97-003029CON Hospice Of North Central Florida, Inc., D/B/A Hospice Of North Central Florida vs. Medlink Management Services, Inc., D/B/A Ramadan Hand Institute/Lake Butler Hospital, And Agency For Health Care Administration Status: Closed Recommended Order on Friday, October 10, 1997.

Summary: Exemption from Certificate of Need review denied where applicant was "for-profit" licensee, operating under fictitious name as "rural hospital."

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

HOSPICE OF NORTH CENTRAL )

FLORIDA, INC., d/b/a HOSPICE OF )

NORTH CENTRAL FLORIDA, )

)

Petitioner, )

)

vs. ) Case No. 97-3029

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION and MEDLINK )

MANAGEMENT SERVICES, INC., )

d/b/a RAMADAN HAND INSTITUTE/ )

LAKE BUTLER HOSPITAL, )

)

Respondents. )

_________________________________)

SUMMARY RECOMMENDED ORDER

On July 10, 1997, Petitioner Hospice of North Central

Florida, Inc. (HNCF) filed a "Motion for Summary Recommended

Order Denying and Dismissing Medlink Management Services, Inc.,

d/b/a Ramadan Hand Institute/Lake Butler's Request for

Exemption." On August 18, 1997, Respondent Medlink filed a

"Response to Petition for Formal Administrative Hearing," which

admitted certain paragraphs of Hospice's initial Petition. Also

on August 18, 1997, Medlink filed a Response to HNCF's Motion and

a Memorandum of Law in opposition to the Motion. It attached

documents relied upon by all parties.

On August 21, 1997, Respondent Medlink filed its own "Motion

for Summary Recommended Order Denying Petitioner's Motion for

Summary Recommended Order and Dismissal, or in the Alternative,

Abatement of Petitioner's Petition for Formal Administrative

Hearing." This pleading adopted the facts, statement of the

case, and arguments set forth in Medlink's prior Memorandum.

Also on August 21, 1997, Medlink filed an Amended

Memorandum.

On August 28, 1997, HNCF filed a "Motion to Strike and in

the Alternative Reply to Medlink's Response to Petition and Reply

to Medlink's Response to Motion for Summary Recommended Order."

On that date, HNCF also filed its "Response to Medlink's Motion

for Summary Recommended Order."

On September 2, 1997, oral argument was heard by telephonic

conference call upon all pending matters. Oral stipulations were

entered into by the parties both as to procedural matters and

facts upon which the Motion(s) for Summary Recommended Order

might be considered. The parties were granted seven days in

which to submit copies of the applicable rules and any further

written argument. The Motion to Abate was denied. The parties

selected November 10, 1997, for formal hearing in Tallahassee in

the event a Summary Recommended Order was not issued.

On September 8, 1997, the Agency filed copies of Rules 59-

1.022, 59C-1.005, and 60Q-2.016, Florida Administrative Code.

On September 9, 1997, Medlink filed a "Response to North

Central Florida's Motion to Strike and Response to Its Reply."

On September 11, 1997, the Agency filed copies of Rules 58A-

2.002, 58A-2.003, and 58A-2.004, Florida Administrative Code.

On September 15, 1997, HNCF filed a Motion to Strike the

September 9, 1997, Medlink Response.

On September 23, 1997, Medlink filed a Response to HNCF's

September 15, 1997, Motion to Strike.

Most of the foregoing pleadings are not authorized by Rule

60Q-2.016, Florida Administrative Code. Many are cumulative and

take advantage of the undersigned's acquiescence in permitting

further written argument after the September 2, 1997, oral

argument. Even so, many are outside the parameters of the oral

order given at that time. The only real issue raised herein is

whether Petitioner or Respondent Medlink is entitled to a Summary

Recommended Order in its favor upon undisputed facts. To that

end, none of the pleadings is struck and all have been

considered.

UNDISPUTED FINDINGS OF FACT

1. Hospice of North Central Florida, Inc., d/b/a Hospice

of North Central Florida (HNCF) is an existing hospice care

provider duly licensed to provide hospice services in the Agency

for Health Care Administration's (AHCA's) Health Planning

District 3A.

2. On or about May 2, 1997, the Ramadan Hand

Institute/Lake Butler Hospital filed a letter with AHCA

requesting an exemption from Certificate of Need (CON) review to

establish a hospice program in health planning District 3A. The

basis of the exemption request was the alleged rural hospital

status of the Ramadan Hand Institute/Lake Butler Hospital.

