69L-30. Expert Medical Advisors

69L-30.002 Definitions.

For purposes of this rule the following definitions apply:

(1) “Board certification” or “board certified” means the physician has been awarded board certification or diplomate status by the American Board of Medical Specialties, American Board of Internal Medicine, American Board of Physician Specialties, American Osteopathic Association, American Board of General Dentistry, American Board of Podiatric Orthopedics and Primary Podiatric Medicine, American Board of Podiatric Surgery, American Chiropractic Rehabilitation Board, American Chiropractic Neurology Board, American Board of Chiropractic Internists, American Chiropractic Board of Nutrition, American Chiropractic Board of Occupational Health, American Board of Chiropractic Orthopedists, American Board of Chiropractic Radiology, or American Chiropractic Board of Sports Physicians.

(2) “Board eligible” or “board eligibility” means the physician has been recognized by the applicable national-specialty board as eligible to take the board certification examination.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.002, Amended 10-11-06, Formerly 59A-30.002.

69L-30.003 Qualifications for Expert Medical Advisor Certification.

To be certified as an Expert Medical Advisor, a physician shall meet the following qualifications:

(1) Must have been certified as a health care provider by the Department pursuant to Chapter 69L-29, F.A.C., for a period of not less than twelve months prior to the date of the Expert Medical Advisor application; and

(2) Must hold valid licensure, issued by the Florida Department of Health, with “clear and active” status; and

(3) Must hold specialty-board certification or specialty-board eligibility applicable to the specialty for which the applicant seeks certification. 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

(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; and

(5) Must demonstrate experience in performing independent medical examinations pursuant to Section 440.13(2) or 440.13(5), Florida Statutes, within the two-year period immediately preceding the date of application; and

(6) Must have completed twenty hours of continuing medical education, specifically related to the practitioner’s field of specialty, within the two-year period immediately preceding the date 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 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.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Amended 6-8-95, Formerly 38F-54.003, Amended 10-11-06, Formerly 59A-30.003.

69L-30.004 Application for Expert Medical Advisor Certification.

(1) A physician shall apply for Expert Medical Advisor certification by 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 Expert Medical Advisor certification application, 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, 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 judge of compensation claims.

(3) The application shall be accompanied by the following documentation to establish that the qualifications for Expert Medical Advisor certification set forth in Rule 69L-30.003, F.A.C., have been met:

(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 greater than zero (0%) 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) 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) The Department 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 in the application submitted. 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, 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.”

(7) Expert Medical Advisor certification 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 Expert Medical Advisor certification shall be revoked.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.004, Amended 10-11-06, Formerly 59A-30.004.

69L-30.005 Selection of Expert Medical Advisors.

(1) All individuals contracted to provide services 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 judge of compensation claims.

(2) When Expert Medical Advisor services are needed by the Department, the Department shall:

(a) Select an Expert Medical Advisor from the Department’s list of certified Expert Medical Advisors; and

(b) Make the necessary arrangements for the Expert Medical Advisor to provide the Expert Medical Advisor services.

(3) When Expert Medical Advisor services are needed in a proceeding before a judge of compensation claims, the judge of compensation claims shall:

(a) Select an Expert Medical Advisor from the Department’s list of certified Expert Medical Advisors; and

(b) Make the necessary arrangements for the Expert Medical Advisor to provide the Expert Medical Advisor services.

(4) Upon receiving notice of selection by the Department or judge of compensation claims as an 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 an Expert Medical Advisor.

(5) A physician who has been decertified pursuant to Chapter 69L-29, F.A.C., and/or has ever been decertified pursuant to Rule 69L-30.010, F.A.C., shall not be certified as an Expert Medical Advisor.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.005, Amended 10-11-06, Formerly 59A-30.005.

69L-30.006 Temporary Expert Medical Advisors.

