The purpose and effect of the proposed rule is to amend the current rule chapter to revise the process by which health care providers meet the minimum criteria for certification pursuant to Section 440.13(3)(a), F.S. The proposed amendment also ...

DEPARTMENT OF FINANCIAL SERVICES
Division of Worker's Compensation

RULE NO.: RULE TITLE:
69L-29.001: Definitions.
69L-29.002: Requirements for Certification
69L-29.003: Certification Time Frames
69L-29.004: Occasional Health Care Providers
69L-29.005: Decertification of a Health Care Provider
69L-29.006: Decertification Process
69L-29.007: Recertification Process
69L-29.008: Determining Certification Status
69L-29.009: Carrier Responsibilities
69L-29.010: Health Care Provider Responsibilities
69L-29.011: Workers' Compensation Certification Training Courses

PURPOSE AND EFFECT: The purpose and effect of the proposed rule is to amend the current rule chapter to revise the process by which health care providers meet the minimum criteria for certification pursuant to Section 440.13(3)(a), F.S. The proposed amendment also introduces the “Florida Workers’ Compensation Health Care Provider Certification Tutorial”, a no-cost, on-line resource that implements an electronic certification process for health care providers that will improve the efficiencies in the certification process. The tutorial ensures participation only by statutorily defined providers and provides a learning tool that allows providers to progress at their own pace and to create and maintain their provider profile. The tutorial consists of an overview of the Florida Workers’ Compensation System and the general administrative policies with which a health care provider must become familiar to be certified and successfully participate under the system. The proposed rule amendment also deletes existing Rule(s) 69L-29.004, 69L-29.006, 69L-29.007, 69L-29.009 and 69L-29.011, F.A.C.

SUMMARY: The proposed amendment, a significant rewrite of the existing rule chapter, introduces an electronic certification process that allows health care providers an efficient and flexible means to obtain, manage and maintain their requisite certifications. The amended rule chapter also includes an on-line, no-cost tutorial to assist providers seeking to gain familiarity with the certification process.

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 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: a preliminary analysis performed by the agency indicates that the proposed amendment imposes no significant costs on health care providers subject to the certification process. The on-line certification process and tutorial introduced by the amendment are provided at no cost to providers. There are no significant costs to the agency, as the proposed changes are not anticipated to require additional employees or an increase in other expenditures to administer.

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(3)(a), 440.591 FS.
LAW IMPLEMENTED: 440.13(3), (13) FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE TIME, DATE, AND PLACE SHOWN BELOW:

DATE AND TIME: Friday, August 3, 2012, 10:00 a.m.

PLACE: Room 102, Hartman Building, 2012 Capital Circle Southeast, Tallahassee, Florida

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULES IS: Eric Lloyd, Program Administrator, Office of Medical Services, Division of Workers’ Compensation, Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232, [phone], [e-mail].

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this program, please advise the Department at least 5 calendar days before the program by contacting the person listed above.

 

THE FULL TEXT OF THE PROPOSED RULES IS:

69L-29.001 Definitions.

(1) “Application” means form DFS Form 3160-0020 required by this rule chapter to be submitted by health care providers to the Department. The DFS Form 3160-0020 application form is incorporated into this rule chapter by reference in subsection 69L-29.002(1), F.A.C.

(2) “Certification training course” is a training and education course approved by the Department to satisfy the minimum five hour course required by Section 440.13(3)(a), F.S.

(1)(3) “Certified health care provider” or “certified provider” is as defined in Section 440.13(1)(d), F.S.

(2)(4) “Certification” is the process through which a health care provider is approved as eligible to receive reimbursement for services rendered under Chapter 440, F.S., upon completion of the Division’s Health Care Provider Certification Tutorial by correctly answering 95% of the tutorial review questions. “Certify” is the process through which the Department grants or denies certification status to a health care provider.

(3) “Deemed certified” is the status of a health care provider not required to complete the Health Care Provider Tutorial pursuant to this rule chapter.

(4) “Division” is defined in Section 440.02(14), F.S.

(5) “Decertification” means Department revocation of certification.

