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Rule Changes & Notices

Rule Changes & Notices


69L-7.501: The proposed rule is amended to adopt the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Hospitals (“Manual”), as approved by the Three-Member Panel during a scheduled meeting held on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the Manual increases the per diem reimbursement rates for surgical and non-surgical hospital inpatient services and the threshold dollar amount triggering Stop-Loss reimbursement above reimbursement allowances specified in the 2014 Edition of the Manual, as adopted by the existing rule. The 2016 Edition of the Manual also provides an updated fee schedule for various categories of hospital outpatient services based on the Current Procedural Terminology (“CPT”) line level charge data, with an adjustment of the Maximum Reimbursement Allowance (“MRA”) based on the geographic location of the service provider.

69L-7.100: The proposed rule amendment incorporates and adopts for use the 2016 Edition of the Florida Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (“ASC Reimbursement Manual”), as approved by the Three-Member Panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The 2016 Edition of the ASC Reimbursement Manual contains an updated list of the Maximum Reimbursement Allowances (“MRAs”) for various medical services provided to Florida’s injured workers.

69L-7.020: The proposed rule amends the existing rule to adopt and incorporate by reference the 2016 Edition of the Florida Workers’ Compensation Health Care Provider Reimbursement Manual, as approved by the Three-Member panel on April 20, 2016, pursuant to paragraph 440.13(12)(a), F.S. The aforementioned manual is updated to incorporate the 2016 Medicare Conversion Factor and Resource Based Relative Value Scale (“RBRVS”) geographic-specific reimbursement levels used to determine Maximum Reimbursement Allowances (“MRAs”) for physician’s services and non-surgical hospital outpatient services provided to Florida’s injured workers.

A copy of the notice and link to the proposed Rules are below:

FL Workers’ Compensation Reimbursement Manual for Hospitals, 2016 Edition
FL Workers’ Compensation Reimbursement Manual for Ambulatory Surgical Centers (ASCs), 2016 Edition
FL Workers’ Compensation Health Care Provider Reimbursement Manual, 2016 Edition


Hurricane Matthew’s path shifts, expected to pummel Haiti

Hurricane Matthew’s path shifts, expected to pummel Haiti

Hurricane Matthew’s projected path has shifted slightly, bringing it closer to Florida’s east coast later this week, but forecasters say their predictions are still fairly uncertain.

And even if Matthew gets close to the coast, it’s too early to say what exactly Florida will see.

“Right now it looks like the worst of it is going to be over the Atlantic,” said Matt Volkmer, meteorologist with the National Weather Service in Melbourne. “We’re just going to have to watch to see how close the track comes.”

Matthew has been creeping north toward Jamaica and Haiti today as a powerful Category 4 storm, bringing 140 mph winds and possibly life-threatening rain to the island countries.

Hurricane warnings have been issued for both Jamaica and Haiti, along with parts of Cuba and the southeastern Bahamas, according to the National Hurricane Center in Miami.

Rain had already started lashing parts of Jamaica, which could see as much as 15 inches of rain during the next few days. Forecasters say it’s Haiti, though, that will most likely see the worst of the storm.

Matthew is expected to reach southern Haiti by tonight and could produce up to 40 inches of rain in some spots, raising concerns about life-threatening flooding and mudslides, according to the Hurricane Center.

Cuba also is expected to see possibly-dangerous amounts rain when Matthew crosses the lightly populated southeastern tip of that country on Tuesday. The storm should then be in the Bahamas by Wednesday and heading up Florida’s east coast on Thursday.

Latest predictions show Matthew moving almost parallel to the coast and staying offshore. Volkmer said local impacts will vary depending on how close Matthew gets to the state.

Strong rip currents, high storm surge and large swells are probable, he said. There’s also a chance the coast could see tropical storm force winds.

“For right now, there’s still a great deal of uncertainty but the probability to see tropical storm force winds have been increasing a little bit,” Volkmer said.

Volusia County officials have already started preparing for possible impacts by moving unsecured signs and lifeguard towers, so they won’t get swept away or damaged.

