05-000926 Huberto E. Merayo vs. Agency For Health Care Administration Status: Closed Recommended Order on Thursday, September 29, 2005.

Summary: The correspondence from a workers` compensation provider was not a valid petition for Respondent to resolve a reimbursement dispute with the carrier.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

HUBERTO E. MERAYO, )

)

Petitioner, )

)

vs. ) Case No. 05 - 0926

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent, )

)

and )

)

WARREN TECHNOLOGIES AND UNITED )

SELF INSURED SERVICES, )

)

Intervenor s . )

)

RECOMMENDED ORDER

Pursuant to notice, a final hearing was conducted on

June 3 , 2005, by video teleconference between Miami and

Tallahassee, Florida, before Administrative Law Judge Claud e B.

Arrington of the Division of Administrative Hearings (DOAH).

Counsel for Intervenors participated by telephone.

APPEARANCES

For Petitioner: L. Barry Keyfetz, Esquire

44 West Flagler Street, Suite 2400

Miami, Florida 33139

For Respondent: Joanna Daniels, Esquire

Agency for Health Care Administration

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

For Int ervenors: Mark S. Spangler, Esquire

Mark S. Spangler, P.A.

1061 Maitland Center Commons

Maitland, Florida 32751

STATEMENT OF THE ISSUE

Whether Petitioner, a health care provider, file d a timely,

valid petition with Respondent to challenge Intervenors’

disallowance of payment for certain dates of service to a

workers’ compensation claimant.

PRELIMINARY STATEMENT

Intervenor Warren Technologies is the employer and

Intervenor United Self Insured Service is the workers’

compensation insurance carrier (the carrier) for a workers’

compensation claimant (claimant). Petitioner is a health care

provider. On September 30, 2004, the carrier’s attorney

(Mr. Spangler) mailed to Petitioner a Notic e of Disallowance

(Notice) and Explanation of Benefits (Explanation) , which

notified Petitioner that the carrier was disallowing payment to

Petitioner for billings for three dates of service to the

claimant. The Notice and Explanation were received by

Pet itioner on October 4, 2004.

By letter dated October 25, 2004, (the October 25

correspondence) Petitioner corresponded with Respondent as to

the disallowance. The import of the October 25 correspondence

and the enclosures with the correspondence are in dis pute.

Petitioner asserts in this proceeding that the October 25

correspondence constitutes a petition to challenge the

disallowances set forth in the Notice and Explanation.

Petitioner further asserts that all requisite enclosures were

enclosed with the correspondence. Respondent and Intervenors

dispute that the October 25 correspondence constitutes a valid

petition. They further dispute that the correspondence included

requisite enclosures. They also argue that the October 25

correspondence cannot be a valid petition because Petitioner

served it by regular mail, not certified mail. As will be

discussed in detail below, the applicable statute is Section

440.13(7), Florida Statutes (2004), and the applicable rule is

Florida Administrative Code Rule 59A - 31.002. 1

It should be noted that the issue before the undersigned is

whether Petitioner filed a valid petition with Respondent. The

merits of the underlying dispute pertaining to the utilization

review is not at issue and will not be discussed. Also no t at

issue and not discussed is whether Petitioner should have an

opportunity to amend the October 25 correspondence should it be

determined that the correspondence was an invalid petition.

The claimant is not a party to this proceeding because the

provide r cannot bill the claimant for the disallowed services.

See Furtick v. William Shults Contractor , 664 So. 2d 288 (Fla.

1 st DCA 1995).

At the final hearing, Petitioner presented the testimony of

Vinnette Febus and Donna Reynolds. Ms. Febus is Petitioner’s

records custodian. Ms. Reynolds, a Registered Nurse, is

employed by Respondent and was responsible for responding to

both the October 25 correspondence and the dispute that ensued

between Petitioner and Intervenors. Petitioner offered one

composite exhi bit, which was admitted into evidence. Respondent

recalled Ms. Reynolds during its case in chief and presented

three exhibits, two of which were composite exhibits and each of

which was admitted into evidence. Intervenors presented no

testimony and no ex hibits. 2

A Transcript of the proceedings was filed on August 8,

2005. Petitioner filed a Proposed Recommended Order and

Respondent and Intervenors filed a J oint Proposed Recommended

Order. The parties’ Proposed Re commended Orders have been duly -

considere d by the undersigned in the preparation of this

Recommended Order.