(6) “Department” is defined in Section 440.02(12), F.S.

(5)(7) “Emergency services and care” is as defined in Section 440.13(1)(f), F.S.

(6)(8) “Health care facility” is as defined in Section 440.13(1)(g), F.S.

(7)(9) “Health care provider” or “provider” is as defined in Section 440.13(1)(h), F.S.

(8) “Health Care Provider Certification List” or “Certification List” is the Division’s electronic database of providers certified pursuant to this Rule Chapter.

(9) “Health Care Provider Certification Tutorial” or “HCP Tutorial”, hereby incorporated by reference in this rule chapter, is the electronic tool used by the Division to educate providers on Chapter 440, F.S., and applicable administrative rules that govern the provision of medical treatment and services under the Florida Workers’ Compensation health care delivery system. The HCP Tutorial is also the tool by which the Division documents a provider’s familiarity with applicable provisions of the statute and administrative rules for certification pursuant to this rule chapter.

(10) “Non-physician health care provider” means a health care provider licensed pursuant to the Florida Statutes who is not a physician as defined in Section 440.13(1)(q), F.S., and who bills for services rendered on form DFS-F5-DWC-9 pursuant to Rule 69L-7.602, F.A.C.

(11) “Occasional provider” means a health care provider who treats twelve (12) or fewer injured employees in one calendar year.

(10)(12) “Physician” is as defined in Section 440.13(1)(q), F.S.

(11) “Recognized practitioner” is a non-physician health care provider licensed by the Department of Health (hereinafter “DOH”) who works under the protocol of a physician or who, upon referral from a physician, can render direct billable services independent of the supervision of a physician.

(12)(13) “Revocation” “Suspension” means Department’s action to remove a provider’s name from the Certification List bar for a specified period of time a health care provider’s eligibility to receive reimbursement for services rendered under Chapter 440, F.S.

(13) “Nursing Home Facility” is a health care facility licensed under Chapter 400, F.S.

(14) “Home Health Agency” is a health care facility licensed under Chapter 400, F.S.

(15) “Home Medical Equipment Provider” or “HME Provider” is a health care facility licensed under Chapter 400, F.S.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.001, 59A-29.001, Amended_________.

 

69L-29.002 Eligibility Requirements for Certification.

(1) A Provider who correctly answers 95% of the HCP Tutorial review questions shall qualify for certification if the Provider is: The Department shall certify health care providers who meet the following requirements:

(a) A physician that The health care provider holds a clear active valid license issued by the Department of Health (hereinafter “DOH”) or a Florida medical school teaching or faculty certificate issued pursuant to Sections 458.3145, 459.0077, 463.0057 or 466.002, F.S., or a chiropractic medicine faculty certificate pursuant to Section 460.4062, F.S., or a temporary certificate in an area of critical need pursuant to Section 458.315, F.S.; or

(b) A recognized practitioner that holds a clear active license issued by DOH. The health care provider has submitted a signed, typed, and completed application form DFS Form 3160-0020 to the Division of Workers’ Compensation, Office of Medical Services, c/o Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-4232. Illegible or unsigned applications shall be returned. The DFS Form 3160-0020 application form is incorporated by reference into Chapter 69L-29, F.A.C. The version of the form required to be submitted to the Department shall bear the date October 15, 1994. A copy of the application form DFS Form 3160-0020 may be obtained from the Department.

(c) Physicians shall enroll in and complete a minimum 5 hour Department approved training course, pursuant to Section 440.13(3)(a), F.S. The Department shall not credit a physician for completion of any training course to meet the requirements of Section 440.13(3)(a), F.S., prior to the date the Department approves the training course for credit.

(2) A health care facility with an unencumbered license issued by the Agency for Health Care Administration (hereinafter “AHCA”) is deemed certified. The Department shall not certify a health care provider when:

(a) The Agency for Health Care Administration has entered an adverse final order imposing an administrative penalty, which revokes or suspends the health care provider’s license, or places the health care provider on probation, or the health care provider agrees to such an administrative penalty, within twelve months preceding the date of filing of the application form DFS Form 3160-0020; or

(b) The Department has entered an adverse final order imposing an administrative penalty or fine against the health care provider within twelve months preceding the date of filing of the application form DFS Form 3160-0020; or

(c) The health care provider has been suspended three times pursuant to subsection 69L-29.006(5), F.A.C.

