Three Member Panel meeting packet published for 01.04.17

Three Member Panel meeting on January 4, 2017

Meeting packet published

http://www.myfloridacfo.com/Division/WC/pdf/Three-Member-Panel-Meeting-Packet-Jan-4-2017.pdf

Division issues 2016 Results and Accomplishments Report

The Division of Workers' Compensation has issued its 2016 Results and Accomplishments Report.  The Report contains important system information related to lost-time claims and medical costs as well as outcome and performance measures for each of the Division's major program areas.  To view the Report, click here:

http://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Reports/AnnualReportWC2016.pdf 

Three Member Panel Meeting - January 4, 2017

The Florida Department of Financial Services, Division of Workers' Compensation announces a public meeting of the Three-Member Panel that will be held on Wednesday, January 4, 2017, beginning at 3:00 p.m. in room 116 of the J. Edwin Larson Building located at 200 East Gaines Street, Tallahassee, Florida. This public meeting, to which all are invited, has been convened to facilitate the Panel's consideration of the following items:

- The Three-Member Panel 2017 Biennial Report

- The Division's Annual Report on the resolution of health care provider medical reimbursement disputes and activities (2016) conducted pursuant to s. 440.13(8), F.S.

The Division of Workers' Compensation will publish the meeting packet for the Panel's January 4, 2017 meeting on the Division's website under "Notices" (http://www.myfloridacfo.com/Division/WC/noticesRules.htm).

Notice of this public meeting appears in the Wednesday, December 21, 2016, issue of the Florida Administrative Register. To view the official (published) notice click on the following link:  https://www.flrules.org/Gateway/View_notice.asp?id=18390441 

If you have questions about this communication, please contact:  Brittany O'Neil, Policy Coordinator, Division of Workers' Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4220, Phone (850) 413-1927 or Brittany.ONeil@myfloridacfo.com. 

 

To learn more about these issues and other Workers' Compensation information click here: http://www.myfloridacfo.com/Division/WC/

Maximum Workers' Compensation Rate, Effective January 1, 2017

The Florida Department of Economic Opportunity has determined the statewide average weekly wage paid by employers subject to the Florida Reemployment Assistance Program Law to be $886.46 for the four calendar quarters ending June 30, 2016.

Subsection 440.12(2), Florida Statutes (2016), expressly provides that, for injuries occurring on or after August 1, 1979, the weekly compensation rate shall be equal to 100 percent of the statewide average weekly wage, adjusted to the nearest dollar, and that the average weekly wage determined by the Department of Economic Opportunity for the four calendar quarters ending each June 30 shall be used in determining the maximum weekly compensation rate with respect to injuries occurring in the calendar year immediately following.

Accordingly, the maximum weekly compensation rate for work-related injuries and illnesses occurring on or after January 1, 2017 shall be $886.00.

Florida DWC to Change Rule 69L-6.027

A Notice of Development of Rulemaking (www.myfloridacfo.com/Division/WC/pdf/69L-6.015-.027-Rule-Development-Notice-2016-Nov-22.doc) was published for proposed Rules 69L-6.015 and 69L-6.027, both for the Florida Administrative Code.

The notice provides that if requested in writing, a Rule Workshop will be held on Monday, December 19, 2016, at 9:30 A.M., eastern time, at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.

Chapter 2016-56, Laws of Florida, amended subsection 440.05(10), F.S., to delete the requirement that any corporation with exempt officers engaged in the construction industry must maintain written statements of those exempted persons acknowledging each such individual's exempt status. The proposed amendment to Rule 69L-6.015, F.A.C., will also delete this requirement from the rule. Chapter 2016-56, Laws of Florida, also included legislative changes to the penalty requirements in subsection 440.107(7), F.S. The changes include: (i) a 25% penalty reduction for non-compliant employers who have not previously been issued a stop-work order or penalty assessment order and who timely provide requested business records; and (ii) a reduction of the imputed payroll multiplier from twice the statewide average weekly wage to the pre-2014 level of one and one-half times the statewide average weekly wage. The proposed amendment to Rule 69L-6.027, F.A.C., will incorporate these changes on the Penalty Calculation Worksheet.

The official Notice of Development of Rulemaking (www.myfloridacfo.com/Division/WC/pdf/69L-6.015-.027-Rule-Development-Notice-2016-Nov-22.doc) appeared in Volume 42, Number 232 of the Florida Administrative Register, published on December 1, 2016.

Florida Division of WC Survey for 3 Member Panel

This e-alert contains a link to survey stakeholders regarding the Florida Workers' Compensation System.  The purpose of the survey is to fulfill the requirements in section 440.13(12)(e), F.S. whereby the Three-Member Panel is to collect data and survey stakeholders to determine the state of the workers' compensation benefit delivery system.  Please use the link below to respond to the survey.  The survey will be open until Thursday, December 8, 2016.  If you have issues accessing the survey please email Brittany.oneil@myfloridacfo.com.

