Feliciana Consultants, Inc. VS State of Louisiana, Department of Health & Hospitals
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NOT DESIGNATED FOR PUBLICATION STATE OF LOUISIANA COURT OF APPEAL FIRST CIRCUIT 2009 CA 1098 FELICIANA CONSULTANTS INC VERSUS STATE OF LOUISIANA DEPARTMENT OF HEALTH HOSPITALS Judgment Rendered On DEe 2 3 2009 Appeal from the Nineteenth Judicial District Court In and for the Parish of East Baton Rouge State of Louisiana Docket No 568 014 Honorable Janice Clark John J Judge Presiding Rabalais Counsel for Plaintiff Appellee Feliciana Consultants Inc Michelle Alt Hazlett Covington Louisiana Daniel L Duhon Counsel for Defendant Baton Louisiana Rouge Louisiana Appellant Department of Health Hospitals BEFORE DOWNING GAIDRY AND McCLENDON JJ r J I i 12 1 v L 4 vc C C V McCLENDON J In this DHH appeal the State of Louisiana Department of Health and Hospitals appeals the judgment of the district court terminate the license of Feliciana Consultants mental health rehabilitation reverse the MHR Inc Feliciana For the provider judgment of the district reversing DHH reasons decision to s as a Medicaid that follow we court FACTUAL AND PROCEDURAL HISTORY This Feliciana matter was not Following began in April 2007 following providing psychiatric consultations MHR program rules but allowed Feliciana to submit was accepted by DHH unit began follow up compliance monitoring On October 3 2007 June 27 2007 on DHH notified Feliciana letter requiring 1 that recipients review 3 on that it 1 2 s could was still noted Education Letter an of two providers have that monitoring as an MHR an See Louisiana Reqister No 05 least See Louisiana Register service of five active application provider effective December 16 2007 and as were met DHH indicated that it Vol 31 Notice of imposition of the administrative an MHR Further administrative review of DHH but noted that if the deficiencies at core other than the initial review reapply for certification entitled to a of the MHR program rules and 2 by were May was not 20 2005 action s 3 Vol 32 No 11 November 20 2006 2 the Feliciana was at that time to sanction the future sanctions Chapter once DHH notified Feliciana taking steps not corrected provider were Subchapter A possible Sections 301 and 315 and MHR Provider Manual Section 312 page 22 3 of its received the never option of obtaining the operational requirements In the education letter provider in violation DHH also advised Feliciana of the program monitoring were be offered the at the time of any Feliciana that it was consumers sanction of termination that and deficiencies November 16 2007 DHH advised Feliciana management2 medication violation of MHR August 2007 the through recipients 1 Thereafter Sanction was in that plan of correction which a Feliciana contends that it findings and required actions education letter In to DHH to its Medicaid DHH concluded that Feliciana investigation some complaint a Chapter 7 S 731 3 H b also advised that after entitled to seek December 19 Feliciana on appeal before the DHH an Feliciana Informal Review an timely requested 2007 DHH January 25 administrative appeal administrative law 4 the AU who concluded that offer the On June 18 2008 2008 was held May 19 2008 core Feliciana filed hearing a January 26 2009 and DHH filed a remanding the 0379 La on an Feliciana did not management and did August 12 2008 the district judgment A DHH s App 1 Cir 5 20 09 State v grant DHH a court signed on judgment was not a issued published we a application for supervisory matter to the district court to Inc was an suspensive appeal a the basis that the on applied for supervisory writs granting Feliciana Consultants an adopted the findings of motion and order for The district court denied the motion decision requested arbitrary capricious and reversing the decision of DHH curiam supply May 8 2008 before on DHH was rendered its decision per of petition for judicial review asserting a Following After DHH on recipients abuse of discretion judgment Feliciana service of medication that the decision of DHH to terminate its license final held license was to terminate the the date of the sanction letter on option of obtaining the not have at least five active February 22 On which review the failure of Feliciana to on appeal hearing AU judge it was Bureau of Appeals s informal an based On The Notice of the Results upheld its decision 2008 requested documentation and devolutive writs and appeal See Dept of Health and Hospitals 09 16 So 3d 379 SPECIFICATIONS OF ERROR In this 1 appeal DHH assigns the following The district court erred in that there by finding MHR provider license 4 Prior to the 1 whether Feliciana hearing were was reversing the administrative law judge s ruling multiple active recipients at the time Feliciana s terminated DHH notified the on as error parties that the the date of the sanction letter and 315 regarding medication management and sanction letter complied with MHR rules at section least five active recipients 3 2 hearing complied would be limited to two issues with MHR rules at sections 301 whether Feliciana 731 H 3 b requiring