This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0161.IBS
DATE: 1/23/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 161 Payments for Health Care Providers and Surgical Procedures under Workers'
Compensation
SPONSOR(S): Daley and others
TIED BILLS: IDEN./SIM. BILLS: SB 362
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Insurance & Banking Subcommittee Herrera Lloyd
2) State Administration & Technology
Appropriations Subcommittee
3) Commerce Committee
SUMMARY ANALYSIS
Florida’s Workers’ Compensation Law (WC Law) requires employers to provide injured employees all
medically necessary remedial treatment, care, and attendance for such period as the nature of the injury or the
process of recovery may require. The Department of Financial Services, Division of Workers’ Compensation
(DFS), provides regulatory oversight of Florida’s workers’ compensation system, including the workers’
compensation health care delivery system. DWC is responsible for ensuring that employers provide medically
necessary treatment, care, and attendance for injured workers.
A three-member panel (panel) consisting of the Chief Financial Officer (CFO) or his or her designee and two
Governor’s appointees sets the MRAs. The DFS incorporates the statewide schedules of the MRAs by rule in
reimbursement manuals. The panel develops three different reimbursement manuals to determine statewide
schedules of maximum reimbursement allowances. The WC Law manual limits the maximum reimbursement
for licensed physicians to 110 percent of Medicare reimbursement, while reimbursement for surgical
procedures is limited to 140 percent of Medicare.
The WC Law limits the amount a health care provider can be paid for expert testimony during depositions on a
workers’ compensation claim. As an expert medical witness, a workers’ compensation health care provider is
limited to a maximum $200, per hour, unless they only provided an expert medical opinion following a medical
record review or provided direct personal services unrelated to the case in dispute, then they limited to a
maximum $200, per day.
The bill increases the maximum hourly amount allowed expert witnesses from $200, per hour, to $300, per
hour. For those expert witnesses’ subject to the daily rate, the maximum amount allowed is increased from
$200, per day, to $300, per day.
Also, the bill increases the maximum reimbursement for physician licensed under ch. 458 or ch. 459, from 110
percent to 200 percent of the reimbursement allowed by Medicare. Additionally, the bill increases the maximum
reimbursement for surgical procedures from 140 percent to 200 percent of the reimbursement allowed by
Medicare.
The bill has no impact on state or local government revenue. It may have a negative impact on state and local
government expenditures and positive and negative impacts on the private sector.
The bill is effective July 1, 2024.
STORAGE NAME: h0161.IBS PAGE: 2
DATE: 1/23/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Division of Workers’ Compensation
Florida’s Workers’ Compensation Law
1
(WC Law) requires employers to provide injured employees all
medically necessary remedial treatment, care, and attendance for such period as the nature of the injury
or the process of recovery may require.
2
The Department of Financial Services, Division of Workers’
Compensation (DFS) provides regulatory oversight of Florida’s workers’ compensation system, including
the workers’ compensation health care delivery system. The law specifies certain reimbursement
formulas and methodologies to compensate workers’ compensation health care providers
3
that provide
medical services to injured employees. Where a reimbursement amount or methodology is not
specifically included in statute, the Three-Member Panel is authorized to annually adopt statewide
schedules of maximum reimbursement allowances (MRAs) to provide uniform fee schedules for the
reimbursement of various medical services.
4
DFS incorporates the MRAs approved by the Three-
Member Panel in reimbursement manuals
5
through the rulemaking process provided by the
Administrative Procedures Act.
6
In 2023, CS/CS/HB 487 eliminated the authority of the Three-Member
Panel to adopt MRA’s for individually licensed health care providers, work-hardening programs, pain
programs, and durable medical equipment providers.
7
Instead, it mandates DFS to annually publish the
maximum reimbursement allowance for physician and non-hospital reimbursements on its website by
July 1
st
, effective the following January 1
st
.
8
Medical Services
DWC is responsible for ensuring that employers provide medically necessary treatment, care, and
attendance for injured workers. Healthcare providers must receive authorization from the insurer before
providing treatment and submit treatment reports to the insurer. Insurers must reimburse healthcare
providers based on statewide schedules of maximum reimbursement allowances developed by the DWC
or an agreed-upon contract price. DWC mediates utilization and reimbursement disputes.
9
Reimbursement for Healthcare Providers
The panel consisting of the Chief Financial Officer (CFO) or their designee and two Governor’s
appointees, sets the MRAs.
10
Beginning with rates developed in 2024 and implemented with rates
effective January 1, 2025, health care providers and non-hospital rates are annually published by DFS,
instead of being included in the reimbursement manuals through rulemaking.
11
DFS incorporates the
panel’s statewide schedules of the MRAs through rulemaking. In establishing the MRA manuals, the
panel considers the usual and customary levels of reimbursement for treatment, services, and care;
12
the cost impact to employers for providing reimbursement that ensures that injured workers have access
to necessary medical care; and the financial impact of the MRAs on healthcare providers and facilities.
13
Florida law requires the panel to develop MRA manuals that are reasonable, promote the workers’
1
Ch. 440, F.S.
2
S. 440.13(2)(a), F.S.
3
The term “health care provider” includes a physician or any recognized practitioner licensed to provide skilled services pursuant to a
prescription or under the supervision or direction of a physician. It also includes any hospital licensed under chapter 395 and any health
care institution licensed under chapter 400 or chapter 429. S. 440.13(1)(g), F.S.
4
S. 440.13(12), F.S.
5
Ss. 440.13(12) and (13), F.S., and Ch. 69L-7, F.A.C.
