The Issue Whether Petitioner, a home and community support services coordinator, was overpaid by the Medicaid program as alleged in the Final Agency Audit Report (FAAR) dated March 25, 2002.
Findings Of Fact Respondent is the agency of the State of Florida responsible for oversight of the integrity of the Medicaid program in Florida. At all times pertinent to this proceeding, Petitioner was a home and community services coordinator who provided services to Medicaid recipients in Florida pursuant to certification from Respondent. Petitioner billed the Medicaid program on a monthly basis and received payments from the Medicaid program based on those billings. As a community services coordinator, Petitioner served developmentally disabled clients who resided in the community, as opposed to residing in an institution. Petitioner coordinated the receipt of the services his clients received, including services from Developmental Services, which is a division of the Department of Children and Family Services. As a support coordination provider, Petitioner is required to determine the needs of each client, prepare a support coordination plan for that client, and, after the support coordination plan is approved by Respondent, coordinate the provision of the services required by the plan. Petitioner is required to document the services he provides for each client. Respondent routinely audits the records of Medicaid providers to ensure compliance with Medicaid requirements. The audit at issue in this proceeding covered the period January 1, 2000, to January 31, 2001. The unnumbered opening sentence of Section 409.913 provides as follows: The agency shall operate a program to oversee the activities of Florida Medicaid . . . providers and their representatives, . . . to recover overpayments and impose sanctions as appropriate. During the audit period, Petitioner was subject to all duly enacted statutes, laws, rules, and policy guidelines that generally govern Medicaid providers. During the audit period, the applicable statutes, laws, rules, and policy guidelines in effect required Petitioner at Respondent's request to provide Respondent all Medicaid-related records and other information that supported all the Medicaid-related invoices or claims that Petitioner made during the audit period. Section 409.913(7) provides, in pertinent part, as follows: (7) When presenting a claim for payment under the Medicaid program, a provider has an affirmative duty . . . to supervise and be responsible for preparation and submission of the claim, and to present a claim that is true and accurate and that is for goods and services that: * * * (e) Are provided in accord with applicable provisions of all Medicaid rules, regulations, handbooks, and policies and in accordance with federal, state, and local law. Section 409.913(1)(d) defines the term "overpayment" as follows: (d) "Overpayment" includes any amount that is not authorized to be paid by the Medicaid program whether paid as a result of inaccurate or improper cost reporting, improper claiming, unacceptable practices, fraud, abuse, or mistake. Following the audit, Respondent sent Petitioner the FAAR dated March 25, 2002, which asserted that Petitioner had received an overpayment in the amount of $45,574.92 and demanded repayment of the overpayment. Respondent stated the following basis for concluding that the claims were overpayments: You billed and were paid for Support Coordination Services when the documentation was not found to substantiate the services billed. The audit letter provided, in part, as follows: In determining payment pursuant to Medicaid policy, the Medicaid program utilizes procedure codes, descriptions, policies, limitations and exclusions found in the Medicaid provider handbooks and (sic) Section 409.913, Florida Statutes (F.S.) and Florida Administrative Code 59G-8.200 (F.A.C.). In applying for Medicaid reimbursement, providers are required to follow the guidelines set forth in the applicable rules. . . . Medicaid cannot pay for services that do not meet these guidelines. Following his receipt of the audit letter, Petitioner provided Respondent with additional documentation. As a result of that information, Respondent reduced the amount of the claimed overpayment to the sum of $39,797.35. Petitioner was required to follow the billing and documentation requirements set forth in the Support Coordinator Guidebook (the Guidebook). The