(1) When a judge of compensation claims needs Expert Medical Advisor services and there is no Expert Medical Advisor on the Department’s list of certified Expert Medical Advisors who meets the needs of the judge of compensation claims and is available to provide the Expert Medical Advisor services needed, the 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 judge of compensation claims as a temporary Expert Medical Advisor if one of the following is met:

(a) All parties in a proceeding before the judge of compensation claims stipulate to the qualifications of the medical specialty-board certified physician to provide Expert Medical Advisor services in the judge of compensation claims proceeding; or

(b) The physician has a valid and active license to practice medicine, has medical specialty-board certification and the judge of compensation claims has established that the physician has training or experience applicable to the specific medical issue before the 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.

(4) A physician who has been decertified pursuant to Chapter 69L-29, F.A.C., and/or has ever been decertified pursuant to Rule 69L-30.010, F.A.C., shall not be certified as a temporary Expert Medical Advisor.

(5) Upon receiving notice of selection by the judge of compensation claims as a temporary 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 Expert Medical Advisor.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.006, Amended 10-11-06, Formerly 59A-30.006.

69L-30.007 Expert Medical Advisor Responsibilities.

(1) A physician shall disclose any conflict of interest upon receiving notice of selection as an 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 Expert Medical Advisor’s opinions and decisions while fulfilling responsibilities to evaluate the medical care provided the injured employee by the examining physician:

(a) Private, business, financial or ownership interests involving potential gain or benefit based on the outcome of the case; or

(b) Prior knowledge of the injured employee.

(2) When the judge of compensation claims selects an Expert Medical Advisor, the Expert Medical Advisor shall complete and submit a written report to the judge of compensation claims within 15-calendar days following receipt of all medical records and examination of the injured employee. The medical records, which may be submitted to an Expert Medical Advisor shall be within the discretion of the judge of compensation claims.

(3) When the Department selects an Expert Medical Advisor, the Expert Medical Advisor shall complete and submit a written report to the Department within 15-calendar days following receipt of all medical records.

(4) The Expert Medical Advisor shall furnish a copy of the written report to the insurer and to the injured employee pursuant to Section 440.13(9)(d), F.S.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.007, Amended 10-11-06, Formerly 59A-30.007.

69L-30.008 Billing and Reimbursement for Expert Medical Advisor Services.

(1) Within 30 calendar days following completion of the written report, the physician must submit billing 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.

(2) In a judge of compensation claims proceeding, if additional diagnostic testing is required for the Expert Medical Advisor to render a medical opinion, charges for diagnostic testing shall:

(a) Require prior authorization from the judge of compensation claims; and

(b) Be billed in accordance with Rule 69L-7.602, F.A.C.; and

(c) Be reimbursed in accordance with the appropriate Florida Workers’ Compensation reimbursement manual in effect on the date services were completed.

(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 Expert Medical Advisor pursuant to Section 440.13(9)(f), F.S.

(4) Hourly reimbursement for Expert Medical Advisor services shall include reimbursement for all services rendered except specialty-diagnostic testing.

(5) Reimbursement for Expert Medical Advisor services, pursuant to an Expert Medical Advisor Contract, shall be as follows:

(a) For an Expert Medical Advisor selected by the Department pursuant to subsection 69L-30.005(2), F.A.C., reimbursement shall not exceed $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 112.081, F.S.

(b) 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.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.008, Amended 10-11-06, Formerly 59A-30.008.

69L-30.010 Expert Medical Advisor Decertification.

(1) An Expert Medical Advisor shall be decertified for any one of the following:

(a) The physician is removed from the Department’s list of physicians authorized to provide services to workers’ compensation injured employees.

(b) The 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.

(2) If an Expert Medical Advisor is decertified by the Department, the physician shall not be eligible for certification as an Expert Medical Advisor in the future.

Specific Authority 440.13(9), 440.591 FS. Law Implemented 440.13(9) FS. History–New 1-23-95, Formerly 38F-54.010, Amended 10-11-06, Formerly 59A-30.010.