Click link to respond to survey:  https://app.smartsheet.com/b/form?EQBCT=7217e3f30e2a4a50895bc962303ad402 

To learn more about these issues and other Workers' Compensation information click here: http://www.myfloridacfo.com/Division/WC/ 

Rules 69L-6.028 and 69L-6.035 Hearing Set November 1, 2016

A Notice of Development of Rulemaking was published for proposed Rules 69L-6.028 and 69L-6.035, both for the Florida Administrative Code.  The notice provides that if requested in writing, a Rule Hearing will be held on Tuesday, November 1, 2016, at 10:00 A.M., eastern time, at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.

Proposed Rule 69L-6.028, F.A.C., clarifies time periods of employer non-compliance for penalty calculation purposes, and provides that the Department may impute the employer's payroll as early as 10 business days following the employer's receipt of the Department's request to produce business records. The rule is also amended to reflect the statutory revision reducing the imputed payroll multiplier from 2 times to 1.5 times the statewide average weekly wage.  Proposed Rule 69L-6.035, F.A.C., broadens the scope of remuneration to employees to include the validation of expense reimbursements; employee classification code assignments for payroll calculation purposes; and remuneration occurring on the day a stop-work order is issued.  The proposed rule also provides guidance regarding the required documentation associated with the aforementioned forms of remuneration.  The proposed rules also include additional technical changes.

The official Notice of Development of Rulemaking appeared in Volume 42, Number 198 of the Florida Administrative Register, published on October 11, 2016.  If you have questions about the contents of this notice, please contact Pam Macon, Chief, Bureau of Compliance, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com.

Reimbursement Manual Discussions at the Division

The Florida Division of Workers' Compensation submitted a Notice of Proposed Rulemaking for Rules 69L-7.501, 69L-7.100, and 69L-7.020, Florida Administrative Code.  The Division will host three hearings on Monday, October 24, 2016, at the times listed below at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.  All times are Eastern Standard Time.  The proposed rules are amended to adopt the 2016 editions of the Florida Workers' Compensation Reimbursement Manual for Hospitals, Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), and Florida Workers' Compensation Health Care Provider Reimbursement 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.

- 9:00 am - 10:30 am, 69L-7.501, Florida Workers' Compensation Reimbursement Manual for Hospitals, 2016 Edition (www.myfloridacfo.com/Division/WC/pdf/Draft-69L-7.501-Workshop-2016HRM-08_22_2016.pdf)

- 10:30 am - 12:00 pm, 69L-7.100, Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2016 Edition (www.myfloridacfo.com/Division/WC/pdf/Draft-69L-7.100-Post-Workshop-2016ASCRM-08_15_2016.pdf)

- 1:00 pm - 2:30 pm, 69L-7.020, Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2016 Edition (www.myfloridacfo.com/Division/WC/pdf/Draft-69L-7.020-Post-Workshop-2016HCPRM-08_11_2016.pdf)

The Notice of Proposed Rulemaking appeared in Volume 42, Number 191 (https://www.flrules.org/BigDoc/View_Section.asp?Issue=2210&Section=2) of the Florida Administrative Weekly, published on September 30, 2016. If you have questions about the contents of this notice, please contact Brittany O'Neil, Policy Coordinator, Division of Workers' Compensation at (850) 413-1927 or Brittany.Oneil@myfloridacfo.com .

To obtain copies of the Notice and Proposed Rule, please use the link below.

https://www.flrules.org/Gateway/View_notice.asp?id=18083436

https://www.flrules.org/Gateway/View_notice.asp?id=18083533

https://www.flrules.org/Gateway/View_notice.asp?id=18083630

Florida Workers' Compensation Rate Increase 14.5% 12.01.16

Florida OIR posted this September 27, 2016 (all quoted direct)

Tuesday, September 27, 2016

Contact Info:

​Contact Information:
Amy Bogner/Karen Kees
(850) 413-2515                       
press@floir.com                    

TALLAHASSEE, Fla. – After a thorough review of the workers’ compensation insurance rate filing submitted by the National Council on Compensation Insurance (NCCI) and careful consideration of hundreds of public comments and testimony received from interested stakeholders, the Florida Office of Insurance Regulation (Office) has issued an Order that gives contingent approval to an overall combined average statewide rate increase of 14.5% versus the requested 19.6%.  Approval of the revised rate increase is contingent on NCCI amending the filing to include the recommended changes stipulated within the Order.  As ordered by the Office, the revised rate increase would become effective on December 1, 2016 for new and renewal business, with no change in rates for current in-force policies. The amended rate filing must be filed with the Office for review and approval no later than October 4, 2016.

The NCCI rate filing was originally submitted in May of this year and amended in June to address the impact of three recent legal changes, including two Florida Supreme court case decisions (Castellanos v. Next Door Company and Westphal v. City of St. Petersburg) and legislatively-mandated updates to the Florida Workers’ Compensation Health Care Provider Reimbursement Manual (HCPR Manual).

