17560606, 69L-31.003 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 17560606

Notice of Development of Rulemaking

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

UTILIZATION AND REIMBURSEMENT DISPUTE RULES

Overview

RULE:

69L-31.003	Petition for Resolution of Reimbursement Dispute Form and Requirements
69L-31.004	Carrier Response to Petition for Resolution of Reimbursement Dispute Form and Requirements
69L-31.005	Written Determinations
69L-31.006	Consolidation of Petitions (Repealed)
69L-31.007	Service of Petition on Carrier and All Affected Parties
69L-31.008	Computation of Time
69L-31.009	Carrier Response Requirements (Repealed)
69L-31.010	Effect of Non-Response by Carrier (Repealed)
69L-31.011	Complete Record (Repealed)
69L-31.012	Joint Stipulation of the Parties (Repealed)
69L-31.013	Petition Withdrawal
69L-31.014	Overutilization Issues Raised in Reimbursement Dispute Resolution (Repealed)
69L-31.016	Reimbursement Disputes Involving a Contract or Workers' Compensation Managed Care Arrangement
69L-31.017	Carrier and Health Care Provider Non-compliance

PURPOSE:

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.

SUBJECT:

The resolution of reimbursement disputes by the Florida Department of Financial Services pursuant to paragraph 440.13(7)(e), FS.

RULEMAKING AUTHORITY:

440.13(7)(e), 440.591, FS.

LAW:

440.13(7), (8), (11)(a), (12), 440.134(15), FS.

PRINT PUBLISH DATE:

5/23/2016 Vol. 42/100

RELATED STATUTES
AND LAWS:

440.13(7)(e), 440.591, FS., 440.13(7), (8), (11)(a), (12), 440.134(15), FS.

OVERSIGHT COMMITTEE:

Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)

RELATED COURT CASES:

Division of Administrative Hearings

FEDERAL eRULEMAKING
WEB PORTAL:

Regulations.gov

HOW TO LINK TO
THIS NOTICE:

http://www.flrules.org/gateway/ruleno.asp?id=69L-31.003&PDate=5/23/2016&Section=1

REFERENCE MATERIALS:

No reference(s).

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