3. HNCF's substantial interests will be substantially

affected by AHCA's decision to exempt Medlink's proposed hospice

from CON review and any future decision to issue a license to

Medlink Management Service d/b/a Ramadan Hand Institute/Lake

Butler Hospital to operate a hospice in Health Planning District

3A.

4. AHCA did not request any further information prior to

acting on the request. Neither did AHCA check out the

applicant's corporate status as a rural hospital.

5. AHCA's licensure files show that the Ramadan Hand

Institute/Lake Butler Hospital is not a corporate entity, but the

fictitious name registered to the facility's actual licensee,

Medlink Management Services, Inc.

6. According to the Florida Secretary of State's records,

Medlink Management Services, Inc., the licensee of Ramadan Hand

Institute/Lake Butler Hospital, is a "for profit" corporation.

This is consistent with the information provided by Medlink to

AHCA in its most recent Hospital Licensure Application, and is

not disputed.

7. The Ramadan Hand Institute/Lake Butler Hospital is a

"rural hospital" as that term is defined under Section 395.602,

Florida Statutes.

8. This instant case was styled as set out above only by

agreement or acquiescence of the parties, and the Respondents do

not dispute the immediately preceding Finding of Fact.

9. On or about May 17, 1997, AHCA responded to the letter

request, authorizing a CON exemption for a Medicare-certified

hospice program to the Ramadan Hand Institute/Lake Butler

Hospital.

10. Medlink Management Services, Inc. d/b/a Ramadan Hand

Institute/Lake Butler Hospital has not made application for

licensure to operate a hospice.

11. Medlink represents that it intends to establish a non-

profit operational entity to operate its rural hospital hospice

and to thereafter become licensed as a hospice. However, these

processes have not been initiated, and all parties concede that

there is no statutory or rule requirement that, or any existing

administrative mechanism in place whereby, any existing hospice

licensee (including but not limited to HNCF) will be notified or

provided an opportunity to participate in another licensee's

application process. Therefore, this instant "exemption"

proceeding, or a CON review, are the only windows of opportunity

for HNCF to assert its substantial interests.

CONCLUSIONS OF LAW

12. The Division of Administrative Hearings has

jurisdiction over the parties and subject matter of this cause,

pursuant to Section 120.57(1), Florida Statutes.

13. Medlink has acknowledged that in order for Medlink to

comply with Chapter 400, Florida Statutes, and the regulations

implementing the licensure requirements of Rule 58A-2.003 and

58A-2.004, Florida Administrative Code, it is necessary for the

corporate health care provider to create a separate and distinct

non-profit corporation to make application as a licensee, 1 but

that it would be "legally impracticable, if not impermissible,

for an established corporate health care provider to become the

actual licensee of a hospice." It further asserted, however,

that Medlink has three options: (a) to submit an application

through an autonomous non-profit entity created to provide

hospice services, (b) convert to a non-profit entity, if

necessary, or (c) seek, with the help of its local delegation, to

introduce legislation to correct the alleged inconsistencies and

ambiguities in Chapters 395, 400, and 408, Florida Statutes.

Medlink further moved for abatement until it could address the

issues legislatively, and abatement was orally denied on

September 2, 1997. Likewise, all Medlink's suggestions that, for

the foregoing reasons, the issue herein is not ripe for

adjudication are not persuasive. See University Community

Hospital v. Department of Health and Rehabilitative Services , 555

So. 2d 922 (Fla. 1st DCA 1990); Baptist Hospital, Inc. v.

Department of Health and Rehabilitative Services , 500 So. 2d 620

(Fla. 1st DCA 1986); South Broward Hospital District v.

Department of Health and Rehabilitative Services , 385 So. 2d 1094

(Fla. 4th DCA 1980). See also Friends of the Hatchineha v.

Department of Environmental Regulation , 580 So. 2d 267 (Fla. 1st

DCA 1991), and Town of Palm Beach v. Department of Natural

Resources , 577 So. 2d 1383 (Fla. 1st DCA 1991).

14. This case may be disposed of by Summary Recommended

Order as a matter of law, and, in fact, must be, because there

will be no notice to HNCF of intended agency action when, and if,

Medlink applies for its own license. Section 408.042, Florida

Statutes, does not address transfer of an exemption from CON

review, as suggested by Medlink, so as to provide a new window

for challenge to a later-created entity. There is no clear

authority to show that an exemption from CON Review granted to a

rural hospital can be subsequently transferred to an affiliated

entity either existing or yet to be formed. See Rule 59C-1.005,

Florida Administrative Code. However, there is authority to

support the proposition that failure to identify the license

holder as the applicant for a health care project is a fatal

defect, requiring dismissal of a CON application. See Brookwood.

