16-005582MTR John Gray vs. Agency For Health Care Administration, And Department Of Health Brain And Spinal Cord Injury Program Status: Closed DOAH Final Order on Thursday, December 29, 2016.

Summary: Petitioner did not prove, by clear and convincing evidence, that a lesser portion of Petitioner's total recovery should be allocated as reimbursement for medical expenses than the amount the Agency calculated pursuant to the sec. 409.910(11)(f) formula.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

JOHN GRAY,

Petitioner,

vs. Case No . 16 - 5582MTR

AGENCY FOR HEALTH CARE

ADMINISTRATION, AND DEPARTMENT

OF HEALTH BRAIN AND SPINAL CORD

INJURY PROGRAM,

Respondents.

_______________________________/

FINAL ORDER

The final hearing in this matter was conducted before

J. Bruce Culpepper, Administrative Law Judge of the Division of

Administrative Hearings, pursuant to sections 120.569 and

120.57(1), Florida Statutes (2016), 1/ on October 2 6, 2016, by

video teleconference with sites in Tallahassee and Tampa,

Florida.

APPEARANCES

For Petitioner: Brandon G. Cathey, Esquire

Swope, Rodante P.A.

1234 East 5th Avenue

Tampa, Florida 33605

For Re spondent: Alexander R. Boler, Esquire

Xerox Recovery Services

Suite 300

2073 Summit Lake Drive

Tallahassee, Florida 32317

STATEMENT OF THE ISSUE

The issue to be determined in this matt er is the amount of

money to be reimbursed to the Agency for Health Care

Administration for medical expenses paid on behalf of Petitioner,

John Gray, a Medicaid recipient, following PetitionerÓs recovery

from a third - party.

PRELIMINARY STATEMENT

On Septemb er 23, 2016, Petitioner, a Medicaid recipient,

filed a Petition to Determine the Amount Payable to the Agency

for Health Care Administration (the ÐAgencyÑ) and Medicaid Health

Maintenance Organizations in Satisfaction of Medicaid Lien

(ÐPetitionÑ), by whic h he challenged the AgencyÓs lien for

medical expenses following PetitionerÓs recovery from a third -

party. The Agency seeks reimbursement of medical expenses paid

by Medicaid on PetitionerÓs behalf based on an amount calculated

using the formula establish ed in section 409.910(11)(f) , Florida

Statutes . Petitioner asserts that reimbursement of a lesser

portion of PetitionerÓs recovery is warranted pursu ant to section

409.910(17)(b).

On September 26, 2016, the Division of Administrative

Hearings (ÐDOAHÑ) not ified the Agency of PetitionerÓs Petition

for an administrative proceeding to determine the amount payable

to the Agency to satisfy the Medicaid lien.

The final hearing was held on October 26, 2016. At the

final hearing, PetitionerÓs Exhibits 1 through 5 were admitted

into evidence. The Agency did not offer any evidence. Neither

party called witnesses to testify.

A court reporter recorded the final hearing. A one - volume

Transcript of the proceeding was filed on December 2, 2016. At

the close of the hea ring, the parties were advised of a ten - day

timeframe following DOAHÓs receipt of the Transcript to file

post - hearing submittals. Both parties filed Proposed Final

Orders which were duly considered in preparing this Final Order.

FINDING S OF FACT

1. On Ja nuary 18, 2007, Petitioner was involved in a

devastating automobile accident. Another vehicle, driven by

Damil Belizaire, crossed a median and collided head - on into the

car Petitioner was driving. No evidence indicates that any

negligence on the part of Petitioner caused or contributed to the

accident or his injury.

2. Petitioner suffered catastrophic injuries from the

collision , including a spinal cord injury resulting in

paraplegia.

3. Following the accident, Petitioner was transported to UF

Health Sh ands Hospital (ÐShandsÑ) in Jacksonville, Florida.

Petitioner remained in Shands receiving medical treatment for

77 days.

4. Once Petitioner became medically stable, he was

transferred to the Brooks Rehabilitation Center (ÐBrooksÑ) in

Jacksonville, Flor ida. There, Petitioner received intensive

physical and occupational therapy care. Petitioner remained at

Brooks until June 1, 2007 , when he was discharged. Petitioner is

permanently paraplegic.

5. On April 7, 2008, Petitioner sued Mr. Belizaire seeking

to recover his damages from the automobile accident.

