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