6
Ch. 120, F.S.
7
Ch. 2023-144, Laws of Fla.
8
Id.
9
S. 440.13, F.S.
10
Id.
11
Ch. 2023-144, Laws of Fla.
12
S. 440.13(12)(i)(1), F.S.
13
S. 440.13(12)(i)(2), F.S. STORAGE NAME: h0161.IBS PAGE: 3
DATE: 1/23/2024
compensation system’s healthcare cost containment and efficiency, and are sufficient to ensure that
medically necessary treatment is available for injured workers.
14
There are three different reimbursement manuals that determine statewide schedules of maximum
reimbursement allowances. The healthcare provider manual, developed by the DWC, limits the maximum
reimbursement for licensed physicians to 110 percent of Medicare reimbursement,
15
while
reimbursement for surgical procedures is limited to 140 percent of Medicare.
16
The hospital manual,
developed by the panel, sets maximum reimbursement for outpatient scheduled surgeries at 60 percent
of usual and customary charges,
17
while other outpatient services are limited to 75 percent of usual and
customary charges.
18
Reimbursement of inpatient hospital care is limited based on a schedule of per
diem rates approved by the panel.
19
The ambulatory surgical centers manual, developed by the panel,
limits reimbursement to 60 percent of usual and customary as such services are generally scheduled
outpatient surgeries. The prescription drug reimbursement manual limits reimbursement to the average
wholesale price plus a $4.18 dispensing fee.
20
Repackaged or relabeled prescription medication
dispensed by a dispensing practitioner has a maximum reimbursement of 112.5 percent of the average
wholesale price plus an $8.00 dispensing fee.
21
Fees may not exceed the schedules adopted under ch.
440, F.S., and department rule.
22
Expert Witness Fees for Health Care Providers
The law limits the amount a health care provider can be paid for expert testimony during depositions on
a workers’ compensation claim. As an expert medical witness, a workers’ compensation health care
provider is limited to a maximum $200, per hour, unless they only provided an expert medical opinion
following a medical record review or provided direct personal services unrelated to the case in dispute,
then they limited to a maximum $200, per day.
23
Effect of the Bill
The bill increases the maximum hourly amount allowed expert witnesses from $200, per hour, to $300,
per hour. For those expert witnesses’ subject to the daily rate, the maximum amount allowed is increased
from $200, per day, to $300, per day.
Also, the bill increases the maximum reimbursement for physician licensed under ch. 458 or ch. 459,
from 110 percent to 200 percent of the reimbursement allowed by Medicare. Additionally, the bill
increases the maximum reimbursement for surgical procedures from 140 percent to 200 percent of the
reimbursement allowed by Medicare or the medical reimbursement level adopted by the three-member
panel.
B. SECTION DIRECTORY:
Section 1. Amends s. 440.13, F.S., relating to medical services and supplies; penalty for violations;
limitations.
Section 2. Providing an effective date of July 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
14
S. 440.13(12)(i)(3), F.S.
15
S. 440.13(12)(f), F.S.
16
S. 440.13(12)(g), F.S.
17
S. 440.13(12)(d), F.S.
18
S. 440.13(12)(a), F.S.
19
Id.
20
S. 440.13(12)(h), F.S.
21
Id.
22
S. 440.13(12)(f), F.S.
23
S. 440.13(10), F.S. STORAGE NAME: h0161.IBS PAGE: 4
DATE: 1/23/2024
1. Revenues:
None.
2. Expenditures:
The bill may have a negative fiscal impact on state government expenditures, specifically leading to
increased workers’ compensation costs and necessitating budgetary adjustments to accommodate
the projected 7.3 percent rise in workers' compensation rates.
24
The bill may have a negative, likely insignificant, impact on expenditures for litigated state employee
workers’ compensation claims to the extent the state elects to increase expert witness fees, as
allowed by the bill.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
The bill may have a negative fiscal impact on local government expenditures, potentially resulting in
higher workers’ compensation costs and requiring budget adjustments to address the anticipated
7.3 percent increase in workers' compensation rates.
25
The bill may have a negative, likely insignificant, impact on self-insured local government
expenditures for litigated public employee workers’ compensation claims to the extent they elect to
increase expert witness fees, as allowed by the bill.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
The bill may increase payments to medical providers who appear as expert witnesses in litigated
workers’ compensation claim and to physicians for medical services provided to injured workers.
The bill may increase worker’s compensation claim costs in litigated cases. If this is significant enough
to impact workers’ compensation rates, it may increase workers’ compensation premiums paid by
employers.
D. FISCAL COMMENTS:
According to the National Council on Compensation Insurance, the fee schedule increase may result in
a 7.3 percent increase in workers’ compensation rates.
26
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
The county/municipality mandates provision of Art. VII, section 18, of the Florida Constitution may
apply because this bill necessitates local governments to allocate additional funds, particularly for
those providing increased workers' compensation reimbursements to physicians, including self-
insured employers; however, an exception may apply. The bill applies to all similarly situated entities
that provide workers’ compensation.
2. Other:
24
Email from Dawn Ingham, State Relations Executive, External & Government Affairs, National Council on Compensation Insurance
(NCCI), 2023 Rate Briefing, Aug. 25, 2023.
25
Id.
26
Id. STORAGE NAME: h0161.IBS PAGE: 5
DATE: 1/23/2024
None.
B. RULE-MAKING AUTHORITY:
None provided by the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES