02-004752 W. Frank Wells Nursing Home vs. Agency For Health Care Administration Status: Closed Recommended Order on Monday, December 15, 2003.

Summary: Petitioner demonstrated excusable neglect and doctrine of "Equitable Tolling" applied so that 13-day delay in filing license renewal application should generate no fine or late filing fee.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

W. FRANK WELLS NURSING HOME, )

)

Petitioner, )

)

vs. ) Case Nos. 02 - 4752

) 02 - 4827

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice this cause came on for formal proceeding

before P. Michael Ruff, duly - designated Administrative Law Judge

of the Division of Administrative Hearings in Tallahassee,

Florida, on August 13, 2003. The appearances were as follows:

APPEARANCES

For Petitioner: John D. Buchanan, Jr., Esquire

Henry, Buchanan, Hudson,

Suber & Carter, P.A.

117 South Gadsden Street

Tallahassee, Florida 32301

For Respondent: Tom R. Moore, Assistan t General Counsel

Agency for Health Care Administration

Office of the Attorney General

2727 Mahan Drive, Building III

Tallahassee, Florida 32308

STATEMENT OF THE ISSUES

The issues to be resolved in this proceeding concern

whether th e Petitioner should be assessed a late fee, pursuant

to Section 400.111, Florida Statutes, for the late filing of the

Petitioner's 2001 license renewal application and, if so, the

amount of the fee.

PRELIMINARY STATEMENT

This proceeding arose upon the fil ing of two cases later

consolidated, before the Division of Administrative Hearings

(DOAH). DOAH Case No. 02 - 4752 is the earlier case concerning

the late filing of the 2001 application for licensure and the

related late fee. The issues concerning this ca se are

delineated above. The later case is DOAH Case No. 02 - 4827

involving the denial by the Agency for Health Care

Administration (AHCA) of the 2002 application for license

renewal filed by W. Frank Wells Nursing Home (Facility).

A Pre - hearing Stipula tion was filed by the parties

indicating that the parties had settled the issues regarding the

2002 licensure denial case, with the exception of an issue

concerning liability insurance coverage. Upon the convening of

the formal hearing, the parties announ ced that they had resolved

that last issue in Case No. 02 - 4827, thus resolving that case in

its entirety and it has been voluntarily dismissed. In

conjunction with that announcement the parties modified their

Pre - hearing Stipulation by striking substantia l portions of it,

paragraphs 5, 6, 14, 20 through 32, and 35. This removes those

stipulated findings of fact which pertain to issues resolved by

the parties, resulting in a simplified stipulation that relates

only to the remaining 2001 late application, l ate - fee case. The

original Pre - hearing Stipulation was accepted as Joint Exhibit

A, and the revised Pre - Hearing Stipulation submitted by the

parties was denominated as Joint Exhibit B and was accepted.

Additionally, the parties have agreed that the late fee at issue

is in a maximum amount of $5,000.00.

The parties stipulated that certain exhibits could be

admitted, as relevant to the remaining late - filing fee case at

issue. Thus, they stipulated that AHCA Exhibits 1 through 5

should be admitted and that Petitioner's Exhibits 1 through 7,

16, 19, and 20 should be admitted. The stipulation was

accepted.

AHCA moved ore tenus , that with the advent of the revised

Pre - Hearing Stipulation and the admitted exhibits submitted by

AHCA, that all material facts as to the remaining late

application, late - filing fee case were established and that

therefore no genuine issue of material fact remained to be

determined in this forum. The Respondent thus moved for

relinquishment of jurisdiction or remand to AHCA for an i nformal

proceeding.

The Petitioner asserted that the testimony and evidence

should be heard as to certain remaining disputed facts. The

Petitioner argued that there were disputed facts concerning

whether the Petitioner could have secured the required bon d

within the time necessary to timely file its application;

whether it had been misled by AHCA concerning the Petitioner's

misunderstanding of the existence of an AHCA policy that

applications could be timely filed even if incomplete because of

a lack of t he required lease bond; and concerning also whether

AHCA had waived the lease bond requirement because it had

accepted "unconditional guarantees" in previous years in lieu of

lease bonds.

Because there appeared to be some disputes of fact

remaining to b e resolved, the Motion to Relinquish or Remand was

denied and testimony and evidence was taken concerning the

issues referenced next above and as to mitigation of the sought

$5,000.00 late - filing fee.

