https://www.flrules.org/gateway/ruleNo.asp?id=69L-30.002
Notice of Change/Withdrawal
RULE
NOS.: RULE TITLES:
69L-30.003 Qualifications for Expert Medical
Advisor Certification
69L-30.004 Application for Expert Medical Advisor
Certification
69L-30.007 Expert Medical Advisor
Responsibilities
69L-30.008 Billing and Reimbursement for Expert
Medical Advisor
NOTICE
OF CHANGE
Notice
is hereby given that the following changes have been made to the proposed rule
in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 41 No.
57, March 24, 2015 issue of the Florida Administrative Register.
The changes to the proposed rules
are made in response to comments submitted by the staff of the Joint
Administrative Procedures Committee. The proposed rules include certain
technical changes and clarifications. The changes are as follows:
69L-30.002
Definitions.
For purposes of this rule chapter
the following definitions apply:
(1) No change.
(2) “Board eligible” or “board
eligibility” means the physician has been determined eligible to take the
board certification examination recognized by one or more of
the applicable national specialty boards recognized by the State of
Florida Department of Health board as eligible to take the board
certification examination.
(3) “Department List of Certified
Expert Medical Advisors” (hereinafter “Certification List”) is the electronic
list of physicians approved as Expert Medical Advisors.
(4) “Expert Medical Advisor”
(hereinafter “EMA”) is a physician certified by the Department to render peer
review or expert medical consultation, opinions and testimony, within the advisor’s
specialty area, 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) “Expert Medical Advisor
Certification” (hereinafter “EMA Certification”) is the application process
through which
a physician must demonstrate eligibility by submitting the required information
and documentation and satisfactorily completing the online EMA Tutorial
to be approved to render expert medical opinions regarding medical
services provided under Chapter 440, F.S.
(6) “DWC Expert Medical Advisor
Certification Portal,” eff. 01/01/2016 (hereinafter “DWC EMA Website”) is accessible
at 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) “EMA Certificate” is the written
documentation issued by the Department authorizing a physician to perform EMA
services pursuant to Section 440.13, F.S.
(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 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) “Examination” means an
Independent Medical Examination as defined in paragraph 440.13(1)(i), F, S.
(10) “Physician” is as defined in
paragraph 440.13(1)(p), F.S.
(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 their
statutory responsibilities under Chapter 440, F.S. PROPOSED EFFECTIVE
DATE: March 1, 2016
69L-30.003
Qualifications for Expert Medical Advisor Certification and Re-Certification.
(1) To be certified as an EMA Expert
Medical Advisor, a physician shall meet the following qualifications:
(a)(1) Must have correctly answered 95%
of the EMA Tutorial review questions been
certified as a health care provider by
the Department pursuant Chapter 69L-29, F.A.C., for a period of no less than
twelve months prior to the date of the Expert Medical Advisor application;
and
(b)(2) Must hold valid licensure, issued
by the Florida Department of Health, with “clear and active” status; and
(c)(3) Must demonstrate hold
specialty-board certification or specialty-board eligibility
applicable to the specialty for which the applicant seeks certification by
submitting proof of current certification or eligibility. If the
applicable national-specialty board does not recognize “board eligible” or
“board eligibility” status, the applicant must hold board certification for the
specialty; and
(d)(4) Must demonstrate experience in the
assignment of permanent impairment ratings greater than zero (0%) to
Florida’s injured employees, pursuant to Rule 69L-7.604, F.A.C., within the
two-year period immediately preceding the date of application by submitting
a minimum of two (2) copies of a completed DFS-F5-DWC-25, Florida
Workers’ Compensation Uniform Medical Treatment/Status Reporting Form, as
incorporated in Rule 69L-7.710(2)(d), F.A.C., assigning a permanent impairment
rating; and
(e)(5) Must demonstrate experience in
performing Independent Medical Examinations independent medical
examinations pursuant to subsections 440.13(2) or 440.13(5), F.S., by submitting
a minimum of two (2) copies of a completed Independent Medical Examination
reports for a determination of the appropriateness of medical treatment being
recommended or provided to an injured employee or for a determination of the
injured employee’s disability and physical limitations, within the two-year
period immediately preceding the date of application; and
(f)(6) Must have completed twenty hours of
continuing medical education (CME),
specifically related to the physician’s practitioner’s field of
specialty, within the two-year period immediately preceding the date of application.
