State-Specific Resources: Florida
Florida Managed Care Information
Beginning October 1, 1994, Florida issued a mandate that all workers compensation medical benefits were to be delivered in an approved managed care arrangement (MCA). Since that time, the Florida MCA has been the standard for workers compensation claims for Travelers in Florida. Travelers partnered with Coventry Health Care Workers’ Compensation, Inc. to provide a network of medical providers and assist in the support of the MCA which required oversight by the Agency for Health Care Administration (AHCA).
The mandate was repealed in 2001 and it no longer was necessary to maintain an MCA in FL for an injured workers medical benefits. At that time, Travelers determined that there was remaining value in maintaining that program.
As time has gone by, the value, primarily intended to limit medical disputes between carriers and claimant attorneys, has eroded to the point that it is no longer effective.
Travelers has determined that the time has come to end the MCA and manage work related injuries within the non-managed care environment.
This change will take effect as of 12/01/2015 for all open claims as well as any newly reported injuries. The provider network will revert to the standard Coventry network which contains the same providers as the MCA program. There will be no continuity of care issues making the change seamless for injured workers and providers.
What will change:
- There will no longer be a requirement for a Medical Care Coordinator to function as a gatekeeper for medical issues
- There will no longer be any need for oversight by the Agency for Health Care Administration (AHCA)
- The Grievance Process will no longer apply
What will not change:
- Employer Direction of Care
- Use of network providers to facilitate cost containment and return to work outcomes
- Utilization Review to ensure that medical care adheres to appropriate treatment guidelines
- One time change of physician for the life of the claim
- Required Specialty Match
- Employer/Carrier has 5 days to authorize a change or the employee may choose any provider
November 30, 2015