STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

I.M.P.A.C.T. INSTITUTE, INC., )

)

Petitioner, )

)

vs. ) CASE NO. 95-6043

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to written notice, a formal hearing was held in this case on June 27, 1996, at Fort Lauderdale, Florida, before Errol H. Powell, a duly designated Administrative Law Judge of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Jason H. Clark, Esquire

Post Office Box 17486

West Palm Beach, Florida 33416

For Respondent: Roger R. Maas, Esquire

Agency for Health Care Administration 2727 Mahan Drive, Ft. Knox No. 3 Tallahassee, Florida 32308-5403

STATEMENT OF THE ISSUE

The issue for determination is whether Petitioner's Medicaid provider number should be cancelled.

PRELIMINARY STATEMENT

By letter dated October 1, 1995, the Agency for Health Care Administration (Respondent) notified I.M.P.A.C.T. Institute, Inc. (Petitioner) that its Medicaid provider number 360025400 would be cancelled, effective July 1, 1995, due to Petitioner's failure to have a contract with the Department of Health and Rehabilitative Services, Alcohol, Drug Abuse and Mental Health Program. In its notice Respondent cited Subsection 409.906(8), Florida Statutes, as authority for its action. Petitioner requested a hearing, and this matter was referred to the Division of Administrative Hearings.

At the hearing, Petitioner presented the testimony of one witness and entered four exhibits into evidence. Respondent presented the testimony of one witness and entered three exhibits into evidence.

A transcript of the hearing was not ordered. At the request of the parties, the time for filing post-hearing submissions was set for more than ten days following the conclusion of the hearing. The parties filed proposed findings of fact which are addressed in the appendix to this recommended order.

FINDINGS OF FACT

1. I.M.P.A.C.T. Institute, Inc. (Petitioner) provides primarily counseling services to residents of Broward County and the surrounding areas. The majority of the residents who receive Petitioner's services are low income, have language barriers and have little education. Petitioner provides a valuable and important service to the community that it serves.

   
   

2. At all times material hereto, Petitioner was licensed by the Department of Health and Rehabilitative Services in accordance with Chapter 397, Florida Statutes. Petitioner was issued its regular license on December 29, 1994.

   
   

3. At all times material hereto, Petitioner was enrolled as a community mental health provider in the Florida Medicaid program pursuant to Subsection 409.906(8), Florida Statutes. Petitioner has been enrolled in the Medicaid program for approximately three years.

   
   

4. At all times material hereto, Petitioner has been issued a Medicaid provider number which has been continuously renewed.

   
   

5. Petitioner is currently receiving Medicaid reimbursement for community mental health services pursuant to Subsection 409.906(8), Florida Statutes.

   
   

6. On June 10, 1994, Petitioner executed a Medicaid Provider Agreement (Agreement). The Agreement provides in pertinent part:

   
   

   1. The provider and the Department [Depart- ment of Health and Rehabilitative Services] 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, F.S.

      
      

7. Respondent has a handbook which describes, among other things, the community mental health services program and provider participation requirements. Effective December 1995, the handbook provides in pertinent part:

   
   

   Community mental health services are governed . . . through the authority of Chapter 409.906(8), Florida Statutes.

   * * *

   To be eligible to be enrolled in Medicaid, a provider must have a current contract pursuant to the provisions of Chapter 394, Florida Statutes, for the provision of community mental health services; and, if applicable, a regular (i.e., not provisional or interim) license as an alcohol prevention

   and treatment or drug abuse treatment and prevention program from the district Depart- ment of Health and Rehabilitative Services (HRS), Alcohol, Drug Abuse and Mental Health (ADM) program office.

   
   

8. Petitioner does not have a contract with the Department of Health and Rehabilitative Services, Alcohol, Drug Abuse and Mental Health (ADM) program office. Petitioner has been attempting to obtain a contract with the Health and Rehabilitative Services ADM program office but has been unable to do so because the Health and Rehabilitative Services ADM office has had no money to fund such a contract.