If NCCI submits the required amended rate filing and it is subsequently approved by the Office at an overall combined average statewide rate increase of 14.5%, the individual rate impacts will include:

·        A 10.1% statewide average rate increase for the April 28^th Florida Supreme Court decision in the case of Castellanos v. Next Door Company, which  found the mandatory attorney fee schedule in Section 440.34, Florida Statutes, unconstitutional as a violation of due process under both the Florida and United States Constitutions.

·        A 2.2%  statewide average rate increase for the June 9^th Florida Supreme Court decision in the case of Westphal v. City of St. Petersburg, in which the Florida Supreme Court found the 104-week statutory limitation on temporary total disability benefits in Section 440.15(2)(a), Florida Statutes, unconstitutional because it causes a statutory gap in benefits in violation of an injured worker’s constitutional right of access to courts. The Supreme Court reinstated the 260-week limitation in effect prior to the 1994 law change.

·        A 1.8% statewide average rate increase related to updates within the Florida Workers’ Compensation HCPR Manual per Senate Bill 1402. The manual became effective on July 1, 2016.

For more information about the NCCI public hearing and rate filing, visit the Office’s “NCCI Public Rate Hearing” webpage.

​About the Florida Office of Insurance RegulationThe Florida Office of Insurance Regulation has primary responsibility for regulation, compliance and enforcement of statutes related to the business of insurance and the monitoring of industry markets. For more information about the Office, please visitwww.floir.com or follow us on Twitter @FLOIR_comm and Facebook. 

Division PPTs available from #WCI2016

The Florida Division of Workers' Compensation recently participated in the 71st Annual Workers' Compensation Educational Conference with the Workers' Compensation Institute, in Orlando, Florida.  The Division's breakout session included the following topics: Legislative and Rule Updates, Audits and Carrier Compliance, Medical Services and EDI Updates.  If you were unable to attend or would like to view the presentations, the Division power point has been published as a .PDF at http://www.myfloridacfo.com/Division/WC/noticesRules.htm.  

Please contact Brittany O'Neil at 850-413-1927 with any questions.

Division Announces Ask the Regulator

The Florida Division of Workers' Compensation, in conjunction with the Workers' Compensation Institute, is pleased to provide the opportunity for attendees to individually meet and speak with Division staff at the 71st Annual Workers' Compensation Educational Conference about regulatory issues that are important to your company.  This year we will offer two options for stakeholder assistance "Ask The Regulator" and "EDI On Demand."

Ask The Regulator: These one-one-one meetings will help maximize your time at the conference and provide the Division with an informal setting to interact with workers' compensation stakeholders.  The meetings will be held on Tuesday, August 23, 8:30 am - 11:30 am in the Tampa room at the Orlando World Center Marriott. Go to Florida DWC regulator (www.wci360.com/conference/ask-the-regulators) to schedule an appointment and identify the issues you would like to discuss with the Division.  This will ensure that the Division has the appropriate staff available to answer your questions.  An email will be sent to you confirming the time.

EDI On Demand: These EDI Triage & Training sessions are available upon email request and will provide access to Division staff on any EDI related issues and processes.  Please email Lisel.Laslie@myfloridacfo.com to request a session.  The meetings will be held on Tuesday, August 23, at the Orlando World Center Marriott.  An email will be sent to you confirming your meeting time.

Contact Brittany O'Neil, Policy Coordinator, Division of Workers' Compensation, 850-413-1927, email Brittany.oneil@myfloridacfo.com

Rule Making Announced for Rules 69L-7.501, 69L-7.100, and 69L-7.020

The notice below is directly quoted from the Division

The Florida Division of Workers' Compensation submitted a Notice of Proposed Rule Making for Rules 69L-7.501, 69L-7.100, and 69L-7.020, Florida Administrative Code.  The Division will host workshops on Thursday, July 28, 2016, at the times listed below at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.  All times are Eastern Standard Time.  The proposed rules are amended to adopt the 2016 Editions of the Florida Workers' Compensation Reimbursement Manual for Hospitals, Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), and Florida Workers' Compensation Health Care Provider Reimbursement 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.

- 9:00 am - 10:30 am, 69L-7.501, Florida Workers' Compensation Reimbursement Manual for Hospitals, 2016 Edition

- 10:30 am - 12:00 pm, 69L-7.100, Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2016 Edition

- 1:00 pm - 2:30 pm, 69L-7.020, Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2016 Edition

The official Notices of Development of Rulemaking appeared in Volume 42, Number 131 (https://www.flrules.org/BigDoc/View_Section.asp?Issue=2150&Section=1) of the Florida Administrative Weekly, published on July 7, 2016.  If you have questions about the contents of this notice, please contact Brittany O'Neil, Policy Coordinator, Division of Workers' Compensation at (850) 413-1927 or Brittany.Oneil@myfloridacfo.com.