Guidebook was made available to Petitioner upon his enrollment as a home and community services support coordinator. Petitioner knew or should have known the billing and documentation requirements set forth in the Guidebook, and he knew or should have known that he was required to follow those requirements to be entitled to compensation from the Medicaid program. The Guidebook1 provided, in part, as follows: Payment to support coordination providers is made when all necessary support coordination activities have been provided to assist an individual in achieving or making progress toward achieving the outcomes identified on the support plan and when all documentation for these supports and services have been completed. Prior to requesting a monthly reimbursement for support coordinator services, the following must be met: The individual's current support plan and district-approved cost plan are filed in the individual's central record. . . . At least one face-to-face contact with the person for the month being billed has occurred. . . . At least once every three months, the monthly face-to-face contact occurs in the individual's or family's place of residence.. . . The support coordinator conducts at least one other activity during the month being billed. These contacts: (1) directly relate to implementing the outcomes identified on the individual's support plan, (2) directly relate to facilitating the development of natural and community supports, or (3) directly relate to facilitating the effective provision of supports and services needed by the individual. These contacts and activities may be either with the individual or other persons such as family members, service vendors, [or] community members. They may also be conducted face- to-face or by phone. Administrative activities such as typing, filing, mailing, billing, letter writing, or leaving messages shall not qualify as contacts or activities meeting the minimum billing criteria for a given month. Additionally, scheduling time to develop the support plan, setting up face-to-face contact, setting up meetings with other persons, and meeting with one's supervisor or co-workers do not qualify as meeting the minimum billing criteria. At least one of the contacts or activities shall be conducted on a different day within the month from the face-to-face contact with the individual. There was a dispute between the parties as to whether Petitioner satisfied the billing criteria that the support coordinator have at least one face-to face meeting the each client each month and, in addition, that the support coordinator perform at least one non-administrative activity on behalf of the client during the month. The greater weight of the credible evidence established that Petitioner did not meet the billing criteria for the claims at issue. While it is clear that Petitioner performed valuable services to his clients, he did not meet the clear billing criteria set forth in the Guidebook. Specifically, Petitioner did not have both a face-to-face meeting with the client and perform a non-administrative activity on behalf of the client during the month for any of the monthly billings at issue. Respondent correctly determined that Petitioner had received an overpayment within the meaning of Section 409.913(1)(d), and it correctly determined the amount of the overpayment to be $39,797.35. The Medicaid program does not provide for partial payments to a provider based on the work the provider actually performed if the provider's billings do not meet the billing criteria set forth in the applicable Guidebook. The Medicaid program provides for no payment to a provider if the provider's billings do not meet the billing criteria set forth in the applicable Guidebook.
Recommendation Based on the foregoing findings of fact and conclusions of Law, it is RECOMMENDED that Respondent enter a final order finding that Petitioner received an overpayment from the Medicaid program in the amount of $39,797.35 and requiring that Petitioner repay that overpayment. DONE AND ENTERED this 8th day of September, 2003, in Tallahassee, Leon County, Florida. S CLAUDE B. ARRINGTON Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 8th day of September, 2003.
The Issue The issue is whether Petitioner's application for a child caring agency license should be denied for the reasons stated in the Department of Children and Families' (Department) letter dated September 25, 2018.
