95-005579 Sunrise Community, Inc. vs. Agency For Health Care Administration Status: Closed Recommended Order on Monday, August 5, 1996.

Summary: Petitioner demonstrated that it is entitled to interim rate adjustments, sub ject to audit/obtained prior approval to incur costs although not written.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

SUNRISE COMMUNITY, INC., )

)

Petitioner, )

)

vs. ) CASE NOS. 95-5579

) 95-5580

AGENCY FOR HEALTH CARE ) 95-5581

ADMINISTRATION, ) 95-5582

)

Respondent. )

____________________________)

RECOMMENDED ORDER

Pursuant to notice, a formal hearing was held in this case on March 11 -

13, 1996, in Miami, Florida, before Errol H. Powell, a duly designated Hearing

Officer of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Steven M. Weinger, Esquire

Kurzban, Kurzban, Weinger & Tetzeli, P.A.

2650 Southwest 27th Avenue

Miami, Florida 33133-3003

For Respondent: Steven A. Grigas, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Building Number3

Tallahassee, Florida 32308-5403

STATEMENT OF THE ISSUE

The issue for determination at final hearing is whether Petitioner should

be granted interim rate adjustments.

PRELIMINARY STATEMENT

Sunrise Community, Inc. (Petitioner) requested interim rate adjustments for

the Sunrise Main Facility and several of its other facilities. By letters dated

October 9, 1995, and October 11, 1995 the Agency for Health Care Administration

(Respondent) notified Petitioner that its request was denied. The reasons for

the denial were that, pursuant to Section IV.G.4 of the Intermediate Care

Facility for the Mentally Retarded and Developmentally Disabled (ICF/MR-DD)

Reimbursement Plan, Respondent was prohibited from considering any costs

incurred prior to June 15, 1995 and that the allowable costs incurred failed to

meet the minimum amount required by Section IV.G.2 of the ICF/MR-DD

Reimbursement Plan. By petition filed October 27, 1995, Petitioner challenged

the denial and requested a formal hearing.

On November 17, 1995, this matter was referred to the Division of

Administrative Hearings. A hearing was scheduled pursuant to written notice.

Prior to hearing, Respondent was permitted to amend its denial letter. 1/

The amended denial letter, dated February 7, 1996, added an additional reason

for the denial and provided that Petitioner's request was also denied due to

Petitioner's failure to obtain prior approval from the Department of Health and

Rehabilitative Services, Office of Developmental Services pursuant to Section

III.G.7 of the ICF/MR-DD Reimbursement Plan. Approximately one month prior to

the hearing, on February 12, 1996, Respondent filed notice that only the reason

provided in its amended denial letter of February 7, 1996, i.e., lack of prior

approval, was the reason for denial of the interim rate adjustment requests. As

a result, the focal point of this case was whether Petitioner had prior approval

for the expenses that it incurred.

At the hearing, Petitioner presented the testimony of five witnesses and

entered 31 exhibits into evidence, with one exhibit being deposition testimony

and one exhibit (Exhibit 1) consisting of four parts. Respondent presented the

testimony of two witnesses and entered seven exhibits into evidence.

A transcript of the hearing was ordered. The parties filed proposed

findings of fact which have been addressed in the appendix to this recommended

order.

FINDINGS OF FACT

1. Sunrise Community, Inc. (Petitioner) is a charitable organization which

serves individuals with developmental disabilities. Petitioner is a licensed

Medicaid provider which owns, and/or operates Intermediate Care Facilities for

the Mentally Retarded and Developmentally Disabled (ICF/MR-DD).

2. The Agency for Health Care Administration (Respondent) is the state

agency responsible for the administration and implementation of the Florida

Medicaid Program.

3. In August 1995, Petitioner submitted interim rate requests, i.e.,

requests for interim changes in its Medicaid reimbursement rate, for costs

incurred associated with several of its facilities. The costs were incurred to

comply with existing state and federal regulations.

