- July 26, 2024
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An administrative law judge Thursday rejected a challenge by workers’ compensation insurance companies to a state proposal that would set payment amounts for inpatient care at hospitals.
Judge Darren Schwartz issued a 23-page order turning down arguments that a proposed rule issued last year by the Department of Financial Services’ Division of Workers’ Compensation was invalid.
The case centered, at least in part, on what are known as “maximum reimbursement allowances,” or MRAs, that would help determine how much workers’ compensation insurers pay to hospitals for inpatient care.
The proposed rule would lead to insurers paying $7,000 a day for inpatients who do not need surgery or intensive care; $11,000 a day for patients who need surgery; and $13,000 a day for intensive-care unit treatment.
Among other things, the workers’ compensation insurers argued that the proposal was “arbitrary and capricious,” but Schwartz wrote that the proposed rule was “supported by logic, the necessary facts, was adopted with thought and reason and is rational. … The Division (of Workers’ Compensation) conducted a thorough analysis of a variety of proposed MRAs and engaged in extensive negotiations and meetings with the carriers and hospitals.”
Normandy Insurance Co., Zenith Insurance Co., Bridgefield Employers Insurance Co., Bridgefield Casualty Insurance Co., BusinessFirst Insurance Co. and RetailFirst Insurance Co. filed the challenge in September. Several hospitals, the Safety Net Hospital Alliance of Florida and the Florida Hospital Association intervened in the case to support the proposed rule.
