STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FOREST HILL COUNSELING CENTER, )

)

Petitioner, )

)

vs. ) CASE NO. 95-5786

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a formal hearing was conducted in this case on February 14, 1996, before Stuart M. Lerner, a duly designated Hearing Officer of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Darlene Silvernail

Forest Hill Counseling Center 2624 Forest Hill Boulevard

West Palm Beach, Florida 33406

For Respondent: Gordon B. Scott, Esquire

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

STATEMENT OF THE ISSUE

Whether Petitioner's Medicaid provider number should be cancelled for the reason stated in Respondent's October 1, 1995, letter to Petitioner?

PRELIMINARY STATEMENT

By letter dated October 1, 1995, the Agency for Health Care Administration (hereinafter referred to as the "Agency") notified Petitioner of its intention to cancel Petitioner's Medicaid provider number (3600335-00), effective immediately. The Agency explained that such action was necessary because Petitioner "does not have a contract with the [Department of Health and Rehabilitative Services] ADM [Alcohol, Drug Abuse and Mental Health] office." Petitioner requested a formal hearing on the matter. On November 29, 1995, the Agency referred the case to the Division of Administrative Hearings for the assignment of a Hearing Officer to conduct the formal hearing Petitioner had requested.

At the formal hearing, which was held on February 14, 1996, two witnesses testified: Sally Morton, an Agency employee who oversees the Agency's enrollment of Medicaid providers; and Darlene Silvernail, Petitioner's Executive Director.

In addition to the testimony of these two witnesses, a total of eight exhibits (Petitioner's Exhibits 1 through 3 and Respondent's Exhibits 1 through 5) were offered and received into evidence. At the conclusion of the evidentiary portion of the formal hearing, both Petitioner and Respondent indicated that they were waiving their right to file proposed recommended orders.

FINDINGS OF FACT

Based upon the evidence adduced at hearing, and the record as a whole, the following Findings of Fact are made:

1. Petitioner is a provider of community mental health services.

   
   

2. It provides these services to residents of Palm Beach County and the surrounding areas.

   
   

3. Some of the services it provides are unique to the area it serves.

   
   

4. Petitioner provides services to Medicaid recipients pursuant to a Medicaid provider agreement dated September 6, 1994, paragraphs 8 and 9 of which provide as follows:

   
   

   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 Depart- ment may terminate this agreement in accordance with Chapter 120, Florida Statutes.

      
      

5. Petitioner has attempted to enter into a contract with the Department of Health and Rehabilitative Services' Alcohol, Drug Abuse and Mental Health office (hereinafter referred to as "ADM"), but to date has been unable to do so because ADM has not had the money to fund such a contract.

   
   

   CONCLUSIONS OF LAW

   
   

6. Effective July 1, 1993, by operation of Section 58 of Chapter 93-129, Laws of Florida, the Agency was transferred "[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."

   
   

7. Among the powers transferred to the Agency was the authority to regulate provider enrollment in the Medicaid program.

   
   

8. Pursuant to Section 409.907, Florida Statutes, Medicaid providers must enter into a provider agreement which requires, among other things, that the provider "comply fully with all state and Federal laws pertaining to the Medicaid program."

   
   

9. Petitioner entered into such a provider agreement on September 6, 1994.

10. The Agency now seeks to terminate this agreement and cancel Petitioner's Medicaid provider number on the grounds that Petitioner does "not have a contract with the ADM office."

    
    

11. Section 409.906(8), Florida Statutes, provides that Medicaid payments may be made "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" only if the provider providing such services is "under contract to the Department of Health and Rehabilitative Services."

    
    

12. Petitioner does not have such a contract with the Department of Health and Rehabilitative Services.

    
    

13. Accordingly, the proposed termination of Petitioner's provider agreement and cancellation of its provider number is appropriate.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a Final Order be entered terminating Petitioner's provider

agreement and cancelling its provider number on the grounds that it "does not have a contract with the [Department of Health and Rehabilitative Services] ADM [Alcohol, Drug Abuse and Mental Health] office."

DONE and ENTERED this 26th day of February, 1996, at Tallahassee, Leon County, Florida.

STUART M. LERNER, Hearing Officer Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675 SC 278-9675

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

COPIES FURNISHED:

Darlene Silvernail, Esquire Forest Hill Counseling Center 2624 Forest Hill Boulevard

West Palm Beach, Florida 33406

Gordon B. Scott, Esquire Agency for Health Care

Administration

2727 Mahan Drive, Fort Knox Number 3 Tallahassee, Florida 32308-5403

Jerome W. Hoffman, General Counsel Agency for Health Care

Administration

2727 Mahan Drive, Fort Knox Number 3 Tallahassee, Florida 32308-5403

Sam Power, Agency Clerk Agency for Health Care

Administration

2727 Mahan Drive, Fort Knox Number 3 Tallahassee, Florida 32308-5403

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 10 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: 95-005786

Orders for Case No: 95-005786