To obtain copies of the Notice and Proposed Rule, please use the link below. 

https://www.flrules.org/gateway/ruleNo.asp?id=69L-7.501

https://www.flrules.org/gateway/ruleNo.asp?id=69L-7.100

https://www.flrules.org/gateway/ruleNo.asp?id=69L-7.020 

Florida Preferred Worker Program Repeal soon Complete

From the Division of Workers' Compensation (direct quoted)

Among the regulatory provisions amended by HB 613 (Chapter 2016-56, Laws of Florida) was the repeal of statutory provisions supporting the Preferred Worker Program under section 440.49, F.S. The aforementioned revision renders Rule Chapter 69L-11, F.A.C., entitled, “Preferred Worker Program,” obsolete; the rule chapter is repealed in its entirety. http://www.myfloridacfo.com/Division/WC/noticesRules.htm

The official Notice of Proposed Rule appeared in Volume 42, Number 119 of the Florida Administrative Register, published on June 20, 2016. If you have questions about the Notice, please contact Tom Krick, Unit Manager, Special Disability Trust Fund, Bureau of Financial Accountability, Division of Workers’ Compensation, Department of Financial Services at (850) 413-1651 or Tom.Krick@myfloridacfo.com. 

If requested in writing and not deemed unnecessary by the agency head, a rule hearing will be held Tuesday, July, 12, 2016, beginning at 2:00 p.m. in Room 102, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida. 

A copy of the Notice may be found via the following link:https://www.flrules.org/Gateway/View_notice.asp?id=17659837

http://www.myfloridacfo.com/Division/WC/noticesRules.htm

Division to offer Ask the Regulator again in August!

The Florida Division of Workers' Compensation, in conjunction with the Workers' Compensation Institute, is pleased to provide the opportunity for attendees to individually meet and speak with Division staff at the 71st Annual Workers' Compensation Educational Conference about regulatory issues that are important to your company.  This year we will offer two options for stakeholder assistance "Ask The Regulator" and "EDI On Demand."

Ask The Regulator:  These one-one-one meetings will help maximize your time at the conference and provide the Division with an informal setting to interact with workers' compensation stakeholders.  The meetings will be held on Tuesday, August 23, 8:30 am - 11:30 am in the Tampa room at the Orlando World Center Marriott.  Go to Florida DWC regulator (www.wci360.com/conference/ask-the-regulators) to schedule an appointment and identify the issues you would like to discuss with the Division.  This will ensure that the Division has the appropriate staff available to answer your questions.  An email will be sent to you confirming the time.

EDI On Demand:  These EDI Triage & Training sessions are available upon email request and will provide access to Division staff on any EDI related issues and processes.  Please email Lisel.Laslie@myfloridacfo.com to request a session.  The meetings will be held on Tuesday, August 23, at the Orlando World Center Marriott.  An email will be sent to you confirming your meeting time.

Contact Brittany O'Neil, Policy Coordinator, Division of Workers' Compensation, 850-413-1927, email Brittany.oneil@myfloridacfo.com

SDTF Assessment Rate Set

In compliance with Section 440.51(1), F.S., the Florida Department of Financial Services, Division of Workers' Compensation issued an Informational Bulletin DFS-02-2016.  The Bulletin advises insurers, self-insurers and other related stakeholders that Florida's Chief Financial Officer has issued an "Order Setting Assessment Rate for Workers' Compensation Administration Trust Fund (WCATF) for Calendar Year 2017".  The Order (Case No. 190815-16-WC) set the assessment rate for the WCATF with respect to calendar year 2017.  The set rate has been reduced to 1.25%.

The informational bulletin and (Assessment Rate) Orders are available on the Division's web site: http://www.myfloridacfo.com/Division/WC/bulletins.htm

The rates are available at: http://www.myfloridacfo.com/division/wc/rates.htm

To learn more about these issues and other Workers' Compensation information click here: http://www.myfloridacfo.com/Division/WC/

NCCI Proposes Florida Workers Compensation Rate Increase

Effective August 1, 2016

 

Overview of Castellanos Decision

On April 28, 2016, the Florida Supreme Court issued an opinion in the case of Castellanos vs. Next Door Company, et al., No. SC13-2082 (“Castellanos”) declaring Section 440.34, Florida Statutes, unconstitutional.  The anticipated impact of the decision is the elimination of the statutory caps on claimant attorney fees and a return to hourly fees.

 

NCCI Proposes Rate Increase

NCCI estimates that the first year impact of Castellanos will be an increase in overall Florida workers compensation system costs of 15%.  This estimate does not include the following:

 

·         Impacts related to the First District Court of Appeal decision dated April 20, 2016 known as Miles v. City of Edgewater Police Department (“Miles”) declaring unconstitutional certain restrictions on claimant paid attorney fees.  After Miles, claimant attorney fees can be earned regardless of whether benefits are secured.  Depending on the scenario, the source of claimant attorney fees could be the claimant, the employer/carrier, or both.  Claimant attorneys may now have the potential to earn greater compensation than that which would result from the Castellanos decision on its own, putting additional upward pressure on system costs in Florida.  NCCI is unable to separately determine the Miles impact.

·         The entire unfunded liability created in the state due to the retroactive nature of the Castellanos court decision.

