Fla. Admin. Code R. 59H-1.014

Current through Reg. 50, No. 235-239, December 10, 2024

Section 59H-1.014 - Utilization Review

(1) Hospitals shall follow utilization review procedures established under the approved hospital utilization review plan for Medicaid.

(2) Disputes between counties and hospitals over the appropriateness of an admission, length of stay, and medical necessity of the services provided may be resolved pursuant to Chapter 120, F.S., or in lieu of an appeal under Chapter 120, F.S., appealed to the federally designated Utilization and Quality Control Peer Review Organization (PRO) for resolution. Both parties must agree voluntarily to take an appeal to the PRO; that the decision of the PRO is binding on the county and hospital; and that no appeal shall be taken pursuant to Chapter 120, F.S.

(3) The county and the hospital shall share equally in the costs incurred by the PRO in resolving such disputes.

Fla. Admin. Code Ann. R. 59H-1.014

Rulemaking Authority 154.3105 FS. Law Implemented 154.306 FS.

New 3-29-89, Formerly 10C-26.014.