Findings Of Fact The Department is the state agency responsible for regulating the licensing of child caring agencies. A child caring agency is defined in section 409.175(2), Florida Statutes (2018), as an agency that "provides staffed 24-hour care for children in facilities maintained for that purpose, regardless of whether operated for profit or whether a fee is charged." Regulations governing this type of facility are found in Florida Administrative Code Chapter 65C-14. A child caring agency, also known as a foster care group home, serves extremely vulnerable children who have been removed from their parents' home for various reasons, such as physical abuse or substance abuse by the parent. Because the children are extremely traumatized, the operator of a facility must have a high degree of skill, training, and experience. For this reason, the Department reviews applications for a child caring agency in a careful and deliberative manner. The proposed child care agency will be owned and operated by Michaelle Streeter. She is a licensed registered nurse who works as a travel nurse throughout the United States.1/ If the application is approved, she will no longer accept travel nurse assignments. From 2013 until 2017, she was licensed by the Agency for Persons with Disabilities (APD) to operate a group home in Lakeland, Florida. In May 2017, Ms. Streeter filed an application with the Department seeking licensure to operate a child caring facility. After a lengthy review of the application, which included numerous discussions with Ms. Streeter, the Department denied the application on December 11, 2017, because she was unable to meet the financial requirements outlined in rule 65C-14.006(10). Resp't Ex. 5. Petitioner did not challenge that denial. After denying the application, the Department informally recommended to Ms. Streeter that she consider becoming a foster parent. However, Ms. Streeter opted to pursue her application for a child caring facility. On an undisclosed date in 2018, she filed a second application. On September 25, 2018, the Department again denied the application, this time for the following reasons: Compliance concerns noted while being licensed as a provider with a different licensing entity around the time frame of June 2016. [§] 409.175, Fla. Stat.; Concerns around the ability to show and maintain financial stability of an owned or rented property after a notice of foreclosure was filed in 2017. During the licensing process there were several concerns on the money that was being reported as viable income to meet the FAC financial requirements for license. (Florida Administrative Code 65C-14.006); [Y]ou were granted an exemption on a previous criminal charge which allowed you to continue but did not guarantee becoming a licensed provider. After reviewing the circumstances of this criminal charge, the Department is not comfortable moving forward with issuing you a child caring agency license. Resp't Ex. 16. Petitioner requested a hearing to contest the Department's decision. The Department's letter stated that the denial was not based solely on the concerns stated above. However, the letter was never amended, and, prior to the hearing, Petitioner was not given notice of any additional concerns. Therefore, only the reasons cited in the letter have been considered.2/ Compliance Concerns While Operating Another License Citing section 409.145, the Department asserts it has "[c]ompliance concerns" based upon the operation of an APD facility by Ms. Streeter "around the time frame of June 2016." Section 409.145 generally requires that children in foster care be provided "quality parenting." The essence of the charge is that Ms. Streeter failed to meet standards for operating a less- restrictive APD facility that had only two clients, and along with the other concerns cited in the letter, collectively, they support a determination that she is not qualified for licensure. As noted earlier, Ms. Streeter operated an APD group facility from 2013 until 2017. According to Ms. Streeter, the facility closed in 2017 when the "partnership ended" and her partner removed all clients from the home. Because APD facilities receive Medicaid funds, they are reviewed periodically by Qlarant, formerly known as the Delmarva Foundation (Delmarva), a state contractor, to determine if the facility is complying with APD standards. The results of the review are found in a Provider Discovery Review (PDR) Report, which assigns a score to each provider. The record is silent, however, as to what score is necessary in order to have a satisfactory review. Delmarva's review findings for the period June 1, 2015, through May 31, 2016, are found in Respondent's Exhibit 1. The PDR Report indicates that overall, the facility received a score of 65.1 percent and a compliance score of 75.4 percent. The PDR Report contains multiple health and safety concerns, such as improperly stored medication, lack of required oversight by a behavioral analyst, and billing discrepancies of $12,986.26, which represents a significant portion of total reimbursed funds of $46,597.39. Also, Ms. Streeter engaged in physical "takedowns" of clients without approval of a medical doctor, proof that she was trained to conduct takedowns, or documentation of when and why these takedowns occurred. Improperly used takedowns present a risk of physical injury to the client. Ms. Streeter