The Petitioner (Facility) presented the testimony of its

Chief Executive Officer, Dennis R. Markos, and Maria Allen, the

Petitioner's Chief Financial Officer. The Respondent (AHCA)

presented the testimony of James A. Kemp, its Health Services

and Facilities Consultant, and Molly McKinstrey, AHCA's bureau

C hief of the Bureau of Long Term Care Services. Upon concluding

the proceeding the parties had the proceedings transcribed and

in due course timely submitted Proposed Recommended Orders which

have been considered in the rendition of this Recommended Order.

FINDINGS OF FACT

1. The parties have agreed in the Pre - hearing Stipulation

and revised Pre - hearing Stipulation to the following undisputed

facts. These facts are quoted and numbered in the manner

numbered in the stipulations. Where numbered paragraphs are

omitted below the omissions are because the parties have agreed

that those paragraphs of the stipulations have no relevance to

the late - filing fee case which is the only remaining disputed

case between the parties. The following facts are thus found in

accordance with the parties' stipulations.

1. BAKER COUNTY MEDICAL is a non - profit

501(c)3 corporation that leases the land and

buildings comprising, and operates but does

not own, a clinic, a hospital and a nursing

home ( the latter, the W. FRANK WELL S

NURSING HOME, referenced herein as the

Facility), in Baker County, Florida. The

lease is between BAKER COUNTY MEDICAL as the

lessee and the BAKER COUNTY HOSPITAL

AUTHORITY [the Authority] as the lessor.

[The Authority, according to the prospectus

docum ents, owns the clinic, hospital and

nursing home buildings, the site (about 8

acres) and the equipment utilized at the

clinic, hospital and nursing home.

Petitioner now wishes to assert that it does

own the buildings and did own the buildings

at all times pertinent to this dispute.]

2. The Authority and BAKER COUNTY MEDICAL

entered into the referenced lease as a

condition to the financing by and through

the Authority's "Health Care Facilities

Revenue Bonds" for the demolition of the old

then - existing hos pital building and nursing

home and the construction of a new hospital

and nursing home. The lease runs to 2025

and involves the payoff by Petitioner of the

authorized $11,650,000 in revenue bonds by

and through the operation of the hospital

and nursing h ome by Petitioner during the

period of the lease.

3. The subject nursing home Facility is

licensed under Chapter 400, Florida

Statutes. The hospital is licensed under

Chapter 395, Florida Statutes. AHCA is the

state's licensing and regulatory agency fo r

both of these facilities under those

chapters.

4. On its 2000 license renewal application,

Petitioner indicated that the Facility was

leased and thereafter filed a lease bond

that met the requirements of Section

400.179(5)(d), Florida Statutes, (2000).

7. By letter dated June 4, 2001, AHCA

advised Petitioner that its license would

expire on October 31, 2001, and that the

license renewal application and fees are due

and payable ninety (90) days before the

expiration date. See AHCA's Exhibit 1.

That i s, the annual license renewal cycle

for Petitioner's Facility commences each

August 1st.

8. On August 13, 2001, Petitioner signed

its 2001 license renewal application. This

was submitted to and received by AHCA on

August 14, 2001. See AHCA's Exhibit 2.

9. AHCA, by letter to Petitioner, dated

August 22, 2001, informed Petitioner that

the "Medicaid Lease Surety Bond submitted

for the (2001) license renewal" was

"insufficient in the amount" required by the

lease bond statute. AHCA Exhibit 3.

10. Petit ioner's 2001 license renewal

application was due on August 1, 2001, and

was submitted to AHCA 13 days late.

Petitioner's license certificate #6304 shows

Petitioner's licensure for the period from

11/01/2000 to 10/31/2001. See AHCA Exhibit

4 (license cert ificate, together with AHCA's

cover letter of October 3, 2000).

11. AHCA, by NOTICE OF INTENT TO IMPOSE

LATE FINE, dated August 25, 2001, informed

Petitioner of its intent to impose a

statutory fee of $5,000.00 for the late

filing of the 2001 application , pursuant to

§ 400.111, Florida Statutes, AHCA Exhibit 5.

