ANNIE ELIZABETH KEARSE, APPELLANT,
v.
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES, APPELLEE
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
Annie Elizabeth Kearse challenges a Florida Administrative Code rule establishing a Medicaid program with prior approval requirements for non-emergency medical services. The court upholds the rule as valid, finding that the agency's interpretation allows for timely notification rather than strict prior approval when case managers are unavailable.
The proposed rule is valid. While the rule's language regarding prior approval for medically necessary services raises concerns, the court defers to the agency's interpretation that providers need only notify the case manager at a reasonable time following provision of services when performed during hours when the case manager was unavailable, rather than requiring strict prior approval.
[1] An agency's interpretation of its own rule is entitled to deference and is controlling when it differs from a party's interpretation.
[2] A rule requiring prior authorization for non-emergency medical services may be valid if the agency interprets it to allow for reasonable post-service notification when pr…
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“Appellant attacks the rule, contending that there are medically necessary services which do not qualify as emergency services and for which payment would be denied under the rule if a case manager were not available to authorize the services before they were performed. The concern of the appellant appears well-taken under the language of the rule; however, deference is given to the agency interpretation which differs from that of the appellant and which we find to be controlling in this case and binding on the agency.”
Establishes the court's acknowledgment of appellant's concern but application of deference to agency interpretation.
Previewing 1 of 2 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceThe case involves a proposed Florida Administrative Code Rule 10C-7.65 governing a Medicaid program with four participation levels. Participants at Le…
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Challenge To Administrative Rule Validity cases and more on FLexlaw
BARFIELD, Judge.
In this appeal Annie Elizabeth Kearse seeks review of the final order of the Division of Administrative Hearings upholding the validity of proposed Florida Administrative Code Rule IOC-7.65. Appellant attacks the rule as being invalid because of an inadequate economic impact statement; violative of the federal regulations regarding the cost effectiveness of Medicaid programs; violative of the federal regulations by leaving selection of participants to the unfettered discretion of the agency’s employees; and violative of the federal regulations regarding access to necessary medical care.
We hold that the proposed rule is valid and the order of the Division of Administrative Hearings is affirmed. In so holding, we find it necessary to comment specifically on one aspect of the rule. The proposed rule provides that participants at Levels Three and Four of the program must obtain the prior approval of a case manager for reimbursement of non-emergency medical services. Proposed F.A.C. Rule 10C-7.65(8)(c) and (d). After the fact approval may be granted for emergency services. Id. “Emergency services” are defined in the rule as: “[Tjhose services ... necessary to prevent death, serious impairment to the health of the recipient, or irreparable damage, or loss or serious impairment of a body function.” Id. at (2)(1).
Appellant attacks the rule, contending that there are medically necessary services which do not qualify as emergency services and for which payment would be denied under the rule if a case manager were not available to authorize the services before they were performed. The concern of the appellant appears well-taken under the language of the rule; however, deference is given to the agency interpretation which differs from that of the appellant and which we find to be controlling in this case and binding on the agency. State Department of Health and Rehabilitative Services v. Framat Realty, Inc., 407 So. 2d 238, 242 (Fla. 1st DCA 1981). That interpretation is that a provider of medically necessary services need only notify the case manager at a reasonable time following provision of such services when they were performed after hours, on the weekend, or such other time when the case manager was not available for “prior” approval.
AFFIRMED.
SMITH and ZEHMER, JJ., concur.
BARFIELD, Judge.
Appellant has correctly pointed out to the court that in an effort to give deference to the agency’s interpretation of its own rules, we allowed the agency to place a construction on a rule which is clearly contradictory to the unambiguous language of the rule. This we should not have done. See Gadsden State Bank v. Lewis, 348 So. 2d 343, 345, n. 2 (Fla. 1st DCA 1977).
Proposed Florida Administrative Code Rule IOC-7.65 does not provide for reimbursement for nonemergency but medically necessary services without prior agency approval as required by 42 CFR § 431.55(c). Accordingly, we find invalid those portions of proposed FAC Rule 10C-7.65 which require prior authorization for reimbursement of medically necessary services.
Appellant’s motion for rehearing is GRANTED, and the final order of the Division of Administrative Hearings upholding the validity of proposed Florida Administrative Code Rule IOC-7.65 is REVERSED in part and AFFIRMED in part.
SMITH and ZEHMER, JJ., concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
Birdie Woodley v. Dep't OF Health & Rehabilitative Servs., 505 So. 2d 676 (Fla. 1st DCA 1987)…ce to agency interpretation is not absolute. When the agency’s construction clearly contradicts the unambiguous language of the rule, the construction is clearly erroneous and cannot stand. Kearse v. Department of Health and Rehabilitative Services, 474 So. 2d 819 (Fla. 1st DCA 1985). Florida Administrative Code Rule 10C-1.-102(4)(b) provides: If documentation or verification is not provided within the time limits allowed, the assistance group must be determined ineligible for assistance. However, if the em…
-
LAS Olas Tower Co. v. City OF Fort Lauderdale, 742 So. 2d 308 (Fla. 4th DCA 1999)…d., Inc. v. Board of County Comm’rs of Brevard County, 642 So. 2d 1081, 1083-84 (Fla.1994); Woodley v. Department of Health and Rehabilitative Servs., 505 So. 2d 676, 678 (Fla. 1st DCA 1987); Kearse v. Department of Health and Rehabilitative Servs., 474 So. 2d 819, 820 (Fla. 1st DCA 1985). Was the interpretation which the BOA placed on section 47-33.1 unreasonable or clearly erroneous? We think not. In statutory construction a literal interpretation need not be given the language used when to do so would lea…
-
Buffa v. Singletary, 652 So. 2d 885 (Fla. 1st DCA 1995)…corrective result. Buffa’s possession of marijuana, however reprehensible, cannot be said to amount to “a serious assault or general disturbance.” An agency must comply with its own rules. Kearse v. Department of Health and Rehabilitative Services, 474 So. 2d 819 (Fla. 1st DCA 1985); Gadsden State Bank v. Lewis, 348 So. 2d 343 (Fla. 1st DCA 1977). Accordingly, we reverse the denial of the petition for writ of mandamus and remand with directions that the circuit court order the Department of Corrections to r…
Previewing 3 of 5 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- State Dep't of Health & Rehabilitative Servs. v. Framat Realty, Inc., 407 So. 2d 238 (Fla. 1st DCA 1981)
- Gadsden State Bank v. Lewis, 348 So. 2d 343 (Fla. 1st DCA 1977)