PROVIDER NAME/ADDRESS: UPMC Magee Women's Health 300 Halket St. Attn: Gulf Bldg. Room# 204 Pittsburgh, PA 15213 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES PROVIDER S REPRESENTATIVE Denise DiPietro PROVIDER S WITNESS (ES) RECIPIENTS INVOLVED: Heather Jorgensen ID# 3003703745 DEPARTMENT REPRESENTATIVE DEPARTMENT WITNESS(ES) CASE # DATE ADVERSE ACTION MAILED BHA ID NUMBER/BHA DOCKET NUMBERS/ISSUE CODES 02J1151-001/926 DATE APPPEAL RECEIVED DATE APPEAL RECEIVED IR DUE DATE POSTMARKED AT DHS AT BHA 2/23/2015 DATE SCHEDULING NOTICE MAILED RESCHEDULED TO DATE OF HEARING START TIME END TIME HEARING LOCATION TELEPHONE FACE TO FACE OTHER ORDER A hearing was properly scheduled to be conducted by an Administrative Law Judge. The Appellant was not available, nor did the Appellant provide good cause for not being available. Because the Appellant has failed to pursue the appeal, it will be DISMISSED in accordance with 55 Pa. Code 41.153. Either party to this proceeding has thirty (30) calendar days from the date of this decision to request reconsideration by the Secretary of the Department. To seek reconsideration, you must fully complete the enclosed application/petition for reconsideration. The application/petition shall be addressed to the Secretary, but delivered to the Director, Bureau of Hearings and Appeals, P.O. Box 2675, Harrisburg, Pennsylvania, 17105-2675, and must be received in the Bureau of Hearings and Appeals within thirty (30) calendar days from the date of this Order. This action does not stop the time within which an appeal must be filed to Commonwealth Court. The applicant/petitioner shall serve a copy of the application/petition for reconsideration on the opposing party(ies). The appropriate party(ies), where permitted, may take issue with this Adjudication, and Order, and may appeal to the Commonwealth Court of Pennsylvania, within thirty (30) days from the date of this order. This appeal must be filed with the Clerk of Commonwealth Court of Pennsylvania, 601 Commonwealth Avenue, Suite 2100, P.O. Box 69185, Harrisburg, Pennsylvania 17106-9185. If you file an appeal with the Commonwealth Court, a copy of the appeal must be served on the government unit which made the determination in accordance with Pa. R.A.P. 1514. In this case, service must be made to: Department of Human Services, Bureau of Hearings and Appeals, 2330 Vartan Way, 2 nd Floor, Harrisburg, Pennsylvania 17110-9721, AND Department of Human Services, Office of General Counsel, 3 rd Floor West, Health & Welfare Building, Harrisburg, PA 17120. Bureau of Hearings and Appeals Final Administrative Action and Mailing Date 7/9/2015 Tracy L. Henry, Esquire Chief Administrative Law Judge Fn12/01/2014
cc: Sarah Witmer
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES APPEAL OF: UPMC Magee Women s Health 300 Halket St. Attn: Gulf Bldg. Rm# 204 Pittsburgh, PA 15213 Attn: Denise DiPietro Docket No.: 02J1151-001 OPENING STATEMENT ADJUDICATION On February 23, 2015, the Appellant filed a Request for Hearing. ISSUE Did the Appellant include a denial notice as the basis of their appeal? FINDINGS OF FACT 1. On February 23, 2015, the Appellant filed a Request for Hearing with the Bureau of Hearing and Appeals (BHA). 2. No denial notice accompanied the appeal. 3. On June 9, 2015, BHA issued a Rule to Show Cause (Rule) offering the Appellant the opportunity to provide a notice of denial. Deadline for response was June 19, 2015. 4. As of July 8, 2015 no response has been received. APPLICABLE LAW The following section of the 55 Pa. Code applies to this appeal: 41.31. Request for hearing. (a) A provider that is aggrieved by an agency action may appeal and obtain review of that action by the Bureau by Fn12/01/2014
filing a request for hearing in accordance with this chapter. (e) If the provider received written notice of the agency action by mail or personal service, the provider shall attach to the request for hearing a copy of the transmittal letter forwarding the written notice and the first page of the written notice, or, if there is no transmittal letter, a copy of the entire written notice. The following two sections of 1 Pa. Code apply to this appeal: 35.14. Orders to show cause. Whenever an agency desires to institute a proceeding against a person under statutory or other authority, the agency may commence the action by an order to show cause setting forth the grounds for the action. The order will contain a statement of the particulars and matters concerning which the agency is inquiring, which shall be deemed to be tentative and for the purpose of framing issues for consideration and decision by the agency in the proceeding, and the order will require that the respondent named respond orally, or in writing (as provided in 35.37 (relating to answers to orders to show cause) or both. 35.37. Answers to orders to show cause. A person upon whom an order to show cause has been served under 35.14 (relating to orders to show cause) shall, if directed so to do, respond to the same by filing within the time specified in the order an answer in writing. The answer shall be drawn so as specifically to admit or deny the allegations or charges which may be made in the order, set forth the facts upon which respondent relies and state concisely the matters of law relied upon. Mere general denials of the allegations of an order to show cause which general denials are unsupported by specific facts upon which respondent relies, will not be considered as complying with this section and may be deemed a basis for entry of a final order without hearing, unless otherwise required by statute, on the ground that the response has raised no issues requiring a hearing or further proceedings. A respondent failing to file answer within the time allowed shall be deemed in default, and relevant facts stated in the order to show cause may be deemed admitted. 4
DISCUSSION As per 55 Pa. Code 41.31, a provider aggrieved by an agency action may appeal and obtain review of that action by filing a Request for Hearing. Section 41.31(e) requires that the written notice of the agency action be included with the Request. As per 1 Pa. Code 35.14, an agency may issue an order to show cause for the purpose of framing issues about which the agency is inquiring. Section 35.37 states that an answer to an order to show cause shall specifically admit or deny charges made in the order, set forth the facts upon which the respondent relies and state concisely the matters of law relied upon. Mere general denials which are unsupported by specific facts will not be considered complying with this section. In the instant case, no denial notice to the Appellant accompanied the Appellant s Request for Hearing. Appellant was offered the opportunity to provide a denial notice but did not respond. CONCLUSION An appeal cannot occur without an agency action that produces adverse affects. The Appellant did not submit a denial notice with their appeal and did not provide such notice when specifically requested. The Appellant s appeal must be DISMISSED due to unsubstantiated adverse affect from Department action. 5
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES BUREAU OF HEARINGS AND APPEALS APPEAL OF: UPMC Magee Women s Health 300 Halket St. Attn: Gulf Bldg. Rm# 204 Pittsburgh, PA 15213 Attn: Denise DiPietro Docket No.: 02J1151-001 RECOMMENDATION It is hereby RECOMMENDED that the above-captioned appeal be DISMISSED as untimely filed since it failed to meet the requirements in 55 Pa. Code 41.31. July 9, 2015 Date Michelle Drachler Administrative Law Judge (ALJ) Bureau of Hearings and Appeals 6