Jackson County Convalescent Center v. Department of Health and

Rehabilitative Services , 591 So. 2d 1085 (Fla. 1st DCA 1992).

15. The Ramadan Hand Institute/Lake Butler Hospital filed

a letter with the Agency requesting an exemption from CON review

to establish a hospice program in Health Planning District 3A.

The basis of the exemption request is the alleged rural hospital

status of the Ramadan Hand Institute/Lake Butler Hospital.

16. Section 408.036(3)(h), Florida Statutes, provides in

pertinent part:

(3) EXEMPTIONS. -- Upon request, supported

by such documentations as the department may

require, the department shall grant an

exemption from the provisions of subsection

(1):

* * *

For hospice or home health services provided

by a rural hospital, as defined in s.

395.602, . . .

17. The Ramadan Hand Institute/Lake Butler Hospital is not

a corporate entity, but the fictitious name registered to the

facility's actual licensee, Medlink Management Services, Inc.

18. Medlink Management Services, Inc., the licensee of

Ramadan Hand Institute/Lake Butler Hospital, is a Florida "for

profit" corporation.

19. Section 400.601(3), Florida Statutes, defines the term

"hospice" to mean, ". . . a centrally administered corporation

not for profit , as defined in chapter 617, providing a continuum

of palliative and supportive care for the terminally ill patient

and his or her family." (emphasis supplied) See also Rule 58A-

2.004, Florida Administrative Code, which provides that a license

shall be issued to any "not-for-profit" agency which otherwise

meets the licensure requirements. Because Medlink is a

"for-profit" corporation, it cannot, as a matter of law, be

licensed as a hospice.

20. The exemption afforded rural hospitals found in

Section 408.036(3)(h), Florida Statutes, does not exempt a

licensee from the requirements of Section 400.601, Florida

Statutes. Because Medlink, as a "for-profit" corporation, fails

to meet this mandatory statutory requirement, the act of issuing

a letter of exemption to Ramadan Hand Institute/Lake Butler

Hospital is an unauthorized exercise of Agency discretion,

inconsistent with the Agency rules, and in violation of the

statute. The Agency should have denied the exemption request and

required the Applicant to submit to the CON Review procedure.

RECOMMENDATION

Upon the foregoing findings of fact and conclusions of law,

it is

RECOMMENDED that the Agency for Health Care Administration

enter a Final Order denying the request for exemption from

Certificate of Need Review.

RECOMMENDED this 10th day of October, 1997, at Tallahassee,

Leon County, Florida.

___________________________ ________

ELLA JANE P. DAVIS

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

[phone] SUNCOM 278-9675

Fax Filing [phone]

Filed with the Clerk of the

Division of Administrative Hearings

this 10th day of October, 1997.

ENDNOTE

1 Cf - Contrariwise, HNCF contended that AHCA has never

interpreted Section 408.610, Florida Statutes, to require that a

hospice be established as a separate legal entity from an

existing health care provider and has interpreted the statute to

allow an existing not for profit provider to operate a hospice

within its existing corporate structure.

COPIES FURNISHED:

Pamela B. Howard

Post Office Box 748

Lake Butler, Florida 32054

Richard Ellis, Esquire

Agency for Health

Care Administration

Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308

R. Terry Rigsby, Esquire

Blank, Rigsby & Meenan

204 South Monroe Street

Tallahassee, Florida 32301

Douglas M. Cook, Director

Agency for Health Care Administration

2727 Mahan Drive

Tallahassee, Florida 32308

Jerome W. Hoffman, General Counsel

Agency of Health Care Administration

2727 Mahan Drive

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within 15

days from the date of this Recommended Order. Any exceptions to

this Recommended Order should be filed with the agency that will

issue the final order in this case.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

HOSPICE OF NORTH CENTRAL )

FLORIDA, INC., d/b/a HOSPICE OF )

NORTH CENTRAL FLORIDA, )

)

Petitioner, )

)

vs. ) Case No. 97-3029

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION and MEDLINK )

MANAGEMENT SERVICES, INC., )

d/b/a RAMADAN HAND INSTITUTE/ )

LAKE BUTLER HOSPITAL, )

)

Respondents. )

_________________________________)

CORRECTED SUMMARY RECOMMENDED ORDER

This cause came on for consideration upon MEDLINK's Motion

for Extension of Time in Which to File Exceptions, received by

the undersigned on November 18, 1997.