FINDINGS OF FACT

1. At the times relevant to this proceeding, Intervenors

had accepted that the claimant had suffered a compensable injury

under the Florida workers’ compensation laws an d had paid

benefits to and on behalf of claimant. The date of the

compensable injury was July 8, 1994.

2. On September 30, 2004, Mr. Spangler, as counsel for the

carrier, prepared the Notice that was received by Petitioner on

October 4, 2004. The Noti ce provided, in part, as follows:

The purpose of this letter is to inform

you of the findings from the Carrier’s

utilization review investigation. Based

upon the opinions of Carrier Medical

Consultants, the Carrier has concluded that

there has been over utilization and/or

misutilization since the treatment has been

excessive and not medically necessary.

Additionally, it appears that some bills may

not have been timely submitted to the

Carrier. . . .

Accordingly, the Carrier has decided that

specific da tes of service will be disallowed

and they are as follows:

04/26/04, 06/01/04, 07/12/04

Based upon its utilization review

investigation, the Carrier also believes

that the treatment rendered on the following

dates [sic] was also excessive, and neither

r easonable nor medically necessary.

Nevertheless, the Carrier has agreed to

reimburse for these specific dates [sic] of

service which are as follows:

08/17/04

As the health care provider, you have

certain rights and responsibilities under

Florida Statute s and Florida Administrative

Code. This office sent you a very detailed

letter that explained the requirements and

procedures under the utilization review

provisions of Section 440.13(7), Florida

Statutes.

Please note the under Section

440.13(7)(a), Flo rida Statutes, “Any health

care provider . . . who elects to contest

the disallowance . . . of payment by a

carrier under 440.13 subsection (6) must,

within 30 days after receipt of notice of

disallowance petition the agency to resolve

the dispute.” The 30 days begin to run from

the date this letter is received.

Additionally, please find enclosed the

Explanation of Benefits regarding these

dates of service.

Please reference our previous

correspondence forwarded to you or contact

the undersigned if you have any questions

concerning this matter.

3. Enclosed with the carrier’s letter of September 30,

2004, was the Explanation, which consisted of two pages.

4. The carrier’s Notice was a “disallowance of payment”

within the meaning of Section 440.13(7), Florida Statutes, and a

“reimbursement decision” within the meaning of Florida

Administrative Code Rule 59A - 31.002.

5. Petitioner mailed a letter to Respondent dated

October 25, 2004, that was received by Respondent’s mailroom and

delivered to Ms. Reynol ds on November 1, 2004. Ms. Reynolds

testified that the envelop e for the letter reflected that it was

mailed on October 29, 2004, in Miami . The two - page letter,

which has been redacted to protect the privacy of the claimant,

stated the following:

I a m a Board Certified physician in the

field of psychiatry. I have been the

treating physician, under the worker’s

compensation law, for the above noted

patient for many years. I undertook

[her/his] treatment on September 19, 2000,

at the request of the ca rrier, following

retirement of [her/his] original treating

physician. At the that time [she/he] was

already adjudicated permanent total

disability and it [sic] was already

determined to be suffering from severe

depression, on various medications and

needi ng continued follow - up care.

I was advised by the patient’s attorney

that the carrier was trying to close the

case including closing the medical. The

patient however is in need of continued

medical care and has no viable alternative

source therefore.

I then received various communications

from the insurance carrier’s attorney

pointing out their rational [sic] for

disallowance of medically necessary

services. In my field the doctor - patient

relationship is of course particularly

important and it would b e most detrimental

to the patient and, at least at this point,

I declined to follow a course of curtailing

needed services.

I then received the enclosed communication

disallowing payment for 4 [sic] recent

visits per the enclosure. The letter

advises to challenge the same it is

necessary to “petition” the agency within 30

days of notification. My office was unable

to determine to whom I was supposed to

respond and in what form. I accordingly

incredibly was required to seek the

assistance of an attorney to simply try to

top [sic] track down whom I was supposed to

contact and in what manner. The attorney

advises me that after his personal efforts

for in excess of two hours, multiple calls

including office of employee assistance,

AHCA itself several times , Division of

Worker’s Compensation and several faxed

letters that he was provided the above

address. I am further advised that there is

no form for this petition, but a responding

letter will serve as the petition.