PetitionerÓs lawsuit was filed in the Circuit Court of the Fourth

Judicial Circuit, in Duval County, Case No. 16 - 2008 - CA - 004366.

6. On April 1, 2013, Petitioner received a jury verdict in

his favor an d was awarded a Final Judgment against Mr. Belizaire

in the amount of $2,859,120.56, including statutory interest.

The damages award was allocated as follows:

a. $128,760.56 for past medical expenses;

b. $1,301,268.00 for future medical expenses;

c. $2 02,670.00 for the loss of earnings in the past;

d. $916,422.00 for loss of earning capacity in the future;

e. $50,000.00 for pain and suffering, disability, physical

impairment, disfigurement, mental anguish, inconvenience , and

loss of capacity for the e njoyment of life in the past; and

f. $260,000.00 for pain and suffering, disability, physical

impairment, disfigurement, mental anguish, inconvenience , and

loss of capacity for the enjoyment of life in the future .

7. Despite his verdict awarding damages, Petitioner has

only been able to recover $10,000.00 from Mr. Belizaire.

Mr. BelizaireÓs automobile liability insurance company paid

Petitioner $10,000 , which was the limit of his bodily injury

liability insurance policy.

8. The Agency, through its Medi caid program, paid a total

of $65,615.05 for Petitioner Ó s medical care resulting from the

2007 automobile accident. 2/

9. This administrative matter centers on the amount the

Agency is entitled to be paid to satisfy its Medicaid lien

following PetitionerÓs recovery of $10,000 from a third - party.

Under section 409.910, the Agency may be repaid for its Medicaid

expenditures from any recovery from liable third - parties. The

Agency claims that, pursuant to the formula set forth in section

409.910(11)(f), it sh ould collect $3,750 regardless of the full

value of PetitionerÓs damages. (The Agency subtracted a

statutorily recognized attorney fee of $2,500 from $10,000

leaving $7,500. One - half of $7,500 is $3,750.)

10. Petitioner asserts that pursuant to section

409.910(17)(b), the Agency should be reimbursed a lesser portion

of PetitionerÓs recovery than the amount it calculated using the

section 409.910(11)(f) formula. Petitioner specifically argues

that the AgencyÓs Medicaid lien must be reduced pro rata, taki ng

into account the full value of PetitionerÓs personal injury claim

as determined by the Final Judgment entered in the underlying

negligence lawsuit. Otherwise, application of the default

statutory formula under section 409.910(11)(f) would permit the

Ag ency to collect more than that portion of the settlement

representing compensation for medical expenses. Petitioner

maintains that such reimbursement violates the federal Medicaid

lawÓs anti - lien provision, 42 U.S.C. § 1396p(a)(1), and Florida

common law. Petitioner contends that the AgencyÓs allocation

from PetitionerÓs recovery should be reduced to the amount of

$230.00.

11. Based on the evidence in the record, Petitioner failed

to prove, by clear and convincing evidence, that a lesser portion

of Petit ionerÓs total recovery should be allocated as

reimbursement for medical expenses than the amount the Agency

calculated pursuant to the formula set forth in section

409.910(11)(f). Accordingly, the Agency is entitled to recover

$3,750.00 from PetitionerÓs recovery of $10,000 from a third -

part y to satisfy its Medicaid lien.

CONCLUSIONS OF LAW

12. The Division of Administrative Hearings has

jurisdiction over the subject matter and parties in this case

pursuant to sections 120.569, 120.57(1), and 409.910(17)( b),

Florida Statutes.

13. The Agency is the Medicaid agency for the state, as

provided under federal law, and administers FloridaÓs Medicaid

program. See § 409.901(2), Fla. Stat.

14. The federal Medicaid program Ðprovide[s] federal

financial assistance to States that choose to reimburse certain

costs of medical treatment for needy persons.Ñ Harris v. McRae ,

448 U.S. 297, 301 (1980). Though a stateÓs participation is

entirely optional, once a state elects to participate in the

federal Medicaid program, it must comply with federal

requirements governing the same. Id. ; and 42 U.S.C. § 1396, et

seq .

15. As a condition for receipt of federal Medicaid funds,

states are required to seek reimbursement for medical expenses

from Medicaid recipients who later re cover from legally liable

third parties. See Arkansas DepÓ t of Health & Hum . Servs. v.