4. Petitioner submitted requests for the following Intermediate Care

Facilities (ICFs): Sunrise Main Facility Number 285013, St. Petersburg Cluster

Number 280186-01, Greentree Court Cluster Number 280283-01, McCauley Cluster

Number 280208-1, Mahan Cluster Number 280291-01, Bayshore Cluster Number 280313-

01, Dorchester Cluster Number 280496-01, Cape Coral Cluster Number 285331-01,

26th Terrace (Number 12) Number 285528, County Meadows (Number 13) Number

285536, 138th Court Number 285480-00, 62nd Place Number 285471-00, 55th Court

Number 285609-00, 53rd Court Number 285595-00, Wentworth Number 285617-00,

Oakmont Number 285587-00, and 148th Court Number 285579-00.

5. Reimbursement to participating ICF/MR-DD for services provided must be

in accordance with Florida Title XIX ICF/MR-DD Reimbursement Plan, Version VI,

dated November 15, 1994 (Reimbursement Plan).

6. Respondent timely denied Petitioner's interim rate requests. 2/

7. Section III.G.7 of the Reimbursement Plan provides:

After June 30, 1984, additional costs incurred

after enrollment in the program that are due

to capital additions or expansions must have

prior approval by the HRS Office of Developmental

Services if such costs exceed 1 percent of the

provider's current total reimbursement rate,

with the exception of the addition of new beds

which are approved through the state's Certificate

of Need process. Costs for specific expansion

or additions that exceed the 1 percent limit

shall not be reimbursable if not previously

approved. Further, financing costs for approved

expansions or additions shall be limited by the

prudent buyer limits established in Section

III.G.4. above.

8. Section IV.G of the Reimbursement Plan provides in pertinent part:

1. Requests for rate adjustments for increases

in property-related costs due to capital additions,

expansion, replacements or repairs shall not be

considered in the interim between cost report

submissions, except for the addition of new beds

or if the cost of the specific expansion, addition,

repair, or replacement would cause a change of 1

percent or more in the provider's total per diem

reimbursement rate.

2. Requests for interim rate changes reflecting

increased costs occurring as a result of resident

care or administration changes or capital replace-

ment other than that specified in (1) above shall

be considered only if such changes were made to

comply with existing state or federal rules, laws,

or standards, and if the change in cost to the

provider is at least $5000 and would cause a

change of 1.0 percent or more in the provider's

current total per diem rate. The provider must

submit documentation showing that the changes

made were necessary to meet existing state or

federal requirements.

9. Around February or March 1993, Petitioner's representatives discussed

with the then Assistant Secretary of Development Services (DS) its plans for the

ICFs, including the day centers, six-bed facilities, and office building. No

costs were discussed because only the approximate costs, not the actual costs,

for the projects were known at that time. The then Assistant Secretary verbally

gave Petitioner's representatives approval to proceed with their plans.

10. Following numerous public hearings, Petitioner executed leases for

properties from Regional Properties, Inc., which acquired the properties through

its tax exempt bond issue in October 1993. Regional Properties is a not-for-

profit corporation, exempt from taxation under Section 501(c)(3) of the Internal

Revenue Code.

11. Subsequently, a new Assistant Secretary took the helm of DS. Around

March 1994, Petitioner representatives met with the new Assistant Secretary and

discussed the ICF projects with him. He advised Petitioner's representatives to

continue with the projects.

12. Respondent required that the costs be incurred before requesting

reimbursement.

13. Petitioner submitted interim rate adjustment requests for the costs

associated with the ICF projects. Medicaid had received approval from DS for

the property items in the interim rate requests. Since the requests involved

items which were required as part of the ICF/MR-DD program, DS took the position

that it could not disapprove the requests.

14. The Assistant Secretaries of DS did not give Petitioner written prior

approval for the costs associated with the projects.

15. However, although not written, the new Assistant Secretary did give

prior approval for the costs. This finding is consistent with the approval of

all of Petitioner's requests for interim rate adjustments (for reimbursement) of

the costs associated with the projects submitted during the tenure of the new

Assistant Secretary.

16. In 1995, the new Assistant Secretary of DS was replaced by the present

Acting Assistant Secretary.

17. The present 1995 interim rate adjustment requests are a continuation

of costs associated with the ICF projects which have already been approved.

18. The identification of costs, as for capital additions or expansions,

by a provider is accepted and not questioned or challenged by DS. The costs in

the 1995 interim rate requests were accepted by DS.

