STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

ALPHA HOUSE OF TAMPA, INC., )

)

Petitioner, )

)

vs. ) CASE NO. 95-5675

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

A hearing was held in this case by telephone conference call on March 14, 1996, before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Lynette M. Wenner, Esquire

Gillick & Wenner

100 North Tampa Street, Suite 2675 Tampa, Florida 33602

For Respondent: Gordon B. Scott, Esquire

Agency for Health Care Administration 2727 Mahan Drive, Ft. Knox Number 3 Tallahassee, Florida 32308-5403

STATEMENT OF THE ISSUE

The issue for consideration in this hearing was whether the Agency for Health Care Administration should cancel Petitioner's Medicaid provider number for the reasons set out in its letter of October 1, 1995, as amended.

PRELIMINARY STATEMENT

By letter dated October 1, 1995, Gary Crayton, the Agency for Health Care Administration's Director of Medicaid, advised Alpha House of Tampa, Inc., (Alpha), of the cancellation of its Medicaid provider number effective that date because Alpha did not have a contract with the Department of Health and Rehabilitative Services' Alcohol, Drug and Mental Health Services, (ADM), program office. By letter dated October 16, 1995, Alpha was advised the provider number would not be cancelled until 30 days from that date.

Thereafter, on October 25, 1995, Alpha requested formal hearing and this hearing ensued.

At the hearing, both parties presented the testimony of Francis C. Powers, Alpha's Executive Director. The Agency introduced Agency Exhibits 1 and 2, and Alpha introduced Alpha Exhibits A and B.

A transcript of the proceedings was furnished and subsequent to the receipt thereof by the Hearing Officer, only counsel for the Respondent submitted Proposed Findings of Fact, which proposed findings have been accepted and are incorporated in this Recommended Order. Counsel for Petitioner submitted its written argument in support of its request to extend or reinstate its participation in the Medicaid program which, though not containing specific Proposed Findings of Fact requiring ruling, was thoroughly reviewed by the undersigned and carefully considered in the preparation of this Recommended Order.

FINDINGS OF FACT

1. Petitioner, Alpha House of Tampa, Inc., is a provider of community mental health services. Its programs deal with all pregnant women and include several which pertain to drugs, alcohol and mental health. These services provided to pregnant woman at Alpha are unique to Hillsborough County because of Alpha's ability to provide residential programs as opposed to merely the day treatment programs offered at other facilities.

   
   

2. In March, 1993, Alpha started billing Medicaid for the services it provided to Medicaid qualified patients. At the time, Francis C. Powers, Alpha's Executive Director, telephonically contacted the Medicaid fiscal agent's office and asked what she needed to do in order for Alpha to be declared eligible for Medicaid reimbursements. She was never told it was necessary for Alpha to have a written contract with the ADM, (alcohol, drug and mental health), office. Because of that, Ms. Powers concluded the routine provider agreement Alpha had with Medicaid, entered into on March 13, 1993, was enough.

   
   

3. In that regard, Alpha received two letters, both dated March 13, 1993, from the Department of Health and Rehabilitative Services. One was from Gary Clarke, Assistant Secretary for Medicaid, and the other was from Consultec, Inc., the Medicaid fiscal agent for the Department. Both letters welcomed Alpha House to the Florida Medicaid program and neither indicated any need for additional contracts with ADM in order to bill Medicaid for services rendered.

   
   

4. As a result of the income derived from Medicaid services Alpha has provided and for which it has been reimbursed, Alpha was able to employ additional staff to provide more comprehensive programs. In 1995 Alpha received

   $133,918 in reimbursement funds, which equals approximately 18 percent of its annual budget. As a result of the loss of Medicaid funds proposed as a result of the termination of the instant reimbursement, Alpha will have to eliminate the drug and alcohol residential treatment program for 33 residents who will now have to get their drug and alcohol treatment at day treatment centers. Alpha personnel anticipate that because this treatment may not be sought and received, these residents will have low weight babies with potential medical problems, all at an added dollar cost to the community.

   
   

5. Paragraphs 8 and 9 of the Medicaid Provider Agreement Alpha signed on March 13, 1993 provide:

   
   

   1. The provider and the Department agree to abide by the Florida Administrative Code, Florida Statutes, policies, procedures, manuals of the Florida Medicaid Program and Federal laws and regulations.

   2. The agreement may be terminated upon thirty days written notice by either party.

      The Department may terminate this agreement

      in accordance with Chapter 120, Florida Statutes.

      
      

6. Petitioner has, in the past, billed Medicaid for mental health services provided and has been paid in response to those billings. It does not now have, nor has it had in the past, a contract with the Department of Health and Rehabilitative Services' Alcohol, Drug Abuse and Mental Health office to provide ADM services to its residents.

   
   

   CONCLUSIONS OF LAW

   
   

7. The Division of Administrative Hearings has jurisdiction over the parties and the subject matter in this case. Section 120.57(1), Florida Statutes.

   
   

8. Effective July 1, 1993, Section 58, Chapter 93-129, Laws of Florida transferred to the Agency for Health care Administration:

   
   

   [a]ll powers, duties and functions, records, personnel, property and unexpended balances

   of appropriations, allocations, or other funds of the Medicaid program within the Department of Health and Rehabilitative Services, as well as the infrastructure and support services that support the program, including, but not limited to, investigative, licensing, legal, and administrative activities.

   
   

9. Included within the authority transferred to the Agency was the authority to regulate provider enrollment in the Medicaid program.

   
   

10. Section 409.907, Florida Statutes, mandates providers enter into a provider agreement which requires, inter alia, the provider "comply fully with all state and Federal laws pertaining to the Medicaid program." Petitioner entered such an agreement with the Department on March 12, 1993, and the Agency, successor to the Department in the agreement, seeks now to terminate it because the Petitioner does not have a contract with the ADM office.

    
    

11. Section 409.906(8), Florida Statutes, permits Medicaid payments to providers "for rehabilitative services provided to a recipient in a mental health, drug abuse, or alcohol abuse center ... which are psychiatric in nature and rendered or recommended by a psychiatrist" and only if the provider of such services "is under contract to the Department of Health and Rehabilitative Services" to do so. Alpha House does not have such a contract with the Department, through its ADM Program office, to provide such services.

    
    

12. Consequently, the proposed termination of Alpha House of Tampa, Inc.'s provider agreement and provider number is legally appropriate.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Agency for Health Care Administration enter a Final

Order in this case cancelling Alpha House of Tampa, Inc.'s Medicaid provider number 0299588-00.

DONE and ENTERED this 26th day of April, 1996, in Tallahassee, Florida.

ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 26th day of April, 1996.

COPIES FURNISHED:

Lynette M. Wenner, Esquire Gillick & Wenner

100 North Tampa Street, Suite 2675 Tampa, Florida 33602

Gordon B. Scott, Esquire Agency for Health Care

Administration 2727 Mahan Drive

Ft. Knox Building Number 3 Tallahassee, Florida 32308-5403

Sam Power Agency Clerk

Agency for Health Care Administration

Ft. Knox Building Number 3, Suite 3431 2727 Mahan Drive

Tallahassee, Florida 32308

Jerome W. Hoffman General Counsel

Agency for Health Care Administration

Ft. Knox Building Number 3 Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions to the Recommended Order. All agencies allow each party at least 10 days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should consult with the agency that will issue the Final Order in this case concerning their rules on the deadline for filing exceptions to this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the Final Order in this case.

Docket for Case No: 95-005675

Orders for Case No: 95-005675