disputed the findings in the PDR Report and requested reconsideration of the billing discrepancies. After Delmarva considered her objections, reconsideration was denied and all findings remain as originally reported. The criticisms noted in Delmarva's PDR Report are legitimate concerns and should be considered in the licensing process. Financial Concerns A second concern by the Department centers around the applicant's "ability to show and maintain financial stability of an owned or rented property after a notice of foreclosure was filed in 2017. During the licensing process there were several concerns on the money that was being reported as viable income to meet the FAC financial requirements for licensure." According to the Department's regional licensing manager, this concern is a very important piece of the Department's decision to deny the application. An applicant for licensure must demonstrate "[s]atisfactory evidence of financial ability to care for children in compliance with licensing requirements." § 409.175(5)(b)8., Fla. Stat. Also, rule 65C-14.006(10) requires an applicant to "provide written documentation that it has sufficient funds to meet all requirements for licensure. Facilities beginning operation shall provide evidence of sufficient funding for operation of the program for at least six (6) months." To satisfy the foregoing requirement, the Department requires an applicant to estimate the facility's first year operating expenses and to have on-hand cash or a line of credit that equals one-half of estimated annual operating expenses. Ms. Streeter estimated her first year operating expenses to be $292,200.00. Resp't Ex. 3. This meant she needed around $146,000.00 in cash or a line of credit to meet the Department's requirement. A bank statement was not provided, but Ms. Streeter submitted a letter from a lending institution stating that her application for a cash-out refinance (second mortgage) on her residence had been approved in the amount of $160,000.00. Resp't Ex. 4. However, the Department does not consider a second mortgage to be a source of capital. Besides a lack of an adequate source of capital to operate the facility, Ms. Streeter filed a Suggestion of Bankruptcy in June 2017 under chapter 13 of the United States Bankruptcy Code. Resp't Ex. 7. On December 1, 2017, the Bankruptcy Court issued an Order Granting [the Trustee's] Motion to Dismiss Chapter 13 Case on the ground Ms. Streeter failed to comply with the Trustee's Order. Resp't Ex. 8. At hearing, Ms. Streeter provided earnings statements for 2017 and 2018 related to her employment as a travel nurse. Although she was well paid for her services, the preponderance of the evidence shows that Petitioner has failed to satisfy the financial stability requirement. Prior Criminal Charges The denial letter states that after "reviewing the circumstances of [a previous] criminal charge, the Department is not comfortable moving forward with issuing [Petitioner] a child caring agency license." The specific criminal charge is not identified in the denial letter. Testimony by a Department licensing official indicates that the Department is concerned with "a domestic violence history" on the part of Ms. Streeter. On August 21, 2000, she pled nolo contendere to a charge of battery (domestic violence), a first degree misdemeanor at that time. Resp't Ex. 14. Adjudication was withheld by the court, and she was placed on 12 months' probation, which she successfully completed in August 2001. The details of the incident are unknown. There is no other evidence of "a domestic violence history." The record also contains evidence of several criminal charges in the State of Massachusetts, which occurred in the early 1980s, or almost 40 years ago, when Ms. Streeter was in her 20s. Resp't Ex. 13. These incidents are so dated that they should not play a role in the Department's decision. In November 2012, Ms. Streeter's name was submitted "for recognition of an honorable deed performed in the community's interest and for [her] assistance to the Hillsborough County Sheriff's Office." Pet'r Ex. C. On September 14, 2007, the Department of Health granted Ms. Streeter an exemption from disqualification for employment as a registered nurse. On January 19, 2011, the Florida Board of Nursing granted Ms. Streeter an exemption from disqualification to serve as a registered nurse. On January 30, 2012, APD granted Ms. Streeter an exemption from disqualification for employment/licensing in a caretaker position working with children or vulnerable adults. On February 5, 2018, the Department granted Ms. Streeter an exemption from disqualification for employment/ licensing in a caretaker position working with children or vulnerable adults. Although APD granted Ms. Streeter an exemption from disqualification to operate a facility licensed by that agency, the Department does not consider that exemption to be binding on its determination here. The Department did not explain or otherwise address the exemption that it granted her in February 2018.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Children and Families enter a final order denying Petitioner's application for a child caring agency license. DONE AND ENTERED this 24th day of January, 2019, in Tallahassee, Leon County, Florida. S R. ALEXANDER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 24th day of January, 2019.