12. By Petition for Formal Proceeding Under

§ 120.57, dated September 12, 2001,

Petitioner sought administrative review of

the 2001 notice to impose the $5,000.00 late

fee. In its petition, Peti tioner asserts as

disputed issues of material fact that:

(a) "The Petitioner was required to

file a bond with its renewal application."

(b) "The application could not be

filed without the bond."

(c) "There is no provision in

400.111(1) , [Florida Statutes] Florida

Administrative Code or the rules, to submit

the application without the bond with an

explanation that the bond could not be

attached to the application to avoid a

penalty."

13. In response to Petitioner's assertions

above, AH CA asserts that it has and has had

at all times material to this dispute, a

uniformly applied policy and practice for

processing annual license renewal

applications, as follows: (a) that any

license renewal application that is filed by

its due date, whic h application is not

complete in some way, including that the

application does not include some item that

is necessary to the granting of the

application for renewal of the license, is

deemed by AHCA as timely filed though

incomplete; and (b) that the applicant is

thereupon notified by AHCA as to the basis

for any determination by AHCA that the

application is incomplete.

* * *

15. In years prior to Petitioner's filing

of its 2000 license renewal application,

AHCA had accepted certain "unconditional

guarantees" in lieu of lease bonds from

lessees of nursing facilities, including

from Petitioner, to establish facilities'

compliance with Section 400.179(5)(d),

Florida Statutes; however, by the due date

of Petitioner's 2000 license renewal

application, A HCA had ceased accepting such

unconditional guarantees from nursing home

applicants. AHCA so informed Petitioner and

refused to accept any such unconditional

guarantee from Petitioner in lieu of a lease

bond to establish compliance with the law as

to Peti tioner's 2000 annual license renewal.

16. Petitioner asserts, and AHCA does not

dispute here, that in the summer of 2001,

Petitioner had considerable difficulty in

securing a lease bond as then required by

law of a lessee of a facility, which lease

bond Petitioner intended to file with a

timely filed 2001 license renewal

application.

17. Petitioner also asserts, and AHCA does

not dispute, that in the summer of 2001,

Petitioner did not understand that AHCA

treats a license renewal application as

timely f iled if it is filed within the

deadline for filing, even though the

application is incomplete; for example, for

not attaching a lease bond.

18. Petitioner further asserts, and AHCA

does not dispute, that Petitioner's filing

"only" thirteen (13) days late in 2001 was

accomplished by Petitioner due to great

effort on Petitioner's part to secure a

lease bond from third parties over whom

Petitioner asserts that it had no control.

19. In 2002, the Florida Legislature

enacted chapter 2002 - 223, Laws of Florida ,

effective May 15, 2002, which among other

things (in its section 28) added the

language to Section 400.179(5)(d), Florida

Statutes, which today appears as the last

sentence of subparagraph 6 of that section

(numbered as subparagraph 5 in the 2002

amendme nt). The pertinent part reads:

(d)6 . . . A lease agreement required

as a condition of bond financing or

refinancing under § 154.213 by a health

facilities authority or required under

§ 159.30 by a county or municipality is not

a leasehold for purposes of this paragraph

and is not subject to the bond requirement

of this paragraph.

33. As to the 2002 lease bond matter,

Petitioner represents, and AHCA does not

dispute based upon documents provided to

AHCA by Petitioner in May 2003:

(a) t hat the referenced lease between

the Authority and Petitioner is identified

as an "Amended and Restated Lease Agreement"

dated August 1, 1998, in the documents for

issuance of the related "Health Care

Facilities Revenue Bonds;"

(b) that the referenc ed lease was

required as a condition of financing through

the Authority for the demolition of the old

hospital and nursing home and the

construction of the new hospital and nursing

home operated by Petitioner; and

(c) that the lease between the

Auth ority and the Petitioner contains the

indicia of a lease by a health facilities

authority under § 154.213, Florida Statutes.

See letter of July 3, 2003, from

counsel for Petitioner, outlining the status

of the lease as a lease under the statute,

atta ched hereto as AHCA's Exhibit 9.

