17-000471RP
Genesis Rehabilitation Hospital, Inc., D/B/A Brooks Rehabilitation Hospital vs.
Agency For Health Care Administration
Status: Closed
DOAH Final Order on Tuesday, April 18, 2017.
DOAH Final Order on Tuesday, April 18, 2017.
1STATE OF FLORIDA
4DIVISION OF ADMINISTRATIVE HEARINGS
8IN RE: MEDICAID REIMBURSEMENT Case Nos. 17 - 0467RP
17RATE PROPOSED AND EXISTING RULE through 17 - 0474RP,
26CHALLENGES 17 - 0496RP,
30_______________________________/ 17 - 0558RP thr ough
3617 - 0560RP
39FINAL ORDER
41On February 23, 2017, a final hearing was held in these
52cases in Tallahassee before J. Lawrence Johnston, Administrative
60Law Judge, Division of Administrative Hearings (DOAH).
67APPEARANCES
68For Petitioners: Mich ael J. Glazer, Esquire
75Ausley McMullen
77123 South Calhoun Street
81Tallahassee, Florida 32302
84Stephen A. Ecenia, Esquire
88Rutledge, Ecenia, & Purnel l, P.A.
94Suite 202
96119 South Monroe Street
100Tallahassee, Florida 32302 - 0551
105Seann M. Frazier, Esquire
109118 North Gadsden Street
113Tallahassee, Florida 32302
116Joanne Barbara Erde, Esquire
120Duane Morris LLP
123Suite 3400
125200 South Biscayne Boulevard
129Miami, Florida 33131
132Christopher Charles Kokoruda, Esquire
136Miami - Dade County
140West Wing, Suite 109
1441611 Northwest 12th Avenue
148Miami, Florida 33136
151Kyle L. Kemper, Esquire
155Sundstrom & Mindlin, LLP
1592548 Blairstone Pines Drive
163Tallahassee, Florida 32301
166For Respondent: Joseph M. Goldstein, Esquire
172Shutts & Bowen LL P
177Suite 2100
179200 East Broward Boulevard
183Fort Lauderdale, Florida 33301
187STATEMENT OF THE ISSUE S
192The issues are whether proposed and existing Florida
200Administrative Code rules, both numb ered 59G - 6.030, are valid
211exercises of delegated legislative authority.
216PRELIMINARY STATEMENT
218In November 2016, numerous Florida hospitals filed petitions
226challenging the methodology used to determine the Medicaid
234outpatient reimbursement rate changes for state fiscal year 2016 -
2442017 as a rule that was not adopted as required, and challenging
256the validity of existing rule 59G - 6.030, which included the
267methodology used to determine the rates for fiscal year 2015 -
2782016. Those petitions became DOAH cases 16 - 63 98RX through
28916 - 6414RX, which were consolidated. The final hearing scheduled
299for December 5 was continued, and the unadopted rule challenges
309were stayed when the Agency for Health Care Administration (AHCA)
319gave notice that it was proposing to amend rule 59G - 6.030 to
332incorporate the methodology used to determine the reimbursement
340rates for fiscal year 2016 - 2017.
347In January 2017 , the hospitals filed petitions challenging
355proposed and existing rule 59G - 6.030. Those petitions became
365DOAH cases 17 - 0467RP thro ugh 17 - 0474RP, 17 - 0496RP, and 17 - 0558RP
382through 17 - 0560RP, which were consolidated and scheduled for
392final hearing on February 23 and 24. The final hearing in the
404existing rule challenges in cases 16 - 6398RX through 16 - 6414RX was
417rescheduled to coincide on February 23 and 24. The stay of the
429unadopted rule challenges in those ÐRXÑ cases remained in effect.
439On February 22, the parties filed their final joint pre -
450hearing stipulation, which focused the issues and established
458many of the pertinent facts. The final hearing was completed in
469one day, on February 23.