(3) A provider under contract with a licensed managed care organization is deemed certified. The following are not required to be certified in order to provide services pursuant to Section 440.13, F.S.:

(a) Health care providers rendering emergency services and care.

(b) Pharmacists licensed under Chapter 465, F.S.

(c) Medical suppliers who bill on the DFS-F5-DWC-10.

(d) Health care providers of medical services rendered outside the State of Florida.

(e) Federal health care providers.

(f) Health care facilities, except that physicians and non-physician health care providers employed as health care providers must be certified under this rule as a condition to eligibility for payment under Chapter 440, F.S.

(4) A pharmacist licensed under Chapter 456, F.S. is deemed certified.

(5) A provider shall not be eligible for reimbursement of services pursuant to Section 440.13, F.S., until such time as the certification requirements under this rule are met.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.002, 59A-29.002, Amended________.

 

69L-29.003 Certification Time Frames.

The Department shall certify health care providers within the following time frames:

(1) Upon correctly answering 95% of the HCP Tutorial review questions, the provider shall receive an electronically generated Division of Workers’ Compensation Approval of Provider Certification and Eligibility for Reimbursement Notification (hereinafter “DWC Provider Certification Notice”). Upon the effective date of this rule, the Department shall accept applications for certification from physicians. Within 90 days of receipt of an application for certification, the Department shall return to the physician a notice of approval or denial of certification, or shall request additional required information not previously submitted, and shall state the reasons for denial of certification. The Department shall maintain the original application form DFS Form 3160-0020 in its files. Physicians, as a condition to eligibility for payment under Chapter 440, F.S., shall be certified within 12 months of the effective date of this rule.

(2) The DWC Provider Certification Notice shall include the effective date on which a provider may begin to receive reimbursement for medical treatment and services rendered to injured employees under Chapter 440, F.S. Beginning 12 months following the effective date of this rule, the Department shall accept applications for certification from non-physician health care providers. Within 90 days of receipt of an application for certification, the Department shall return to the non-physician health care provider a notice of approval or denial of certification, and shall request additional required information not previously submitted, or shall state the reasons for denial of certification. The Department shall maintain the original application form DFS Form 3160-0020 in its files. Non-physician health care providers, as a condition to eligibility for payment under Chapter 440, F.S., shall be certified within 24 months of the effective date of this rule.

(3) A provider’s certification remains in effect unless voluntarily withdrawn by the provider or revoked by the Department pursuant to Rule 69L-29.005, F.A.C.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.002, 59A-29.003, Amended_________.

 

69L-29.004 Occasional Health Care Providers.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.004, 59A-29.004, Repealed_________.

 

69L-29.005 Revocation Decertification of Certification Status a Health Care Provider.

(1) The Department shall revoke a provider’s certification and shall issue a final order removing a certified provider’s name from the Certification List when any one of the following conditions occurs: Pursuant to Section 440.13(13), F.S., the Department shall suspend and remove health care providers from its database of certified health care providers, upon the following:

(a) The Department determines that a provider is in violation of Chapter 440, F.S., or the administrative rules adopted by the Department pursuant to Chapter 440, F.S.; or When the Department enters an adverse final order against the health care provider imposing an administrative fine or penalty upon the health care provider for violations of Chapter 440, F.S., or the administrative rules adopted by the Department;

(b) DOH changes the physician’s or recognized practitioner’s license to a status other than clear active; or When the Department of Health has entered an adverse final order imposing an administrative penalty, which revokes or suspends the health care provider’s license, or places the health care provider on probation, or the health care provider agrees to such an administrative penalty.

(c) AHCA revokes the facility’s license; or

(d) The certified provider fails to renew or voluntarily surrenders the applicable license issued by DOH or AHCA; or

(e) The certified provider no longer meets the eligibility requirements for being certified or deemed certified pursuant to this Rule Chapter.