Proof of required CMEs must be provided at time of application.
Completion of courses required for licensure by the Florida Department of
Health addressing Domestic Violence, HIV-AIDS and Prevention of Medical Errors
will not be applied to the medical continuing education requirements for EMA Certification.
Expert Medical Advisor certification; and
(7) Must possess knowledge of the
Florida Statutes related to workers’ compensation, specifically Sections
440.02, 440.09, 440.093, 440.102, 440.105, 440.13, 440.134, 440.15(3),
440.15(5), 440.151, 440.20 and 440.491; and possess knowledge of the Florida Administrative Code
Rules 69L-7.602 and 69L-7.020 related to workers’ compensation.
(2) A physician who has performed services as a Temporary EMA for either a JCC or the Department within the two-year period immediately
preceding the date of application for certification shall not be required to
meet the requirements of subparagraphs (1) (d) and (e) of this rule.
(3) An EMA applying for renewal
prior to or no more than 90 days after the expiration of the EMA’s most current
certification period shall not be required to meet the requirement of
subparagraph (1) (a) of this rule.
(4) A physician who, pursuant to a
final order, has been found to have engaged in standard of care or billing
violations pursuant to subsections 440.13(8) and (13), F.S., shall not be
certified as an EMA.
PROPOSED EFFECTIVE DATE: March 1, 2016
69L-30.004
Application Process for Expert Medical Advisor Certification.
(1) A physician shall apply for Expert
Medical Advisor 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 Rule 69L-30.002(6), F.A.C submitting a signed, legible and
accurately completed Expert Medical Advisor Certification Application,
DFS Form 3160-0021, to the following address: Division of Workers’ Compensation,
Office of Medical Services, c/o Department of Financial Services, 200 E. Gaines
Street, Tallahassee, FL 32399-4232. The Expert Medical Advisor
Certification Application, DFS Form 3160-0021, revised May 2006, is
incorporated by reference into Chapter 69L-30, F.A.C., and may be obtained from
the Office of Medical Services, c/o Department of Financial Services,
Division of Workers’ Compensation’s website: www.myfloridacfo.com/wc/forms.html#7.
(2) As part of the EMA Expert
Medical Advisor certification application process, the physician shall agree to provide
consultation or services in accordance with the timetables set forth in Chapter
440, F.S., and abide by rules adopted by the Department may appoint a
physician including, but not limited to, rules pertaining to procedures for
review of the services rendered by health care providers and preparation of
reports and testimony or recommendations for submission to the Department or
JCC judge of compensation claims.
(3) The certification application
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 EMA Website accompanied
by the following the required documentation, establish
that the qualifications for Expert Medical Advisor certification as
set forth in Rule 69L-30.003, F.A.C., have been met 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.
(a) To document specialty-board
certification or specialty-board eligibility, the applicant must submit a copy
of a current certificate of national specialty-board certification or written
proof of specialty-board eligibility and documentation that indicates any
expiration date for specialty-board certification or specialty-board
eligibility applicable to the specialty for which the applicant seeks
certification.
(b) To demonstrate experience in the
assignment of permanent impairment ratings to Florida’s injured employees, pursuant to Rule
69L-7.604, F.A.C., the applicant must submit five completed DFS-F5-DWC-25 forms
(with all patient identification redacted) indicating assignment of the date
of maximum medical improvement and calculation of the permanent
impairment rating for injured employee evaluations completed within the
two-year period immediately preceding the date of application; and
(c) To demonstrate experience in
performing independent medical examinations pursuant to Section 440.13(2) or 440.13(5), F.S., the
applicant must submit copies of five independent medical examination reports
(with all patient identification redacted) written for workers’ compensation
injured employees within the two-year period immediately preceding the date of
application; and
(d) To demonstrate completion of
twenty hours of continuing medical education specifically related to the practitioner’s field of
specialty, the applicant must submit copies of certificates of completion for
twenty hours of continuing medical education, related to the specialty
field of practice, completed within the two-year period immediately
preceding the date of application. Certificates for courses required for licensure
by the Florida Department of Health addressing Domestic Violence,
HIV-AIDS and Prevention of Medical Errors will not be applied to the
medical education requirements for Expert Medical Advisor certification; and
(4) Successful applicants shall
receive an electronically generated EMA Certificate issued by the Department’s
Division of Workers’ Compensation. To demonstrate knowledge of
Florida Workers’ Compensation, the physician must attest to knowledge of
the Florida Statutes related to workers’ compensation, specifically Sections
440.02, 440.09, 440.093, 440.102, 440.105, 440.13, 440.134, 440.15(3),
440.15(5), 440.151, 440.20 and 440.491, F.S.; and knowledge of the
Florida Administrative Code Rules 69L-7.602 and 69L-7.020. If an Expert Medical
Advisor applicant is not otherwise familiar with the statutes and rules
identified above, he/she may attest to familiarity with those rules and
statutes upon completion of the Workers’ Compensation Health Care Provider
Educational Tutorial available on the Department of Financial Services,
Division of Workers’ Compensation’s website: www.myfloridacfo.com/wc.
