The purpose of the changes being made to Rules 69L-30.002, 69L-30.003, 69L-30.004, 69L-30.006, 69L-30.007, and 69L-30.010, F.A.C., are to reflect statutory changes allowing Judges of Compensation Claims to appoint temporary Expert Medical Advisors, ...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker’s Compensation

RULE NOS.: RULE TITLES:

69L-30.002Definitions

69L-30.003Qualifications for Expert Medical Advisor Certification and Re-Certification

69L-30.004Application Process for Expert Medical Advisor Certification

69L-30.006Temporary Expert Medical Advisors

69L-30.007Expert Medical Advisor Responsibilities

69L-30.010Expert Medical Advisor Decertification

PURPOSE AND EFFECT: The purpose of the changes being made to Rules 69L-30.002, 69L-30.003, 69L-30.004, 69L-30.006, 69L-30.007, and 69L-30.010, F.A.C., are to reflect statutory changes allowing Judges of Compensation Claims to appoint temporary Expert Medical Advisors, to update the address for the website on which application for Expert Medical Advisor certification is made, and to add final orders finding that a physician engaged in overutilization, as defined in section 440.13(8), Florida Statutes, to the list of final orders which disqualify a physician from eligibility for Expert Medical Advisor certification.

SUMMARY: The proposed changes reflect statutory changes allowing Judges of Compensation Claims to appoint temporary Expert Medical Advisors, update a website address, and update the list of final orders that disqualify a physician from Expert Medical Advisor certification.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: This rule is being amended to reflect statutory changes and to remedy technical issues.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 440.13(9), 440.591

LAW IMPLEMENTED: 440.13(9)

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Tuesday, February 7, 2017 @ 10:00 AM

PLACE: Room 102, Hartman Building, 2012 Capital Circle SE, Tallahassee, FL 32301

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: . If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Theresa Pugh, Program Administrator – Medical Services Section, Bureau of Monitoring and Auditing, Division of Workers’ Compensation, Department of Financial Services, telephone: [phone], email: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

69L-30.002 Definitions.

For purposes of this rule the following definitions apply:

(1) through (3) No change.

(4) “Expert Medical Advisor” (hereinafter “EMA”) is a physician certified by the Department of Financial Services (“Department”), or appointed by a Judge of Compensation Claims (“JCC”) under paragraph 440.13(9)(c), F.S., to render peer review or expert medical consultation, opinions, and testimony, within the advisor’s specialty area, concerning to assist Judges of Compensation Claims (“JCC”) and the Department in resolving issues related to reimbursement, differing opinions of health care providers, and physician and health care services rendered under the Florida Workers’ Compensation health care delivery system.

(5) No change.

(6) “DWC Expert Medical Services Web Advisor Certification Portal,” http://www.flrules.org/Gateway/reference.asp?No=Ref-05965,” eff. 03/01/2016 (hereinafter “DWC EMA Website”) is accessible at https://msuwebportal.fldfs.com/ www.myfloridacfo.com/division/wc/provider.html and provides physicians with the means to navigate the online EMA certification process and is incorporated by reference herein.

(7) No change.

(8) “EMA Tutorial” means the Florida Department of Financial Services, Division of Workers’ Compensation (“DWC”), Expert Medical Advisor Certification Tutorial, which is accessible online at the DWC Medical Services Web Portal EMA Website at www.myfloridacfo.com/division/wc/provider.html. The EMA Tutorial provides subject matter information and then tests the applicant’s knowledge of Section 440.13, F.S., and applicable administrative rules adopted by the Department.

(9) through (10) No change.

(11) “Temporary EMA” is a physician identified by a JCC or the Department for temporary certification by the Department, who is board certified in a specialty area in which no Certified EMA is available to render the services necessary for the JCC or the Department to fulfill its their statutory responsibilities under Chapter 440, F.S.

Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.002, Amended 10-11-06, Formerly 59A-30.002, Amended 3-1-16,         .

 

69L-30.003 Qualifications for Expert Medical Advisor Certification and Re-Certification.

(1) through (3) No change.