Gov. Rick Scott has urged Floridians to get ready, just in case Matthew turns toward the state.

“This storm is catastrophic, and if it hits our state, we could see impacts that we have not seen in many years,” he said in a statement released Sunday. “Even though the storm’s projected path is just east of our state, no one should take this lightly.”

As of 11 a.m., Matthew was 275 miles southwest of Port Au Prince, Haiti and moving north at 6 mph, according to the Hurricane Center. The storm’s winds decreased overnight to 130 mph from a high on Friday of 160 mph. The winds speeds have changed a little this morning, but Matthew has remained a Category 4 storm since Saturday.

Even still, the Hurricane Center warns that such a powerful storm can cause “severe damage” to homes and other structures, while toppling trees and power poles. “Catastrophic damage will occur” with a Category 4 storm, the Hurricane Center says.

Officials with Haiti’s civil protection agency said there were roughly 1,300 emergency shelters across the country, enough to hold up to 340,000 people. Authorities broadcast warnings over the radio telling people to swiftly heed evacuation warnings, trying to counter a common tendency for people to try to stay in their homes to protect them during natural disasters.

Teams of civil protection officials walked the streets of Les Cayes and other areas urging residents to secure their homes, prepare emergency kits and warn their neighbors. They also evacuated people from some outlying islands.

After passing Jamaica and Haiti, Matthew was projected to reach Cuba. The center was expected to pass about 50 miles east of the U.S. Navy base at Guantanamo Bay, where authorities evacuated about 700 spouses and children of service members on military transport planes to Florida.

Matthew is expected to weaken back to a Category 2 storm by Friday, according to the Hurricane Center. If it stays on its current projected path, it will then head toward the Carolinas this weekend.

The Associated Press contributed to this report.

SOURCE: OrlandoSentinel

Hurricane Matthew Grows Even Stronger; Jamaica, Hispañola, Cuba, Bahamas Threat

Hurricane Matthew Grows Even Stronger; Jamaica, Hispañola, Cuba, Bahamas Threat

Hurricane Matthew is now a Category 2 hurricane and it continues to intensify. Matthew poses a danger to Jamaica, parts of Hispañola, eastern Cuba, and the Bahamas early next week. It’s potential U.S. impact later next week still remains unclear.

Hurricane Matthew became the fifth hurricane of the 2016 Atlantic hurricane season early Thursday afternoon.

Matthew was located 130 miles northeast of Punta Gallinas, Colombia, as of Friday morning.

Current Storm Status

A Hurricane Hunters reconnaissance mission early Friday morning measured flight-level winds a few thousand feet above the sea of just over 114 mph north of the eye, prompting the upgrade to Category 2 status.

Matthew will continue to strengthen and should become a major hurricane (Category 3) later in the day.

A tropical storm watch continues for Aruba, and the northern coast of Colombia. The hurricane watch for Curaçao has been discontinued. Winds of 40 mph or greater are possible in Aruba this morning, and in northern Colombia on Friday afternoon.

Current Watches/Warnings

Radar from Curaçao overnight indicated that a sturdy eyewall was apparent and that lightning was probably taking place in the northern eyewall. Lightning is often a precursor or icon of phases of strong intensification.

The ‘Caribbean Right Turn’

Matthew is currently experiencing some wind shear provided by southwest winds several thousand feet above the surface, which has blown convection away from its center of circulation. Matthew has proven that wind shear can be supportive of strenthening in some conditions.

Strengthening is forecast throughout at least the next two days, or through Saturday evening. Matthew is forecast to become aCategory 3 hurricane by this evening, however, if the current rapid intensification phase continues that upgrade could come earlier.

First up, given the southern track, outer bands of rain and winds to tropical storm force are possible in portions of the typically drier “ABC Islands” – Aruba and Curaçao – as well as parts of coastal Venezuela and Colombia Thursday through early Saturday.

Beyond that, uncertainty is still considerable on the critical details of this system.

(MORE: Just Because It’s Fall Doesn’t Mean We Shouldn’t Pay Attention to the Tropics)

Over the next couple of days, Matthew should continue to move west or just south of due west as it rides the southern periphery of the Bermuda high.