Findings Of Fact Introduction On February 26, 1988 respondent, Department of Health and Rehabilitative Services (HRS), through its District IX office, advertised a Request for Proposal (RFP) in the Florida Administrative Weekly inviting qualified and interested organizations and vendors to submit proposals for the designation of an Area Agency on Aging in District IX. The designation would run from May 2, 1988 through the end of the calendar year but the successful vendor could be expected to be redesignated in subsequent years. According to the advertisement: Proposals will be received by District IX until 12:00 p.m., EST, March 24, 1988, for the designation of an Area Agency on Aging authorized under Title III of the Older Americans Act as amended, within the jurisdictional areas of Martin, St. Lucie, Indian River, Okeechobee and Palm Beach Counties. * * * Contract awards will be based on approximately 75 percent federal funds, 11 percent general revenue and 14 percent local matching funds. * * * Written inquiries concerning the Request for Proposals will be received until 4:00 p.m., EST, March 11, 1988. A Bidders Conference, to review the proposed format and contract award process, will be held on March 4, 1988. * * * Under this proposal, HRS intended to award the contract to the best qualified firm since price proposals were not being submitted. To this extent, the proceeding differs from the typical state project where the contract is ordinarily awarded to the lowest and most responsive bidder. In response to the above RFP, petitioner, Banyan Area Agency on Aging, Inc. (Banyan), timely submitted its proposal. As it turned out, Banyan was the only organization that filed a bid. After being reviewed by a seven person evaluation committee, the proposal was given a score of 480 out of a possible 1525 and a recommendation that it be rejected. This recommendation was later adopted by the District Administrator. This decision was conveyed to petitioner by letter dated April 4, 1988. That prompted a request for hearing by petitioner to challenge the preliminary agency action. As grounds for contesting the action, petitioner contended the agency was arbitrary and capricious in rejecting its proposal. If its preliminary action is sustained, HRS intends to seek authority from the Department of General Services to negotiate a noncompetitive bid. Under this process, HRS desires to designate, after a screening process, one person from each of the five counties to serve on the board of a corporation to be established to run the program. Thus, HRS does not intend to readvertise the RFP and seek competitive proposals a second time. The Contract The contract in question is funded principally through federal grant dollars under the federal Older Americans Act of 1965, as amended. The monies, commonly known as Title III funds, are used to provide programs for senior citizens. Respondent is the State agency charged with the responsibility of administering the program funds. To receive federal funds, HRS was required to prepare a state plan and submit it to the U.S. Commissioner on Aging for his approval. A part of that plan calls for HRS, or District IX in this case, to designate an area agency on aging (AAA) to plan and administer a comprehensive and coordinated system of services for the aging in the five county area of Palm Beach, Okeechobee, Indian River, Martin and S. Lucie Counties. Among other things, the local AAA must develop an area plan for supportive services, senior centers and nutrition services in the five county area. The AAA will receive $300,000 to cover administrative costs in administering the program and will be in charge of dispensing several million dollars annually in grant dollars for aging programs. District IX had previously designated Gulfstream Area Agency on Aging (Gulfstream) as its AAA. However, due to a combination of faulty management, lack of supervision and other factors, Gulfstream was designated as AAA in May, 1987. Since then, HRS has received several waivers from the Commissioner on Aging but now faces a mandate to designate a District IX AAA by October 1, 1988 or lose its federal funding. To avoid a recurrence of the Gulfstream problem, the HRS District IX contract manager, and several other district personnel, prepared a comprehensive RFP to be issued in conjunction with the selection of a new AAA designee. After a draft was assembled at the local level, the RFP was forwarded to HRS' Tallahassee office where further refinements were made. The final product has been received in evidence as petitioner's exhibit 9 and respondent's exhibit 11. According to the District IX contract manager, the RFP is the "state of the art" in terms of what an AAA ought to be. The RFP is a voluminous