·         Unanticipated cost impacts not otherwise reflected in this filing that may emerge over time such as additional stakeholder behavioral changes or interactions that may result in changes to workers compensation benefits or practices in Florida. 

 

On May 27, 2016, NCCI submitted its filing to the Office of Insurance Regulation (OIR).  It includes components for two law changes:

 

• First year impact for Castellanos of 15%
• Impact of 1.8% in response to SB 1402 which ratified updates to the Florida Workers’ Compensation Health Care Provider Reimbursement Manual

 

The combined impact of the two components is 17.1% or $623M (17.1 x $3.645B).  NCCI proposes that the increased rates will apply to new and renewal policies that are effective on or after August 1, 2016.  Additionally, NCCI proposes that the increased rates will apply to all policies in effect on August 1, 2016 on a pro-rata basis through the remainder of the term of these policies.  Currently, Florida has a voluntary pure loss cost of 0.99 that is comparable to other states in the Southeast[1] ranging from 0.94 to 1.14.   If the rate filing is approved as filed increasing rates by 17.1%, Florida at 1.16 would rank as the highest state in the Southeast. 

 

Retroactive Impact of Castellanos Decision is Not Part of Proposed Rate Increase

 

This Castellanos component of this filing only addresses the expected increase in Florida workers compensation system costs for accidents occurring on or after August 1, 2016. However, the decision in Castellanos is also expected to increase overall system costs in the state for accidents occurring prior to August 1, 2016 that remain open or are re-opened.  Because workers compensation ratemaking is prospective only, insurers are not afforded the opportunity to recoup premium to cover such unforeseen increases in system costs. Therefore, it is expected that a significant unfunded liability will be created due to the retroactive impact of this court decision.  NCCI is currently in the process of estimating the unfunded liability and will provide further information at a later date.

 

[1] Using Florida’s payroll distribution.  Southeast includes FL, AL, GA, NC, SC, TN, MS, LA.

Notice of Rulemaking for a June 10 Hearing - Rule 69L-31

Attention: Self-Insurers, Insurers, Claim Administrators, and Medical Service Providers

A Notice of Development of Rulemaking was published for 69L-31, Florida Administrative Code.  The notice provides that if requested in writing, a Rule Development Workshop will be held on Friday, June 10, 2016, at 9:30 A.M., eastern time, at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.

The Rules of 69L-31, F.A.C. are being amended which govern the process for resolution of disputes between workers' compensation carriers and health care providers. Revised forms are adopted. Rule 69L-31.005, F.A.C., is amended to provide greater detail regarding materials required to be included in a petition for dispute resolution. Rule 69L-31.008, F.A.C., is revised to provide clarity regarding computation of the time period to submit a petition for dispute resolution, including expanding the time period for submitting petitions for dispute resolution from 30 to 45 days. The time period in Rule 69L-31.009, F.A.C., for a carrier to respond to a petition is expanded from 10 to 30 days. New Rule 69L-31.016, F.A.C., is proposed to limit the scope of the dispute resolutions to compliance with standards under Chapter 440, F.S., and exclude issues of contract interpretation. New Rule 69L-31.017, F.A.C. is proposed to stipulate the consequences for failure to comply with Department Determinations. Minor edits to enhance clarity and additional technical changes are also included. The proposed rules have been renumbered accordingly.

The official Notice of Development of Rulemaking appeared in Volume 42, Number 100 (https://www.flrules.org/BigDoc/View_Section.asp?Issue=2119&Section=1) of the Florida Administrative Weekly, published on May 23, 2016. If you have questions about the contents of this notice, please contact Theresa Pugh, Program Administrator,  Medical Services Section, Division of Workers' Compensation at (850) 413-1721 or Theresa.Pugh@myfloridacfo.com.

https://www.flrules.org/gateway/ruleNo.asp?id=69L-31.003

PROPOSED RULES  http://www.myfloridacfo.com/Division/WC/pdf/Notice%20of%20Development%205-17-16.doc

Rules 69L-6.028 and 69L-6.035

Attention: Employers

A Notice of Development of Rulemaking was published for proposed Rules 69L-6.028 and 69L-6.035, both for the Florida Administrative Code. The notice provides that if requested in writing, a Rule Development Workshop will be held on Tuesday, June 7, 2016, at 2:00 P.M., eastern time, at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.

Proposed Rule 69L-6.028, F.A.C., clarifies time periods of employer non-compliance for penalty calculation purposes, and provides that the Department may impute the employer's payroll 10 business days following the employer's receipt of the Department's request to produce business records. The amendment to Rule 69L-6.035, F.A.C., further defines remuneration to employees, adding language to address the validation of expense reimbursements; remuneration occurring on the day a stop-work order is issued; and employee classification code assignments for payroll calculation purposes. The proposed rules also delete obsolete language and include additional technical changes.