Although the undersigned is without jurisdiction to grant

such a motion once a Recommended Order is entered, the motion

correctly points out a serious scrivener's error in the Summary

Recommended Order entered herein on October 10, 1997. That

error, which is the failure to "copy" MEDLINK's counsel with the

Summary Recommended Order, occurred in the office of the

undersigned and clearly affects due process in this cause.

Such a situation is exactly the type of inadvertent error

addressed by Rule 60Q-2.032, Florida Administrative Code. That

rule provides that at any time on her own motion, the undersigned

may enter a corrected order.

Therefore, pursuant to Rule 60Q-2.032(2), Florida

Administrative Code, this Corrected Summary Recommended Order is

entered to correct the "copies list" to include MEDLINK's counsel

and to provide a copy of the decision herein to such counsel. In

so doing, the time for filing exceptions is automatically

adjusted 15 days from instant date.

On July 10, 1997, Petitioner Hospice of North Central

Florida, Inc. (HNCF) filed a "Motion for Summary Recommended

Order Denying and Dismissing Medlink Management Services, Inc.,

d/b/a Ramadan Hand Institute/Lake Butler's Request for

Exemption." On August 18, 1997, Respondent Medlink filed a

"Response to Petition for Formal Administrative Hearing," which

admitted certain paragraphs of Hospice's initial Petition. Also

on August 18, 1997, Medlink filed a Response to HNCF's Motion and

a Memorandum of Law in opposition to the Motion. It attached

documents relied upon by all parties.

On August 21, 1997, Respondent Medlink filed its own "Motion

for Summary Recommended Order Denying Petitioner's Motion for

Summary Recommended Order and Dismissal, or in the Alternative,

Abatement of Petitioner's Petition for Formal Administrative

Hearing." This pleading adopted the facts, statement of the

case, and arguments set forth in Medlink's prior Memorandum.

Also on August 21, 1997, Medlink filed an Amended

Memorandum.

On August 28, 1997, HNCF filed a "Motion to Strike and in

the Alternative Reply to Medlink's Response to Petition and Reply

to Medlink's Response to Motion for Summary Recommended Order."

On that date, HNCF also filed its "Response to Medlink's Motion

for Summary Recommended Order."

On September 2, 1997, oral argument was heard by telephonic

conference call upon all pending matters. Oral stipulations were

entered into by the parties both as to procedural matters and

facts upon which the Motion(s) for Summary Recommended Order

might be considered. The parties were granted seven days in

which to submit copies of the applicable rules and any further

written argument. The Motion to Abate was denied. The parties

selected November 10, 1997, for formal hearing in Tallahassee in

the event a Summary Recommended Order was not issued.

On September 8, 1997, the Agency filed copies of Rules 59-

1.022, 59C-1.005, and 60Q-2.016, Florida Administrative Code.

On September 9, 1997, Medlink filed a "Response to North

Central Florida's Motion to Strike and Response to Its Reply."

On September 11, 1997, the Agency filed copies of Rules 58A-

2.002, 58A-2.003, and 58A-2.004, Florida Administrative Code.

On September 15, 1997, HNCF filed a Motion to Strike the

September 9, 1997, Medlink Response.

On September 23, 1997, Medlink filed a Response to HNCF's

September 15, 1997, Motion to Strike.

Most of the foregoing pleadings are not authorized by Rule

60Q-2.016, Florida Administrative Code. Many are cumulative and

take advantage of the undersigned's acquiescence in permitting

further written argument after the September 2, 1997, oral

argument. Even so, many are outside the parameters of the oral

order given at that time. The only real issue raised herein is

whether Petitioner or Respondent Medlink is entitled to a Summary

Recommended Order in its favor upon undisputed facts. To that

end, none of the pleadings is struck and all have been

considered.

UNDISPUTED FINDINGS OF FACT

1. Hospice of North Central Florida, Inc., d/b/a Hospice

of North Central Florida (HNCF) is an existing hospice care

provider duly licensed to provide hospice services in the Agency

for Health Care Administration's (AHCA's) Health Planning

District 3A.

