MM Curator summary
[MM Curator Summary]: A mental health provider is suing the state for removing it from the Medicaid network.
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On Thursday a case was filed in the Southern District of Florida by Mental Health Network, Inc. (MHN) against Simone Marstiller, in her capacity as Secretary of the State of Florida Agency for Health Care Administration (AHCA). The case is regarding breach of contract for the provision of Medicaid services.
The federal Medicaid program provides funding for state Medicaid agencies provided that the agencies agree to administer their programs in accordance with Title XIX of the Social Security Act. Under this act, the complaint says, “a state is only allowed to restrict a provider from participating in the Medicaid program for a reasonable period of time, and prior to imposing any such restriction, the state’s Medicaid agency must meet certain conditions: (1) give the provider notice and an opportunity for a hearing; (2) find that the provider engaged in certain bad conduct: and (3) ensure that the restrictions do not result in denying reasonable access to Medicaid services. Similarly, 42 C.F.R. § 455.422 requires a state to give terminated providers “any appeal rights available under procedures established by State law or regulations.””
MHN is a behavioral health provider which specializes in therapy provided at home, focused on the community of Tavernier. The provider was contracted with AHCA to provide mental health services under the Florida Medicaid State Plan. AHCA has sent a 30 day notice terminating MHN’s participation in the plan, which MHN argues violates the provisions of the federal Medicaid program noted above.
MHN also argues that certain provisions in the Florida State statutes are directly contrary to the federal law on this subject, including a provision that permits termination of a provider without an appeal.
The plaintiffs are suing for violations of the Federal Medicaid Act, argues that the termination process violates Due Process, and argues that the action was arbitrary and capricious. The plaintiff is represented by Duane Morris, LLP.