Florida Lawmakers Finally Approved Workers’ Comp Physician Reimbursement Plan

By Insurance Journal staff | June 9, 2023

For the first time in six years, Florida has a new health care provider reimbursement manual, governing workers’ compensation fees for doctors.

But the manual already could be considered three years out of date. It also will soon face a legal challenge by insurers because of new physician dispensing rules in it.

The Florida Division of Workers’ Compensation adopted the 2020 edition of the fee schedule manual in 2021, but under state law, the Legislature must ratify the changes if it is shown that they would cost businesses in the state more than a nominal amount. Until this spring, lawmakers had declined to act on the reimbursement plan since 2016, leaving Florida doctors who treat injured workers with some of the lowest payment schedules in the United States, officials have said.

The new manual significantly raises maximum reimbursement allowances for physicians, which most stakeholders were happy with. But one highly debated section in the manual now allows physicians and physician assistants to dispense medications to patients, and bars insurers from denying payment. A coalition of workers’ compensation insurance companies have fought against that provision for years, saying that doctors often charge more for the medications, the practice is akin to self-dealing when physicians own a stake in pharmacies that supply the drugs, and it provides fewer safeguards on drug conflicts or overuse.

The coalition is expected to file a lawsuit over the provision, which, they argue, thwarts state law on physician dispensing and workers’ choice of pharmacies.

The new reimbursement manual can be seen here. It takes effect July 1.

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