document, weighing some 6 1/2 pounds according to Banyan, and requires a great deal of information and detail regarding the AAA organization, procedures, and program plans and goals to satisfy the federal act. The RFP was given to interested organizations, including Banyan, around March 1, 1988. This gave vendors approximately three and one-half weeks to prepare and submit a proposal. Only Banyan was interested in being the designee and thus was the only bidder on the job. Its proposal contained 135 pages. Evaluation Process HRS created a seven person evaluation committee to review the proposals. The committee included five HRS employees and two non-HRS members. All members were given Banyan's proposal prior to the selection date. On March 28, 1988 the committee met and each member independently evaluated Banyan's proposal. Although a top score of 1525 was theoretically possible, Banyan received an average overall score from each There of 480, or a rating of approximately thirty-one and one half percent. After the scores were tallied, Banyan was given one hour to orally explain its proposal before the full committee. At the conclusion of the presentation, the committee voted unanimously to reject the proposal. The reasons for rejecting Banyan's proposal are set forth in respondent's exhibit 2. The three primary deficiencies, as broadly stated, were the "proposal did not develop ideas fully enough to demonstrate a clear understanding of the needs and conditions of the District IX 60+ population," the proposal "did not demonstrate a clear understanding of the role and responsibility of area agency on aging nor was there evidence of administrative capability,' and (c) the proposal "did not offer assurance that current board members fully understood their position as the governing board." At hearing, several members of the committee amplified on the above three shortcomings and pointed out specific deficiencies in Banyan's proposal which led them to reject the proposal. For example, the proposal failed to focus on areas outside of Palm Beach County, did not contain a proposed budget, lacked minority representation, failed to fully identify goals and objectives, did not include a detailed description of the fair hearing process and the make- up and procedure of the advisory council and omitted the corporation's bylaws. Given these deficiencies, and others, HRS was justified in rejecting the bid. Petitioner's Case Petitioner contends that three and one-half weeks was too short a time to prepare a responsible proposal to the RFP. In this regard, HRS acknowledged it was a lengthy RFP, but it considered the time adequate for a qualified and experienced organization, particularly since much of the RFP was reference material. Banyan also pointed out that its board of directors was made up of highly qualified people with impressive work experience. While this is true, as evidenced by testimony at hearing, none were experienced in managing a federally funded program of this magnitude. Banyan further stated that, after the proposal was filed, it could have corrected or expanded on many of its abbreviated responses. However, once the proposal was filed, such changes were impermissible. Finally, Banyan conceded that while many of its responses were brief and nonspecific, this was because Banyan intended to rely upon HRS for technical assistance to implement the programs. However, the RFP called for specific, detailed responses so that HRS could properly evaluate the proposal. Allegations of Bias or Impropriety There is no evidence that the committee acted unfairly or improperly during the evaluation process or that any eber was personally biased towards Banyan. There is also no evidence that HRS rejected the bid so that it could "control" the management of the program.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the protest filed by petitioner be DENIED and that a Final Order be entered confirming the rejection of petitioner's proposal. DONE AND ORDERED this 20th day of June, 1988, in Tallahassee, Leon County, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 20th day of June, 1988. COPIES FURNISHED: Mr. Colman B. Stein 100 Worth Avenue Apartment 416 Palm Beach, Florida 33480 Laurel D. Hopper, Esquire 111 Georgia Avenue Third Floor West Palm Beach, Florida 33401 R. S. Power, Esquire Agency Clerk Department of Health and Rehabilitative Services 1323 Winewood Boulevard Building One, Room 407 Tallahassee, Florida 32399-0700 Gregory L. Coler, Secretary Department of Health and Rehabilitative Services 1323 Winewood Boulevard Tallahassee, Florida 32399-0700
The Issue Whether the Department of Children and Family Services (Department) failed to immediately provide Destiny Smith with the developmental services to which she is entitled.