474Joint Exhibits 1 through 34 were received in evidence. The
484Petitioners called three witnesses: John Owens, a healthcare
492consultant focusing on hospital reimbursement; Tom Wallace, who
500is AHCAÓs b ur eau c hief for Medicaid program finance; and Jennifer
513Hinson, an attorney who works for Wellcare Health Plans, a
523managed care organization (MCO) that contracts with numerous
531hospitals to provide Medicaid plans for a large number of
541Medicaid patients. Petit ionersÓ Exhibits 1, 2, 5, 6, 7, 9, 10,
55316 through 24, 26, 27 , and 28 were received in evidence. Ruling
565was reserved on relevance and hearsay objections to PetitionerÓs
574Exhibits 14 and 15. Those objections are overruled, and the
584e xhibits are received. Finally, RespondentÓs Exhibits 3, 4,
593and 6 were received in evidence.
599The Transcript of the final hearing was filed on March 15.
610The partiesÓ proposed final orders have been considered.
618All statutory references are to the 2016 codification of the
628Florida Statutes, unless otherwise indicated.
633FINDING S OF FACT
6371. The Petitioners are 120 hospitals -- some not - for - profit,
650some for - profit, and some governmental -- that are licensed under
662c hapter 395, Florida Statutes, provide both inpatient and
671outpatient servic es , and participate in the Medicaid program.
680AHCA is the state agency authorized to make payments for services
691rendered to Medicaid patients.
6952. Before 2013, all Medicaid outpatient services were
703provided and paid fee - for - service. Under the fee - for - serv ice
719model, hospitals submit claims to AHCA, and AHCA reimburses the
729hospitals based on the established rate.
7353. For many years, AHCA has set prospective Medicaid fee -
746for - service reimbursement rates f or outpatient hospital services,
756either semi - annually or annually, based on the most recent
767complete and accurate cost report s submitted by each hospital;
777has re - published the Florida Title XIX Hospital Outpatient
787Reimbursement Plan (Outpatient Plan) that explained how the rates
796were determined; and has adopt ed the current Outpatient Plan by
807reference in rule 59G - 6.030 .
8144. In 2005, the Florida LegislatureÓs General
821Appropriations Act (GAA) stated that the funds appropriated for
830Medicaid outpatient hospital services reflected a cost savings of
839$16,796,807 Ðas a result of modifying the reimbursement
849methodology for outpatient hospital rates.Ñ It instructed AHCA
857to Ðimplement a recurring methodology in the Title XIX Outpatient
867Hospital Reimbursement Plan that may include, but is not limited
877to, the inflation fac tor, variable cost target, county rate
887ceiling or county ceiling target rate to achieve the cost
897savings.Ñ
8985. AHCA responded by amending the Outpatient Plan to
907provide: ÐEffective July 1, 2005, a recurring rate reduction
916shall be established until an agg regate total estimated savings
926of $16,796,807 is achieved each year. This reduction is the
938Medicaid Trend Adjustment.Ñ The amended Outpatient Plan was then
947adopted by reference in rule 59G - 6.030, effective July 1, 2005.
9596. AHCA collaborated with the hos pitals to determine how to
970accomplish the legislatively mandated reduction in a manner that
979would be fair to all the hospitals. It was decided to take the
992hospitalsÓ unaudited cost reports from the most recent complete
1001fiscal year and the number of Medica id occasions of service from
1013the monthly report of AHCAÓs Medicaid fiscal agent that
1022corresponded to the hospitalsÓ fiscal years, and use an Excel
1032spreadsheet program with a function called Goal Seek to calculate
1042proportionate rate adjustments for each hos pital to achieve the
1052legislatively mandated aggregate savings . The resulting rate
1060adjustments were incorporated in the hospital reimbursement
1067rates, effective July 1, 2005.
10727. In 2006, there was no further Medicaid Trend Adjustment
1082( MTA ) reduction. Ho wever, in accordance with the instructions in
1094the 2005 GAA, the 2005 MTA reduction of $16,796,807 was treated
1107as a recurring reduction and was applied again in the 2006
1118Outpatient Plan, which again stated: ÐEffective July 1, 2005, a
1128recurring rate reducti on shall be established until an aggregate
1138total estimated savings of $16,796,807 is achieved each year.