on that a the date of the provider have at 2 The district court erred by reversing the administrative law judge on the s above stated factual finding that is completely basis of the district court unsubstantiated 3 The by the administrative record district court erred grounds for as the recipients address the other ground of termination by only considering of the one the failure to have at least five active termination basis of its reversal and failing the failure to offer the core to service of medication management STANDARD OF REVIEW Louisiana 49 950 Administrative Procedure Act s The LAPA et seq was is set forth in LSA LAPA enacted to establish certain procedures for 5 R state agencies for adoption of rules adjudication of matters and judicial review of administrative Health and Women rulings s and Children Hospitals 08 946 pp 5 6 La The LAPA The or LAPA 1 21 09 v Dept of State 2 So 3d 397 401 provides for judicial review of administrative adjudications pertinent part LSA R S 49 964A states decision Hosp s order in an a person who is aggrieved by developed in the administrative proceedings LSA R S to the 49 964F by the district court is governed by LSA record Further 5 R 49 964G provides The court may affirm the decision of the agency or remand the case for further proceedings The court may reverse or modify the decision if substantial rights of the appellant have been prejudiced because conclusions or the decisions administrative findings inferences are 1 In violation of constitutional 2 In excess of the 3 Made upon unlawful 4 Affected or statutory provisions statutory authority of the agency by other procedure error of law 5 Arbitrary or capricious or characterized by abuse of discretion clearly unwarranted exercise of discretion or 6 as or supported and sustainable by a preponderance of evidence determined by the reviewing court In the application of this Not rule the court shall make its fact by final adjudication proceeding is entitled to judicial review specifies that judicial review shall be confined extent of the review a In own determination and conclusions of preponderance of evidence based upon its own evaluation of the record reviewed in its entirety upon judicial review In the application of the rule where the agency has the opportunity to judge the credibility of witnesses by first hand observation of a 4 as the which demeanor on the witness stand and the due regard shall credibility issues the as absence of of a the clear and Children s 342 So 2d 609 was without Or 4 8 94 1 7 1 94 Company 612 Stated 8 Louisiana v La 1977 where some courts in are the The test for 2 So 3d at 403 Public Service determining whether is whether the action taken is reasonable differently the question Matter of reason 08 946 at p Hosp s arbitrary and capricious under the circumstances App is that of showing that the administrative action is arbitrary and Rouge Water Works the action is La determination regulatory bodies exercising discretionary authority Women Commission taken agency great weight and should not be overturned by the capricious Baton the to court does not reasonably interpreted supports the regulatory body s determination orders accorded given s general principle governing judicial review The evidence be reviewing Recovery 635 SO 2d 690 I 699 700 is whether the action Inc 93 0441 writ denied 17 18 pp 94 1232 La 639 So 2d 1169 Once a final may seek review judgment is rendered by the district by appeal to the On review of the district court appeal to the factual findings deference is owed 08 1056 Consequently we no p appeal Wild La 1 will conduct accordance with the standards 5 R 49 965 by the court of legal conclusions of the district court just or 6 aggrieved party LSA court deference is owed by the Louisiana Supreme Court conclusions of the court of Hospitals appropriate appellate judgment s court an App our own v to factual State Or findings as no or legal Dept of Health and 12 23 08 7 So 3d 1 4 5 independent review of the record in provided in LSA 5 R 49 964G DISCUSSION Established in 1965 the Medicaid program is benefits to certain groups of low income Hosp 08 946 at p administered Act 42 people 1 2 SO 3d at 398 99 by the federal and state 5 Uc 9 1396 et seq designed to Women s provide medical and Children The Medicaid program is s jointly governments pursuant to the Medicaid Act Although 5 the federal government establishes general guidelines for the program established by each state and Human Medicaid Women program s DHHS a is are voluntary program At the federal level the participate Services requirements program The Medicaid program is which each state may choose to of Health the Medicaid in Department responsible for administering the and Children 08 946 at pp Hasp s 1 2 2 So 3d at 399 In order to receive federal Medicaid written state is plan that has been submitted essentially the state s funding states must have in effect to and approved by DHHS The plan agreement that it will conform to the requirements of the Act and the official issuances of DHHS Louisiana is Medicaid program and administers its program via a state a participant in