The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 362
INTRODUCER: Fiscal Policy Committee and Senator Bradley
SUBJECT: Medical Treatment Under the Workers’ Compensation Law
DATE: February 9, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Johnson Knudson BI Favorable
2. Morgan Brown HP Favorable
3. Johnson Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 362 increases the maximum medical reimbursements for physicians and surgical
procedures and the maximum fees for expert witnesses under ch. 440, F.S., “Workers
Compensation Law” (law). The 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 bill increases the maximum reimbursement allowances (MRA) for physicians and surgical
procedures to 200 percent of Medicare. Currently, the maximum reimbursement allowance for a
physician licensed under ch. 458, F.S., or ch. 459, F.S., is 110 percent of Medicare and the
maximum reimbursement allowance for surgical procedures is 140 percent of Medicare.
In regards to expert medical witnesses, the law currently limits the amount health care providers
can be paid for expert testimony during depositions on a workers’ compensation claim to $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, in which case they are
limited to a maximum of $200 per day. The bill increases the maximum hourly amount allowed
expert witnesses to $300 per hour. For those expert witnesses subject to the daily rate, the
maximum amount allowed is increased to $300 per day.
REVISED: BILL: CS/SB 362 Page 2
Implementation of the bill is estimated to result in a 7.3 percent increase (or $286 million) in
overall workers’ compensation system costs. The estimated impact on state and local
governments is indeterminate.
The bill provides an effective date of January 1, 2025.
II. Present Situation:
Florida Workers’ Compensation System
Florida’s Workers’ Compensation Law
1
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 Division of Workers’ Compensation within
the Department of Financial Services (DFS), provides regulatory oversight of the workers’
compensation system in Florida, including the health care delivery system.
Reimbursement for Health Care Providers
Health care providers must receive authorization from the insurer before providing treatment,
and submit treatment reports to the insurer.
3
Insurers must reimburse an individual physician,
hospital, ambulatory surgical center, pain program, or work-hardening program at either the
agreed-upon contract price or the maximum reimbursement allowance in the appropriate
schedule.
4
DFS mediates utilization and reimbursement disputes.
5
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.
6
The DFS incorporates the statewide
schedules of the MRAs by rule in reimbursement manuals. In establishing the MRA manuals, the
panel considers the usual and customary levels of reimbursement for treatment, services, and
care; 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.
7
Florida law requires the panel to develop MRA manuals that are
reasonable, promote the workers’ compensation system’s health care cost containment and
efficiency, and are sufficient to ensure that medically necessary treatment is available for injured
workers.
8
The panel develops four different reimbursement manuals to determine statewide schedules of
maximum reimbursement allowances. The health care provider manual limits the maximum
reimbursement for licensed physicians to 110 percent of Medicare reimbursement,
9
while
reimbursement for surgical procedures is limited to 140 percent of Medicare.
10
The hospital
1
Ch. 440, F.S.
2
Section 440.13(2)(a), F.S.
3
Section 440.13, F.S.
4
Section 440.13(12)(a), F.S.
5
Section 440.13, F.S.
6
Id.
7
Section 440.13(12)(i), F.S.
8
Id.
9
Section 440.13(12)(f), F.S.
10
Section 440.13(12)(g), F.S. BILL: CS/SB 362 Page 3
manual sets maximum reimbursement for outpatient scheduled surgeries at 60 percent of
charges,
11
while other outpatient services are limited to 75 percent of usual and customary
charges.
12
Reimbursement of inpatient hospital care is limited based on a schedule of per diem
rates approved by the panel.
13
The ambulatory surgical centers manual 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.
14
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.
15
Fees may not exceed the schedules adopted under
Ch. 440, F.S., and DFS rule.
16
DFS incorporates the MRAs approved by the Three-Member
Panel in reimbursement manuals
17
through the rulemaking process provided by the
Administrative Procedures Act.
18
Expert Witness Fees for Health Care Providers
Chapter 440.13, F.S., 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. An expert witness
who only provided an expert medical opinion following a medical record review or provided
direct personal services unrelated to the case in dispute is limited to a maximum witness fee of
$200 per day.
