Florida Regulations 59H-1.014: Utilization Review
Current as of: 2024 | Check for updates
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(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 Florida Statutes Chapter 120, or in lieu of an appeal under Florida Statutes Chapter 120, 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 Florida Statutes Chapter 120
(3) The county and the hospital shall share equally in the costs incurred by the PRO in resolving such disputes.
Rulemaking Authority 154.3105 FS. Law Implemented Florida Statutes § 154.306. History-New 3-29-89, Formerly 10C-26.014.
Terms Used In Florida Regulations 59H-1.014
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
(3) The county and the hospital shall share equally in the costs incurred by the PRO in resolving such disputes.
Rulemaking Authority 154.3105 FS. Law Implemented Florida Statutes § 154.306. History-New 3-29-89, Formerly 10C-26.014.