STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

LITTLE ROY TAXI SERVICE, )

)

Petitioner, )

)

vs. ) CASE NO. 95-4659

) STATE OF FLORIDA, AGENCY FOR ) HEALTH CARE ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Susan B. Kirkland, held a formal hearing in this case on November 20, 1995, in West Palm Beach, Florida, via video teleconference.

APPEARANCES

For Petitioner: Roy Richards, Pro Se

649 Southwest 3rd Street Belle Glade, Florida 33430

For Respondent: Moses E. Williams, Senior Attorney

Agency for Health Care Administration Fort Knox Building No. 3

2727 Mahan Drive

Tallahassee, Florida 32308-5403 STATEMENT OF THE ISSUES

Whether Petitioner's Medicaid Provider Number should be terminated.

PRELIMINARY STATEMENT

By letter dated August 19, 1995, Respondent, Agency for Health Care Administration (AHCA) advised Petitioner, Roy Richards, Little Roy Taxi (Richards), that his Medicaid transportation provider number was being terminated for failure to successfully comply with the re-enrollment process. Petitioner requested an administrative hearing and the case was forwarded to the Division of Administrative Hearings on September 20, 1995, for assignment to a Hearing Officer.

At the final hearing Petitioner testified in his own behalf. Respondent called Bette Hickey and Carol Portz as its witnesses. Joint Exhibits 1-5 were admitted in evidence.

No transcript was ordered. The parties agreed to file proposed findings of fact and conclusions of law on or before November 30, 1995. Petitioner did not

file a proposed recommended order. Respondent filed a proposed recommended order on November 27, 1995. Respondent's proposed findings of fact are addressed in the Appendix to this Recommended Order.

FINDINGS OF FACT

1. Petitioner, Little Roy Taxi Service (Richards), formerly known as Roy Richards, Cotton Club Taxi, received a Medicaid transportation provider number in May, 1993.

   
   

2. Respondent, Agency for Health Care Administration (AHCA) is the state agency responsible for administering the Florida Medicaid program.

   
   

3. By letter dated April 11, 1995, Respondent, Agency for Health Care Administration (AHCA), advised Richards that Medicaid Transportation Services was in the process of becoming a part of the coordinated transportation disadvantaged program in Palm Beach County. Richards was advised that under the coordinated system, the operators of the transportation services would have to meet certain insurance, licensing, safety inspection, and driver drug-testing requirements.

   
   

4. By certified letter dated May 11, 1995, AHCA notified Richards that he must enroll as a Medicaid provider in order to maintain his eligibility to participate in the Medicaid program. In order to re-enroll, Richards had to provide the following documents within 30 days of his receipt of the letter:

   
   

   1. A completed, signed and dated application.

   2. A signed and dated Non-Institutional Agreement.

   3. Proof of insurance coverage of at least

      $100,000 per person and $300,000 per incident for all vehicles, whether owned by your company or subcontracted by you.

   4. Copies of current state, county, and municipal licensing documents for each vehicle and driver for all cities, counties, and towns in which you will provide "pick-up" services.

      
      

      Blank copies of the application and Non-Institutional Agreement were attached to the letter. The receipts for the certified mail indicate that the May 11, 1995, letter was mailed to Richards on June 20, 1995, and delivered to him on June 21, 1995. In the meantime, Richards had informed AHCA that he had not received his re-enrollment package. A duplicate package was sent to him. He received it on June 29, 1995.

      
      

   5. The re-enrollment application was due back to AHCA on July 29, 1995.

      
      

   6. By August 19, 1995, Richards had failed to submit the re-enrollment application. By letters dated August 19, 1995, AHCA notified Richards that his Medicaid transportation provider number was being terminated due to his failure to respond to the re-enrollment request for documents. Additionally, AHCA advised Richards that there was a moratorium in Palm Beach County for accepting and processing new applications to become a Medicaid transportation provider and that because he failed to timely re-enroll, he would be considered a new provider regarding future applications. The letters were mailed to Richards on August 21, 1995, and received by Richards on August 22, 1995.