(5) Upon issuance of the EMA Certificate, the following provider information will
be recorded on the Certification List:
(a) Certificate expiration date;
(b) First
and Last Name;
(c) DOH
license number and licensure status;
(d)
Place of business, name, address(es) and telephone number(s); and
(e)
Specialty board affiliation(s) and sub-specialty(ies) and certification status.
(6)(5)The Department shall deny applications
that do not meet the minimum requirements set forth in Rule 69L-30.003,
F.A.C. will review the Expert Medical Advisor certification
application, pursuant to the requirements of Section 120.60, Florida
Statutes, and notify the
applicant of any deficiencies. If the Department does not
receive, within 30-calendar days of the applicant’s receipt of notice of
deficiencies, information curing all deficiencies identified by
the Department, of deficiencies, the Expert Medical
Advisor Certification Application will be denied.
(6) Throughout the certification
period, the Expert Medical Advisor shall notify the Department:
(a) If specialty-board certification
has expired.
(b) If Florida Department of Health
license status is changed from “clear and active.”
(c) Of any change in address or
contact information.
(7) Expert
Medical Advisor Certifications shall be for a period of two years.
If at any time during the certification period, the physician no longer meets
all qualifications for Expert Medical Advisor certification, the EMA
Expert Medical Advisor certification shall be decertified and
removed from the Certification List revoked.
(8) An EMA who fails to obtain
certification renewal before the expiration of the two year certification
period is ineligible to perform EMA services and will be removed from the
Certification List until such time as the EMA re-applies and his/her re-certification is approved.
PROPOSED EFFECTIVE DATE: March 1, 2016
69L-30.005
Selection of Expert Medical Advisors.
(1) All individuals on the
Certification List are eligible contracted to provide EMA services
for through certification as an Expert Medical Advisor will be
placed on an Department list of certified Expert Medical Advisors eligible
for selection as an Expert Medical Advisor by the Department or a JCC
judge of compensation claims.
(2) When Expert Medical Advisor
services are needed by the Department, the Department shall:
(a) Select an EMA Expert Medical Advisor from the Certification List
Department’s list of certified Expert Medical Advisors; and
(b) Make the necessary arrangements
for the EMA Expert Medical Advisor to provide the Expert Medical Advisor
services.
(3) When Expert Medical Advisor
services are needed in a proceeding before a JCC judge of
compensation claims, the JCC judge of compensation claims
shall:
(a) Select an EMA Expert
Medical Advisor from the Certification List Department’s list
of certified Expert Medical; and
(b) Make the necessary arrangements
for the EMA Expert Medical Advisor
to provide the Expert Medical Advisor services.
(4) Upon receiving notice of
selection by the Department or JCC judge of compensation claims as an
Expert Medical Advisor, the EMA physician shall
disclose any conflict of interest related to the case for which the physician
was selected and shall decline selection if a conflict of interest,
pursuant to Rule 69L-30.007, F.A.C., exists as an Expert Medical Advisor.
(5) A physician who has been disciplined for a violation decertified
pursuant to Section 440.13, F.S. Chapter 69L-29, F.A.C.,
and/or has ever been decertified pursuant to Rule 69L-30.010, F.A.C., or
who, pursuant to a final order, has been found to have violated Chapter
440, F.S., shall not be certified as an
EMA Expert Medical Advisor.
