On October 13, 2014, a coalition of hospitals filed a petition with the Florida Division of Administrative Hearings to challenge the Agency for Health Care Administration's ("AHCA") policies regarding emergency treatment of undocumented immigrants.
The coalition alleges that effective July 1, 2010, AHCA implemented a new policy limiting the duration of an undocumented immigrant's emergency medical condition to a period different that that established by the Department of Children and Family Services; ceased paying for all services medically necessary for the treatment of an undocumented immigrant's emergency medical condition; and applied a new standard of medical necessity to undocumented aliens without following the rulemaking procedures set forth in the Administrative Procedure Act. The coalition argues that AHCA's policies with respect to the endpoint of an emergency medical condition and the standard for medical necessity meet the definition of a "rule," as defined in Section 120.52, Florida Statutes, and is an invalid exercise of legislative authority.
In response to the coalition's petition, AHCA seeks entry of a summary final order. In support thereof, AHCA contends that the coalition's unadopted rule challenge is improper because the coalition fails to identify any AHCA statement which differs from existing provisions in duly adopted rules and law. More specifically, AHCA claims that Rule 59G-4.160(2), Florida Administrative Code, incorporates by reference AHCA's December 2011 Florida Medicaid Hospital Services Coverage and Limitations Handbook, which stated that Medicaid would not pay for continuous or episodic services after the emergency medical condition was alleviated.
Administrative Law Judge John D.C. Newton scheduled a hearing in this matter for November 12-13.
If you have any questions concerning this topic, please contact the member of our GrayRobinson health care practice group with whom you work.
F. Ryan Waters
GrayRobinson, P.A.
301 East Pine Street
Suite 1400
Orlando, FL 32801
Phone: 407.843.8880
Fax: 407.244.5690