The official Notice of Development of Rulemaking appeared in Volume 42, Number 94 (https://www.flrules.org/BigDoc/View_Faw.asp?IID=2113) of the Florida Administrative Weekly, published on May 13, 2016. If you have questions about the contents of this notice, please contact Pam Macon, Chief, Bureau of Compliance, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com.

https://www.flrules.org/gateway/RuleNo.asp?title=WORKERS%27%27%20COMPENSATION%20COMPLIANCE&ID=69L-6.028

https://www.flrules.org/gateway/RuleNo.asp?title=WORKERS%27%27%20COMPENSATION%20COMPLIANCE&ID=69L-6.035

PROPOSED RULES http://www.myfloridacfo.com/Division/WC/pdf/Draft%20Rules%2069L-6.028%20and%2069L-6.035.docx

  

To learn more about these issues and other Workers' Compensation information click here: http://www.myfloridacfo.com/Division/WC/

DWC Medical Annual Report Published

The Medical Services unit at the Division of Workers' Compensation has released its annual report. Much detail on reimbursement disputes.

http://www.myfloridacfo.com/Division/WC/pdf/2015%20Annual%20Report%20ReimbDisputes.pdf

2015 Reimbursement Manual Effective this year

The Following is from an announcement provided by the Division. It is all direct quoted.  

The 2015 Health Care Provider Reimbursement Manual is effective July 1, 2016 and is available on the Division's website at http://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Manuals/Default.htm

Rule 69L-7.020, F.A.C., was adopted and published in the Florida Administrative Register, volume 41, number 145, July 28, 2015, and subsequently the 2016 Legislature ratified SB 1402 - Ratification of Department of Financial Services Rules.  If you have any questions, please contact Brittany O'Neil, Policy Coordinator with the Division of Workers' Compensation at 850-413-1927 or Brittany.oneil@myfloridacfo.com. 

Three Member Panel Meeting in April

The Following is from an announcement provided by the Division. It is all direct quoted.  

The Florida Department of Financial Services, Division of Workers' Compensation announces a public meeting of the Three-Member Panel that will be held on Wednesday, April 20, 2016, beginning at 10:00 a.m. in room 116 of the J. Edwin Larson Building located at 200 East Gaines Street, Tallahassee, Florida. This public meeting, to which all are invited, has been convened to facilitate the Panel's consideration of the following items:

- Health Care Provider Reimbursement Manual, 2016 Edition (Rule 69L-7.020, F.A.C.) - Adoption of the 2016 Edition of the Health Care Provider (HCP) Reimbursement Manual

- Ambulatory Surgical Center Reimbursement Manual, 2016 Edition (Rule 69L-7.100, F.A.C.) - Adoption of the 2016 Edition of the Ambulatory Surgical Center (ASC) Reimbursement Manual

- Hospital Reimbursement Manual, 2016 Edition (Rule 69L-7.501, F.A.C.) - Adoption of the 2016 Edition of the Hospital Reimbursement Manual.

- The Division's Annual Report on the resolution of health care provider medical reimbursement disputes and activities (2015) conducted pursuant to s. 440.13(8), F.S.

The Division of Workers' Compensation will publish the meeting packet for the Panel's April 20, 2016 meeting on the Division's website under "Notices" (http://www.myfloridacfo.com/Division/WC/noticesRules.htm).

Notice of this public meeting appears in the Monday, April 4, 2016, issue of the Florida Administrative Register. To view the official (published) notice click on the following link:  http://www.FLRules.org/gateway/View_Notice.asp?id=17373396

If you have questions about this communication, please contact:  Brittany O'Neil, Policy Coordinator, Division of Workers' Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4220, Phone (850) 413-1927 or Brittany.ONeil@myfloridacfo.com. 

Florida not Short-Staffed for EMA Providers

Florida seems to be on a course towards marked changes in the Expert Medical Adviser process. There is some discussion about whether the legislative changes to 440.13(9)(c) will have any relevance. 

In the meantime, the Division of Workers' Compensation has changed various rules regarding the EMA process. According to WorkCompCentral, the Division wants more Expert Medical Providers, but the changes "were not made because there was a shortage of doctors." The rationale was instead because "the doctors who are in the program tend to be located in and around the state's big population centers like Miami and Tampa." Thus, there was a perception that "the problem we had was a geographic distribution."  

There is "no magic number" of EMA providers required or wanted, and the list is "not short-staffed." According to WorkCompCentral, the new rules will (in italics is all directly quoted from WCC) result in:

* Increased compensation from $200 an hour to $300 an hour for reviewing records and giving expert testimony and depositions.

* Simplification of qualification language.

* Reduction in amount of paperwork necessary to apply.

Physicians quoted in the story agree that "there's been a problem out there," that "doctors tend to shy away from workers compensation cases." The perception is "that workers' compensation cases tend to be fairly litigious." 

According to the database, there are 147 EMA providers currently certified. 

Of those listed, 59 are in Central Florida, 58 in Southeast Florida, 15 in North Florida, and 14 in Southwest Florida:

Most of these are orthopedic surgeons. The others are detailed here:

So, with the rule changes in reimbursement, time will tell. If you are a physician, consider submitting your paperwork to serve as an EMA. Or, if you know a physician, forward this post to the physician and encourage them to consider joining this effort. 