Before my addressing the 4 [sic] bill s I

would suggest it imperative that you need to

address a requirement that the carrier in

any disallowing communication be required to

advise as to whom is to be contacted if

objection is made and that a letter will

suffice.

Given the diagnosis of the p atient, Major

Depressive Disorder, Recurrent, Severe, With

Psychotic Features, it is the accepted

guidelines of treatment based on research

and practice to combine the use of

individual psychotherapy and psychotropic

medication for maximum results.

This patient’s care has been minimized to

6 visits a year and I don’t see how she can

be treated with less frequency and time than

that. The minimum time that can be given

with this frequency of visits is at least

45 - 60 minutes to obtain results. An

alternati ve would be twice a month visits of

25 minutes, which will be more costly.

If any additional information is needed to

expedite my petition please advise.

6. It is undisputed that three forms completed and signed

by Petitioner were enclosed with the let ter of October 25, 2004.

Each form was captioned “Workmen [sic] Compensation Report” (the

Report forms) and were, respectively, for the dates of service

April 26, 2004; June 1, 2004; and July 12, 2004, that are at

issue in this proceeding (the dates of se rvice). 3 The three

Report forms were the only enclosures with the letter of

October 25 received by Ms. Reynolds on November 1, 2004.

7. Ms. Febus typed and mailed the letter of October 25.

Ms. Febus testified that in addition to the three Report forms,

she also included with the October 25 letter a “Health Insurance

Claim Form” for each date of service, the Notice, and the two -

page Explanation.

8. The original of each of the Health Insurance Claim

Forms was mailed to the carrier and constituted a bill ing for

the services rendered to the claimant by Petitioner on each

respective date of service. Petitioner introduced as part of

its composite exhibit a copy of his file copy of each Health

Insurance Claim Form. Each of the Health Insurance Claim Forms

i ntroduced by Petitioner (the three forms Ms. Febus testified

she enclosed with the October 25 correspondence) reflects that

Petitioner signe d the form on December 22, 2004 (block 31 of

each form) , and that the claimant signed a release of medical

informati on on December 22, 2004 (block 12 on each form). These

three Health Insurance Claim Forms were the only billings that

Petitioner alleged was enclosed with the October 25

correspondence.

9. Ms. Febus’ testimony was based on her memory. She did

not note on the letter the list of enclosures (other than a

reference to the Notice) and she did not keep a file copy of her

complete submission package.

10. The mailing of the October 25 correspondence was by

regular mail, not certified mail. A notation on th e bottom of

Petitioner’s letter reflects that a copy was mailed to the

carrier’s adjuster, to Mr. Spangler, and to Mr. Keyfetz. Each

of these mailings was by regular mail. There was no evidence as

to what enclosures were included with any of these mailin gs and

there was no indication on the letter whether the copies

included the enclosures.

11. On November 1, 2004, after her review of the

October 25 correspondence, Ms. Reynolds telephoned Petitioner’s

office and talked to Ms. Febus. Ms. Reynolds belie ved the

correspondence constituted an inquiry, not a petition to resolve

a disputed disallowance. Ms. Reynolds and Ms. Febus discussed

the applicable statute and rule and they discussed the required

contents of a petition to resolve a disputed disallowanc e.

Ms. Reynolds and Ms. Febus did not discuss the enclosure that

had been received with the October 25 correspondence.

12. On November 1, 2004, Ms. Reynolds followed up her

conversation with Ms. Febus by sending her an e - mail.

Ms. Reynolds’ e - mail pro vided, in part, the following:

This is a continuation of our telephone

conversation of today regarding the 10 - 25 - 04

letter from Dr. Merayo. Attached are 2

documents which may assist to orient you to

2 sections of the Florida WC Law which may

impact the issues which are spoken to in the

letter. Please feel free to call me for

further discussion regarding Florida’s WC

Law and the medical issues that you may have

questions [sic].

The 2 sections of the law that I

immediately wish to draw your attention t o

are: ss. 440.13 and subsection 7(a) and ss.