1149This reduction is the Medicaid Trend Adjustment.Ñ The 2006
1158Outpatient Plan also stated: ÐThis recurring reduction, called
1166the Medicaid Trend Adjustm ent, shall be applied proportionally to
1176all rates on an annual basis.Ñ It also came to be known as the
1190first cut or cut 1 . It again was applied by taking the
1203hospitalsÓ most current unaudited cost reports and the
1211corresponding occasions of service from t he appropriate monthly
1220report of the fiscal agent, and using the Excel spreadsheets and
1231the Goal Seek function to calculate rate adjustments for each
1241hospital. The cut 1 rate adjustments were incorporated in the
1251hospital reimbursement rates, effective Jul y 1, 2006.
12598. In 2007, the GAA stated that the funds appropriated for
1270Medicaid outpatient hospital services were reduced by $17,211,796
1280Ðas a result of modifying the reimbursement for outpatient
1289hospital rates, effective July 1, 2008.Ñ This has been refe rred
1300to as the second cut or cut 2 . It instructed AHCA to Ðimplement
1314a recurring methodology in the Title XIX Outpatient Hospital
1323Reimbursement Plan to achieve this reduction.Ñ The 2008
1331Outpatient Plan again applied the first cut as a recurring
1341reduction and stated that it was to be Ðapplied proportionally to
1352all rates on an annual basis.Ñ It then made the second cut,
1364which was to be Ðapplied to achieve a recurring annual reduction
1375of $17,211,796.Ñ These cuts were again applied by taking the
1387hospitalsÓ most current unaudited cost reports and the
1395corresponding occasions of service from the appropriate monthly
1403report of the fiscal agent, and using the Excel spreadsheets and
1414the Goal Seek function to calculate rate adjustments for each
1424hospital. The result ing rate adjustments were incorporated in
1433the hospital reimbursement rates, effective July 1, 2008.
14419. This process was repeated in subsequent years. The
1450third cut (cut 3) was in 2008; it was a $36,403,451 reduction.
1464The fourth cut (cut 4) was in 2009, during a special session; it
1477was a $19,384,437 reduction; however, per the GAA that made the
1490fourth cut, it was not applied to the rates of certain childrenÓs
1502specialty hospitals, which were excluded from the reduction. In
1511addition, using language similar to what AHCA had been using in
1522the Outpatient Plans, the 2009 GAA stated: ÐThe agency shall
1532reduce individual hospital rates proportionately until the
1539required savings are achieved.Ñ The Legislature enacted cut 5
1548and cut 6 in 2009 and 2010. Howeve r, th e GAAs stated that AHCA
1563should not take these cuts if the unit costs before the cuts were
1576equal to or less than the unit costs used in establishing the
1588budget. AHCA determined that cut s 5 and 6 should not be taken.
1601However, cuts 1 through 4 continued to be applied as recurring
1612reductions , and rates were adjusted f or cut s 1 through 4 in 2009
1626and 2010 in the same manner as before .
163510. In 2011, the GAA enacted cut 7; it was for $99,045,233
1649and was added to the previous cuts for all but certain childrenÓs
1661sp ecialty and rural hospitals, which were excluded from the
1671additional reduction.
167311. In setting the individual hospitalsÓ reimbursement
1680rates, AHCA first applied cut 7 in the same manner as cuts 1
1693through 4. The result was a 16.5 percent rate adjustment f or
1705cut 7 , which was much higher than for previous cuts . Some of the
1719hospitals pointed this out to AHCA and to the Legislature and its
1731staff. There was lots of discussion, and it was determined that
1742the rate adjustment from cut 7 would be more like what the
1754Legislature was expecting (about 12 percent ) , if budgeted
1763occasions of service were used , instead of the number from the
1774fiscal agentÓs monthly report that corresponded to the most
1783recent cost reports . AHCA agreed to change to budgeted fee - for -
1797service occasions of service for cut 7, w ith the concurrence of
1809the hospitals an d the Legislature and its staff .
