OIR Meeting Recap: Florida Workers’ Compensation Manual for Hospitals

 

Meeting of the Three-Member Panel

Rule 69L-7.501–Florida Workers’ Compensation Manual for Hospitals

On May 8, 2007, the Florida Office of Insurance Regulation (OIR) convened a public meeting before a Three Member Panel (“Panel”) in Tallahassee, Florida regarding proposed changes to the Florida Workers’ Compensation Reimbursement Manual for Hospitals.

The panel was comprised of OIR Commissioner Kevin McCarty, Anne Dickinson and Jorge Durland. Ms. Dickinson and Mr. Durland participated via teleconference. The proposed changes had been agreed to by the following parties who signed a Settlement Agreement on April 10, 2007: Florida Department of Financial Services, Division of Worker’s Compensation, the Florida Hospital Association, HCA Health Services of Florida, Inc. d/b/a/ St. Lucie Medial Center and Miami Beach Healthcare Group, Ltd, d/b/a Aventura Hospital and Medical Center.

Click here to review a copy of the settlement agreement and here to review the proposed changes to the Manual.

A representative from the Division of Workers’ Compensation presented the following recommended proposed changes to the Manual:

1. Section VIII regarding patient reimbursement and per diem schedule,
2. Section IX regarding surgical implants, and
3. Section X regarding outpatient reimbursement.

Tammy Purdue, on behalf of Zenith Insurance Company, FCCI Insurance Group, and the Florida Insurance Council testified in opposition to the proposed changes. Notably, Ms. Purdue stated that the term “usual and customary” should be–but is not–included in the Manual. 

Also, the term “aggregate” in the payment methodology is inconsistent and problematic because it will likely lead to payments for services not rendered. A representative from Zenith also testified in opposition to the proposed rule. Representatives from the hospitals testified in support of the proposed changes.

After the close of public testimony, Commissioner McCarty made a motion to set another meeting to see if the parties can reach consensus on an alternative to the term “aggregate.” The motion was seconded and adopted by the Panel. No vote was taken on the proposed amendments at this meeting. 

A date and time has not been set for the next meeting at this point. We will provide you with additional information as it becomes available.

The above is a brief summary of the public meeting and is not intended to be a comprehensive review of the issues contained herein.

Please do not hesitate to contact this office should you require additional information.