Ahlborn , 547 U.S. 268, 276 (2006). Consistent with this federal

requirement, the Florida Legislature enacted section 409.910,

FloridaÓs ÐMedicaid Third - Party Liability Act,Ñ which authorizes

and requires the Agency to be reimbursed for Medi caid funds paid

for a recipientÓ s medical care when that recipient later receives

a personal injury judg ment or settlement from a third - party.

See Smith v. Ag. for Health Care Admin . , 24 So. 3d 590 (Fla. 5th

DCA 2009). Section 409.910 creates an automatic lien on any such

judgment or settlement with a third - party for the full amount of

medical assistance Medicaid provided to the Medicaid recipient.

See § 409.910(6)(c), Fla. Stat.

1 6. Accordingly, by accepting Medicaid benefits, Medicaid

recipients automatically subrogate their rights to third - party

benefits for the full amount of medical assistance provided by

Medicaid and automatically assigned to the Agency the right,

title, and interest to those benefits, other than those excluded

by federal law. See § 409.910(6)(a), (b), Fla. Stat.; see also

42 U.S.C. § 1396k(a)(1) (requiring states participating in the

federal Medicaid program to provide, as a condition of Medicaid

eligibility , assignment to the state the right to payment for

medical care from any third - party); and Giraldo v. Ag . for Health

Care Admin. , No. 1D16 - 0392, 2016 Fla. App. LEXIS 18299 (1st DCA

Dec. 12, 2016). 3/

17. The obligation to reimburse the Agency (and Medicaid )

following recovery from a third - party, however, is not unbounded.

Pursuant to 42 U.S.C. §§ 1396a(a)(25)(A), (B), and (H) ; 1396k(a),

and 1396p(a), the Agency may only assert a Medicaid lien against

that portion of PetitionerÓs award from a third - party th at

represents the costs of the medical assistance made available for

the individual. See Ahlborn , 547 U.S. at 278; Wos v. E.M.A. ,

133 S. Ct. 1391, 133 S. Ct. 1391, 1396 (2013) ; Harrell v. State ,

143 So. 3d 478, 480 (Fla. 1st DCA 2014); and Davis v. Rober ts ,

130 So. 3d 164, 266 (Fla. 5th DCA 2013). The federal Medicaid

statuteÓs anti - lien provision, 42 U.S.C. § 1396p(a)(1), prohibits

a state from attaching a lien on a Medicaid recipientÓs property

for the medical assistance paid by the state other than th at

portion of a Medicaid recipientÓs recovery designated as payment

for medical care. See also section 409.910(4), (6)(b)1., and

(11)(f ) , which provides that the Agency may not recover more than

it paid for the Medicaid recipientÓ s medical treatment.

18. As Ahlborn explains, the anti - lien provisions of the

federal Medicaid Act circumscribe these obligations by

authorizing payment to a state only from those portions of a

Medicaid recipientÓs third - party settlement recovery allocated

for payment of medical care. See also E.M.A. ex rel. Plyler v.

Cansler , 674 F.3d 290, 312 (4th Cir. 2012) , where the court

concluded Ð[a]s the unanimous Ahlborn CourtÓ s decision makes

clear, fede ral Medicaid law limits a stateÓ s recovery to

settlement proceeds that are shown to be properly alloc able to

past medical expenses.Ñ

19. In cases where a Medicaid recipient only recovers a

limited amount, section 409.910 protects the Medicaid recipientÓ s

interest in the non - medical expense portion of the judgment,

award, or settlement. In this matter, the Agency, through the

Medicaid program, paid a tot al of $65,615.05 for PetitionerÓ s

medical expenses. PetitionerÓs actual recovery for his injuries

($10,000), however, was less than the amount needed to fully

satisfy the AgencyÓs Medica id expenditures. Therefore, the

Agency employed the formula established in section 409.910 to

calculate the portion of his recovery that should be set aside to

reimburse the medical assistance it prov ided to Petitioner.

20. Section 409.910(11)(f) sets fo rth the fo rmula to

determine the amount the Agency may recover for medical expenses

from a judgment, award, or settlement from a third - party.

Section 409.910(11)(f) states , in pertinent part:

[I ]n the event of an action in tort against a

third party in wh ich the recipient or his or

her legal representative is a party which

results in a judgment, award, or settlement

from a third party, the amount recovered shall

be distributed as follows:

1. After attorneyÓs fees and taxable costs as

defined by the Flori da Rules of Civil

Procedure, one - half of the remaining recovery

shall be paid to the agency up to the total

amount of medical assistance provided by

Medicaid.