Findings Of Fact For the period July 1, 1998 through June 30, 2003, the Health Care Financing Administration (HCFA), Region IV, of the U.S. Department of Health and Human Services, by agreement with the State of Florida, has agreed to permit the Department to provide services in a home and community-based setting to persons diagnosed with mental retardation or developmental disabilities. This was allowed as an alternative to receiving services in an institutional setting. It is referred to as the Home and Community-Based Services Waiver Program, or less formally, the "waiver" or "waiver program." The waiver provided that in "year three" of the program, 25,945 persons would be served, should the Florida Legislature appropriate sufficient funds to serve that number. If the appropriation is insufficient, then fewer persons will be served. Fiscal year 2000-2001 is "year three." Florida has elected to serve the number of individuals funded by the Florida Legislature, up to the number listed in the waiver agreement with HCFA, in fiscal year 2000-2001. Historically, all individuals eligible for developmental services have not received them because of insufficient funding. The Florida Legislature, when providing funding for this program in 1999, established priorities in the 1999-2000 General Appropriations Act, through the use of proviso language. Priorities for this funding, in order, are as follows: 1) Transitions for those requesting transfers from Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) institutional placements; and 2) Meeting the needs of identified under-served participants in the Home and Community Based Waiver Services after accurately assessing the actual costs of each person's support plan. The Department implemented the 1999 appropriation for fiscal year 1999-2000 by promulgating a spending plan that directed the Department's districts to provide services to 15,984 persons pursuant to the priorities set by the Florida Legislature. The 2000 Florida Legislature appropriated funds to serve an additional 7,377 persons for a total of 23,360. This appropriation contained proviso language which was identical to that found in the 1999 General Appropriations Act. An addition to the proviso, however, stated that, "The Medicaid waiver services mix must be fully met for all eligible participants before funds are transferred to non-Medicaid covered services, with the exception of room and board payments." The Department implemented the 2000 appropriation by promulgating a spending plan that continued the previous year's spending plan. This plan stated that individuals who are new to the system after July 1, 1999, would only be served after those on the original waiting list are served, unless they have been determined to be in crisis pursuant to a crisis assessment tool. Petitioner applied for the general revenue individual and family support program. This program is in the category of "non-Medicaid covered services." The Department determined that Petitioner was eligible for developmental services on July 11, 2000. However, the Department further determined that Petitioner did not presently qualify for funds appropriated for fiscal year 2000-2001 because she became eligible after July 1, 1999, and because the program she sought was one which the Florida Legislature determined should be funded at the previous year's level. The crisis assessment tool is used to identify individuals who are in crisis situations. A crisis situation occurs when there is a court order mandating care; when there has been a determination that an individual is dangerous to himself, herself, or others; where there is abuse or neglect; where the person is homeless; when the person's caregiver can no longer provide for the person; or in other situations where there is a need to ensure the individual's safety and security. Petitioner does not meet any of the criteria on the crisis identification tool. As a result, she is not eligible for immediate service. At the time of the hearing there were individuals who were on the waiting list who were determined to be eligible prior to July 1, 1999 who have not yet been served. Only after those individuals are served can the persons eligible after July 1, 1999, be served. Petitioner may ultimately be provided developmental services, but this cannot occur until funds are available to the Department for that purpose.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law set forth herein, it is RECOMMENDED: That the Department enter a final order finding that the Petitioner is not entitled to receive developmental services until the Department determines that funds are available for that purpose. DONE AND ENTERED this 8th day of January, 2001, in Tallahassee, Leon County, Florida. HARRY L. HOOPER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 8th day of January, 2001. COPIES FURNISHED: Lucy Goddard, Esquire Department of Children and Family Services Post Office Box 390, Mail Stop 3 Gainesville, Florida 32602 Destiny Smith 27619 25th Place Branford, Florida 32008 Virginia A. Daire, Agency Clerk Department of Children and Family Services Building 2, Room 204B 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 Josie Tomayo, General Counsel Department of Children and Family Services 1317 Winewood Boulevard Building 2, Room 204 Tallahassee, Florida 32399-0700