   
   

9. Respondent is cancelling Petitioner's Medicaid provider number because Petitioner does not have a contract with the Health and Rehabilitative Services ADM program office.

   
   

   CONCLUSIONS OF LAW

   
   

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

    
    

11. Effective July 1, 1993, by operation of Section 58, Chapter 93-129, Laws of Florida, all powers, duties and functions, records, personnel and funds of the Medicaid program within the Department of Health and Rehabilitative Services were transferred to the Respondent.

    
    

12. Respondent is the single state agency responsible for the administration of the Florida Medicaid program. Section 409.902, Florida Statutes.

    
    

13. Section 409.907, Florida Statutes, requires, among other things, that a Medicaid provider have a provider agreement in order to receive payment for the services it has rendered under the Medicaid program and that each provider comply fully with all state and federal laws pertaining to the Medicaid program. Petitioner has entered into such a provider agreement.

14. Section 409.906, Florida Statutes, provides in pertinent part: 409.906 Optional Medicaid services.--Subject

    to specific appropriations, the agency may make payments for services which are optional to the state . . . and are furnished by Medicaid providers to recipients who are determined eligible . . . Optional services may include:

    * * *

    (8) COMMUNITY MENTAL HEALTH SERVICES.-The agency may pay for rehabilitative services provided to a recipient in a mental health, drug abuse, or alcohol abuse center licensed by the agency and under contract to the Department of Health and Rehabilitative Services, which are psychiatric in nature and rendered or recommended by a psychiat-

    rist or which are medical in nature and rendered or recommended by a physician or psychiatrist.

    
    

15. Respondent interprets Subsection 409.906(8) to mean that a Medicaid provider of community mental health services must have a current contract with the Health and Rehabilitative Services, Alcohol, Drug Abuse and Mental Health (ADM) program office. Petitioner does not have a contract with the Health and Rehabilitative Services ADM program office.

RECOMMENDATION

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

order terminating I.M.P.A.C.T. Institute, Inc.'s Medicaid provider contract and cancelling its Medicaid provider number.

DONE AND ENTERED on this 8th day of October, 1996, in Tallahassee, Leon County, Florida.

ERROL H. POWELL

Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675 SUNCOM 278-9675

Fax Filing (904) 921-6847

Filed with the Clerk of the Division of Administrative Hearings this 8th day of October, 1996.

APPENDIX

The following rulings are made on the parties' proposed findings of fact: Petitioner

1. Partially accepted in finding of fact 1.

2. Partially accepted in finding of fact 1.

3. Partially accepted in finding of fact 4.

4. Rejected as being argument, or a conclusion of law.

5. Rejected as being argument, or a conclusion of law.

6. Rejected as being argument, or a conclusion of law.

7. Partially accepted in findings of fact 5, 8, and 9.

8. Rejected as being subordinate, irrelevant, or unnecessary.

Respondent

1. Partially accepted in finding of fact 2.

2. Partially accepted in finding of fact 3.

3. Partially accepted in finding of fact 6.

4. Partially accepted in finding of fact 5.

5. Partially accepted in finding of fact 7.

6. Partially accepted in finding of fact 8.

NOTE: Where a proposed finding has been partially accepted, the remainder has been rejected as being subordinate, irrelevant, unnecessary, cumulative, not supported by the evidence, argument, or a conclusion of law.

COPIES FURNISHED:

Jason H. Clark, Esquire Post Office Box 17486

West Palm Beach, Florida 33416

Roger R. Maas, Esquire

Agency for Health Care Administration 2727 Mahan Drive, Ft. Knox No. 3 Tallahassee, Florida 32308-5403

Sam Power, Agency Clerk Agency for Health Care

Administration

Fort Knox Building 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 32308-5403

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within 15 days from the date of 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: 95-006043

Orders for Case No: 95-006043