The proposed rulemaking amends existing rules governing the process for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, creates a new rule, and repeals an existing rule. Changes proposed ...

 

DEPARTMENT OF FINANCIAL SERVICES

Division of Worker's Compensation

RULE NOS.:RULE TITLES:

69L-31.003Petition Form

69L-31.004Carrier Response Form

69L-31.005Petition Requirements

69L-31.006Consolidation of Petitions

69L-31.007Service of Petition on Carrier and Affected Parties

69L-31.008Computation of Time

69L-31.009Carrier Response Requirements

69L-31.010Effect of Non-Response by Carrier

69L-31.011Complete Record

69L-31.012Joint Stipulation of the Parties

69L-31.013Petition Withdrawal

69L-31.014Overutilization Issues Raised in Reimbursement Dispute Resolution

69L-31.016Reimbursement Disputes Involving a Contract or Workers' Compensation Managed Care Arrangement

PURPOSE AND EFFECT: The proposed rulemaking amends existing rules governing the process for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers, creates a new rule, and repeals an existing rule. Changes proposed include: amending Rule 69L-31.005, F.A.C., to provide greater detail regarding the materials that must accompany a petition for dispute resolution (Petition Form); amending Rule 69L-31.008, F.A.C., to clarify the computation of the time period within which a Petition Form must be submitted to the Division, to increase the time period for the submission of a Petition Form from 30 days to 45 days, to add the website address for the Division’s Web Portal, and to provide additional guidance regarding the electronic submission of a Petition Form; amending Rule 69L-31.009, F.A.C., to increase the time period for a carrier to respond to a petition from 10 days to 30 days; repealing Rule 69L-31.012, F.A.C.; and creating Rule 69L-31.016, F.A.C., to address penalties for improper reimbursement and billing practices. Revisions to certain rule titles are proposed to more accurately reflect the subject matter or issues addressed by the rule. Other changes proposed include minor edits and the adoption of revised forms.

SUBJECT AREA TO BE ADDRESSED: Procedures for the resolution of reimbursement disputes between workers’ compensation carriers and health care providers.

RULEMAKING AUTHORITY: 440.13(7)(e), 440.591, FS.

LAW IMPLEMENTED: 440.13(7), 440.13(7)(a), (b), (c), (e), 440.13(8)(b), 440.13(11)(a), 440.13(12), 440.525, 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:

DATE AND TIME: Friday, February 23, 2018, 9:30 a.m. – 12:00 p.m.

PLACE: Hartman Building, Room 102, 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: Theresa Pugh, telephone: [phone], email: [e-mail]. 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Theresa Pugh, Program Administrator – Medical Services Section, Bureau of Monitoring and Auditing, Division of Workers’ Compensation, address: 2012 Capital Circle SE, Tallahassee, FL 32399-4229, telephone: [phone], email: [e-mail].

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.