18347373, 69L-31.003 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 18347373

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

UTILIZATION AND REIMBURSEMENT DISPUTE RULES

Overview

RULE:

69L-31.003	Petition for Resolution of Reimbursement Dispute Form and Requirements
69L-31.004	Carrier Response to Petition for Resolution of Reimbursement Dispute Form and Requirements
69L-31.005	Written Determinations
69L-31.006	Consolidation of Petitions (Repealed)
69L-31.007	Service of Petition on Carrier and All Affected Parties
69L-31.008	Computation of Time
69L-31.009	Carrier Response Requirements (Repealed)
69L-31.010	Effect of Non-Response by Carrier (Repealed)
69L-31.011	Complete Record (Repealed)
69L-31.012	Joint Stipulation of the Parties (Repealed)
69L-31.013	Petition Withdrawal
69L-31.014	Overutilization Issues Raised in Reimbursement Dispute Resolution (Repealed)
69L-31.016	Reimbursement Disputes Involving a Contract or Workers' Compensation Managed Care Arrangement
69L-31.017	Carrier and Health Care Provider Non-compliance

PURPOSE:

The proposed rulemaking amends existing rules governing the process for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, creates two new rules, and repeals an existing rule. Noteworthy highlights of the proposed rulemaking are as follows: Rule 69L-31.005, F.A.C., is amended to provide greater detail regarding the materials that must accompany a petition for dispute resolution; Rule 69L-31.008, F.A.C., is amended to clarify the computation of the time period within which a petition for dispute resolution must be submitted to the Division, to increase the time period from 30 days to 45 days for the submission of a Petition Form, to add a link to the Division’s Web Portal, and to provide additional guidance regarding the electronic submission of a Petition Form; Rule 69L-31.009, F.A.C., is amended to increase the time period for a carrier to respond to a petition from 10 days to 30 days; Rule 69L-31.012, F.A.C., is repealed; proposed new Rule 69L-31.016, F.A.C., specifies that the scope of Department determinations involving reimbursement disputes is limited to findings relating to reimbursement schedules, practice parameters, and protocols of treatment, and clarifies that the Department will issue no findings regarding an improper disallowance or adjustment in reimbursement involving managed care contracts or when the carrier asserts that medical treatment was either not compensable or not medically necessary; and proposed new Rule 69L-31.017, F.A.C., stipulates the consequences for failure to comply with Department determinations. Certain rule section titles are revised to more accurately reflect the subject matter or issues addressed by the underlying rule. The proposed rules include additional minor edits and technical changes, and have been renumbered accordingly. Revised forms are also adopted.

SUMMARY:

: Rulemaking to amend rules governing the procedures for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, identified under Rule Chapter 69L-31, F.A.C.

RULEMAKING AUTHORITY:

440.13(7)(e), 440.591, FS.

LAW:

440.13(7) (a), (b), (c), (e), FS.

PRINT PUBLISH DATE:

12/7/2016 Vol. 42/236

COMMENTS:

From 12/7/2016 To 12/28/2016 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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