(4) A physician who, pursuant to a final order, has been found to have engaged in certain violations, including a standard of care or billing violation, or overutilization, violations pursuant to subsections 440.13(8), and (13), or (15), F.S., shall not be certified as an EMA.

Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Amended 6-8-95, Formerly 38F-54.003, Amended 10-11-06, Formerly 59A-30.003, Amended 3-1-16,         .

 

69L-30.004 Application Process for Expert Medical Advisor Certification.

(1) A physician shall apply for certification by satisfactorily completing the online EMA Tutorial that is accessible through the DWC EMA Website at www.myfloridacfo.com/division/wc/provider.html, pursuant to subsection 69L-30.002(6), F.A.C.

(2) No Change.

(3) The certification process shall be considered properly completed when the physician correctly answers 95% of the online EMA Tutorial questions and uploads to the above-referenced DWC Medical Services Web Portal EMA Website the required documentation, as set forth in Rule 69L-30.003, F.A.C. Failure to properly complete the certification process shall result in the application being rejected. Subject to the limitations in this rule chapter, a rejected applicant can immediately re-apply.

(4) through (8) No change.

Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.004, Amended 10-11-06, Formerly 59A-30.004, Amended 3-1-16,        .

 

69L-30.006 Temporary Expert Medical Advisors.

(1) When a JCC cannot identify an EMA from the physicians on the Certification List to provide the services needed, the JCC may propose a specific physician for temporary certification by the Department.

(2) The Department will certify the physician proposed by the JCC as a Temporary EMA for a specific case, if one of the following is met:

(a) All parties in a proceeding before the JCC stipulate to the qualifications of the board certified or board eligible physician to provide services in the JCC proceeding; or

(b) The physician has a clear active license to practice medicine, has board certification or is board eligible, and the JCC has established that the physician has training or experience applicable to the specific medical issue before the JCC.

(3) is renumbered as (1) No other change.

(4) Upon receiving notice of selection by the JCC as a Temporary EMA, the physician shall disclose any conflict of interest related to the case for which the physician was selected and shall decline selection as a Temporary EMA if a conflict of interest, pursuant to Rule 69L-30.007, F.A.C., exists.

(5) through (7) is renumbered (2) through (4) No change.

(5) Selection of an EMA by a JCC under paragraph 440.13(9)(c), F.S., is independent of the Department’s selection of a Temporary EMA under this rule.

Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.006, Amended 10-11-06, Formerly 59A-30.006, Amended 3-1-16,         .

 

69L-30.007 Expert Medical Advisor Responsibilities.

(1) No change.

(2) An EMA shall be responsible for notifying the Department of any change in the physician’s license or board certification status or change in address or contact information, within 30 calendar days of the change. EMAs may notify the Department by updating their profiles through the DWC Medical Services Web Portal EMA Website at www.myfloridacfo.com/division/wc/provider.html, or by emailing the Department at [e-mail]. EMAs may also forward documentation regarding such changes to the Division of Workers’ Compensation, Medical Services Section, c/o Department of Financial Services, 200 E. Gaines Street, Tallahassee, Florida, 32399-4232.

(3) When the JCC selects an EMA from the Certification List or Temporary EMA, the EMA or Temporary EMA shall complete and submit a written report to the JCC within 15 calendar days following receipt of all medical records and, when appropriate, the examination of the injured employee. The medical records to be submitted shall be within the discretion of the JCC.

(4) through (5) No change.

Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.007, Amended 10-11-06, Formerly 59A-30.007, Amended 3-1-16,         .

 

69L-30.010 Expert Medical Advisor Decertification.

(1) An EMA shall be decertified and removed from the Certification List for any one of the following:

(a) Pursuant to a final order, the EMA was found to have engaged in certain violations, including a standard of care or billing violation, or overutilization, under subsections 440.13(8), and (13), or (15), F.S.; or

(b) through (c) No change.

(2) No change.

Rulemaking Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.010, Amended 10-11-06, Formerly 59A-30.010, Amended 3-1-16,        .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Theresa Pugh

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: CFO Jeff Atwater

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 12/29/2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 11/22/2016