Fla. Admin. Code Ann. R. 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.
Notes
Rulemaking Authority 154.3105 FS. Law Implemented 154.306 FS.
New 3-29-89, Formerly 10C-26.014.
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