181912. The year 2011 was also the year the Legislature
1829instituted what became known as the Ðunit cost cap.Ñ In that
1840year, the Legislature amended sec tion 409.908 , Florida Statutes,
1849to provide: ÐThe agency shall establish rates at a level that
1860ensures no increase in statewide expenditures resulting from a
1869change in unit costs effective July 1, 2011. Reimbursement rates
1879shall be as provided in the Gene ral Appropriations Act.Ñ
1889§ 409.908(23)(a), Fla. Stat. (2011). This part of the statute
1899has not changed. The GAA that year elaborated:
1907In establishing rates through the normal
1913process, prior to including this reduction
1919[cut 7], if the unit cost is equ al to or less
1931than the unit cost used in establishing the
1939budget, then no additional reduction in rates
1946is necessary. In establishing rates through
1952the normal process, if the unit cost is
1960greater than the unit cost used in
1967establishing the budget, then ra tes shall be
1975reduced by an amount required to achieve this
1983reduction, but shall not be reduced below the
1991unit cost used in establishing the budget.
199813. ÐUnit costÑ was not defined by statute or GAA. To
2009calculate what it was in 2011, AHCA divided the to tal dollar
2021amount of Medicaid payments made to hospitals by AHCA by the
2032number of Medicaid occasions of service for all hospitals. The
2042result was $141.51.
204514. Since 2011, AHCA has applied the unit cost cap with
2056reference to the 2011 unit cost of $141. 51. Since then, AHCA has
2069compared the 2011 unit cost to the current cost, calculated by
2080dividing the total dollar amount of Medicaid payments made to all
2091hospitals by AHCA by the number of Medicaid occasions of service
2102for all hospitals, except in childre nÓs and rural hospitals , to
2113determine whether the unit cost cap would require a further rate
2124reduct ion, after applying the MTA cuts . Using this comparison,
2135the unit cost cap never has been exceeded, and no further rate
2147adjustments ever have been required.
215215. It is not clear why AHCA excluded Medicaid occasions of
2163service for childrenÓs and rural hospitals from the unit cost
2173calculations made after 2011. It could have been because those
2183hospitals were excluded from cut 7 and cut 8.
219216 . Cut 8 was ena cted in 2012; it was for $49,078,485 and
2208was added to the previous cuts for all but certain childrenÓs
2219specialty and rural hospitals, which were excluded from the
2228additional reduction. In 2012, the Legislature specified in the
2237GAA that budgeted occasions of service should be used in
2247calculating the MTA reduction for inpatient hospitals. AHCA
2255always treated inpatient and outpatient MTAs the same, and it
2265viewed the specific legislative direction for the inpatient MTA
2274as guidance and indicative of legislativ e intent that it should
2285continue to use budgeted occasions of service for the outpatient
2295cut 7 and should also use them for the outpatient cut 8. Again,
2308the hospitals did not object since the result was a higher
2319reimbursement rate.
232117 . In 2014, the Flor ida Medicaid program began to
2332transition Medicaid recipients from a fee - for - service model to a
2345managed care model. Under the managed care model, AHCA pays a
2356managed care organization (MCO) a capitation rate per patient.
2365The MCOs negotiate contract s with hospitals to provide outpatient
2375care at an agreed reimbursement rate per occasion of service.
238518 . Since August 2014, the majority of Medicaid recipients
2395has been receiving services through MCOs , rather than through
2404fee - for - service. Currently, about 75 t o 80 percent of Medicaid
2418outpatient hospital occasions of service are provided through
2426managed care
242819 . In recognition of the shift to MCOs, the Legislature
2439began to divide the Medicaid outpatient hospital reimbursement
2447appropriation in the GAA between w hat AHCA reimburses directly to
2458hospitals under the fee - for - service model and what it pays MCOs
2472to provide those services under the MCO delivery system. This
2482allocation of the budgets between fee - for - service and managed
2494care necessarily accomplished a cor responding division of the
2503recurring MTA reductions between the two delivery systems. The
2512Legislature did not enact any statutes or GAAs requir ing AHCA to
2524change how it applies MTA reductions to determine fee - for - service
2537outpatient reimbursement rate adj ustments , or make any other
2546changes in respo nse to the transition to MCOs .
