Insurance-Related Administrative Actions: Week Ending October 17

The following insurance-related administrative actions were posted on Friday, October 17, 2008.

Notice of Change: Public Hurricane Loss Projection Model-Fee Schedule

• 69O-170.0144: Public Hurricane Loss Projection Model-Fee Schedule

The following changes have been made to this proposed Rule:

• This Rule establishes the procedure and fee schedule, applicable to residential property insurers, for access and use of the Public Hurricane Loss Projection Model
• A residential property insurer that elects to access and use the Public Hurricane Loss Projection Model shall file a request, and set up an account with, Florida International University at http://irene.cs.fiu.edu:8080/hldms/. The fees charged for access and use of the Model, per run, shall be computed as follows: Fee = $2,400 + 0.03xPOL1 +0.015xPOL2 + .005xPOL3 where POL1,POL2. POL3 are number of policies (records) in the policy file. POL1 is equal to number of policies (records) from 1 to 200,000. POL2 is equal to number of policies (records) in excess of 200,000 with maximum of 400,000. POL3 is equal to number of policies (records) in excess of 400,000.

Notice of Rulemaking Development: Florida Office of Insurance Regulation

The Florida Department of Financial Services, Office of Insurance Regulation, has issued a Notice of Development of Rulemaking regarding the following Rule:

• 69O-175.008: Unfair Discrimination in Private Passenger Motor Vehicle Insurance Rates – Based on History of Accidents

The proposed Rule would clarify that imposing additional premium on a new or existing insured based upon non-fault accidents is a violation of Florida law.

If requested in writing and not deemed unnecessary by the agency head, a Rule Development Workshop will be held at the date, time and place below:

Date: Tuesday, November 18, 2008
Time: 11:00 a.m.
Place: Room 116 of the Larson Building, 200 East Gaines Street, Tallahassee, Florida

Notice of Rulemaking Development: Board of Employee Leasing Companies

The Florida Department of Business and Professional Regulation, Board of Employee Leasing Companies, has issued Notices of Development of Rulemaking regarding the following Rules:

• 61G7-10.0012: Workers’ Compensation Liability Statement (Notice)
• 61G7-10.0014: Requirements for Evidence of Workers’ Compensation Coverage (Notice)
• 61G7-5.001: Application Procedure; Application Form; Fees; Confidential Information; Denial of Application; Request for Hearing (Notice)

The proposed Rule amendments would no longer require applicants for initial licensure to present evidence of workers’ compensation insurance coverage if they have no leased employees.

If requested in writing and not deemed unnecessary by the agency head, a Rule Development Workshop will be noticed in the next available Florida Administrative Weekly.

Notice of Proposed Rule: Florida Division of Workers’ Compensation

The Florida Department of Financial Services, Division of Workers’ Compensation, has issued a Notice of Proposed Rule regarding the following Rule:

• 69L-7.020: Florida Workers’ Compensation Health Care Provider Reimbursement Manual

The purpose of the proposed Rule amendment is to adopt the 2008 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual and implement the 2008 conversion factors issued by the Centers for Medicare and Medicaid Services.

Additional proposed amendments to the Rule will adopt the CPT® 2008 Current Procedural Terminology Professional Edition, Copyright 2007, American Medical Association and the “Healthcare Common Procedure Coding System, Medicare’s National Level II Codes, HCPCS 2008,” American Medical Association, Twentieth Edition, Copyright 2007, Ingenix Publishing Group.

The 2008 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual also provides new language addressing issues relating to co-payments, insurer reimbursement responsibilities, and reimbursement disputes.

Specifically, it states that while health care providers are entitled to collect a $10.00 co-payment from injured workers who have reached maximum medical improvement, such co-payments are not in addition to any maximum reimbursement allowance or fee agreement, and that the reimbursement amount otherwise payable by the insurer shall be reduced by the amount of the co-payment. It further specifies that such co-payments do not apply in cases involving emergency care or service to injured employees. The 2008 Manual also provides new language recognizing National Correct Coding Initiative Edits as an appropriate resource for insurer use in the bill review process. On the subject of reimbursement disputes, new language provides that where an insurer has disallowed or adjusted payment for services rendered pursuant to an authorized workers’ compensation managed care arrangement, a health care provider may not elect to petition the Department of Financial Services pursuant to Florida law.

If requested by Friday, November 14, 2008, a Hearing will be held at the date, time and place below:

Date: Friday, November 21, 2008
Time: 10:00 a.m.
Place: Room 104J of the Hartman Building, 2012 Capital Circle South East, Tallahassee, Florida

Should you have any questions or comments, please do not hesitate to contact Colodny Fass.

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