34. In light of such uncontested

representations by Petitioner regarding the

status of the Authority's lease to

Petitioner, AHCA and Petitioner mutually

submit a confession of error as to the

existence of a legal requirem ent for

Petitioner, even though Petitioner is a

lessee of the Facility, to provide a lease

bond with its 2002 annual license renewal

application. That is, by virtue of the

referenced 2002 amendment to the lease bond

provisions of the statute, the lease wi th

the Authority is accepted by AHCA as within

those leases to which the statutory

exemption applies, which thus relieves

Petitioner from the requirement for filing a

lease bond as to its 2002 renewal

application.

2. The Petitioner submits that admitted or stipulated

facts 15 through 34, as quoted above, are relevant and material

and should entitle the Petitioner to mitigation or reduction, if

not elimination, of the late - filing fee. AHCA, by stipulating

to the accuracy to those facts, does not, however , agree that

those facts require mitigation as to the amount of the late -

filing fee for late - filing of the 2001 renewal application.

3. AHCA, on or about June 4, 2001, sent a letter to the

Petitioner, wherein it was stated:

The license to operate the above named

Facility expires October 31, 2001. It is a

violation of Florida Statutes to operate a

nursing home facility without a valid

license.

In order to continue to operate the

Facility, it is necessary that the enclosed

application form(s) be compl eted and

returned with the appropriate license

fee. . . .

The application and fee are due 90 days

before the expiration date noted above.

Failure to file a renewal application within

this time frame will result in the

imposition of a late fee as allowe d by

Florida Statute. Application without

licensure fees will not be accepted, and the

application will be returned without

processing. . . (Petitioner Exhibit 2 in

evidence.)

4. The instructions under "number 12" of the instructions

accompanying that letter stated:

Attach a copy of the surety bond or

membership in a self - insurance pool.

5. There are no instructions in that letter to the effect

that an incomplete application could be filed and would be

accepted as timely - filed even if incomplete.

6. Maria Allen is the CFO of Baker County Medical

Services, Inc. (Facility). She was designated as the person

responsible for filing the nursing home renewal application at

issue. Ms. Allen relied upon the instructions in the above -

referenced letter and on the form and understood that a

completed application had to be filed with the agency. It was

Ms. Allen's understanding that the application had to be

submitted in complete form including both relevant surety bonds.

Thus, she was under the impression t hat the application could

only be submitted in complete form. Neither Ms. Allen nor the

Facility was ever informed by any personnel of AHCA, verbally or

in writing, that an incomplete application could be submitted

and would be considered as timely, provi ded the necessary fee

was submitted with an incomplete application.

7. Ms. Allen was aware that the application should be

filed by August 1, 2001. She was having difficulties with the

surety company because, as shown by Exhibit 20 in evidence, the

sur ety company had moved its offices and had misplaced the

nursing home's bond application documents. She repeatedly

called the surety company or its broker or agent to determine

when the surety bond would be ready. The surety bond was

promised by the suret y company prior to the deadline. In fact,

the surety bond was delayed and was submitted to Ms. Allen some

11 to 12 days later. When she received the bond, she thereupon

"over - nighted" a completed application with the bond

accompanying it to the Responden t, such that the application was

filed 13 days late. In the fact of the surety bond company's

delay, it was unreasonable and impracticable for Ms. Allen to

seek an alternative surety bond company or agency because it

would take considerably more time to g et a new surety company to

issue a surety bond, after starting that process over again.

8. After she submitted the application 13 days late, she

never had any advice from AHCA to the effect that she could have

submitted an incomplete application.

9. Mr. James Kemp is the Health Services and Facilities

consultant who reviewed and received renewal applications,

including that of the Petitioner. Mr. Kemp maintains that he

seldom received a renewal application with the renewal bond

attached. He maintain s that only ten percent of applications

are first submitted in complete fashion. He stated that the

same instructions are sent out to all nursing facilities that

are leased. Incomplete applications come in with defects such

as typing errors or other erro rs or omissions. AHCA reviews for

errors or omissions and informs the applicant as to what is

needed to properly complete an application. If a nursing home

does not correct the omission within 90 days, the date of

license expiration, AHCA will send a not ice of intent to deny.

Mr. Kemp stated that there was no fine or penalty for nursing

homes if omissions or errors are corrected within 90 days.

