CEO 88 - 4 -- February 4, 1988
To: (Name withheld at the person's request.)
SUMMARY:
QUESTION:
In your letter of inquiry you advise that .... is a Registered Nurse Specialist with the District V CARES (Comprehensive Assessment and Review of Long Term Care Services) Unit, Medicaid Program Office, Department of Health and Rehabilitative Services. In a telephone conversation with our staff, her supervisor advised that she evaluates individuals for Medicaid eligibility, files Medicaid applications, and provides placement services. Her position involves professional work in the Medicaid preadmission screening program monitoring medical needs for appropriate placement in the Long Term Care System.
The
CARES Unit is responsible for establishing the necessary level of care for
all Medicaid/Institutional Care Program (ICP) applicants and for making a
nonbinding recommendation for placement in the least restrictive environment
which can meet a client's needs. This "level of care" decision is
made either by a desk review of medical information submitted by a nursing
home or by an on-site assessment performed by a CARES Human Services Analyst
and a CARES Registered Nurse Specialist.
This medical information then is evaluated by the Medicaid contract
physician consultant, the assigned CARES team, and the CARES Unit Supervisor,
who establish the CARES recommendation.
The "level of care" function is designed to determine whether
a Medicaid applicant requires either an "intermediate" or "skilled"
level of care according to Chapter 10C-7, Florida Administrative Code.
If an individual does not meet this nursing home level of care, he
is declared ineligible for the Institutional Care Program payment to a nursing
home.
You
further advise that the Registered Nurse Specialist recently assumed the guardianship
of an individual who resided at a nursing home where she was a part-time employee.
She resigned from this position when the nursing home applied for a
Medicaid provider number. The petition
for evaluation of the ward's competency was signed by the social services
designee at the nursing home, a Department Adult and Aging Program employee,
and a CARES Unit Human Services Analyst.
The Registered Nurse Specialist informed her supervisor of the guardianship
after she had assumed the responsibility.
She informed her supervisor that her ward never had been a Department
client, but that she soon would be applying for ICP Medicaid for her ward.
Her supervisor later discovered that she previously had filed the Medicaid
application and requested retroactive payment for several months.
In a telephone conversation with our staff, the supervisor advised
that if the application is approved, Medicaid payments will be made directly
to the providing nursing home while the guardian will be required to pay the
client responsibility portion of any costs out of her ward's assets.
CONFLICTING
EMPLOYMENT OR CONTRACTUAL RELATIONSHIP. No public officer or employee of an
agency shall have or hold any employment or contractual relationship with
any business entity or any agency which is subject to the regulation of, or
is doing business with, an agency of which he is an officer or employee .
. . ; nor shall an officer or employee of an agency have or hold any employment
or contractual relationship that will create a continuing or frequently recurring
conflict between his private interests and the performance of his public duties
or that would impede the full and faithful discharge of his public duties.
This provision prohibits a public employee from having any employment or contractual relationship with any business entity which is subject to the regulation of, or doing business with, her agency.
A "guardian" is one to whom the law has entrusted the custody and control of the person, property, or both, of an incompetent individual. A guardian is appointed by the court and is entitled to receive a reasonable fee for any services she renders on behalf of her ward. These fees are payable by the court. See Chapter 744, Florida Statutes. The relationship between a guardian and ward is of a fiduciary nature under court supervision and in our view cannot be classified as an employment or contractual relationship.
MISUSE
OF PUBLIC POSITION. No public officer or employee of an agency shall corruptly
use or attempt to use his official position or any property or resource which
may be within his trust, or perform his official duties, to secure a special
privilege, benefit, or exemption for himself or others.
This section shall not be construed to conflict with s. 104.31.
DISCLOSURE
OR USE OF CERTAIN INFORMATION. No public officer or employee of an agency
shall disclose or use information not available to members of the general
public and gained by reason of his official position for his personal gain
or benefit or for the personal gain or benefit of any other person or business
entity.