19. The costs in the 1995 interim rate change requests were considered by

DS to be a continuation of costs for the ICF projects previously approved. As a

result, the Acting Assistant Secretary of DS took the position that DS could not

disapprove the requests.

20. Written prior approval was not required by DS prior to Petitioner's

1995 interim rate change requests.

21. Petitioner was entitled to rely upon the terms of the Reimbursement

Plan and the past practice of Medicaid, DS, and Respondent regarding prior

approval. In reliance on the past practice, Petitioner proceeded and continued

with the ICF projects and incurred costs associated with the projects.

22. Petitioner leases properties from Regional Properties, Inc. The

Phineas Corporation controls both Petitioner and Regional Properties.

Petitioner leases the properties from a "related" party or organization.

23. The lease payments are not costs for capital additions or expansions

under the Reimbursement Plan.

24. Repairs and replacements are not capital additions or expansions under

the Reimbursement Plan.

25. Each facility must be evaluated separately regarding capital additions

or expansions in terms of the 1 percent requirement of Section III.G.7 of the

Reimbursement Plan.

26. In the 1995 interim rate adjustment requests, there are no capital

additions or expansions beyond those identified by Petitioner in its requests.

27. The 1 percent requirement of Section III.G.7 does not apply to any of

Petitioner's 1995 interim rate adjustment requests.

28. The costs submitted by Petitioner in the 1995 interim rate adjustment

requests are reasonable and necessary and are, therefore, allowable subject to

audit.

CONCLUSIONS OF LAW

29. The Division of Administrative Hearings has jurisdiction over the

subject matter of this proceeding and the parties thereto pursuant to Subsection

120.57(1), Florida Statutes.

30. Petitioner bears the burden of showing that it is entitled to the

interim rate changes as requested. Florida Department of Transportation v. J.

W. C. Company, 396 So. 2d 778 (Fla 1st DCA 1981); Balino v. Department of Health

and Rehabilitative Services, 348 So. 2d 349 (Fla. 1st DCA 1977).

31. The Reimbursement Plan has been adopted and incorporated by reference

in Rule 59G-6.040, Florida Administrative Code.

32. Petitioner has met its burden of proof. Petitioner has demonstrated

that, in accordance with the Reimbursement Plan, it received prior approval,

although not in writing, for the interim rate adjustment requests submitted in

August 1995; that, even though it received prior approval, the interim rate

adjustment requests submitted in 1995 are not subject to the 1 percent

requirement of Section III.G.7 of the Reimbursement Plan; and that the costs in

the interim rate adjustment requests are reasonable and necessary subject to

audit.

33. Having found and determined that Petitioner is entitled to the interim

rate adjustment requests, all other arguments are moot.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of Law, it is

RECOMMENDED that the Agency for Health Care Administration enter a final

order granting Petitioner's interim rate adjustment requests submitted in August

1995, subject to auditing.

DONE AND ENTERED this 5th day of August 1996, in Tallahassee, Leon County,

Florida.

___________________________________

ERROL H. POWELL, Hearing Officer

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

[phone]

Filed with the Clerk of the

Division of Administrative Hearings

this 5th day of August 1996.

ENDNOTES

1/ This Hearing Officer is not persuaded that the ruling granting Respondent's

emergency motion to amend its denial letter should be reconsidered. The ruling

is affirmed.

2/ Ibid.

APPENDIX

The following rulings are made on the parties' proposed findings of fact:

Petitioner's Proposed Findings of Fact

General Findings

A. Partially accepted in findings of fact 1 and 3-5. Also, see

Preliminary Statement.

B - C. Rejected as being subordinate.

D. Partially accepted in finding of fact 15, 17, 21, and 26-28.

E. Partially accepted in findings of fact 9 and 15.

F. Partially accepted in finding of fact 10.

G. Partially accepted in findings of fact 9-11 and 14-17.

H. Partially accepted in findings of fact 12, 13, 15, and 17.

I. Partially accepted in finding of fact 16.

J. Partially accepted in findings of fact 19 and 20.

K. Partially accepted in finding of fact 13.

L. Partially accepted in findings of fact 20 and 27.

M. Partially accepted in findings of fact 7 and 27.

N. Partially accepted in findings of fact 22 and 23.

O. Partially accepted in findings of fact 20 and 27.

P. Partially accepted in finding of fact 25.

Q - T. Rejected as being irrelevant, or unnecessary.