10. The W. Frank Wells Nursing Home only filed a lease

bond once before, with its 2000 application. Prior to that time

it was not legally required to file a lease bond. The prior

lease bond and application filed for the year 2000 was filed on

time. Thus, there was no reason at that time for the Facility

to have known of any policy which would allow an incom plete

application to be submitted on the due date, to be completed

within 90 days thereafter. Because neither Mr. Kemp nor any

other agency personnel, by letter, written instructions, or

verbally, ever informed the Petitioner that AHCA would accept an

inc omplete application as timely filed, the only way the

Facility could have learned of that policy would be to inquire

of the Agency by letter or by phone call. This was not done

because the Facility and Ms. Allen had no information that would

alert them to that possibility.

11. Ms. Molly McKinstrey is Bureau Chief for Long Term

Care Services. In her testimony she acknowledged that the

statute, Section 400.111, Florida Statutes, does not use the

modifier "incomplete" or "complete." She also admits that t he

language of the letter, Petitioner's Exhibit Two, referenced -

above, as well as the application document, references the

requirement that the application be completed and returned with

the appropriate license fee. She also admits that the Agency

has a r egularly - established, unwritten policy that the Agency

will accept an incomplete application, filed before the

deadline, as a timely application.

12. There is no evidence that the Respondent Agency makes

a practice of giving notice of this policy in any way unless a

substantially affected party makes inquiry of the Agency. If

Ms. Allen and the Facility had been informed, before the

August 1 deadline, of this routinely followed, unwritten policy,

the Facility would have filed the application timely and t hen

submitted the surety bond at such time thereafter as it was

obtained. Further, the evidence establishes that Ms. Allen, in

June 2001, soon after receiving the notice letter of June 4,

2001, began immediate steps to timely obtain the required surety

bo nd. The bond was not obtained in time to submit the

application with the bond on August 1 due to no fault of the

Facility but rather due to the mistakes made by the surety bond

company or its agents.

CONCLUSIONS OF LAW

13. The Division of Administrati ve Hearings has

jurisdiction of the subject matter of and the parties to this

proceeding. §§ 120.569 and 120.57(1), Florida Statutes (2003).

14. Pursuant to Section 400.411, Florida Statutes, a

skilled nursing facility such as the Petitioner is required to

file an annual application for renewal of its license at least

90 days prior to the expiration of its current license.

15. In this license renewal statute the Legislature

provides for a late - filing fee in the following language:

The failure to file a n application within

the period established in this subsection

shall result in a late fee charged to the

licensee by the Agency in an amount equal to

50 percent of the fee in effect on the last

preceding regular renewal date. A late fee

shall be levied fo r each and every day the

filing of the license application is

delayed, but in no event shall such fine

aggregate more than $5,000.00.

16. The use of the word "shall" in the above - quoted

statutory authority for the assessment and amount of such fee

wou ld appear to be mandatory language. AHCA, however, did not

cite any decisional law which would preclude an administrative

law judge the authority to mitigate a late - filing fee imposed

pursuant to Section 400.411, Florida Statutes. AHCA submitted

that it knew of no such authority for the agency itself to

reduce the fee amount established by this statute, except

through and as a part of settlement of litigation. That

acknowledgement, however, is tacit recognition that the

statutory requirement to assess th e late fee is waivable by the

party which has authority to assess the late fee.

17. The preponderant evidence culminating in the above

Findings of Fact establishes that there are circumstances which

should excuse the assessment of the late fee. The Peti tioner

had, for many years, not been required to file the subject

surety bond but rather was allowed to submit "unconditional

guarantees" to AHCA upon filing of the annual renewal

applications. That course of dealing between the parties was

ended the yea r before when the 2000 renewal application was

filed, at which point AHCA began requiring of the Petitioner the

filing of a surety bond with its renewal application. The

Petitioner did so and filed its application and the bond timely

in the year 2000. Th us, it really had no occasion to learn that

there was an unwritten policy followed by AHCA which would have

permitted it to file an incomplete application on a timely basis

without being deemed untimely provided the errors or omission

were corrected within 90 days thereafter.

18. When June 2001 arrived and the June 4, 2001, notice

letter regarding the filing date of the application was sent to

the Petitioner by AHCA, there still was no notice to the

Petitioner of this unwritten policy. Through the entir e

application process, and even after the filing date of August 1,

2001, there was no communication or notice of this unwritten

policy to the Petitioner.