   7. On August 21, 1995, Richards delivered his Florida Medicaid Provider Enrollment Application to AHCA. At the time that he delivered the application, he noticed on the desk of one of AHCA's employees the letter informing him that his provider number was being terminated.

      
      

   8. The documentation of insurance coverage which Richard supplied with his application showed that his insurance coverage was for $50,000 per person and

      $100,000 per occurrence. The coverage did not meet the minimum insurance coverage requirements for re-enrollment.

      
      

   9. Copies of current state licensing documents for each vehicle and driver were not included with the application.

      
      

   10. Richards admits that his application was filed late. He attributes the failure to file on time to a number of factors. In March, 1995, his taxi was involved in an accident. His mother was taken ill, and he had to go to Jamaica to take care of her. His sister became ill and died. He lost the envelope containing the materials needed to submit with the application.

       
       

       CONCLUSIONS OF LAW

       
       

   11. The Division of Administrative Hearings has jurisdiction over the subject matter of and the parties to this proceeding. Section 120.57(1), Florida Statutes.

       
       

   12. As it relates to this proceeding, Section 409.907(7), Florida Statutes, provides:

       
       

       Each provider agreement shall be a voluntary contract between the department and the provider, in which the provider agrees to comply with all laws and rules pertaining to the Medicaid program when furnishing a service or goods to a Medicaid recipient and the department agrees to pay a sum, determined by fee schedule, payment methodology, or other manner, for the service or goods provided

       to the Medicaid recipient. Each provider agreement shall be effective for a stipulated period of time, shall be terminable by either party after reasonable notice, and shall be renewable by mutual consent.

       
       

   13. AHCA notified Richards that he would have to re-enroll as a Medicaid provider because the Medicaid transportation services were going to be coordinated through the local community transportation coordinator. He was later provided with the application for re-enrollment, a Non-Institutional Agreement to sign, and directions for providing proof of a specified amount of insurance and for providing copies of current licensing documents. AHCA advised Richards that failure to complete and return the application within 30 days of receipt of the letter transmitting the application to him would result in his disenrollment from the Medicaid program.

       
       

   14. Richards did not timely return the application and did not provide proof of sufficient insurance and all current licenses.

       
       

   15. Having failed to timely file a complete application for re-enrollment, Richards' agreement with AHCA to provide Medicaid transportation services should have been terminated.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered denying Little Roy's Taxi Service

request that its application for re-enrollment be accepted and denying Little Roy's Taxi Service's request that it be allowed to continue as a Medicaid Transportation Provider.

DONE AND ENTERED this 7th day of December, 1995, in Tallahassee, Leon County, Florida.

SUSAN B. KIRKLAND

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 7th day of December, 1995.

APPENDIX TO RECOMMENDED ORDER, CASE NO. 95-4659

To comply with the requirements of Section 120.59(2), Florida Statutes (1993), the following rulings are made on the parties' proposed findings of fact:

Petitioner's Proposed Findings of Fact.

Petitioner did not file proposed findings of fact. Respondent's Proposed Findings of Fact.

1. Paragraphs 1-6: Accepted in substance.

2. Paragraphs 7-8: Subordinate to the facts found.

COPIES FURNISHED:

Moses Williams, Esquire

Agency for Health Care Administration 2727 Mahan Drive

Fort Knox Building 3, Suite 3431

Tallahassee, Florida 32308-5403

Roy Richards, Owner/Administrator Little Roy Taxi Service

649 Southwest 3rd Street Belle Glade, Florida 33430

Sam Power, Agency Clerk

Agency for Health Care Administration Fort Knox Bldg. 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403

Jerome W. Hoffman, General Counsel Agency for Health Care Administration 2727 Mahan Drive

Tallahassee, Florida 32309

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions to this recommended order. All agencies allow each party at least ten days in which to submit written exceptions. Some agencies allow a larger period within which to submit written exceptions. You should contact the agency that will issue the final order in this case concerning agency 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: 95-004659

Orders for Case No: 95-004659