Bill Text: FL S1580 | 2014 | Regular Session | Introduced

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

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Bill Title: Workers' Compensation Cost Task Force

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Failed) 2014-05-02 - Died in Appropriations [S1580 Detail]

Download: Florida-2014-S1580-Introduced.html

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       Florida Senate - 2014                                    SB 1580
       
       
        
       By Senator Hays
       
       
       
       
       
       11-01488-14                                           20141580__
    1                        A bill to be entitled                      
    2         An act relating to reimbursement allowances for
    3         hospital care; amending s. 440.13, F.S.; modifying
    4         reimbursement allowance rates; providing that the
    5         maximum reimbursement allowance for inpatient hospital
    6         care is a specified percentage of the rate allowed
    7         under the Medicare hospital inpatient prospective
    8         payment system; providing that compensable charges for
    9         hospital outpatient care is a specified percentage of
   10         the rate allowed under the Medicare hospital
   11         outpatient prospective payment system; providing an
   12         effective date.
   13          
   14  Be It Enacted by the Legislature of the State of Florida:
   15  
   16         Section 1. Subsection (12) of section 440.13, Florida
   17  Statutes, is amended to read:
   18         440.13 Medical services and supplies; penalty for
   19  violations; limitations.—
   20         (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
   21  REIMBURSEMENT ALLOWANCES.—
   22         (a) A three-member panel is created, consisting of the
   23  Chief Financial Officer, or the Chief Financial Officer’s
   24  designee, and two members to be appointed by the Governor,
   25  subject to confirmation by the Senate, one member who, on
   26  account of present or previous vocation, employment, or
   27  affiliation, shall be classified as a representative of
   28  employers, the other member who, on account of previous
   29  vocation, employment, or affiliation, shall be classified as a
   30  representative of employees. The panel shall determine statewide
   31  schedules of maximum reimbursement allowances for medically
   32  necessary treatment, care, and attendance provided by
   33  physicians, hospitals, ambulatory surgical centers, work
   34  hardening programs, pain programs, and durable medical
   35  equipment. The maximum reimbursement allowances for inpatient
   36  hospital care shall be 140 percent of the rate allowed under the
   37  Medicare hospital inpatient prospective payment system based on
   38  a schedule of per diem rates, to be approved by the three-member
   39  panel no later than October 1, 2015 March 1, 1994, to be used in
   40  conjunction with a precertification manual as determined by the
   41  department, including maximum hours in which an outpatient may
   42  remain in observation status, which may shall not exceed 23
   43  hours. All compensable charges for hospital outpatient care
   44  shall be reimbursed at 140 percent of the rate allowed under the
   45  Medicare hospital outpatient prospective payment system 75
   46  percent of usual and customary charges, except as otherwise
   47  provided by this subsection. Annually, the three-member panel
   48  shall adopt schedules of maximum reimbursement allowances for
   49  physicians, hospital inpatient care, hospital outpatient care,
   50  ambulatory surgical centers, work-hardening programs, and pain
   51  programs. An individual physician, hospital, ambulatory surgical
   52  center, pain program, or work-hardening program shall be
   53  reimbursed either the agreed-upon contract price or the maximum
   54  reimbursement allowance in the appropriate schedule.
   55         (b) It is the intent of the Legislature to increase the
   56  schedule of maximum reimbursement allowances for selected
   57  physicians effective January 1, 2004, and to pay for the
   58  increases through reductions in payments to hospitals. Revisions
   59  developed pursuant to this subsection are limited to the
   60  following:
   61         1. Payments for outpatient physical, occupational, and
   62  speech therapy provided by hospitals shall be reduced to the
   63  schedule of maximum reimbursement allowances for these services
   64  which applies to nonhospital providers.
   65         2. Payments for scheduled outpatient nonemergency
   66  radiological and clinical laboratory services that are not
   67  provided in conjunction with a surgical procedure shall be
   68  reduced to the schedule of maximum reimbursement allowances for
   69  these services which applies to nonhospital providers.
   70         3. Outpatient reimbursement for scheduled surgeries shall
   71  be reduced from 75 percent of charges to 60 percent of charges.
   72         4. Maximum reimbursement for a physician licensed under
   73  chapter 458 or chapter 459 shall be increased to 110 percent of
   74  the reimbursement allowed by Medicare, using appropriate codes
   75  and modifiers or the medical reimbursement level adopted by the
   76  three-member panel as of January 1, 2003, whichever is greater.
   77         5. Maximum reimbursement for surgical procedures shall be
   78  increased to 140 percent of the reimbursement allowed by
   79  Medicare or the medical reimbursement level adopted by the
   80  three-member panel as of January 1, 2003, whichever is greater.
