare provider reimbursements to 110% of Medicare reimbursement allowances. Manuals containing updated billing codes are also updated. Notice and Draft Rules 69L-7.020 and 69L-7.100 Draft FL Workers’ Comp Reimbursement Manual for Ambulatory Surgical Centers 2015 Draft FL Workers’ Comp Health Care Provider Reimbursement Manual 2015

New Rules

Note: This tab reflects Rules adopted within the past 6 months.

Type	Rule	Effective Date
Rule Adoption	69L-6.027, Penalty Calculation Worksheet 69L-6.028, Procedures for Imputing Payroll & Penalty Calculations 69L-6.035, Definition of Payroll for Calculating Penalty	April 12, 2015
Summary: The amendment to Rule 69L-6.027 revises the penalty calculation worksheet to provide the premium credit for the initial payment of premium made to secure coverage against an assessed penalty and to adjust the penalty look back period and the penalty multiplier to conform to statutory changes. The amendment to Rule 69L-6.028 changes the time frame to impute the employer's payroll in the absence of business records from 20 to 28 days after receipt of the department's request to produce records, and changes the factor to calculate employee payroll from 1.5 to 2 times state average weekly wage, to conform to section 440.107, Florida Statutes as it now reads. Also, the timeframe for the employer to provide additional records is revised to twenty business days after the service of the first amended order of penalty assessment. The amendment to Rule 69L-6.035 also changes the factor to calculate employee payroll from 1.5 to 2 times state average weekly wage, to conform to section 440.107, Florida Statutes as it now reads. Additionally the amendments change citations in Rules 69L-6.028 and 69L-6.035 to reflect the current convention of naming to the specific subdivision cited. Adopted Rule

Type	Rule	Effective Date
Rule Adoption	Chapter 69L-7.501, Florida Workers' Compensation Reimbursement Manual for Hospitals	January 1, 2015
Summary: The Florida Department of Financial Services, Division of Workers' Compensation has adopted Rule 69L-7.501, F.A.C., Florida Workers’ Compensation Reimbursement Manual for Hospitals. This rule will be effective on January 1, 2015. Adopted Rule

 

Notices

Date	Subject
January 22, 2015	Meeting Materials for the Three-Member Panel
Summary: The following items are included in the meeting materials: Agenda, NCCI pricings for the Health Care Provider and Ambulatory Surgical Center Reimbursement Manuals, Biennial Report, Annual Report on Reimbursement Disputes and Overutilization. Meeting Materials