440.192 F.S.

The second section deals with the

CLAIMANT’S benefits under Fla. WC Law ...

these issues, when impacted, are decided by

a Judge of Compensation Claims, following

the submission of a proper req uest by the

CLAIMANT.

THE FIRST SECTION, ss. 440.13(7), F.S.,

addresses the way a dispute is submitted to

this Agency (using the address below).

Should you have further questions, do not

hesitate to contact me.

13. Ms. Reynolds attached to her e - mail copies of Sections

440.192 and 440.13(7), Florida Statutes, and Florida

Administrative Code Rule 59A - 31.002.

14. Section 440.192, Florida Statutes, pertains to

disputes between a claimant and a carrier that are resolved by a

Judge of Compensation Claims. Those provisions are not relevant

to the issues in this proceeding.

15. Section 440.13(7), Florida Statutes, pertains to

reimbursement disputes between a provider and a carrier and

provides in relevant part, as follows:

(7) UTILIZATION AND REIMBURS EMENT

DISPUTES. -

(a) Any health care provider, carrier, or

employer who elects to contest the

disallowance or adjustment of payment by a

carrier under subsection (6) must, within 30

days after receipt of notice of disallowance

or adjustment of payment, petition the

agency to resolve the dispute. The

petitioner must serve a copy of the petition

on the carrier and on all affected parties

by certified mail. The petition must be

accompanied by all documents and records

that support the allegations contain ed in

the petition. Failure of a petitioner to

submit such documentation to the agency

results in dismissal of the petition.

(b) The carrier must submit to the agency

within 10 days after receipt of the petition

all documentation substantiating th e

carrier's disallowance or adjustment.

Failure of the carrier to timely submit the

requested documentation to the agency within

10 days constitutes a waiver of all

objections to the petition.

(c) Within 60 days after receipt of all

documentation, the agency must provide to

the petitioner, the carrier, and the

affected parties a written determination of

whether the carrier properly adjusted or

disallowed payment. The agency must be

guided by standards and policies set forth

in this chapter, including all applicable

reimbursement schedules, practice

parameters, and protocols of treatment, in

rendering its determination.

(d) If the agency finds an improper

disallowance or improper adjustment of

payment by an insurer, the insurer shall

reimburse the h ealth care provider,

facility, insurer, or employer within 30

days, subject to the penalties provided in

this subsection.

(e) The agency shall adopt rules to carry

out this subsection. The rules may include

provisions for consolidating petitions filed

by a petitioner and expanding the timetable

for rendering a determination upon a

consolidated petition. ...

16. Florida Administrative Code Rule 59A - 31.002, provides

as follows:

In those instances when a provider does

not agree with a carrier’s recon sidered

reimbursement decision, the Agency will,

upon request, provide for a settlement of

such reimbursement dispute through a review

process conducted by the Agency’s Bureau of

Managed Care.

(1) The provider, the carrier or the

employer may request a resolution to a

reimbursement dispute from the Agency. A

valid Request for Resolution of Disputed

Reimbursement must:

(a) Be in writing and specify the

specific service(s) and policy being

disputed.

(b) Include copies of the following:

1. All bi lls submitted or resubmitted

that are related to the services in question

and their attachments.

2. All applicable Explanation s of Medical

Benefits.

3. All correspondence between the carrier

and provider which is relevant to the

disputed reimbursemen t.

4. Any notation of phone calls regarding

authorization.

5. Any pertinent or required health care

records or reports or carrier medical

opinions.

(2) The Agency’s response to a valid

disputed reimbursement request will:

(a) Be within 60 days of receipt.

(b) Establish the proper reimbursement

amount, including over and under payments.

(c) Identify the basis for the decision.

(d) Be sent to the provider, carrier and

employer.

(e) Be in writing.

(f) Provide for reconsiderations thr ough

physicians and peer review before an appeal

[sic] pursuant to Section 120.57, Florida

Statutes.

(3) Requests for Resolution of Disputed

Reimbursement will be returned as not valid

when:

(a) The required documentation is not

included with the req uest.

(b) The date of the request for a

reconsideration exceeds the time

requirements as specified in this section.

. . .

