Bill Text: FL S0662 | 2013 | Regular Session | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Workers' Compensation

Spectrum: Bipartisan Bill

Status: (Passed) 2013-06-10 - Chapter No. 2013-131 [S0662 Detail]

Download: Florida-2013-S0662-Comm_Sub.html

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       Florida Senate - 2013                              CS for SB 662
       
       
       
       By the Committee on Appropriations; and Senator Hays
       
       
       
       
       576-04958-13                                           2013662c1
    1                        A bill to be entitled                      
    2         An act relating to workers’ compensation; amending s.
    3         440.13, F.S.; revising requirements for determining
    4         the amount of a reimbursement for repackaged or
    5         relabeled prescription medication; providing an
    6         exception; prohibiting a dispensing manufacturer from
    7         possession of a medicinal drug until certain persons
    8         are paid; providing an effective date.
    9  
   10  Be It Enacted by the Legislature of the State of Florida:
   11  
   12         Section 1. Subsection (12) of section 440.13, Florida
   13  Statutes, is amended to read:
   14         440.13 Medical services and supplies; penalty for
   15  violations; limitations.—
   16         (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
   17  REIMBURSEMENT ALLOWANCES.—
   18         (a) A three-member panel is created, consisting of the
   19  Chief Financial Officer, or the Chief Financial Officer’s
   20  designee, and two members to be appointed by the Governor,
   21  subject to confirmation by the Senate, one member who, on
   22  account of present or previous vocation, employment, or
   23  affiliation, shall be classified as a representative of
   24  employers, the other member who, on account of previous
   25  vocation, employment, or affiliation, shall be classified as a
   26  representative of employees. The panel shall determine statewide
   27  schedules of maximum reimbursement allowances for medically
   28  necessary treatment, care, and attendance provided by
   29  physicians, hospitals, ambulatory surgical centers, work
   30  hardening programs, pain programs, and durable medical
   31  equipment. The maximum reimbursement allowances for inpatient
   32  hospital care shall be based on a schedule of per diem rates, to
   33  be approved by the three-member panel no later than March 1,
   34  1994, to be used in conjunction with a precertification manual
   35  as determined by the department, including maximum hours in
   36  which an outpatient may remain in observation status, which
   37  shall not exceed 23 hours. All compensable charges for hospital
   38  outpatient care shall be reimbursed at 75 percent of usual and
   39  customary charges, except as otherwise provided by this
   40  subsection. Annually, the three-member panel shall adopt
   41  schedules of maximum reimbursement allowances for physicians,
   42  hospital inpatient care, hospital outpatient care, ambulatory
   43  surgical centers, work-hardening programs, and pain programs. An
   44  individual physician, hospital, ambulatory surgical center, pain
   45  program, or work-hardening program shall be reimbursed either
   46  the agreed-upon contract price or the maximum reimbursement
   47  allowance in the appropriate schedule.
   48         (b) It is the intent of the Legislature to increase the
   49  schedule of maximum reimbursement allowances for selected
   50  physicians effective January 1, 2004, and to pay for the
   51  increases through reductions in payments to hospitals. Revisions
   52  developed pursuant to this subsection are limited to the
   53  following:
   54         1. Payments for outpatient physical, occupational, and
   55  speech therapy provided by hospitals shall be reduced to the
   56  schedule of maximum reimbursement allowances for these services
   57  which applies to nonhospital providers.
   58         2. Payments for scheduled outpatient nonemergency
   59  radiological and clinical laboratory services that are not
   60  provided in conjunction with a surgical procedure shall be
   61  reduced to the schedule of maximum reimbursement allowances for
   62  these services which applies to nonhospital providers.
   63         3. Outpatient reimbursement for scheduled surgeries shall
   64  be reduced from 75 percent of charges to 60 percent of charges.
   65         4. Maximum reimbursement for a physician licensed under
   66  chapter 458 or chapter 459 shall be increased to 110 percent of
   67  the reimbursement allowed by Medicare, using appropriate codes
   68  and modifiers or the medical reimbursement level adopted by the
   69  three-member panel as of January 1, 2003, whichever is greater.
   70         5. Maximum reimbursement for surgical procedures shall be
   71  increased to 140 percent of the reimbursement allowed by
   72  Medicare or the medical reimbursement level adopted by the
   73  three-member panel as of January 1, 2003, whichever is greater.
   74         (c) As to reimbursement for a prescription medication, the
   75  reimbursement amount for a prescription shall be the average
   76  wholesale price plus $4.18 for the dispensing fee, except where
   77  the carrier has contracted for a lower amount. For repackaged or
   78  relabeled prescription medications dispensed by a dispensing
   79  practitioner as provided in s. 465.0276, the fee schedule for
   80  reimbursement shall be 112.5 percent of the average wholesale
   81  price, plus $8.00 for the dispensing fee. For purposes of this
   82  subsection, the average wholesale price shall be calculated by
   83  multiplying the number of units dispensed times the per-unit
   84  average wholesale price set by the original manufacturer of the