2. On or about May 2, 1997, the Ramadan Hand

Institute/Lake Butler Hospital filed a letter with AHCA

requesting an exemption from Certificate of Need (CON) review to

establish a hospice program in health planning District 3A. The

basis of the exemption request was the alleged rural hospital

status of the Ramadan Hand Institute/Lake Butler Hospital.

3. HNCF's substantial interests will be substantially

affected by AHCA's decision to exempt Medlink's proposed hospice

from CON review and any future decision to issue a license to

Medlink Management Service d/b/a Ramadan Hand Institute/Lake

Butler Hospital to operate a hospice in Health Planning District

3A.

4. AHCA did not request any further information prior to

acting on the request. Neither did AHCA check out the

applicant's corporate status as a rural hospital.

5. AHCA's licensure files show that the Ramadan Hand

Institute/Lake Butler Hospital is not a corporate entity, but the

fictitious name registered to the facility's actual licensee,

Medlink Management Services, Inc.

6. According to the Florida Secretary of State's records,

Medlink Management Services, Inc., the licensee of Ramadan Hand

Institute/Lake Butler Hospital, is a "for profit" corporation.

This is consistent with the information provided by Medlink to

AHCA in its most recent Hospital Licensure Application, and is

not disputed.

7. The Ramadan Hand Institute/Lake Butler Hospital is a

"rural hospital" as that term is defined under Section 395.602,

Florida Statutes.

8. This instant case was styled as set out above only by

agreement or acquiescence of the parties, and the Respondents do

not dispute the immediately preceding Finding of Fact.

9. On or about May 17, 1997, AHCA responded to the letter

request, authorizing a CON exemption for a Medicare-certified

hospice program to the Ramadan Hand Institute/Lake Butler

Hospital.

10. Medlink Management Services, Inc. d/b/a Ramadan Hand

Institute/Lake Butler Hospital has not made application for

licensure to operate a hospice.

11. Medlink represents that it intends to establish a non-

profit operational entity to operate its rural hospital hospice

and to thereafter become licensed as a hospice. However, these

processes have not been initiated, and all parties concede that

there is no statutory or rule requirement that, or any existing

administrative mechanism in place whereby, any existing hospice

licensee (including but not limited to HNCF) will be notified or

provided an opportunity to participate in another licensee's

application process. Therefore, this instant "exemption"

proceeding, or a CON review, are the only windows of opportunity

for HNCF to assert its substantial interests.

CONCLUSIONS OF LAW

12. The Division of Administrative Hearings has

jurisdiction over the parties and subject matter of this cause,

pursuant to Section 120.57(1), Florida Statutes.

13. Medlink has acknowledged that in order for Medlink to

comply with Chapter 400, Florida Statutes, and the regulations

implementing the licensure requirements of Rule 58A-2.003 and

58A-2.004, Florida Administrative Code, it is necessary for the

corporate health care provider to create a separate and distinct

non-profit corporation to make application as a licensee, 1 but

that it would be "legally impracticable, if not impermissible,

for an established corporate health care provider to become the

actual licensee of a hospice." It further asserted, however,

that Medlink has three options: (a) to submit an application

through an autonomous non-profit entity created to provide

hospice services, (b) convert to a non-profit entity, if

necessary, or (c) seek, with the help of its local delegation, to

introduce legislation to correct the alleged inconsistencies and

ambiguities in Chapters 395, 400, and 408, Florida Statutes.

Medlink further moved for abatement until it could address the

issues legislatively, and abatement was orally denied on

September 2, 1997. Likewise, all Medlink's suggestions that, for

the foregoing reasons, the issue herein is not ripe for

adjudication are not persuasive. See University Community

Hospital v. Department of Health and Rehabilitative Services , 555

So. 2d 922 (Fla. 1st DCA 1990); Baptist Hospital, Inc. v.

Department of Health and Rehabilitative Services , 500 So. 2d 620

(Fla. 1st DCA 1986); South Broward Hospital District v.

Department of Health and Rehabilitative Services , 385 So. 2d 1094

(Fla. 4th DCA 1980). See also Friends of the Hatchineha v.

Department of Environmental Regulation , 580 So. 2d 267 (Fla. 1st

DCA 1991), and Town of Palm Beach v. Department of Natural

Resources , 577 So. 2d 1383 (Fla. 1st DCA 1991).