Sometime on Saturday or early Sunday, Matthew should make its long-anticipated northwest or northward turn in the Caribbean Sea, as the system reaches the southwestern edge of the Bermuda high.

The critical details regarding when exactly that turn is made, how sharp it is, and Matthew’s intensity at that time will dictate the impacts for Jamaica, Hispañola, and eastern or central Cuba.

Unfortunately, there is still some important forecast uncertainty regarding those important details, which is common for a tropical cyclone forecast several days out. Phases of rapid intensification like the one experienced by Matthew on Thursday and Friday only hamper efforts to gain a better handle on the forecast.

(MORE: Facts/Myths About the Hurricane Cones of Uncertainty)

For now, impacts could begin in Jamaica and Hispañola (particularly Haiti) as soon as Sunday night, and in eastern Cuba as soon as Monday.

In addition, there is uncertainty regarding Matthew’s intensity as it nears those locations. Matthew may be stronger than the current forecast.


Shifts in pooling regulation

Shifts in pooling regulation

A group of public entity pools and Self-Insured Groups (SIGs) convened in July to informally discuss state regulatory environments, perceived shifts within regulatory relationships, and possible solutions or next steps. Suggestions from the group to all pools and SIGs included:

  • Work to ease regulator concerns and start right now to build trust with your
  • regulators or could-be regulators (by time the crisis happens, it’s too late)
  • Develop a pooling education plan for your state legislature and regulators
  • Watch what is happening in other groups because regulation may be a matter of
  • when, not if
  • Build strong relationships with other pools and SIGs in your state, and
  • collaborate to communicate with regulators
  • Define a person within your organization to establish and maintain a good
  • regulator relationship
  • Be sure key staff are politically savvy enough to manage the future of regulation
  • Engage in more Board governance education and training – the Board should
  • understand everything being discussed with or by the regulators and should
  • exercise true independent oversight
  • Educate your staff and Board about the wide variation of acceptable financials
  • and the rationale behind different financial goals, so they understand the
  • totality of the spectrum
  • Consider accreditation or certification options for your organization, because
  • strong self-regulation is a good answer to why state legislation is not needed
  • Review all coverage and related forms for consistent language that your coverage
  • is not insurance (unless you are classified as such)
  • Post your organization’s financials on your website
  • Track the cost of compliance with regulations

The group outlined common expectations for turnover in regulators because of
retirements and related transitions, potential for lacking regulator familiarity with pools and SIGs, likely expectations that “one size fits all” regulations might be determined, and the possibility that one bad outcome in a pool/SIG could have ripple effect on all others. Contact Ann Gergen for more information about the conversation or meeting outcomes. And, consider attending a presentation about shifting state regulation of pools being given at this year’s Fall Educational Forum by former Nebraska Senator and Governor Ben Nelson, who was also CEO of the National Association of Insurance Commissioners from 2013 – 2016.

Source: AGRIP

Communication Can Help Reduce Workers’ Insurance Costs

Communication Can Help Reduce Workers’ Insurance Costs

Injuries, illnesses and other accidents at the workplace will happen, even with the best possible security measures in place. However, that doesn’t mean a company should ignore proper safety procedures, or skip steps to prevent these incidents from happening and finding ways to lower workers compensation insurance costs.Read More Here

Work Comp Case Law Update: Compensability

Work Comp Case Law Update: Compensability

In Dilallo v. Sch. Bd. of Broward Cnty./OptaComp, d/a 4/16/12, 13-16388, Judge Hogan held that an idiopathic fall on employer premises before reaching the elevator to her office to start work was compensable under the premises rule.  “[A]n injury is deemed to have occurred in the course and scope of employment if it is sustained by a worker, on the employer’s premises, while preparing to begin a day’s work or while doing other acts which are preparatory or incidental to performance of his or her duties, and which are reasonably necessary for such purpose.” Vigliotti v. K-Mart, 1st DCA.  JCC rejected E/C argument that Caputo and Walker required that claimant was actively engaged in work at the time of the idiopathic fall.