2. The remaining amount of the recovery shall

be paid to the recipient.

3. For purposes of ca lculating the agencyÓs

recovery of medical assistance benefits paid,

the fee for services of an attorney retained

by the recipient or his or her legal

representative shall be calculated at 25

percent of the judgment, award, or settlement.

4. Notwithstand ing any provision of this

section to the contrary, the agency shall be

entitled to all medical coverage benefits up

to the total amount of medical assistance

provided by Medicaid. For purposes of this

paragraph, Ðmedical coverageÑ means any

benefits under health insurance, a health

maintenance organization, a preferred provider

arrangement, or a prepaid health clinic, and

the portion of benefits designated for medical

payments under coverage for workersÓ

compensation, personal injury protection, and

casual ty.

2 1. The section 409.910(11)(f) formula establishes that the

AgencyÓs recovery for a Medicaid lien is limited to the lesser of:

(1) its full lien ; or (2) one - half of the total award, after

deducting attorneyÓs fees of 25 percent of the recovery and a ll

taxable costs, up to, but not to exceed, the total amount actually

paid by Medicaid on the recipientÓs behalf. See Ag. f or Health

Care Admin. v. Riley , 119 So. 3d 514, 515 n.3 (Fla. 2d DCA 2013).

22. The parties stipulate that, using the section

409.9 10(11)(f) formula, $3,750 of PetitionerÓs $10,000 total

recovery is the amount due to the Agency to satisfy its Medicaid

lien .

23. However, section 409.910(17)(b) provides a method by

which a Medicaid recipient may contest the amount designated as

recover ed medical expenses payable under section 409.910(11)(f).

Following the U.S. Supreme Court decision in Wos , the Florida

Legislature created an administrative process to determine the

portion of the judgment, award, or settlement in a tort action

represent ing medical expenses, and thus the portion the AgencyÓ s

Medicaid lien that must be reimbursed. Section 409.910(17)(b)

states:

A recipient may contest the amount designated

as recovered medical expense damages payable

to the agency pursuant to the formula

specified in paragraph (11)(f) by filing a

petition under chapter 120 within 21 days

after the date of payment of funds to the

agency or after the date of placing the full

amount of the third - party benefits in the

trust account for the benefit of the agenc y

pursuant to paragraph (a). The petition shall

be filed with the Division of Administrative

Hearings. For purposes of chapter 120, the

payment of funds to the agency or the

placement of the full amount of the third -

party benefits in the trust account fo r the

benefit of the agency constitutes final agency

action and notice thereof. Final order

authority for the proceedings specified in

this subsection rests with the Division of

Administrative Hearings. This procedure is

the exclusive method for challeng ing the

amount of third - party benefits payable to the

agency. In order to successfully challenge

the amount payable to the agency, the

recipient must prove, by clear and convincing

evidence, that a lesser portion of the total

recovery should be allocated as reimbursement

for past and future medical expenses than the

amount calculated by the agency pursuant to

the formula set forth in paragraph (11)(f) or

that Medicaid provided a lesser amount of

medical assistance than that asserted by the

agency . (Emphas is added ) .

24. Section 409.910(17)(b) establishes that the section

409.910(11)(f) formula constitutes a default allocation of the

amount of a settlement that is attributable to medical costs, and

sets forth an administrative procedure for an adversarial

challenge of that allocation. See Harrell , 143 So. 3d at 480 ( Ðwe

now hold that a plaintiff must be given the opportunity to seek

reduction of the amount of a Medicaid lien established by the

statutory formula outlined in section 409.910(11)(f), by

demons trating, with evidence, that the lien amount exceeds the

amount recovered for medical expenses Ñ ) .

25. In order to successfully challenge the amount payable to

the Agency, the burden is on the Medicaid recipient to prove, by

clear and convincing evidence, that a lesser portion of the total

recovery should be allocated as reimbursement for past and future

medical expenses than the amount the Agency calculated.

§ 409.910(17)(b), Fla. Stat.