17. The next communication between Petitioner and

Respondent was in the form of a letter dated December 22, 2004,

from Mr. Keyfe tz on behalf of Petitioner to Respondent. After

referencing the reimbursement dispute, the letter provided as

follows:

I am in receipt of copy of responsive

petition by Dr. Merayo dated October 25,

2004, in connection with the above matter.

Dr. Merayo advises he has received no

response thereto let alone the required

response within 10 days receipt by the

carrier. It is provided:

Failure of the carrier to timely submit

the requested documentation to the agency

within 10 days constitutes a waiver o f all

objections to the petition.

We await your written determination, which

is now due regarding the carrier

disallowance of these amounts.

18. The letter from Mr. Keyfetz dated December 22, 2004,

prompted a letter from Mr. Spangler on behalf of the c arrier

dated December 30, 2004. After receiving a copy of

Mr. Spangler’s letter, Mr. Keyfetz wrote a second letter to

Respondent on January 5, 2005, that attempts to refute

Mr. Spangler’s letter and again demands a written determination

of the disputed re imbursements.

19. On January 26, 2005, Ms. Reynolds responded to

Petitioner with copies to Mr. Keyfetz and Mr. Spangler.

This is to acknowledge not only your

letter of October 25, 2004, but also the

correspondence recently received from

[Mr. Keyfetz and Mr. Spangler].

At issue is the acknowledgment of

correspondence sent by you to this office

dated October 25, 2004, received by this

office on November 1, 2004. This

correspondence was a two - page letter with

reference to a disallowance of payment fo r

treatment rendered to the claimant: [name

redacted]. Attachments to this letter were

3 progress reports dated: 08 - 12 - 04, 06 - 01 -

04, and 04 - 26 - 04, from the Merayo Medical

Arts Group and signed with your apparent

signature. The progress reports show

[cla imant’s] Date of Accident (D/A) as 07 -

08 - 1984.

On November 1, 2004, in response to this

correspondence, I telephoned your office and

spoke with Vinette, who identified herself

as a representative of your office staff.

It was during this telephone conver sation, I

clarified the definition of a disallowance,

denial and a payment made at a different

amount from that which was billed. Each of

these circumstances has specific procedures,

which must be met in order to address a

disagreement concerning the carr ier’s

action.

I followed this conversation with an e -

mail sent, at Vinette’s direction to ... I

have attached a copy of this e - mail and the

attachments contained in this e - mail to this

letter.

I have had no follow - up communication from

your office f ollowing this action. No file

was established in this office. This

correspondence was handled as an inquiry.

However, subsequent to this action, on

December 27 [, 2004] and on January 10,

2005, letters were received from [Mr.

Keyfetz] regarding your or iginal October 25,

2004, correspondence. [Mr. Spangler], the

carrier’s representative, sent a letter

dated December 30, 2004.

This is to inform you that this office

cannot address the issues brought forward

except to clarify to you sections of Chapter

4 40, which may be of import to your quest

for assistance.[ 4 ]

* * *

You failed to comply with these

requirements as a contested disallowance or

adjustment of payment by the carrier. I

have dismissed this correspondence as an

invalid submission of a reimbursement

dispute.[ 5 ]

CONCLUSIONS OF LAW

20. The Division of Administrative Hearings has

jurisdiction over the subject matter of and the parties to this

case pursuant to Sections 120.569 and 120.57(1), Florida

Statutes.

21. Petitioner has the burde n of proving that he timely

filed a valid petition with Respondent. That burden is by a

preponderance of the evidence. See Florida Department of

Transportation v. J. W. C. Company, Inc. , 396 So. 2d 778 (Fla.

1st DCA 1981), and Section 120.57(1)(j), Flori da Statutes.

22. A “preponderance” of the evidence means the greater

weight of the evidence. See Fireman's Fund Indemnity Co. v.

Perry , 5 So. 2d 862 (Fla. 1942).

23. “Competent” evidence must be relevant, material and

otherwise fit for the purpose for which it is offered. See

Gainesville Bonded Warehouse v. Carter , 123 So. 2d 336 (Fla.

1960), and Duval Utility Co. v. FPSC , 380 So. 2d 1028 (Fla.

1980).