(2) The provider whose certification is revoked pursuant to this section shall not be eligible for reimbursement under Chapter 440, F.S. When a health care provider is suspended or decertified, the health care provider shall notify each carrier from whom he/she has received authorization to treat an injured employee. The carrier shall transfer the care of the injured employee to another certified health care provider.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.005, 59A-29.005, Amended_________.

 

69L-29.006 Decertification Process.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (8), (13) FS. History–New 3-14-95, Formerly 38F-53.006, 59A-29.006, Repealed_________.

 

69L-29.007 Recertification Process.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.007, 59A-29.007, Repealed_________.

 

69L-29.008 Verification of Determining Certification Status.

(1) Upon issuance of the DWC Provider Certification Notice, the following information will be recorded on the Certification List: When a carrier or an agent of the carrier requests the certification status of a health care provider, the health care provider shall provide proof of current certification before being authorized to render care. A copy of the notice of approval of certification issued by the Department to the health care provider may be used as proof of current certification.

(a) Provider’s First and Last Name;

(b) Provider’s DOH or AHCA license number;

(c) Provider’s place of business name, address(es) and telephone number(s);

(d) Provider’s specialty board affiliation(s) and sub-specialty(ies).

(2) The certification status of a provider may be verified by accessing the Certification List at http://www.myfloridacfo.com/WC/index.htm under the “Databases” link. The Department shall maintain on a quarterly basis a list of health care providers suspended or decertified and the duration of suspension.

(3) A provider who, pursuant to this rule chapter, is deemed certified may elect to be listed on the Certification List by completing the HCP Tutorial Pre-Screening Assessment at: taps://apps.fldfs.com/provider/HCPSearch.aspc.

The Department shall respond to written requests for certification status within sixty days of receipt of the request. The request shall provide the full name, license number, and mailing address of each health care provider for whom certification status is being requested. No request for certification status shall be answered over the telephone or accepted by facsimile transmission.

(4) A provider who, pursuant to this rule chapter, is deemed certified and elects not to be listed on the Certification List, shall provide proof of current licenser or contract with a licensed managed care organization upon which certification status is deemed when requested in writing by an insurer, including electronic written requests, within ten (10) days of the request.

(5) Providers are responsible for maintaining and updating their provider profile to reflect any changes in the information identified in subsection (1).

Rulemaking Specific Authority 440.13(3)(a), 440.591 F.S. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.008, 59A-29.008, Amended_________.

 

69L-29.009 Carrier Responsibilities.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.009, 59A-29.009, Repealed_________.

 

69L-29.010 Certified Health Care Provider Responsibilities.

(1) A certified provider Health care providers shall be responsible for notifying the Division Department in writing of any change in the status of the that health care provider’s license or contract with a licensed managed care organization, or mailing address within 30 10 days of such change. Such notifications changes shall be sent to: Division of Workers’ Compensation, Office of Medical Services, c/o Department of Financial Services, 200 E. Gaines Street, Tallahassee, Florida, 32399-4232 or [e-mail].

(2) A certified provider shall ensure the information recorded on the Certification List is current and accurate by updating his, her or its provider record maintained in the Division’s Provider Database, accessible on the Division’s website at https://apps.fldfs.com/provider/HCPSearch.aspx.

(3) Failure to comply with this rule shall result in forfeiture of any remedy pursuant to Section 440.13(7), F.S., for services rendered on or subsequent to the change in the provider’s certification status.

Rulemaking Specific Authority 440.13(3)(a), 440.591 F.S. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.010, 59A-29.010, Amended_________.

 

69L-29.011 Workers’ Compensation Certification Training Courses.

Rulemaking Specific Authority 440.13(3)(a), 440.591 FS. Law Implemented 440.13(3), (13) FS. History–New 3-14-95, Formerly 38F-53.011, 59A-29.011, Repealed_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Eric Lloyd, Office of Medical Services, Program Administrator, Division of Workers’ Compensation, Department of Financial Services

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jeff Atwater, Chief of Financial Officer, Department of Financial Services

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 18, 2012

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: June 17, 2011