14. This case may be disposed of by Summary Recommended

Order as a matter of law, and, in fact, must be, because there

will be no notice to HNCF of intended agency action when, and if,

Medlink applies for its own license. Section 408.042, Florida

Statutes, does not address transfer of an exemption from CON

review, as suggested by Medlink, so as to provide a new window

for challenge to a later-created entity. There is no clear

authority to show that an exemption from CON Review granted to a

rural hospital can be subsequently transferred to an affiliated

entity either existing or yet to be formed. See Rule 59C-1.005,

Florida Administrative Code. However, there is authority to

support the proposition that failure to identify the license

holder as the applicant for a health care project is a fatal

defect, requiring dismissal of a CON application. See Brookwood.

Jackson County Convalescent Center v. Department of Health and

Rehabilitative Services , 591 So. 2d 1085 (Fla. 1st DCA 1992).

15. The Ramadan Hand Institute/Lake Butler Hospital filed

a letter with the Agency requesting an exemption from CON review

to establish a hospice program in Health Planning District 3A.

The basis of the exemption request is the alleged rural hospital

status of the Ramadan Hand Institute/Lake Butler Hospital.

16. Section 408.036(3)(h), Florida Statutes, provides in

pertinent part:

(3) EXEMPTIONS. -- Upon request, supported

by such documentations as the department may

require, the department shall grant an

exemption from the provisions of subsection

(1):

* * *

For hospice or home health services provided

by a rural hospital, as defined in s.

395.602, . . .

17. The Ramadan Hand Institute/Lake Butler Hospital is not

a corporate entity, but the fictitious name registered to the

facility's actual licensee, Medlink Management Services, Inc.

18. Medlink Management Services, Inc., the licensee of

Ramadan Hand Institute/Lake Butler Hospital, is a Florida "for

profit" corporation.

19. Section 400.601(3), Florida Statutes, defines the term

"hospice" to mean, ". . . a centrally administered corporation

not for profit , as defined in chapter 617, providing a continuum

of palliative and supportive care for the terminally ill patient

and his or her family." (emphasis supplied) See also Rule 58A-

2.004, Florida Administrative Code, which provides that a license

shall be issued to any "not-for-profit" agency which otherwise

meets the licensure requirements. Because Medlink is a "for-

profit" corporation, it cannot, as a matter of law, be licensed

as a hospice.

20. The exemption afforded rural hospitals found in

Section 408.036(3)(h), Florida Statutes, does not exempt a

licensee from the requirements of Section 400.601, Florida

Statutes. Because Medlink, as a "for-profit" corporation, fails

to meet this mandatory statutory requirement, the act of issuing

a letter of exemption to Ramadan Hand Institute/Lake Butler

Hospital is an unauthorized exercise of Agency discretion,

inconsistent with the Agency rules, and in violation of the

statute. The Agency should have denied the exemption request and

required the Applicant to submit to the CON Review procedure.

RECOMMENDATION

Upon the foregoing findings of fact and conclusions of law,

it is

RECOMMENDED that the Agency for Health Care Administration

enter a Final Order denying the request for exemption from

Certificate of Need Review.

RECOMMENDED this 18th day of November, 1997, at Tallahassee,

Leon County, Florida.

___________________________________

ELLA JANE P. DAVIS

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

[phone] SUNCOM 278-9675

Fax Filing [phone]

Filed with the Clerk of the

Division of Administrative Hearings

this 18th day of November, 1997.

ENDNOTE

1 Cf - Contrariwise, HNCF contended that AHCA has never

interpreted Section 408.610, Florida Statutes, to require that a

hospice be established as a separate legal entity from an

existing health care provider and has interpreted the statute to

allow an existing not for profit provider to operate a hospice

within its existing corporate structure.

COPIES FURNISHED:

Pamela B. Howard

Post Office Box 748

Lake Butler, Florida 32054

Herbert M. Webb, Esquire

4400 Northwest 23rd Avenue, Suite E

Gainesville, Florida 32606

Richard Ellis, Esquire

Agency for Health

Care Administration

Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308

R. Terry Rigsby, Esquire

Blank, Rigsby & Meenan

204 South Monroe Street

Tallahassee, Florida 32301

Douglas M. Cook, Director

Agency for Health Care Administration

2727 Mahan Drive

Tallahassee, Florida 32308

Jerome W. Hoffman, General Counsel

Agency of Health Care Administration

2727 Mahan Drive

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within 15

days from the date of this Recommended Order. Any exceptions to

this Recommended Order should be filed with the agency that will

issue the final order in this case.