The Florida Senate

440.135  Pilot programs for medical and remedial care in workers' compensation.--

(1)  It is the intent of the Legislature to determine whether the costs of the workers' compensation system can be effectively contained by monitoring more closely the medical, hospital, and remedial care required by s. 440.13, while providing injured workers with more prompt and effective care and earlier restoration of earning capacity without diminution of the quality of such care. It is the further intent of the Legislature to determine whether the total cost to an employer that provides a policy or plan of health insurance and a separate policy or plan of workers' compensation and employer's liability insurance for its employees can be reduced by combining both coverages under a policy or plan that provides 24-hour health insurance coverage as set forth in this section. Therefore, the Legislature authorizes the establishment of one or more pilot programs to be administered by the Department of Insurance after consulting with the division. Each pilot program shall terminate 2 years after the first date of operation of the program, unless extended by act of the Legislature. In order to evaluate the feasibility of implementing these pilot programs, the Department of Insurance shall consult with the division regarding:

(a)  Establishing alternate delivery systems using a health maintenance organization model, which includes physician fees, competitive bidding, or capitation models.

(b)  Controlling and enhancing the selection of providers of medical, hospital, and remedial care and using the peer review and utilization review procedures in s. 440.13(1) to control the utilization of care by physicians providing treatment pursuant to s. 440.13(2)(a).

(c)  Establishing, by agreement, appropriate fees for medical, hospital, and remedial care pursuant to this chapter.

(d)  Promoting effective and timely utilization of medical, hospital, and remedial care by injured workers.

(e)  Coordinating the duration of payment of disability benefits with determination made by qualified participating providers of medical, hospital, or remedial care.

(f)  Initiating one or more pilot programs under which participating employers would provide a 24-hour health insurance policy to their employees under a single insurance policy or self-insured plan. The policy or plan must provide a level of health insurance benefits which meets criteria established by the Department of Insurance but which provides medical benefits for at least occupational injuries and illnesses comparable to those required by this chapter and which may use deductibles and coinsurance provisions that require the employee to pay a portion of the actual medical care received by the employee, notwithstanding any other provisions of this chapter. The policy or plan may also provide indemnity benefits as specified in s. 440.38(1)(e). The employer shall pay the entire premium for the 24-hour health insurance policy or self-insured plan other than the portion of the premium which relates to dependent coverage.

(g)  Other methods of monitoring reduced costs within the workers' compensation system while maintaining quality care.

(2)  The Department of Insurance, after consulting with the division, may, without a bidding process, negotiate and enter into such contracts as may be necessary or appropriate in its judgment to implement the pilot program.

(3)  The Department of Insurance may also accept grants and moneys from any source and may expend such grants and moneys for the purposes of the program.

(4)  No provision of the pilot programs may vary the methods for calculating weekly payments for disability compensation under this chapter. Likewise, no provision of the pilot programs shall limit the right to a hearing under s. 440.25

(5)  The Department of Insurance shall make an interim report on or before December 1, 1991, and a final report on or before the termination date specified in subsection (1) to the Speaker of the House of Representatives, the President of the Senate, the Minority Leader of the Senate, the Minority Leader of the House of Representatives, and the Governor, on the activities, findings, and recommendations of the Department of Insurance relative to the pilot programs. The Department of Insurance shall monitor, evaluate, and report the following information regarding physicians, hospitals, and other remedial care providers:

(a)  Cost savings.

(b)  Effectiveness.

(c)  Effect on earning capacity and indemnity payments.

(d)  Complaints from injured workers and providers.

(e)  Concurrent review of quality of care.

(f)  Other pertinent matters.

The information from the pilot programs shall be reported in a format to permit comparisons to other similar data.

History.--s. 19, ch. 90-201; s. 17, ch. 91-1; s. 19, ch. 93-415.