24. "Substantial" evidence must be sufficient to allow a

reasonable mind to accept the evidence as adequate to support a

conclusion. See Degroot v. Sheffield, 95 So. 2d 912 (Fla.

1957), and Agrico Chemical Co. v. Fla. Dept. of Environmental

Regulation, 365 So. 2d 759 (Fla. 1st DCA 1978).

25. The testimony by Ms. Febus that she enclosed in the

lette r dated October 25, 2004, a copy of the three Health

Insurance Claim Forms is not credible since each form reflects

signatures dated December 22, 2004. It is concluded that

Petitioner failed to meet his burden of proof in this proceeding

because he failed to prove by credible evidence that he enclosed

with his October 25 correspondence all enclosures required by

Section 440.13(7), Florida Statutes, and Florida Administrative

Code Rule 59A - 31.002(1). Petitioner’s argument that the

correspondence was in sub stantial compliance with the applicable

statute and rule is rejected as being contrary to the greater

weight of the competent evidence.

26. On November 1, 2004, Ms. Reynolds reviewed the

correspondence of October 25, 2005, and reasonably concluded

that th e correspondence was an inquiry. She appropriately

responded to that inquiry by telephoning Petitioner’s records

custodian and e - mailing her copies of the applicable statute and

rule. The letter from Mr. Keyfetz dated December 22, 2004,

specifically advi sed, for the first time, that Petitioner

considered the October 25 correspondence to be a petition, not

an inquiry. Once Ms. Reynolds knew that Petitioner considered

the October 25 correspondence to be a petition to resolve a

disputed disallowance, she wa s required to review the

correspondence and determine whether the petition satisfied

appropriate statutory and rule criteria. Ms. Reynolds correctly

determined that the petition did not meet that criteria. She

further correctly determined that the petiti on should be

dismissed pursuant to Section 440.13(7)(a) Florida Statutes.

27. Because of the foregoing conclusions, Petitioner’s

contention that Intervenors have waived all objections to the

petition pursuant to Section 440.13(7)(b), Florida Statutes,

be cause the carrier did not respond to the correspondence within

10 days of its receipt by the adjuster for the carrier is moot.

28. Also moot is the contention by Respondent and

Intervenors that the correspondence of October 25 is invalid

because it was served by regular mail, not by certified mail.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is RECOMMENDED that Respondent enter a final order

dismissing the October 25 correspondence as an invalid petition.

DONE A ND ENTERED this 29 th day of September , 2005 , in

Tallahassee, Leon County, Florida.

S

CLAUDE B. ARRINGTON

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 967 5 SUNCOM 278 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

t his 29th day of September, 2005 .

ENDNOTES

1 / Unless otherwise noted, all statutory references are to

Florida Statutes ( 2004) and all rule references are to the

version of the rule in the Florida Administrative Code as of the

date of this Recommended Order.

2 / Prior to the hearing, counsel for Intervenor filed a copy of

the deposition of the carrier’s adjuster (Arnie Blak e) with

DOAH. This deposition was not admitted into evidence. See

transcript, page 102, lines 16 - 19. The joint Proposed

Recommended Order filed by Respondent and Intervenors

erroneously reflects that Intervenors moved the deposition into

evidence.

3 / The amount in controversy for each date of service is

$180.00 and the total amount in controversy is $540.00.

4 / The letter sets forth the relevant portions of Section

440.13(7)(a), Florida Statutes, and Florida Administrative Code

Rule 59A - 31.002, which have been set forth above and need not be

repeated.

5 / The letter then advised Petitioner of his rights pursuant to

Chapter 120, Florida Statutes, which need not be repeated.

COPIES FURNISHED :

Joanna Daniels, Esquire

Agency for Health Care Administrati on

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Mark S. Spangler, Esquire

Mark S. Spangler, P.A.

1061 Maitland Center Commons

Maitland, Florida 32751

L. Barry Keyfetz, Esquire

44 West Flagler Street, Suite 2400

Miami, Florida 33139

Ric hard Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Station 3

Tallahassee, Florida 32308

Alan Levine, Secretary

Agency for Health Care Administration

Fort Knox Building, Suite 3116

2727 Mahan Drive

Tallahassee, Florida 32308

William Roberts, Acting 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 exception s 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.