U. Partially accepted in findings of fact 3 and 28.

V - W. Rejected as being irrelevant, or unnecessary.

Specific Findings

A. Mitchell: 1 - 21, B. Leech: 1 - 18, C. Hughes: 1 - 47, D.

Vaughn: 1 - 7, E. Weeks:1 - 23, F. Allen: 1 - 17 -- Petitioner addresses the

testimony of each of these witnesses, and where its findings are inconsistent

with the findings of fact, they are rejected as being subordinate, irrelevant,

unnecessary, cumulative, recitation of testimony, not supported by the more

credible evidence, not supported by the greater weight of the evidence,

argument, or a conclusion of law.

Respondent's Proposed Findings of Fact

1. Partially accepted in finding of fact 1.

2. Partially accepted in finding of fact 2.

3. Partially accepted in finding of fact 5.

4. Rejected as being subordinate.

5. Partially accepted in finding of fact 8.

6. Partially accepted in finding of fact 3.

7. Partially accepted in finding of fact 6. Also, see Preliminary

Statement.

8. See Preliminary Statement and Endnotes.

9. See Preliminary Statement.

10. Partially accepted in finding of fact 7.

11. Partially accepted in finding of fact 8.

12. Partially accepted in finding of fact 22.

13. Partially accepted in finding of fact 22.

14. Rejected as being irrelevant, or unnecessary.

15. Rejected as being irrelevant, unnecessary, or not supported by the

greater weight of the evidence.

16. Rejected as being irrelevant, unnecessary, or not supported by the

greater weight of the evidence.

17. Rejected as being not supported by the more credible evidence, not

supported by the greater weight of the evidence, argument, or a conclusion of

law.

18. Rejected as being recitation of testimony, unnecessary, argument, or a

conclusion of law.

19. Rejected as being not supported by the more credible evidence, not

supported by the greater weight of the evidence, argument, or a conclusion of

law.

20. Partially accepted in finding of fact 9.

21. Rejected as being recitation of testimony.

22. Rejected as being recitation of testimony.

23. Rejected as being unnecessary, argument, or a conclusion of law.

NOTE: Where a proposed finding has been partially accepted, the remainder

has been rejected as being irrelevant, unnecessary, cumulative, recitation of

testimony, not supported by the more credible evidence, not supported by the

greater weight of the evidence, argument, or a conclusion of law.

COPIES FURNISHED:

Steven M. Weinger, Esquire

Kurzban, Kurzban, Weinger & Tetzeli, P.A.

2650 Southwest 27th Avenue

Miami, Florida 33133

Steven A. Grigas, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Building Number 3

Tallahassee, Florida 32308-5403

Sam Power

Agency Clerk

Agency for Health Care Administration

Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308

Jerome W. Hoffman

General Counsel

Agency for Health Care Administration

Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions to this recommended

order. All agencies allow each party at least 10 days in which to submit

written exceptions. Some agencies allow a larger period within which to submit

written exceptions. You should contact the agency that will issue the final

order in this case concerning agency rules on the deadline for filing exceptions

to this recommended order. Any exceptions to this recommended order should be

filed with the agency that will issue the final order in this case.

=================================================================

AGENCY FINAL ORDER

=================================================================

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

SUNRISE COMMUNITY, INC.,

Petitioner, CASE NO.: 95-5579

95-5580

vs. 95-5581

95-5582

STATE OF FLORIDA, AGENCY FOR RENDITION NO.:

HEALTH CARE ADMINISTRATION AHCA-96-FOF-MDR

Respondent.

________________________________/

FINAL ORDER

PRELIMINARY STATEMENT

Sunrise owns and operates intermediate care facilities for the mentally

retarded, known in regulatory jargon as ICF/DDs. At issue in this case is the

Medicaid per diem rate to be paid for each Medicaid resident at 17 of Sunrise's

ICF/DD's. Specifically, Sunrise challenges the denial of its requests for

interim rate increases. The requested rate adjustments reflect costs incurred

for a major program expansion begun in 1993 including acquisition of facilities

for an off-site day training program for residents and an office building.