Florida Division Proposes Changes for Rules 69L-22.006, .008, .009, .011

From Florida Administrative Weekly, March 4, 2016 (Page 934)

Division of Worker’s Compensation 

RULE NOS.:   RULE TITLES: 

69L-22.006      Screening Process 

69L-22.008      Reemployment Services and Programs 

69L-22.009      Employee Responsibilities 

69L-22.011      List of Forms 

PURPOSE AND EFFECT: The proposed rules are amended to clarify the process injured employees must follow when seeking to obtain Department-sponsored reemployment services. The proposed rules provide injured employees with information and guidance regarding available reemployment services and the terms, conditions, and responsibilities associated with receiving such services. Additionally, the proposed rulemaking incorporates two new forms and revises two existing forms. 

SUMMARY: The proposed rules clarify the process through which injured employees access reemployment services. 

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency. The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department conducted an economic analysis of the potential impact of the proposed rule and determined that there will be no resulting adverse economic impact or regulatory increases that would require legislative ratification. 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. RULEMAKING AUTHORITY: 440.491(6), 440.591 FS. LAW IMPLEMENTED: 440.491 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: Monday, March 28, 2016, 9:00 a.m. ‒ 11:00 a.m. PLACE: Room 102, Hartman Building, 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: Stephen Yon, telephone: (850)413-1786, email: Stephen.Yon@myfloridacfo.com. 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: Stephen Yon, Chief, Bureau of Employee Assistance and Ombudsman Office, Division of Workers’ Compensation, Department of Financial Services, address: 200 East Gaines Street, Tallahassee, Florida 32399- 4225, telephone: (850)413-1786, email: Stephen.Yon@myfloridacfo.com

THE FULL TEXT OF THE PROPOSED RULE IS: 69L-22.006 Screening Process. (1) A request for screening must be is made using a Form DFS-F3-DWC-23, Request for Screening. Before the Department will consider a request complete and initiate a screening, the injured employee must: sign the Form DFS-F3- DWC-23. (a) Complete, sign and submit Form DFS-F3-DWC-23, Request for Screening; (b) Complete, sign and submit Form DFS-F3-DWC-27, Reemployment Services Questionnaire; (c) Provide documentation to establish identity and employment eligibility. Such documentation shall be consistent with the acceptable documents for verifying identity and employment eligibility as required by the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services’ Form I-9, Employment Eligibility Verification (Rev. 03/08/13 N), which is incorporated by reference herein and available at http://www.uscis.gov/files/form/i-9.pdf. (d) Provide the most current DFS-F5-DWC-25, Florida Workers’ Compensation Uniform Medical Treatment/Status Report Form, from all authorized treating physicians. (2) An injured employee may submit an electronic Requestrequest for Screeningscreening and Reemployment Services Questionnaire screening through the Injured Employee Web Portal located on the internet at https://wcres.fldfs.com/resportal/ieweb/ielogin.aspx. An electronically submitted Requestrequest for Screeningscreening and Reemployment Services Questionnaire shall be considered electronically signed by the injured employee. (3) through (8) No change. (9) The Department shall not provide a vocational evaluation or any reemployment services when Form DFS-F3- DWC-23, Request for Screening, which is signed by the injured employee, and all documents specified in 69L- 22.006(1), F.A.C., are is received by the Department more than one (1) year from the date of last payment of indemnity benefits or the furnishing of remedial treatment, care, or attendance from the employer or carrier. (10) through (11) No change. Rulemaking Authority 440.491(6), 440.591 FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F- 55.009, Amended 5-5-04, 5-7-09, Formerly 6A-22.006, Amended 3- 31-14, ________. 69L-22.008 Reemployment Services and Programs. (1) through (3) No change. (4) The Department will approve entry into a recommended training and education program at the next available start date. (5) The Department will not approve training and education programs at a community college when the injured employee must complete more than two (2) remedial courses. (6) The Department will not approve training and education programs at a career center when the injured employee must remediate more than two (2) grade levels to meet the exit requirements of the program. (7) The Department will approve an individual course or multiple courses when it is demonstrated that the skills to be gained are necessary for the injured employee to secure suitable gainful employment. (8)(4) The Department will shall approve training and education programs which exceed 52 weeks only when there is no program shorter than 52 weeks which would enable the injured employee to return to suitable gainful employment, the injured employee provides a plan for living expenses during the period in excess of 52 weeks, and the injured employee has no formal marketable vocational training and education. (9)(5) If the Department determines a training and education program is necessary to return an injured employee to suitable gainful employment, the Department shall have the exclusive right to approve training and education programs and facilities at which to sponsor the injured employee. (a) through (d) No change. (10)(6) The Department will shall not approve the transfer its approval of reemployment services unless the Department determines that the substantially same services are available in the location to which theyservices would be transferred. (11)(7) The Department will shall not approve reemployment services if the vocational evaluation does not recommend reemployment services. Rulemaking Authority 440.491(6), 440.591 FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 2-9-00, 6-26-01, Formerly 38F-55.011, Amended 3-1-05, 5-7-09, Formerly 6A- 22.008, Amended 3-31-14,_________. 69L-22.009 Employee Responsibilities. (1) Upon approval of training and education by the Department, the injured employee and Department staff shall sign and date: (a)(2) Form A Department and student agreement for sponsorship of training and education form DFS-F3-DWC-24, Department and Student Agreement for Sponsorship of Training and Education, which is adopted incorporated by reference in Rule 69L-22.011, F.A.C.; and, (b)(3) An Individualized Written Reemployment Plan. (2) Upon approval of reemployment services, including job-seeking assistance, by the Department, the injured employee and Department staff must sign and date Form DFS-F3-DWC-26, Department and Injured Employee Agreement for the Provision of Contracted Placement Services, which is adopted in Rule 69L-22.011, F.A.C. Rulemaking Authority 440.491(6), 440.591 FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F- 55.012, Amended 3-1-05, 5-7-09, Formerly 6A-22.009, Amended 3- 31-14, _________. 69L-22.011 List of Forms. (1) The following forms are to be used with this rule chapter and are hereby incorporated by reference: (a) Form DFS-F3-DWC-23 (Revised: 12/2015), Request for Screening; (b) Form DFS-F3-DWC-24 (Revised: 12/2015), Department and Student Agreement for Sponsorship of Training and Education; (c) Form DFS-F3-DWC-26 (Effective: 12/2015), Department and Injured Employee Agreement for the Provision of Contracted Placement Services. (d) Form DFS-F3-DWC-27 (Effective: 12/2015), Reemployment Services Questionnaire; (2) No change. Rulemaking Authority 440.491(6), 440.591 FS. Law Implemented 440.491 FS. History–New 7-1-96, Amended 6-26-01, Formerly 38F- 55.014, Amended 5-5-04, 5-7-09, Formerly 6A-22.011, Amended 3- 31-14, _________. NAME OF PERSON ORIGINATING PROPOSED RULE: Stephen Yon, Chief, Bureau of Employee Assistance and Ombudsman Office, Division of Workers’ Compensation, Department of Financial Services NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jeff Atwater, Chief Financial Officer, Department of Financial Services DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 29, 2016 DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: January 7, 2016.