the plan and amendments DHH is the state agency that administers the Louisiana State Medicaid Id a Program An individual is entitled to Medicaid assistance if the criteria established the state where the individual resides are fulfilled Wild 08 1056 at p 8 by 7 So 3d at 6 In this matter operations was the first to She stated that October 1 Pamela Brown no 2006 testify for DHH medication and program manager for Medicaid at the administrative management December 31 2007 She management is normally provided by physicians require medication of time on of management for Keith program some recipients complaints that it had consultations with stated that staff for any Feliciana psychiatrist a medication recipients who over a period on came to her attention staff who did not do recipients Durham also testified and it by Feliciana between provider would have billed for mental health special services He stated that an initial was provided by Feliciana confirmed that medication Thereafter a notice of 6 director complaint department regarding medication management conducted appeal hearing recipients need medication however it is reasonable to believe that each MHR medication because Not all billed was program was for the MHR referred to his Consumer interviews were not being management deficiency was was issued to Feliciana4 on May 10 2007 which was denied by Feliciana and a 60 On On June 27 2007 On approved was day fOllow up At that time May 23 2007 Feliciana submitted revised plan of correction plan of correction informed that the was 2007 submitted being implemented was accepted was education letter so an was Mr Durham stated that this was the letter that Feliciana contends it did not receive sanctioned Feliciana at that time was plan of correction The follow up showed that deficiencies still existed sent to Feliciana on October 3 plan of correction August 30 2007 the monitoring unit began to determine if the Feliciana a a He explained that but sent the letter DHH could have to educate the courtesy as a provider Besides Feliciana the medication providing services also not was Mr the MHR rules Durham authorization the client is eligible for the report can be run report MHR program Therefore On that date November 1 that time 2007 to a place computer system services are authorized Mr by Medicaid recipients have once a on Feliciana November 16 had only one one 2007 active a prior systems provider has at he ran a recipient active PA report showing that the January 29 2008 totaled a If Durham to have imputed into the database Durham stated that Durham also submitted required by as wants to to determine how many active PA numbers Mr anyone time numbers DHH that provider requests authorization from the prior stated that in order to be reimbursed by recipients provider a stated Durham unit to have the client entered into the PA authorization to five active explained that when the client in the MHR program Mr management issue PA Mr numbers from active authorization during period Mr Durham further testified that because of these rule violations a notice was 19 Mr Durham stated that no new information was 2008 informal review issued and informal review of sanction ran hearing was hearing to establish compliance but Feliciana opportunity and another Mr Durham an another ten days to show compliance report for active PAs 7 There held on December presented was given another On December 29 was still at the only one 2007 active PA He stated that telephone calls were exchanged another week Feliciana to provide the necessary information established Therefore on however no was compliance DHH made the decision to January 25 2008 to given was impose the sanction of termination Darrell Montgomery the program manager for the day of the MHR program testified on behalf of Feliciana Services without had the date in than five active clients documents considered Mr an Montgomery stated that active client if he department to determine if services system before they an are MHR services if found to be Mr Feliciana on providers authorized was not were consultations In its were are allowed to enter clients into the impose sanctions because to given a choice to was see a psychiatrist at Feliciana Mr Durham was being performed by the recipients primary management and did found that AU was not in Feliciana also submitted a s Office of Mental Health based on showing physicians care testimony showed that option of obtaining the we on 8 core service recipients find that there is sufficient October 11 2007 documents submitted for review the date of on We also conclude that DHH that s preponderance of the not have at least five active findings document the evidence that no compliance with the cited rules carefully reviewed the record and support the AU only showing that point in the proceedings that there the based not interviews with clients the sanction letter Feliciana did not offer the evidence to require that anyone on The AU concluded that the evidence and 5 medically necessary criteria for Accreditation standards but also based evidence established that Feliciana We have by the PA ineligible appeal