Interim rate increases for the expansion were approved in 1993 and 1994. Off-

site day training is a required part of services to be provided to residents of

an ICF/DD. The reason given for the denial decisions at issue was that Sunrise

did not obtain the prior approval of HRS for the program expansion. The Florida

Reimbursement Plan (Plan) requires prior approval by HRS before a provider

incurs additional costs for capital additions or expansions when such costs are

expected to increase the current reimbursement rate by one percent or more. An

interim rate increase can be granted only for costs which have already been

incurred by a provider. Thus, the requirement for prior approval of planned

capital expenditures must be distinguished from review of a request for an

interim rate increase. Sunrise's capital improvements under the circumstances

of this case are in effect publicly funded by the Medicaid program; thus, cost

containment through a requirement of prior approval is clearly appropriate.

RULING ON EXCEPTIONS BY AHCA

Counsel excepts to the findings in paragraph 3 that the costs were incurred

to comply with state or federal regulatory requirements. It is not disputed in

the record that a major part of the expenditures at issue were to acquire

facilities for off-site day training and that such training is required by state

and/or federal regulations. The exception is denied.

Counsel excepts to the finding in paragraph 9 that in early 1993 HRS's

Assistant Secretary of Developmental Services verbally approved Sunrise's

expansion plans. There is ample support in the record that Sunrise undertook

the expansion plan with the knowledge of the Assistant Secretary. However,

having reviewed the record it is fair to say that the issue is whether HRS gave

its approval, not just to the projects, but to the costs of those projects and

whether Sunrise had to obtain that approval in writing. There was no

substantial competent evidence to support a finding that any prior approval was

obtained for the costs of the project from the then Assistant Secretary, much

less that the approval was in writing.. The exception is granted. Likewise,

the exceptions to paragraph 11 is granted; there is no substantial competent

evidence identifying which specific "projects" were discussed with the new

Assistant Secretary.

Counsel for the Agency also excepts to the finding in paragraph 13 of the

Recommended Order in that the record contains no substantial competent evidence

to prove that Developmental Services gave its approval to the property items in

the interim rate request submitted by Petitioner. The exception is granted.

The finding is contrary to the evidence in the record that approval of interim

rate requests is not even within the authority of Developmental Services; it

being a function of the Agency in administering the Medicaid Program.

Counsel excepts to paragraph 15 of the Recommended Order in that the

finding contradicts the record evidence. The testimony of Donna Allen ( T560-

585) clearly demonstrates that only the Assistant Secretary of Developmental

Services had the authority to give prior approval for such project costs and

that such prior approval had never been given for these costs. What's more, the

finding is inconsistent with other evidence which indicates that DS does not

have the authority to approve interim rate requests. The exception is granted.

Counsel excepts to paragraph 17 wherein the hearing officer found that the

interim rate request is a continuation of costs approved in two prior requests

for interim rate increases. The testimony of staff persons from HRS and AHCA

support the hearing officer's finding. The exception is denied.

Counsel excepts to paragraph 18 on the grounds that the record evidence

from the testimony of Donna Allen and related exhibits shows that no prior

approval was given by her for the 1995 costs. The exception is granted.

Likewise the exception to paragraph 19 is granted.

Counsel excepts to the finding in paragraph 20 that written prior approval

was not required prior to Sunrise's 1995 interim rate request. The evidence is

uncontradicted that no written prior approval of HRS was obtained prior to this

case, but the prior interim rate requests were approved by Medicaid.

Counsel excepts to paragraph 21 on the grounds that it is a legal

conclusion. The Agency is not bound to accept legal conclusions that have been

erroneously designated as findings of fact. Department of Community Affairs v.