   81         (c) As to reimbursement for a prescription medication, the
   82  reimbursement amount for a prescription shall be the average
   83  wholesale price plus $4.18 for the dispensing fee. For
   84  repackaged or relabeled prescription medications dispensed by a
   85  dispensing practitioner as provided in s. 465.0276, the fee
   86  schedule for reimbursement shall be 112.5 percent of the average
   87  wholesale price, plus $8.00 for the dispensing fee. For purposes
   88  of this subsection, the average wholesale price shall be
   89  calculated by multiplying the number of units dispensed times
   90  the per-unit average wholesale price set by the original
   91  manufacturer of the underlying drug dispensed by the
   92  practitioner, based upon the published manufacturer’s average
   93  wholesale price published in the Medi-Span Master Drug Database
   94  as of the date of dispensing. All pharmaceutical claims
   95  submitted for repackaged or relabeled prescription medications
   96  must include the National Drug Code of the original
   97  manufacturer. Fees for pharmaceuticals and pharmaceutical
   98  services shall be reimbursable at the applicable fee schedule
   99  amount except where the employer or carrier, or a service
  100  company, third party administrator, or any entity acting on
  101  behalf of the employer or carrier directly contracts with the
  102  provider seeking reimbursement for a lower amount.
  103         (d) Reimbursement for all fees and other charges for such
  104  treatment, care, and attendance, including treatment, care, and
  105  attendance provided by any hospital or other health care
  106  provider, ambulatory surgical center, work-hardening program, or
  107  pain program, must not exceed the amounts provided by the
  108  uniform schedule of maximum reimbursement allowances as
  109  determined by the panel or as otherwise provided in this
  110  section. This subsection also applies to independent medical
  111  examinations performed by health care providers under this
  112  chapter. In determining the uniform schedule, the panel shall
  113  first approve the data which it finds representative of
  114  prevailing charges in the state for similar treatment, care, and
  115  attendance of injured persons. Each health care provider, health
  116  care facility, ambulatory surgical center, work-hardening
  117  program, or pain program receiving workers’ compensation
  118  payments shall maintain records verifying their usual charges.
  119  In establishing the uniform schedule of maximum reimbursement
  120  allowances, the panel must consider:
  121         1. The levels of reimbursement for similar treatment, care,
  122  and attendance made by other health care programs or third-party
  123  providers;
  124         2. The impact upon cost to employers for providing a level
  125  of reimbursement for treatment, care, and attendance which will
  126  ensure the availability of treatment, care, and attendance
  127  required by injured workers;
  128         3. The financial impact of the reimbursement allowances
  129  upon health care providers and health care facilities, including
  130  trauma centers as defined in s. 395.4001, and its effect upon
  131  their ability to make available to injured workers such
  132  medically necessary remedial treatment, care, and attendance.
  133  The uniform schedule of maximum reimbursement allowances must be
  134  reasonable, must promote health care cost containment and
  135  efficiency with respect to the workers’ compensation health care
  136  delivery system, and must be sufficient to ensure availability
  137  of such medically necessary remedial treatment, care, and
  138  attendance to injured workers; and
  139         4. The most recent average maximum allowable rate of
  140  increase for hospitals determined by the Health Care Board under
  141  chapter 408.
  142         (e) In addition to establishing the uniform schedule of
  143  maximum reimbursement allowances, the panel shall:
  144         1. Take testimony, receive records, and collect data to
  145  evaluate the adequacy of the workers’ compensation fee schedule,
  146  nationally recognized fee schedules and alternative methods of
  147  reimbursement to health care providers and health care
  148  facilities for inpatient and outpatient treatment and care.
  149         2. Survey health care providers and health care facilities
  150  to determine the availability and accessibility of workers’
  151  compensation health care delivery systems for injured 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         (f) The department, as requested, shall provide data to the
  161  panel, including, but not limited to, utilization trends in the
  162  workers’ compensation health care delivery system. The
  163  department shall provide the panel with an annual report
  164  regarding the resolution of medical reimbursement disputes and
  165  any actions pursuant to subsection (8). The department shall
  166  provide administrative support and service to the panel to the
  167  extent requested by the panel. For prescription medication
  168  purchased under the requirements of this subsection, a
  169  dispensing practitioner shall not possess such medication unless
  170  payment has been made by the practitioner, the practitioner’s
  171  professional practice, or the practitioner’s practice management
  172  company or employer to the supplying manufacturer, wholesaler,
  173  distributor, or drug repackager within 60 days of the dispensing
  174  practitioner taking possession of that medication.
  175         Section 2. This act shall take effect July 1, 2014.