The purpose of the proposed rule is to 1) set forth the requirements for carriers to report an instance or instances of overutilization to the Agency pursuant to Section 440.13(8)(a), Florida Statutes and initiate an Agency investigation pursuant to ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing

RULE NO: RULE TITLE
59A-34: CARRIER REPORT OF OVERUTILIZATION AND INITIATION OF INVESTIGATION
PURPOSE AND EFFECT: The purpose of the proposed rule is to 1) set forth the requirements for carriers to report an instance or instances of overutilization to the Agency pursuant to Section 440.13(8)(a), Florida Statutes and initiate an Agency investigation pursuant to Section 440.13(8)(b), (11), Florida Statutes; 2) establish the criteria for identifying the responsible party for overutilization of services and determine if a pattern or practice of overutilization or other violations of Chapter 440, F.S. have occurred; and 3) to establish the criteria for imposing administrative sanctions and fines in accordance with Section 440.13(8)(a), (11), (13), F.S.
SUBJECT AREA TO BE ADDRESSED: The Agency’s Overutilization Review and Initiation of Investigation Process.
SPECIFIC AUTHORITY: 440.591 FS.
LAW IMPLEMENTED: 440.13(8), 440.13(11), 440.13(13) FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: November 7, 2006, 9:00 a.m. – 12:00 Noon
PLACE: 2012 Capital Circle, S.E., 104-J Hartman Building, Tallahassee, FL.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Beverly Williams, Medical Health Care Program Analyst, [phone], [e-mail]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS AVAILABLE AT NO CHARGE FROM THE CONTACT PERSON LISTED ABOVE.