26. Clear and convincing evidence Ðrequires more proof than

a Òprepon derance of the evidenceÓ but less than Òbeyond and to the

exclusion of a reasonable doubt.ÓÑ In re Graziano , 696 So. 2d

744, 753 (Fla. 1997). Clear and convincing evidence requires:

[T] hat the evidence must be found to be

credible; the facts to which the witnesses

testify must be distinctly remembered; the

testimony must be precise and explicit and the

witnesses must be lacking in confusion as to

the facts in issue. The evidence must be of

such weight that it produces in the mind of

the trier of fact a f ir m belief or conviction,

without hesi tancy, as to the truth of the

allegations sought to be established.

In re Davey , 645 So. 2d 398, 404 (Fla. 1994); Slomowitz v. Walker ,

429 So. 2d 797, 800 (Fla. 4th DCA 1983).

27. Accordingly, if Petitioner can prove , by clear and

convincing evidence, that the past and future medical expense

portion of his award is less than the amount the Agency calculated

using the section 409.910(11)(f) formula, Petitioner may reduce

the amount it must reim burse the Agency below $3 ,750.

28. Petitioner proposes that the Agency should be allocated

only 2.3 percent of PetitionerÓs total recovery ($230) as

reimbursement for its payment of PetitionerÓs medical expenses.

Petitioner calculates this amount as follows: the Final Judgment

in PetitionerÓs negligence case established that Petitioner

suffered a total of $2,859,120.56 in damages. Of this amount, the

jury allocated $128,760.56 for past medical expenses and

$1,301,268.00 for future medical expenses. Medicaid paid

$65,615.05 of PetitionerÓs medical expenses. Thus, the medical

assistance Medicaid expended on PetitionerÓs behalf equals

approximately 2.3 percent of PetitionerÓs total claim ($65,615.05

divided by $2,859,120.56). Applying this percentage to

PetitionerÓs total recove ry of $10,000, as a matter of fairness,

the Agency should only recover $230 ($10,000 times 2.3 percent ).

29. However, while Petitioner did prove that a lesser

portion of PetitionerÓs total recovery of $10,000 should be

allocated to reimburse the Agency, P etitioner did not meet his

burden of demonstrating, by clear and convincing evidence, that

that amount should be less than the $3,750 the Agency calculated

under section 409.910(11)(f), or should be reduced to $230.

Primarily, no evidence in the record se ts out how PetitionerÓs

$10,000 recovery should be divided between medical and non - medical

expenses (if it can be at all). As a result, the alternative

calculation Petitioner proposes fails to take into account or

designate some limited portion of Petitio nerÓs award that

represents past or future medical expenses. Consequently, no

evidence demonstrates that the $10,000 recovery does not include

at least $3,750 that could be attributed to PetitionerÓs medical

costs. Neither does the evidence indicate that the $3,750 amount

includes payments for expenses other than PetitionerÓs medical

care and services. Therefore, because Petitioner bears the burden

of proving, clearly and convincingly, that his formula properly

allocates a lesser amount to be reimbursed to satisfy the AgencyÓs

Medicaid lien, Petitioner failed to present the evidence necessary

to avoid the application of the statutory formula contained in

section 409.910(11)(f). 4/

30. Accordingly, while PetitionerÓs calculation may offer a

more equitable portion of PetitionerÓs $10,000 recovery to be

allotted to the Agency in light of the large amount of damages

Petitioner suffered, the undersigned is mindful that ÐMedicaid is

a cooperative federal - state welfare program providing medical

assistance to need y people.Ñ Roberts v. AlbertsonÓs Inc. , 119

So. 3d 457, 458 (Fla. 4th DCA 2012) (quoting Ag . for Health Care

Admin. v. Estabrook , 711 So. 2d 161, 163 (Fla. 4th DCA 1998)); see

also 42 U.S.C. § 1396a(a)(25)(A) - (B). Although state

participation in this fe deral program is voluntary, once a state

elects to participate, it must comply with federal Medicaid law.

Roberts , 119 So. 3d at 458; see also Wilder v. Va. Hosp. AssÓn ,

496 U.S. 498, 502 (1990). Further, as expressed in Giraldo :

To keep the Medicaid pro gram viable, Congress

recognized that it is necessary to obtain

reimbursement when a third party makes payment

to the Medicaid beneficiary for medical care

already paid for by Medicaid. Roberts , 119

So. 3d at 459. As Roberts explains, the goal

of the rei mbursement provision of the Medicaid

Act was at least in part to protect tax

dollars. 119 So. 3d at 459 (citing Tristani v.

Richman , 652 F.3d 360, 373 (3d Cir. 2011)).

