Florida Joint Report on Fraud and Non-Compliance

The Division of Investigative and Forensic Services, Bureau of Workers’ Compensation Fraud and the Division of Workers' Compensation, Bureau of Compliance issued a joint report summarizing their respective efforts and activities in combating workers' compensation fraud and employer non-compliance. The July 1, 2017 - June 30, 2018 report can be viewed at: https://www.myfloridacfo.com/Division/WC/PublicationsFormsManualsReports/Reports/

Meeting of the Three-Member Panel

On February 12, 2019 The Florida Department of Financial Services, Division of Workers' Compensation announces a public meeting of the Three-Member Panel that will be held on Monday, February 18, 2019, beginning at 1:00 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 2019 Biennial Report
• Rulemaking status update for the 2018 editions of the Reimbursement Manuals
• The Division's Annual Report on the resolution of health care provider medical reimbursement disputes and activities (2018) conducted pursuant to s. 440.13(8), F.S.

The Three-Member Panel Meeting agenda and meeting documents are available here, under the Notices tab.

Notice of this public meeting appeared in Volume 45, Number 26 of the of the Florida Administrative Register, published on February 7, 2019.

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.

2019 Maximum Comp Rate Florida

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 $939.41 for the four calendar quarters ending June 30, 2018.

Section 440.12(2), Florida Statutes (2018), 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, 2019, shall be $939.00.

Rules 69L-7.020 and 69L-7.100 - Health Care Provider Reimbursement Manual

The Florida Division of Workers' Compensation submitted a Notice of Proposed Rule for Rules 69L-7.020 and 69L-7.100, F.A.C. Rule Hearings will be held on Tuesday, November 27, 2018, at the times listed below, at 2012 Capital Circle, SE, Room 102, Hartman Building. All times are Eastern.

SUBJECT AREA TO BE ADDRESSED:
Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2018 Edition; Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2018 Edition.

02:00 p.m., Eastern,  69L-7.100, Florida Workers' Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2018 Edition.

03:00 p.m., Eastern,  69L-7.020, Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2018 Edition.

The official Notice of Proposed Rule appeared Volume 44, Number 217, of the Florida Administrative Weekly, published on November 6, 2018. 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.

• A copy of the notice and preliminary text of the Rules may be found here.
• Draft versions of the reimbursement manuals may be found at the following links.
• Draft of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, 2018
• Draft of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers, 2018

Rule 69L-7.501 - Reimbursement Manual for Hospitals

The Florida Division of Workers' Compensation submitted a Notice of Development of Rulemaking for Rule 69L-7.501, F.A.C.  A rule development workshop will be held on Tuesday, November 27, 2018, at 1:00 p.m., Eastern, at 2012 Capital Circle SE, Room 102, Hartman Building.

SUBJECT AREA TO BE ADDRESSED:

Florida Workers’ Compensation Reimbursement Manual for Hospitals, 2018 Edition

The official Notice of Development of Rulemaking appeared in Volume 44, Number 217, of the Florida Administrative Weekly, published on November 6, 2018. 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.

• A copy of the notice and the preliminary text may be found here.
• Draft version of the reimbursement manual may be found here.

Rule 69L-31 Hearing Notice

The Florida Division of Workers' Compensation submitted Notice of Proposed Rule for 69L-31, F.A.C.  A hearing will be held Tuesday, November 27, 2018, 11:00 a.m., Eastern, at 2012 Capital Circle, SE, Room 102, Hartman Building, in Tallahassee, Florida.

SUBJECT AREA TO BE ADDRESSED: Procedures for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers.

Please note that the Division encourages all parties to provide details regarding any potential economic or cost impact related to the proposed rule.

The official Notice of Proposed Rule appeared in appeared Volume 44, Number 217, of the Florida Administrative Weekly, published on November 6, 2018. 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.

• A copy of the notice and text of the proposed Rule may be found here.
• A copy of the Draft Petition Form may be found here.
• A copy of the Petition Response Form may be found here.

Florida Division Notices Proposed Rule - Grievous Harm

The Florida Division of Workers' Compensation submitted a Notice of Proposed Rule for Rule 69L-3.009, F.A.C.  If requested within 21 days of the notice, a hearing will be held on Tuesday, November 27, 2018, 9:00 a.m. ET, at the Hartman Building Room 102, 2012 Capital Circle SE, Tallahassee, FL 32301.

A new rule is being introduced due to the passage of CS/CS/SB 376, which added subsections (5) and (6) to section 112.1815, Florida Statutes (F.S.). Section 112.1815(5)(f), F.S., requires the Department of Financial Services to adopt rules specifying injuries qualifying as grievous bodily harm of a nature that shocks the conscience.

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.

Rule draft:
69L-3.009 Injuries that Qualify as Grievous Bodily Harm of a Nature that Shocks the Conscience. Pursuant to section 112.1815(5), F.S., for purposes of determining the compensability of employment-related posttraumtic stress disorder for first responders, the following injuries qualify as grievous bodily harm of a nature that shocks the conscience: 
(1) Decapitation (full or partial), 
(2) Degloving, 
(3) Enucleation, 
(4) Evisceration. 
(5) Exposure of one or more internal organs, 
(a) Brain, 
(b) Heart, 
(c) Intestines 
(d) Kidneys, 
(e) Liver, or 
(f) Lungs 
(6) Impalement, 
(7) Severance (full or partial), and 
(8) Third degree burn on 9% or more of the body 

Rulemaking Authority 112.1815(5)(f), 440.591, FS. Law Implemented 112.1815, FS. History-New.