Killearn Properties, Inc., 15 FALR. 1827, 1829-30. These conclusions

necessarily involve legal and policy determinations which are clearly within the

expertise of the Agency and where the Agency's determinations should be given

deference. Bayonet Point Regional Medical Center v. DHRS., 516 So,2d 995,996-

97. (Fla. 1st DCA, 1987). The legal conclusion that Petitioner was entitled to

rely on past practice for approval of its added costs is clearly erroneous. As

a general rule estoppel applies only rarely against the state. North American

Company v. Green, 120 So.2d 603, 610 (Fla. 1959); State Department of Revenue v.

Anderson, 403 So.2d 397,400 (Fla. 1981); Department of Health and Rehabilitative

Services v. Belveal, 663 So.2d 650 (Fla. 2d DCA. 1995). Mistaken statements of

law can not estop the State. Austin v. Austin, 350 So.2d 102,105 (Fla. 1st DCA.

1977, cert. denied, 357 So.2d 184 (1978); Department of Revenue v. Hobbs, 368

So.2d 367 (Fla. 1st DCA. 1977), appeal dismissed, 378 So.2d 345 (1979). This

case demonstrates the reason why prior approval in writing is necessary.

Without a clear written statement of approval there is the potential for

confusion as to what costs have and have not been approved. Since these

projects may extend over several years, memories may fade and personnel may

change. The potential for unintended approval of runaway costs is great. The

exception is granted.

Counsel excepts to the legal conclusion in paragraph 23 that the lease

payments to Regional Properties for the off-site day training facilities are not

capital expenditures. In paragraph 22 the hearing officer found that Sunrise

and Regional Properties are related organizations; thus, Sunrise is deemed to be

the owner of the facilities it leases from Regional Properties. Under this

circumstance the lease obligation constitutes a capital expenditure. The

exception is granted. Likewise, the exception to paragraph 26 is granted.

Counsel excepts to paragraph 25 which concludes that each facility must be

evaluated separately as to whether the one percent threshold requirement is met.

This is correct for evaluation of the requests for interim rate requests, but

not for the prior approval required for planned capital expenditures by a

provider. For planned capital improvements or expansion, the one percent

threshold is applied to the total planned expenditure for all facilities

affected. In other words, the provider must present the total planned spending

package for prior approval. This facilitates the cost control function of the

requirement for prior approval. The exception is granted.

Counsel excepts to the legal conclusion in paragraph 27. Again this

interpretation is one which is within the authority of the Agency to make. The

Agency interprets the Section 111.G.7 of the plan which requires prior HRS

approval of planned capital expenditures to apply in this case to the costs

covered by this interim rate request.

Paragraph 28 of the Recommended Order is a legal conclusion labeled as a

finding of fact. It is rejected as erroneous and not supported by substantial

competent evidence. The reasonableness of the costs was never demonstrated.

Paragraph 32 reiterates findings already addressed and is modified to

conform the above rulings on exceptions. Paragraph 33 is likewise modified.

FINDINGS OF FACT

The agency hereby adopts and incorporates by reference the findings of fact

set forth in the Recommended Order except where inconsistent with the rulings on

the exceptions.

CONCLUSIONS OF LAW

The agency hereby adopts and incorporates by reference the conclusions of

law set forth in the Recommended Order except where inconsistent with the

rulings on the exceptions.

Based upon the foregoing, it is

ADJUDGED, that the interim rate request submitted by Sunrise in August 1995

be denied.

DONE and ORDERED this 8th day of January, 1996, in Tallahassee, Florida.

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION

____________________________

Douglas M. Cook, Director

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL

REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH

THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED

BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE

AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS

SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE

OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.

COPIES FURNISHED:

Steven Grigas, Esquire Steven M. Weinger, Esquire

Senior Attorney, Agency for Kurzban, Kurzban, Weinger &

Health Care Administration Tetzell, P. A.

2727 Mahan Drive, Suite 3431 2650 SW 27th Avenue, 2nd Floor

Fort Knox Building III Miami, Florida 33133

Tallahassee, Florida 32308-5403

Errol H. Powell

Hearing Officer

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been

furnished to the above named addresses by U.S. Mail this 8th day of January,

1996.

________________________________

Charlene Thompson for

R.S. Power, Agency Clerk

State of Florida, Agency for

Health Care Administration

2727 Mahan Drive

Fort Knox 3, Suite 3431

Tallahassee, Florida 32308-5403

[phone]