Rules Workshop Announced for January 12, 2015 in Tallahassee

Summary: Rules 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. 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. Changes are also made to provide several minor edits, primarily for the purpose of clarity.

A copy of the notice and link to the proposed Rules may be found through the following link. https://www.flrules.org/Gateway/View_notice.asp?id=16896544

2016 Maximum Compensation Rate Announced

December 8, 2105

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 $862.51 for the four calendar quarters ending June 30, 2015.

Section 440.12(2), Florida Statutes (2015), 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, 2016 shall be $863.00.

Division proposes changes

The Florida Division of Workers' Compensation submitted a Notice of Change for Chapters 69L-7 and 69L-8 of the Florida Administrative Code.  The changes to the proposed rules are being made to address public comments and comments submitted by the Joint Administrative Procedures Committee.  Completion instructions for incorporated forms DFS-F5-DWC-9-A, DFS-F5-DWC-9-B, and DFS-F5-DWC-9-C are changed to clarify the dates of use for the ICD-9 and the required use of the ICD-10 upon federal implementation.  The proposed rules also include certain technical changes.

The official Notices of Change appeared in the Volume 41, Number 216 of the Florida Administrative Weekly, published on November 5, 2015.  If you have questions about the Notices, please contact Pam Macon, Chief, Bureau of Monitoring and Audit, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com.

A copy of each Notice may be found via the following links:

http://www.FLRules.org/gateway/View_Notice.asp?id=16732711

http://www.FLRules.org/gateway/View_Notice.asp?id=16732905

Florida Rates Will Decrease in 2016

The following is quoted from an NCCI release:

OIR Issues Order on NCCI's Florida Workers Compensation Rate Filing

On August 19, 2015, the National Council on Compensation Insurance (NCCI) proposed an overall workers compensation rate level decrease of 1.9% in Florida effective January 1, 2016. On November 3, 2015, the Office of Insurance Regulation (OIR) issued an order denying the 1.9% decrease and requesting NCCI make an amended filing for an overall workers compensation rate level decrease of 5.1% effective January 1, 2016.


The 3.2% difference between NCCI's filing of 1.9% and the OIR's request for an amended filing of 5.1% is due to the inclusion of a 0.1% decrease associated with the Reimbursement Manual for Ambulatory Surgical Centers, and the disapproval of profit and contingency provision, expense constant component; and, indemnity trend.

The OIR's order requested that NCCI amend its filing by November 9, 2015.

NCCI is currently in the process of reviewing the order and making a decision on how to respond.

SDTF Report Published on September 10, 2015

The Florida Division of Workers' Compensation has submitted its Special Disability Trust Fund, Estimation of Liabilities as of June 30, 2015.  The report was published according to 440.49(9)(e), Florida Statutes, on September 10, 2015, and is available on the Division's website on the Division of Workers' Compensation Report screen (www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Reports/).

Revision to Rule 69L-7.100

Revised Rule 69L-7.100, Florida Administrative Code, (Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs)), became effective as of September 28, 2015; however, the reimbursement manual does not go into effect until January 1, 2016 (as provided in the rule text).

https://www.flrules.org/gateway/RuleNo.asp?title=WORKERS''%20COMPENSATION%20MEDICAL%20REIMBURSEMENT%20AND%20UTILIZATION%20REVIEW&ID=69L-7.100

If you have any questions regarding this message, please contact Pam Macon, Chief, Bureau of Monitoring and Audit, Division of Workers' Compensation at (850) 413-1708 or Pamela.Macon@myfloridacfo.com. 

ICD 10 is Here According to the Florida Division

The following is directly from a Division of Workers' Compensation notification and is all quoted verbatim. 

On October 1, 2015 the Centers for Medicare & Medicaid Services (CMS) will be transitioning to ICD-10 (diagnosis coding).  In line with the CMS policy, the Division of Workers' Compensation will require ICD-10 codes for medical bills and medical EDI transactions containing dates of service on or after 10/1/15.  The Division will require ICD-9 codes on medical bills and medical EDI transactions with dates of service prior to 10/1/15.

In an effort to promote the self-executing nature of the workers' compensation system, the Division urges all interested parties to consider Rule 69L-7.710(5)(j)1.a., F.A.C. in securing correct diagnosis codes.  The rule states, in part, the insurer, service company/TPA, or entity acting on behalf of the insurer can:

"Secure and/or correct the information on the medical bill and proceed to make a reimbursement decision to pay, adjust, disallow, or deny billed charges within 45-calendar days from the "date insurer received".

If you have any questions or concerns please contact the Medical Services Section at Workers.MedService@myfloridacfo.com. 

Ed Note: What does this mean, here is a good post on the effects of ICD10