This, no doubt, is at least in part so that

other "needy people" may secure the car e th ey

so desperately require.

Giraldo , supra. , at 18 .

31. In sum, Petitioner failed to prove, by clear and

convincing evidence, that a lesser portion of PetitionerÓs total

recovery should be allocated as reimbursement for past medical

expenses than the amou nt the Agency calculated using the section

409.901(11)(f) formula. Based on the facts in the record, the

Agency is entitled to $3,750.00 for its Medicaid expenditures from

PetitionerÓs third - party recovery.

ORDER

Based on the foregoing Findings of Fact an d Conclusions of

Law, it is hereby

ORDERED that t he Agency for Health Care Administration is

entitled to $3,750.00 from the third - party settlement at issue in

this matter in satisfaction of its Medicaid lien.

DONE AND ORDERED this 29th day of December , 201 6 , in

Tallahassee, Leon County, Florida.

S

J. BRUCE CULPEPPER

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 29th day of December , 201 6 .

ENDNOTE S

1/ All references to the Florida Statutes are to the 2016

version, unless otherwise noted.

2/ Following Peti tionerÓs discharge from Brooks, he moved to

Valdosta, Georgia. Georgia Medicaid paid a total of $13,507.56

for PetitionerÓs continued medical care resulting from the

accident. No evidence of a lien initiated by Georgia Medicaid

(if any) was presented at the final hearing.

3/ Giraldo was issued on December 12, 2016 , and is not final

until time expires to file motion for rehearing and disposition

thereof if filed.

4/ In determining the portion of a Medicaid recipientÓs recovery

available to reimburse th e Agency, funds attributed to both past

and future medical costs should be included in the calculation.

See Giraldo , supra. , at 8 - 9, 17, which holds that the Agency has

the right to reimbursement from settlement proceeds attributed to

both past medical ex penses, as well as that portion of a

settlement designated as future medical expenses. Giraldo

explains:

[W]e find no error in the ALJÓ s legal

determination relating to AHCAÓ s right to

secure reimbursement for payments already made

for medical costs from not only that portion

of the settlement allocated for past medical

expenses but also from that portion of the

settlement intended as compensation for future

medical expenses. We do so initially because

that is precisely what Florida law required

the ALJ to do. . . . Specifically, the

of the gross (or entire settlement) recovered

(which would include the recipient's recovery

for past and future medical costs) less only

attorney's fees and costs as designated to

repay the state's Medicaid agency for the

medi cal expenses that it has paid.

Likewise, section 409.910(17)(b), which

authorizes a Medicaid recipient to

challenge the amount allocated under

section 409.910(11)(f), expressly requires

consideration of t he amou nts the Medicaid

recipient has Ð recovered Ñ to reimburse him or

her Ð for pa st and future medical expenses.Ñ

* * *

[W] e choose . . . to align ourselves with

what we believe are the better reasoned

decisions of those courts which have held

th at a state agency may secure payment from

both past and future recoveries for medical

expenses.

COPIES FURNISHED:

John Cofield

Xerox Recovery Services

2073 Summit Lake Drive, Suite 300

Tallahassee, Florida 32317

Alexander R. Boler, Esquire

Xerox R ecovery Services

Suite 300

2073 Summit Lake Drive

Tallahassee, Florida 32317

(eServed)

Brent G. Steinberg, Esquire

Swope, Rodante P.A.

1234 East 5th Avenue

Tampa, Florida 33605

(eServed)

Brandon G. Cathey, Esquire

Swope, Rodante P.A.

1234 East 5th Aven ue

Tampa, Florida 33605

(eServed)

Richard J. Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Stuart Williams, General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Justin Senior, Interim Secretary

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florida 32308

(eServed)

Shena L. Grantham, Esquire

Agency for Health Care Adminis tration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

Thomas M. H oeler, Chief Facilities Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(eServed)

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Final Order is entitled

to judicial review pursuant to section 120.68, Florida Statutes.

Review proceedings are governed by the Florida Rules of Appellate

Procedure. Such proceedings are commence d by filing the original

notice of administrative appeal with the agency clerk of the

Division of Administrative Hearings within 30 days of rendition

of the order to be reviewed, and a copy of the notice,

accompanied by any filing fees prescribed by law, w ith the clerk

of the District Court of Appeal in the appellate district where

the agency maintains its headquarters or where a party resides or

as otherwise provided by law.