17-006025FL Felicia Whipple, As Owner/Operator Of Miracles House, Inc. vs. Agency For Persons With Disabilities Status: Closed Recommended Order on Wednesday, May 23, 2018.

Summary: APD met its burden and demonstrated that Petitioner's Medical Waiver Services Agreement should be terminated.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FELICIA WHIPPLE, AS

OWNER/OPERATOR OF MIRACLES

HOUSE, INC.,

Petitioner,

vs. Case No. 17 - 6025FL

AGENCY FOR PERSONS WITH

DISABILITIES,

Respondent.

_______________________________/

RECOMMENDED ORDER

Pursuant to notice, a hearing was conducted in this case on

January 16, 2018, by video teleconference at sites in Miami and

Tallahassee, Florida, before Administrative Law Judge June C.

McKinney of the Division of Administrative Hearin gs, pursuant to

the authority set forth in sections 120.569 and 120.57(1),

Florida Statutes (2017).

APPEARANCES

For Petitioner: Adres Jackson - Whyte, Esquire

10735 Northwest 7th Avenue

Miami, Florida 33168

For Respondent : Trevor S. Suter, Esquire

Agency for Persons with Disabilities

4030 Esplanade Way, Suite 315C

Tallahassee, Florida 32399 - 0950

STATEMENT OF THE ISSUE

Whether Petitioner ' s Medicaid Waiver Services Agree ment

should be terminated with cause by Respondent Agency for Persons

with Disabilities .

PRELIMINARY STATEMENT

By letter dated October 5, 2017, Respondent notified Felicia

Whipple , as Owner/Operator of Miracles House, Inc. ( " Petitioner "

or " Whipple " ) of Re spondent ' s intent to terminate Petitioner ' s

Medicaid Waiver Services Agreement ( " MWSA " ) with cause.

Dissatisfied with Respondent ' s decision, Petitioner challenged

the termination and timely requested a formal hearing. On

November 2, 2017, Respondent refe rred the case to the Division

of Administrative Hearings ( " DOAH " ) for assignment of an

administrative law judge to conduct the hearing. On January 16,

2018, the formal hearing was held as scheduled.

At the formal hearing, Whipple testified on her own beha lf

but did not offer any evidentiary exhibits. Respondent presented

the testimony of Cassandra Jenkins and Tom Rice. Respondent ' s

Exhibits 1 through 3 and 8 were received into evidence.

The proceedings of the hearing were recorded. On April 2,

2018, the Transcript of the hearing was filed at DOAH.

P etitioner did not file any post - hearing pleadings. Respondent

filed a timely P roposed R ecommended O rder, which the undersigned

has considered, as well as the testimony and exhibits presented

at hearing, in t he preparation of this Recommended Order. The

undersigned is prohibited from taking any new evidence after a

hearing adjourns. Accordingly, the undersigned did not consider

Respondent ' s e xhibits attached to Respondent ' s Proposed

Recommended Order in deci ding this matter.

Unless ot her wise indicated, all references are to the 201 7

version of Florida Statutes.

FINDING S OF FACT

1. The Agency for Health Care Administration ( " AHCA " ) is

Florida ' s designated Medicaid agent pursuant to chapter 409,

Florida Statut es. In that role, AHCA has delegated d uties with

respect to the MWSA to Agency for Persons with Disabilities

(" APD " or "Respondent") .

2. APD ensures that Medicaid w aiver providers comply with

applicable Medicaid rules. To ensure compliance, APD enters i nto

a MWSA with providers to facilitate payment. AHCA pays the

providers for services rendered according to the MWSA.

3. On April 22, 2015, Petitioner entered into a MWSA with

Respondent. As a qualified provider, the MWSA allowed Petitioner

to perform s ervices for APD clients and get paid through the

Medicaid program by reimbursement.