PROPOSED EFFECTIVE DATE: March 1, 2016
69L-30.006
Temporary Expert Medical Advisors.
(1) When a JCC judge of
compensation claims cannot identify an EMA needs Expert Medical
Advisor services and there is no Expert Medical Advisor from the
physicians on the Certification List
Department’s list of certified Expert Medical Advisor who meets
the needs of the judge of compensation claims and is available to
provide the Expert Medical Advisor services needed, the JCC judge
of compensation claims may propose a specific physician for temporary Expert
Medical Advisor certification by the Department.
(2) The Department will certify the specific
physician proposed by the JCC judge of compensation claims as a
Temporary EMA for a specific case, Expert Medical Advisor if one
of the following is met:
(a) All parties in a proceeding
before the JCC judge of compensation claims stipulate to the
qualifications of the medical specialty-board certified or board
eligible physician to provide Expert Medical Advisor services in the
JCC judge of compensation claims proceeding; or
(b) The physician has a clear
valid and active license to practice medicine, has medical specialty-board
certification or is board eligible, and the JCC judge of
compensation claims has established that the physician has training or
experience applicable to the specific medical issue before the JCC judge
of compensation claims.
(3) Certification as a temporary
Expert Medical Advisor shall be limited to the specific case for which the
judge of
compensation claims proposed the physician for temporary Expert Medical Advisor
certification.
(3)(4) A physician who has been disciplined
for a violation decertified pursuant
to Section 440.13, F.S., Chapter 69L-29, F.A.C., and/or has ever been
decertified to Rule 69L-30.010, F.A.C.,
shall not be certified as a Temporary EMA Expert Medical Advisor.
(4)(5) Upon receiving notice of selection
by the JCC judge of compensation claims as a Temporary EMA Expert Medical Advisor, 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 Expert Medical Advisor.
(5) When the Department needs EMA
services and there is no EMA on the Certification List who meets the needs of the Department or who
is available to provide the EMA services needed, the Department may certify a
physician as a Temporary EMA, for a specific case, if the physician:
(a) Holds a clear active medical
license or a valid Florida medical school teaching certificate pursuant to Sections 458.3145, 459.0077,
463.0057 or 466.002, F.S.; and
(b) Holds board certification or is
board eligible in the specialty area needed by the Department to fulfill its
responsibilities under subsections 440.13(9) and (11), F. S.
(6) Upon receiving notice of
selection by the Department 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, if a
conflict of interest, pursuant to Rule 69L-30.007, F.A.C., exists.
(7) Any physician certified as a
Temporary EMA shall have the same duties and responsibilities under this rule
chapter as a certified EMA.
PROPOSED EFFECTIVE DATE: March 1,
2016
69L-30.007 Expert Medical Advisor
Responsibilities.
(1) A physician shall disclose any
conflict of interest upon receiving notice of selection as an EMA or Temporary
EMA Expert Medical Advisor and shall not accept selection if a
conflict of interest exists. For the purposes of this rule, “conflict of
interest” means that any of the following matters may exist, potentially
influencing the EMA’s Expert Medical Advisor’s opinions and
decisions while fulfilling responsibilities to evaluate the medical care
provided the injured employee by the examining physician:
(a) through (b) 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 days of the change. EMAs may
notify the Department by updating their profiles through the DWC EMA
Website at www.myfloridacfo.com/division/wc/provider.html, or by
emailing the Department at workers.compmedservice@myfloridacfo.com. 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)(2) When the JCC judge of compensation claims
selects an EMA or Temporary EMA Expert Medical Advisor,
the EMA or Temporary EMA Expert
Medical Advisor shall complete and submit a written report to the JCC
judge of compensation claims within
15 calendar days following receipt of all medical records and, when appropriate,
the examination of the injured employee. The medical records to which may be submitted to an Expert
Medical Advisor shall be within the discretion of the JCC judge
of compensation claims.
(4)(3) When the Department selects an EMA
or Temporary EMA Expert Medical Advisor and provides the complete
medical record for the treatment under review, the EMA or Temporary EMA
Expert Medical Advisor shall complete and submit a written report to the
Department within 15 calendar days 15-calendar days following
receipt of all medical records. Should an EMA find it necessary to perform
an examination of the injured employee, the EMA’s written report shall be
submitted to the Department within 15 calendar days following the completion of
such examination.