19. While it is true that had the Petitioner started

early, perhaps in April or May of 2001, to pre pare its

application and take steps to obtain a surety bond, it might

have obtained a surety bond on a timely basis so that it could

file the entire, completed application on August 1, 2001; that

did not occur. Although it did not occur, the evidence show s

that, immediately upon receiving the June 4th notice letter from

the Agency, the Facility began preparing to file its application

and took steps to obtain the surety bond. The surety bond could

not be obtained on a timely basis through no reasonable fau lt of

the Petitioner because the surety company apparently lost the

relevant bond application documents and this rendered the bond

incapable of being delivered on or before August 1. The

evidence shows that when this became known, late July, it was

too la te to get another surety company because that would have

entailed even more delay.

20. The Petitioner had made a number of communications to

the surety company to try to speed the bonding process, to no

avail. The evidence shows that the Petitioner beg an its

application preparation steps, including applying for the surety

bond on a reasonable and practicable timely basis. Credible

evidence shows that, had it known of that policy, it would have

submitted its application by August 1 in incomplete fashion so

as to prevent the issue of the late fee arising.

21. Although the Petitioner could have inquired of the

Agency as to an acceptable course of action when it saw that it

could not obtain the bond by August 1, there was no

communication by the Agency t o the Petitioner which would

indicate any basis for it to make such inquiry concerning the

excusing of a late or incomplete filing, and certainly the

policy which would have allowed such was never communicated to

the Petitioner. The fact that the Petition er was unaware of the

policy is borne out by the fact the Petitioner was still

proceeding with all possible haste, after the deadline, to

complete the application by obtaining the bond and submitting

it. This is evidenced by the fact that, as soon as the bond

reached the hands of the Petitioner, it "overnight - mailed" it

with the then - complete application to AHCA.

22. It certainly seems clear that, although a fair

interpretation of the above statute would seem to indicate that

the late - filing fee is a mandatory assessment that, as

acknowledged by the Respondent in its Proposed Recommended

Order, even that legislatively - imposed requirement can be waived

in settlement of litigation. This is because, in effect, a

party to litigation can waive its statutor y rights if it chooses

to do so.

23. Moreover, the above, preponderantly - proven

circumstances show that, in effect, substantial compliance with

the above statutory requirement and the filing deadline has been

met because of the circumstance of the Petit ioner filing the

complete application only 13 days late and because the above

facts show "excusable neglect." It is appropriate that

excusable neglect, encompassed by the doctrine of "equitable

tolling," should excuse the late - filing to the extent that,

u nder the peculiar facts and circumstances confined to this

case, that the late filing fee should not be assessed. See

Machules v. Dept. of Administration , 523 So. 2d 1132 (Fla.

1988); Broward County Board of County Commissioners v. State

Dept. of Environm ental Regulation , 495 So. 2d. 863 (Fla. 4th DCA

1987). It is so concluded.

RECOMMENDATION

Having considered the foregoing Findings of Fact,

Conclusions of Law, the evidence of record, the candor and

demeanor of the witnesses, and the pleadings and argum ents of

the parties, it is, therefore,

RECOMMENDED that a Final Order be entered by AHCA excusing

the Petitioner herein of the payment of the $5,000.00 late fee

for the late filing of its 2001 application for its renewal of

licensure. It is further

RECOM MENDED that, as to DOAH Case No. 02 - 4827, in view of

the withdrawal by AHCA of its denial of the 2002 application for

licensure renewal and withdrawal of its intent to seek an

administrative fine for failure to have professional liability

insurance, that C ase No. 02 - 4827 be dismissed.

DONE AND ENTERED this 15th day of December, 2003, in

Tallahassee, Leon County, Florida.

S

___________________________________

P. MICHAEL RUFF

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675 SUNCOM 278 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with Clerk of the

Division of Administrative Hearing s

this 15th day of December, 2003.

COPIES FURNISHED :

John D. Buchanan, Jr., Esquire

Henry, Buchanan, Hudson,

Suber & Carter, P.A.

117 South Gadsden Street

Tallahassee, Florida 32301

Tom R. Moore, Assistant General Counsel

Agency for Heal th Care Administration

Office of the Attorney General

2727 Mahan Drive, Building III

Tallahassee, Florida 32308

Lealand McCharen, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Valda Clark Christian, General Counsel

Agency for Health Care Administration

Fort Knox Building, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days fr om 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.