4. Section I.B. of the MWSA provides:

Prior to executing this Agreement and

furnishing any waiver services, the Provider

must have executed a Medicaid Provider

Agreement with the Agency for Health Care

Administration (AHCA), and be issued a

Medicaid provider number by AHCA. The

Provider must at all times during the term of

this Agreement maintain a current and valid

Medicaid Provider Agreement with AHCA, and

comply with the terms and conditions of the

Medicaid Provider Agreement.

5. On or about August 3, 2017, AHCA terminated Petitioner ' s

Medicaid Provider Agreement and notified Petitioner by letter

that " Medicaid will no longer pay for claims for reimbursement

for good s or services that you furnish. "

6. APD investigated AHCA ' s termination and concluded that

Petitioner did not comply with section I. B. of the MWSA that

required P etitioner to maintain a current and valid Medicaid

Provider Agreement with AHCA.

7. On Oct ober 5, 2017, by letter , APD terminated

Petitioner ' s MWSA pursuant to section III. B., which provides

Petitioner ' s " agreement may be terminated for the Provider ' s

unacceptable performance, non - performance or misconduct. " APD ' s

letter detailed the basis for Petitioner ' s termination as

follows:

Provider ' s Medicaid Provider Number was

terminated by the Agency for Health Care

Administration (AHCA) on September 2, 2017.

Therefore, the Provider is not performing in

accordance with the MWSA, Section I., B.,

which requires that " The Provider must at all

times during the term of this Agreement,

maintain a current and valid Medicaid

Provider Agreement with AHCA, and comply with

the terms and conditions of the Medicaid

Provider Agreement .

8. At hearing, Petitioner ad mitted that Respondent

terminated the MWSA when APD became aware of ACHA ' s termination.

Petitioner also acknowledged that Miracle s House , Inc., has been

unable to bill since ACHA suspended its services, but Whipple is

contesting ACHA ' s actions.

9. On o r about October 27, 2017, Petitioner challenged

APD ' s termination and timely requested a formal hearing.

CONCLUSIONS OF LAW

10. DOAH has jurisdiction over the subject matter of

this proceeding and of the parties thereto pursuant to

sections 120.569 and 12 0.57(1), Florida Statutes (2017).

11. Petitioner lost its Medicaid provider authorization

rights to furnish Medicaid services and receive Medicaid

reimbursements from ACHA. Uncontested evidence at hearing

demonstrated that Petitioner no longer met the MW SA ' s

section I. B. after ACHA terminated Petitioner ' s Medicaid

Provider Agreement. By Petitioner no longer being a Medicaid

provider in good standing , APD properly sought termination of the

MWSA according to section III.B. Accordingly, APD met its burden

in this matter and demonstrated that Petitioner ' s MWSA should be

terminated with cause.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of

Law, it is RECOMMENDED that the Agency for Persons with

Disabilities enter a final order terminating Petitioner ' s

Medicaid Waiver Services Agreement.

DONE AND ENTERED this 23rd day of May , 2018 , in Tallahassee,

Leon County, Florida.

S

JUNE C. MCKINNEY

Administrative Law Judge

Division of Administrative Hearin gs

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 23rd day of May , 2018 .

COPIES FURNISHED:

A dres Jackson - Whyte, Esquire

10735 Northwest 7th Avenue

Miami, Florida 33168

(eServed)

Trevor S. Suter, Esquire

Agency for Persons with Disabilities

4030 Esplanade Way , Suite 315C

Tallahassee, Florida 32399 - 0950

(eServed)

Gypsy Bailey, Agency Clerk

A gency for Persons with Disabilities

4030 Esplanade Way, Suite 335E

Tallahassee, Florida 32399 - 0950

(eServed)

Richard Ditschler, General Counsel

Agency for Persons with Disabilities

4030 Esplanade Way, Suite 380

Tallahassee, Florida 32399 - 0950

(eServ ed)

Barbara Palmer, Director

Agency for Persons with Disabilities

4030 Esplanade Way, Suite 380

Tallahassee, Florida 32399 - 0950

(eServed)

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.