T.B. c/o Teri Berket, Appellant, v. HUMANA MEDICAL PLAN INC (2020)

In this appeal, Teri Berket, on behalf of T.B., challenges the hearing officer's determination that the Agency for Health Care Administration (AHCA) did not have jurisdiction. Ms. Berket argues that she was entitled to a fair hearing because Humana Medical Plan, Inc., made a final determination that reduced the number of service hours T.B. was eligible to receive and refused to pay Ms. Berket for the additional sixteen hours of services she provided to T.B. After reviewing the record, we find no error with the hearing officer's determination.

The appellate court reviews an agency determination with regards to jurisdiction de novo. Dep't of Revenue v. Vanamburg, 174 So. 3d 640, 642 (Fla. 1st DCA 2015). A hearing officer may dismiss a request for a fair hearing if the hearing officer determines that AHCA does not have subject-matter jurisdiction. Fla. Admin. Code R. 59G-1.100(9)(b)1. Rule 59G-1.100(3) specifies AHCA's jurisdiction and the circumstances that require AHCA to hold a hearing.

AHCA has jurisdiction to hold a hearing when a fee-for-services recipient has her previously authorized service reduced, suspended, or terminated or is denied a service she has requested. Fla. Admin. Code R. 59G-1.100(3)(a)1.–2. In 2018, T.B. had received healthcare benefits from UnitedHealthcare. UnitedHealthcare had authorized T.B. to receive forty hours of services provided by Ms. Berket and an additional sixteen hours of services that had to be performed by outside servicers. In 2019, T.B. received healthcare benefits from Humana. In a letter to Ms. Berket dated January 23, 2019, Humana stated that it would still provide the same services as authorized by UnitedHealthcare. Humana further informed Ms. Berket that the additional sixteen hours of authorized services had to be provided by outside servicers. Because Humana had not changed the services that T.B. was previously authorized to receive or denied T.B. additional services, AHCA did not have jurisdiction to hold a hearing on this matter.

Ms. Berket also claims that the hearing officer incorrectly determined that AHCA did not have jurisdiction to hear her claim for payment for the additional sixteen hours of services she provided to T.B. The record on appeal shows that Ms. Berket requested payment from the healthcare provider for these additional hours. A request for payment by a service provider is not one of the enumerated circumstances over which AHCA has jurisdiction. See Fla. Admin. Code R. 59G-1.100(3); 42 U.S.C. § 1396a(a)(3). Accordingly, the hearing officer correctly determined that AHCA did not have jurisdiction.

Affirmed.

Per Curiam.

Roberts, Rowe, and Bilbrey, JJ., concur.