(5)(4) The EMA
or Temporary EMA Expert
Medical Advisor shall furnish a copy of the written report to the insurer
and to the injured employee pursuant to paragraph Section
440.13(9)(d), F.S.
PROPOSED EFFECTIVE DATE: March 1, 2016
69L-30.008
Billing and Reimbursement for Expert Medical Advisor Services.
(1) Within 30 calendar days
following submittal completion of the written report, the EMA physician must submit billing,
per the contract with the Department or JCC, for Expert Medical Advisor
services on the Department approved or judge of compensation claims approved
invoice, as applicable, documenting total number of hours and total dollar
charges for the contracted services.
(2) In a judge of compensation
claims proceeding, If additional diagnostic testing is required for the EMA Expert Medical Advisor to render a
medical opinion, charges for diagnostic testing shall:
(a) Require prior authorization from
the JCC judge of compensation claims or of the Department; and
(b) Be billed in accordance with
Rule 69L-7.710 69L-7.602, F.A.C.; and
(c) No change.
(3) Within 45 calendar days from
receipt of both the Expert Medical Advisor’s copy of the written report
and invoice, reimbursement shall be rendered to the EMA Expert Medical Advisor pursuant to paragraph Section 440.13(9)(f), F.S.
(4) Hourly reimbursement for EMA Expert Medical Advisor services
shall be include reimbursement for all services rendered
except specialty-diagnostic testing.
(5) Reimbursement for Expert
Medical Advisor services, pursuant to an EMA
Expert Medical Advisor Contract, in accordance with subsections
69L-30.005(2) and (3), F.A.C., shall be as follows:
(a) Except as provided in paragraph
(b), For an Expert Medical Advisor selected by the Department pursuant to
subsection 69L-30.005(2), F.A.C., reimbursement for shall not exceed
$300.00 $200.00 per hour,
for no more than 8 hours per case, not including reasonable expenses
associated with travel, when applicable, which will be reimbursed in accordance
with Section 112.061 112.081, F.S. The review shall not exceed
8 hours per case unless specifically approved in writing by the
Department or JCC, as applicable.
(b) When
an examination of an injured employee is required for the EMA to render a
medical opinion, charges for an examination shall:
1. Require prior authorization from
the requesting party;
2. Be billed in accordance with Rule
69L-7.710, F.A.C.; and
3. Be reimbursed in accordance with
the appropriate Florida Division of Workers’ Compensation reimbursement manual in effect
on the date services were rendered. For an Expert Medical Advisor
selected by a judge of compensation claims pursuant to subsection
69L-30.005(3), F.A.C., reimbursement shall not exceed $300.00 per hour, nor
more than 8 hours per case, not including reasonable expenses associated with
travel, when applicable, which will be reimbursed in accordance with Section
112.081, F.S.
(c) An EMA shall be reimbursed for
travel and other administrative expenses consistent with the terms of the contract between the EMA and the
Department.
(d) Fees for EMA deposition
testimony are limited to $200 per hour, pursuant to subsection 440.13(10), F.S.
PROPOSED EFFECTIVE DATE: March 1, 2016
69L-30.010 Expert Medical Advisor
Decertification.
(1) An EMA Expert Medical Advisor shall be decertified and
removed from the Certification List for any one of the following:
(a) Pursuant to a final order,
the EMA physician was found to
have engaged in a standard of care or billing violation under subsections
440.13, (8) and (13), F.S.; or removed
from the list of physicians authorized to provide services to workers’
compensation injured employees.
(b) The EMA physician fails to report a conflict of interest and
decline selection in a case assignment as required in Rule 69L-30.004, F.A.C.; or
(c) The EMA no longer meets the criteria
for EMA status pursuant to Rule 69L-30.003, F.A.C.
(2) An EMA If an
Expert Medical Advisor is decertified by the Department, for
any reason other than that described in (1)(c) above, the
physician shall not be eligible for re-certification certification
as an EMA Expert Medical Advisor in
the future.
PROPOSED EFFECTIVE DATE: March 1, 2016
The remainder of the proposed rule reads as previously published.