255620 . There were no additional MTA reductions in 2015. The
25672015 Outpatient Plan, which is incorporated in existing rule 59G -
25786.030, applied the previous cuts as recurring reductio ns. The
2588evidence was confusing as to whether cuts 7 and 8 were applied
2600using the occasions of service in the fiscal agentÓs monthly
2610report corresponding to the hospitalsÓ most current unaudited
2618cost reports , or using budgeted occasions of service. If the
2628former, the numbers did not yet reflect much of the shift to the
2641managed care model because of a time lag in producing cost
2652reports , and the evidence suggested that the numbers were
2661approximately the same as the budgeted occasions of service used
2671previous ly . Whichever numbers were used, the resulting rate
2681adjustments were incorporated in the hospitalsÓ reimbursement
2688rates, effective July 1, 2015.
269321 . Leading up to the 2016 legislative session, there was a
2705legislative proposal to determine prospective Medicaid outpatient
2712reimbursement rates using a completely new method called Enhanced
2721Ambulatory Patient Groups (EAPGs). EAPGs would eliminate the
2729need to depend on hospital cost reports and complicated
2738calculations to determine the effects of MTA reducti ons on
2748prospective hospital outpatient reimburseme nt rates, effective
2755July 1 , following the end of the legislative session each year.
2766Hospitals, including some if not all of the Petitioners, asked
2776the Legislature not to proceed with the proposed EAPG legi slation
2787until they had an opportunity to study it and provide input , and
2799EA PGs were not enacted in 2016. However, section 409.905(6)(b)
2809was amended, effective July 1, 2017, to require t he switch to
2821EAPGs. See note to § 409.905, Fla. Stat.; and ch. 2016 - 6 5,
2835§ 9 , Laws of Fl a. (2016 ) .
284422 . When it became apparent that EAPGs would not be in use
2857for prospective reimbursement rates for fiscal year 2016/2017,
2865AHCA basically repeated the 2015/2016 process, but adjusted the
2874occasions of service used for calculat ing the hospitalsÓ rate
2884reductions for cuts 7 and 8 by adding 14,000 occasions of
2896service . At the end of July, AHCA published new rates effective
2908July 1, 2016.
291123 . When the new rates were published, they were challenged
2922by some of the Petitioners under section 120.57(1) , Florida
2931Statutes . Citing section 409.908(1)(f)1., AHCA took the position
2940that there was no jurisdiction and dismissed the petitions. That
2950decision is on appeal to the First District Court of Appeal.
296124 . The Petitioners also challenge d the methodology used to
2972calculate the new prospective reimbursement rates as a rule that
2982was not adopted as required, and challenged the validity of
2992existing rule 59G - 6.030, which incorporated the 2015 Outpatient
3002Plan by reference. These challenges beca me DOAH cases 16 - 6398RX
3014through 16 - 6414RX.
301825 . In response to DOAH cases 16 - 6398RX through 16 - 6414RX,
3032AHCA adopted the 2016 Outpatient Plan by reference in proposed
3042rule 59G - 6.030.
304626 . The 2016 Outpatient Plan provides more detail than the
30572015 version . AHCAÓs position is that the additional detail was
3068provided to clarify the 2015 version. However, it changed the
3078occasions of service used for calculating the hospitalsÓ rate
3087reductions for cuts 7 a nd 8, as indicated in Finding 22 , as well
3101as some other substantive changes.
310627 . The 2015 Outpatient Plan addressed the unit cost cap by
3118stating: ÐEffective July 1, 2011, AHCA shall establish rates at
3128a level that ensures no increase in statewide expenditures
3137resulting from a change in unit costs.Ñ The 201 6 Outpatient Plan
3149elaborates and specifies the calculation AHCA has been using, as
3159stated in Finding 14.
316328. The 2015 Outpatient Plan provided that an individual
3172hospitalÓs prospective reimbursement rate may be adjusted under
3180certain circumstances, such as when AHCA makes an error in the
3191calculation of the hospitalÓs unaudited rate. It also stated:
3200ÐAny rate adjustment or denial of a rate adjustment by AHCA may
3212be appealed by the provider in accordance with Rule 28 - 106,
3224F.A.C., and section 120.57(1), F. S.Ñ The 2016 Outpatient Plan
3234deleted the appeal rights language from the existing rule.
324329. The effect of the existing and proposed rules on the
3254Petitioners through their effect on managed care contract rates
3263is debatable. