Published on: 20658010. Petition Form, Carrier Response Form, Petition Requirements, Consolidation of Petitions, Service of Petition on Carrier and Affected Parties, Computation of Time, Carrier Response Requirements, Effect of Non-Response by Carrier, Complete Record, Joint Stipulation of the Parties, Petition Withdrawal, Overutilization Issues Raised in Reimbursement Dispute Resolution, Reimbursement Disputes Involving a Contract or Workers' Compensation Managed Care Arrangement, Carrier and Health Care Provider Non-compliance
Published on: 18916278. Petition Form, Carrier Response Form, Petition Requirements, Service of Petition on Carrier and Affected Parties, Computation of Time, Carrier Response Requirements, Reimbursement Disputes Involving a Contract or Workers' Compensation Managed Care Arrangement, Carrier and Health Care Provider Non-compliance
Published on: 18916181. Petition Form, Carrier Response Form, Petition Requirements, Consolidation of Petitions, Service of Petition on Carrier and Affected Parties, Computation of Time, Carrier Response Requirements, Effect of Non-Response by Carrier, Complete Record, Joint Stipulation of the Parties, Petition Withdrawal, Overutilization Issues Raised in Reimbursement Dispute Resolution, Managed Care Arrangements (Repealed), Reimbursement Disputes Involving a Contract or Workers' Compensation Managed Care Arrangement, Carrier and Health Care Provider Non-compliance
Published on: 18347373. 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to increase the time period for a carrier to respond to a petition from 10 days to 30 days; Rule 69L-31.012, F.A.C., is repealed; proposed new Rule 69L-31.016, F.A.C., specifies that the scope of Department determinations involving reimbursement disputes is limited to findings relating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.
Published on: 17560606. Rules are being amended which govern the process for resolution of disputes between workers’ compensation carriers and health care providers. Revised forms are adopted. Rule 69L-31.005, F.A.C., is amended to provide greater detail regarding materials required to be included in a petition for dispute resolution. Rule 69L-31.008, F.A.C., is revised to provide clarity regarding computation of the time period to submit a petition for dispute resolution, including expanding the time period for submitting petitions for dispute resolution from 30 to 45 days. The time period in Rule 69L-31.009, F.A.C., for a carrier to respond to a petition is expanded from 10 to 30 days. New Rule 69L-31.016, F.A.C., is proposed to limit the scope of the dispute resolutions to compliance with standards under Chapter 440, FS., and exclude issues of contract interpretation. New Rule 69L-31.017, F.A.C. is proposed to stipulate the consequences for failure to comply with Department Determinations. Minor edits to enhance clarity and additional technical changes are also included. The proposed rules have been renumbered accordingly.