19
III. Effect of Proposed Changes:
Section 1 amends s. 440.13, F.S. Subsection (10) is amended to increase the maximum amount a
health care provider can be paid for expert testimony during a deposition on a workers’
compensation claim from $200 to $300 per hour. A health care provider that only provides an
expert medical opinion following a medical record review or provides direct personal services
unrelated to the case in dispute, is limited to a maximum witness fee of $300 rather than $200
per day.
Subsection (12) is amended to increase the maximum reimbursement for a physician licensed
under ch. 458, F.S., or ch. 459, F.S., from 110 percent to 200 percent of 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. The maximum reimbursement for
surgical procedures is increased from 140 percent to 200 percent of 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.
11
Section 440.13(12)(d), F.S.
12
Section 440.13(12)(a), F.S.
13
Id.
14
Section 440.13(12)(h), F.S.
15
Id.
16
Section 440.13(13)(b), F.S. DFS also has rulemaking authority under s. 440.591, F.S.
17
Sections 440.13(12) and 440.13(13), F.S., and Ch. 69L-7, F.A.C.
18
Ch. 120, F.S.
19
S. 440.13(10), F.S. BILL: CS/SB 362 Page 4
Section 2 provides an effective date of July 1, 2025.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
The bill increases the maximum payments to medical providers who appear as expert
medical witnesses in litigated workers’ compensation claims.
The bill increases payments to physicians and for surgical procedures (including all
scheduled, non‐emergency clinical laboratory and radiology services; and outpatient
physical, occupational, and speech therapy services). Implementation of the bill would
result in an estimated 6.9 percent increase (or $300 million) in overall workers’
compensation system costs, as described below.
The National Council on Compensation Insurance, Inc., Analysis of SB 1344
20
The National Council on Compensation Insurance, Inc., (NCCI) provided the following
analysis of the impact of changing maximum reimbursement allowances (MRAs) in the
2020 edition of the Health Care Provider Reimbursement Manual (HCPRM) to 200
20
NCCI, Analysis of Florida Medical Fee Schedule Changes (2024 Session, HB 161/SB 362) (Feb. 6, 2024). On file with
Senate Banking and Insurance Committee. BILL: CS/SB 362 Page 5
percent. The current state multiplier for surgical is 140 percent and the current state
multiplier for all others is 110 percent. The NCCI estimates that the changes to medical
fees schedule would result in an impact of +6.9 percent (+ 300 million) on overall
workers compensation system costs.
In addition to physician services, the proposed changes would also impact MRAs for the
following hospital outpatient services contained in the Florida Workers’ Compensation
Reimbursement Manual for Hospitals:
All scheduled, non‐emergency clinical laboratory and radiology services; and
Outpatient physical, occupational, and speech therapy services.
Overall system costs are based on 2022 net written premium for insurance companies
including an estimate of self-insured premium as provided by the Florida Division of
Workers’ Compensation of the Department of Financial Services. The estimated dollar
impact is displayed for illustrative purposes only and calculated as the percentage
impact(s) multiplied by $4,355M. This figure does not include the policyholder retained
portion of deductible policies, or adjustments for subsequent changes in premium levels.
The use of premium as the basis for the dollar impact assumes that expenses and other
premium adjustments will be affected proportionally to the change in benefit costs.
Expert Medical Witness Fees
Currently, the reimbursement for an expert medical witness cannot exceed $200/hour.
HB 1299/SB 1344 seek to increase the maximum reimbursement amount to $300/hour,
an increase of 50 percent (= $300 / $200 – 1). Comprehensive data on expert medical
witness payments by employers/insurers is not readily available to NCCI. While the
magnitude of the increase in workers compensation system costs resulting from the
proposed change in the hourly rate for expert medical witness depositions is uncertain,
NCCI anticipates that any such potential increase would be minimal. Minimal is defined
in this context to be an impact on overall system costs of less than an increase of 0.2
percent.
C. Government Sector Impact:
See above, in Private Sector Impact. Indeterminate.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 440.13 of the Florida Statutes. BILL: CS/SB 362 Page 6
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Fiscal Policy on February 7, 2024:
The effective date of the bill is changed from July 1, 2024, to January 1, 2025.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.