Rule 69L-30 changes effective March 1, 2016

Summary: The rule dictates how to qualify, apply to become, be selected, and be recertified as an Expert Medical Advisor (EMA). This Rule also dictates how to bill for and receive reimbursement for EMA services. Finally, this Rule states circumstances under which previously certified EMAs can become decertified.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-30

DWC Rule Changes February 18, 2016

Summary for 69L-8 series Rules: The rules within this new chapter reorganize incorporated materials that are utilized in conjunction with DWC medical reimbursement manuals and throughout Rule Chapter 69L-7, F.A.C.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-8

Summary for 69L-7 series Rules: The rules within this chapter represent a substantial rewrite and reorganization of the previous Rule 69L-7.710, F.A.C. It is now 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.

https://www.flrules.org/gateway/ChapterHome.asp?Chapter=69L-7

Division Proposes Amendment of 69L-22 - Reemployment Services

The Florida Division of Workers' Compensation submitted a Notice of Development for Chapters 69L-22 of the Florida Administrative Code. The proposed rules are amended to clarify the process injured employees must follow when seeking to obtain Department-sponsored reemployment services. The proposed rules provide injured employees with information and guidance regarding available reemployment services and the terms, conditions, and responsibilities associated with receiving such services. Additionally, the proposed rulemaking incorporates two new forms and revises two existing forms.

The official Notices of Change appeared in the Volume 42, Number 04 of the Florida Administrative Weekly, published on January 7, 2016. If you have questions about the Notice, please contact Stephen Yon, Chief, Bureau of Employee Assistance and Ombudsman Office, Division of Workers' Compensation at (850) 413-1786 or Stephen.Yon@myfloridacfo.com.

If requested in writing and not deemed unnecessary by the agency head, a rule development workshop will be held Thursday, February 4, 2016, 9:00 a.m. in Room 102, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida.

New Fraud Report Published

The Division of Insurance Fraud, Bureau of Worker's Compensation Fraud and the Division of Workers' Compensation, Bureau of Compliance issue a joint report summarizing their respective efforts and activities in combating workers' compensation fraud and employer non-compliance.  The July 1, 2014 - June 30, 2015 report can be viewed at:

http://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Reports/DIF-DWC-Joint-Annual-Report-2014-2015.pdf

Please contact Robin Delaney at Robin.Delaney@myfloridacfo.com or (850) 413-1775 if additional information is needed. 

DWC has Released 2015 Report

The Division of Workers' Compensation has issued its 2015 Results and Accomplishments Report.  The Report contains important system information related to lost-time claims and medical costs as well as outcome and performance measures for each of the Division's major program areas.  To view the Report, click here:

http://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Reports/AnnualReportWC2015.pdf