decision of medication to the has to be accounted for and transferred to other provider billing also stated at this Referring question offering medication management services not established that it PA she is not authorized after review client meets the a a client of the MHR program is not a Montgomery testified that the decision the lack of recipients or He further testified that who goes to on day operations Feliciana asserted that its reports entitled Active Client List and more to it was s decision to recertified by the terminate the license of Feliciana as reasonably interpreted and agency Therefore DHH s the we find action no demonstrated that the by Feliciana or taken reasonable was The evidence capricious under grounds upon which the district that Feliciana had offered arbitrary supports the determination of the administrative decision to terminate Feliciana finding not was more core s license the court could have reversed The district court than five active clearly erred Also recipients service of medication circumstances management in the evidence was not and the district court failed to address this being MHR rule violation Accordingly decision we reverse the judgment of the district court reversing the of DHH to terminate the rehabilitation license of Feliciana as a mental health provider CONCLUSION For the above and judgment foregoing of the district court reasons Costs of this Consultants Inc REVERSED 9 we reverse appeal are the January 26 2009 assessed to Feliciana STATE OF LOUISIANA COURT OF APPEAL FIRST CIRCUIT 2009 CA 1098 FELICIANA CONSULTANTS INC VERSUS STATE OF LOUISIANA DEPARTMENT OF HEALTH DOWNING J q While the and its n to deference to pursuant to 49 964G 6 this a the 4 this trial La court App correct result it 1 Cir 6 10 05 explained why factual court s Louisiana This reasons In St Martinville matter 05 0457 p predecessors assigns reaches the majority standard of review Tax Com and concurs HOSPITALS findings Administrative subparagraph provides as applies L L C an v incorrect Louisiana 917 So 2d 38 an appellate in an 41 42 court must give administrative review Procedure Act La RS follows affirm the decision of the agency or remand the The court may reverse or modify case for further proceedings the decision if substantial rights of the appellant have been The court may because prejudiced conclusions 6 Not evidence or the administrative decisions application are determined of this by the rule the by a preponderance of reviewing court In the court shall determination and conclusions of fact of evidence reviewed in based upon its its inferences and sustainable supported as findings entirety own upon by a make its own preponderance evaluation of the record judicial review In the application of the rule where the agency has the opportunity to judge the credibility of witnesses by first hand observation of demeanor on the witness stand and the reviewing court does not due regard shall be given to the agency s determination of credibility issues This 128 S 1 Emphasis added language enacted by the Louisiana legislature in effective June 12 1997 to amend paragraph G 6 Acts 1997 No clearly makes the trial court fact finder who a conclusions of fact deference to by preponderance of the evidence Accordingly the trial court factual determinations and s standard of review where the of fact 10 6 05 St Virgil Company 507 So 2d 825 factual findings written reports records and to three tiered system court Louisiana function function the trial as the trial to well as court 4 La credibility s 1 App Cir and Insurance Liability Court Supreme to applies court the trial solely explained of that finding function under Louisiana s system allocates the fact finding Because the trial as court of that allocation of s normal of procedure great deference is accorded the to findings both express and implicit and evaluations of credibility and reasonable inferences reasonable factual of fact should not be judgment While the disturbed on appellate review of the trial Id majority determinations it claims s not to finds defer to the trial court s factual which the district court decision and concludes that the district court specifically could have reversed DHH The p The supreme fact courts s court in s court trial clearly erred 05 0457 error follows live witnesses s the agency to standard of review depositions evaluating court manifest when the evidence before it consists three tiered s deference give we it with the function La 1987 the Louisiana error even deference is due empowered Guarantee 826 observed that the manifest s use a own 42 American v has L L C Martinville at 41 917 So 2d In court legislature finding while giving due determinations the evidence and makes its weighs no grounds finding that Feliciana had more majority also concluded that the district on than five active court recipients failed to address an MHR rule violation Essentially the manifestly and legally the result reached majority concluded that the trial erroneous in its by the majority 2 findings court On this basis was both I agree with
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