   85  underlying drug dispensed by the practitioner, based upon the
   86  published manufacturer’s average wholesale price published in
   87  the Medi-Span Master Drug Database as of the date of dispensing.
   88  All pharmaceutical claims submitted for repackaged or relabeled
   89  prescription medications must include the National Drug Code of
   90  the original manufacturer. Fees for pharmaceuticals and
   91  pharmaceutical services shall be reimbursable at the applicable
   92  fee schedule amount except where the employer or carrier, or a
   93  service company, third party administrator, or any entity acting
   94  on behalf of the employer or carrier directly contracts with the
   95  provider seeking reimbursement for a lower amount. Where the
   96  employer or carrier has contracted for such services and the
   97  employee elects to obtain them through a provider not a party to
   98  the contract, the carrier shall reimburse at the schedule,
   99  negotiated, or contract price, whichever is lower. No Such
  100  contract shall rely on a provider that is not reasonably
  101  accessible to the employee.
  102         (d) Reimbursement for all fees and other charges for such
  103  treatment, care, and attendance, including treatment, care, and
  104  attendance provided by any hospital or other health care
  105  provider, ambulatory surgical center, work-hardening program, or
  106  pain program, must not exceed the amounts provided by the
  107  uniform schedule of maximum reimbursement allowances as
  108  determined by the panel or as otherwise provided in this
  109  section. This subsection also applies to independent medical
  110  examinations performed by health care providers under this
  111  chapter. In determining the uniform schedule, the panel shall
  112  first approve the data which it finds representative of
  113  prevailing charges in the state for similar treatment, care, and
  114  attendance of injured persons. Each health care provider, health
  115  care facility, ambulatory surgical center, work-hardening
  116  program, or pain program receiving workers’ compensation
  117  payments shall maintain records verifying their usual charges.
  118  In establishing the uniform schedule of maximum reimbursement
  119  allowances, the panel must consider:
  120         1. The levels of reimbursement for similar treatment, care,
  121  and attendance made by other health care programs or third-party
  122  providers;
  123         2. The impact upon cost to employers for providing a level
  124  of reimbursement for treatment, care, and attendance which will
  125  ensure the availability of treatment, care, and attendance
  126  required by injured workers;
  127         3. The financial impact of the reimbursement allowances
  128  upon health care providers and health care facilities, including
  129  trauma centers as defined in s. 395.4001, and its effect upon
  130  their ability to make available to injured workers such
  131  medically necessary remedial treatment, care, and attendance.
  132  The uniform schedule of maximum reimbursement allowances must be
  133  reasonable, must promote health care cost containment and
  134  efficiency with respect to the workers’ compensation health care
  135  delivery system, and must be sufficient to ensure availability
  136  of such medically necessary remedial treatment, care, and
  137  attendance to injured workers; and
  138         4. The most recent average maximum allowable rate of
  139  increase for hospitals determined by the Health Care Board under
  140  chapter 408.
  141         (e) In addition to establishing the uniform schedule of
  142  maximum reimbursement allowances, the panel shall:
  143         1. Take testimony, receive records, and collect data to
  144  evaluate the adequacy of the workers’ compensation fee schedule,
  145  nationally recognized fee schedules and alternative methods of
  146  reimbursement to certified health care providers and health care
  147  facilities for inpatient and outpatient treatment and care.
  148         2. Survey certified health care providers and health care
  149  facilities to determine the availability and accessibility of
  150  workers’ compensation health care delivery systems for injured
  151  workers.
  152         3. Survey carriers to determine the estimated impact on
  153  carrier costs and workers’ compensation premium rates by
  154  implementing changes to the carrier reimbursement schedule or
  155  implementing alternative reimbursement methods.
  156         4. Submit recommendations on or before January 1, 2003, and
  157  biennially thereafter, to the President of the Senate and the
  158  Speaker of the House of Representatives on methods to improve
  159  the workers’ compensation health care delivery system.
  160  
  161  The department, as requested, shall provide data to the panel,
  162  including, but not limited to, utilization trends in the
  163  workers’ compensation health care delivery system. The
  164  department shall provide the panel with an annual report
  165  regarding the resolution of medical reimbursement disputes and
  166  any actions pursuant to subsection (8). The department shall
  167  provide administrative support and service to the panel to the
  168  extent requested by the panel. For prescription medication
  169  purchased under the requirements of this subsection, a
  170  dispensing practitioner shall not possess such medication unless
  171  payment has been made by the practitioner, the practitioner’s
  172  professional practice, or the practitioner’s practice management
  173  company or employer to the supplying manufacturer, wholesaler,
  174  distributor, or drug repackager within 60 days of the dispensing
  175  practitioner taking possession of that medication.
  176         Section 2. This act shall take effect July 1, 2013.