Title: Workers' Compensation Fees

Summary: Revises maximum reimbursement allowance for inpatient hospital care; revises date by which panel shall approve allowance; revises maximum compensable charges for hospital outpatient care.

Full Text:
An act relating to workers' compensation fees; amending s. 440.13, F.S.; revising the maximum reimbursement allowance for inpatient hospital care; revising a date by which the panel shall approve the allowance; revising the maximum compensable charges for hospital outpatient care; making a conforming change; providing an effective date. Be It Enacted by the Legislature of the State of Florida: Section 1. Paragraph (a) of subsection (12) of section 440.13, Florida Statutes, is amended to read: 440.13 Medical services and supplies; penalty for violations; limitations.-(12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM REIMBURSEMENT ALLOWANCES.-(a) A three-member panel is created, consisting of the Chief Financial Officer, or the Chief Financial Officer's designee, and two members to be appointed by the Governor, subject to confirmation by the Senate, one member who, on account of present or previous vocation, employment, or affiliation, shall be classified as a representative of employers, the other member who, on account of previous vocation, employment, or affiliation, shall be classified as a representative of employees. The panel shall determine statewide CS/HB 1351 2014 schedules of maximum reimbursement allowances for medically necessary treatment, care, and attendance provided by physicians, hospitals, ambulatory surgical centers, work hardening programs, pain programs, and durable medical equipment. The maximu mreimbursement allowances for inpatient hospital care shall be based on a rate of up to percent of the Medicare inpatient prospective payment system a schedule of per diem rates,to be approved by the three-member panel no later than October 1st of ea ch year for the following calendar year March 1, 1994,to be used in conjunction with a precertification manual as determined by the department, including maximum hours in which an outpatient may remain in observation status, which shall not exceed hour s. No later than October 1st of each year for the following calendar year, the three-member panel must approve all compensable charges for hospital outpatient care,which shall be reimbursed at up to 42 percent of the Medicare outpatient prospective payme nt system 43 percent of usual and customary charges,except as otherwise provided by this subsection. Annually, the three-member panel shall adopt schedules of maximum reimbursement allowances for physicians, hospital inpatient care, hospital outpatient ca re, ambulatory surgical centers, work-hardening programs, and pain programs. An individual physician, hospital, ambulatory surgical center, pain program, or work-hardening program shall be reimbursed either the agreed-upon contract price or the maximum reimbursement allowance in the appropriate schedule. CS/HB 1351 2014 Section 2. Effective January 1, 2015, paragraph (b) of subsection (12) of section 440.13, Florida Statutes, is amended to read: 440.13 Medical services and supplies; penalty for violations; limitation s.-(12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM REIMBURSEMENT ALLOWANCES.-(b) It is the intent of the Legislature to increase the schedule of maximum reimbursement allowances for selected physicians effective January 1, 2004, and to pay for the increases through reductions in payments to hospitals. Revisions developed pursuant to this subsection are limited to the following: 1. Payments for outpatient physical, occupational, and speech therapy provided by hospitals shall be reduced to the schedule of maximum reimbursement allowances for these services which applies to nonhospital providers. 2. Payments for scheduled outpatient nonemergency radiological and clinical laboratory services that are not provided in conjunction with a surgical procedure shall be reduced to the schedule of maximum reimbursement allowances for these services which applies to nonhospital providers. 3. Outpatient reimbursement for scheduled surgeries shall be reduced from percent of charges to percent of char ges. 3.4. Maximum reimbursement for a physician licensed under chapter or chapter shall be increased to percent of CS/HB 1351 2014 the reimbursement allowed by Medicare, using appropriate codes and modifiers or the medical reimbursement level adopted by the three-member panel as of January 1, 2003, whichever is greater. 4.5. Maximum reimbursement for surgical procedures shall be increased to percent of the reimbursement allowed by Medicare or the medical reimbursement level adopted by the three-member panel as of January 1, 2003, whichever is greater. Section 3. Except as otherwise provided in this act, this act shall take effect July 1, 2014.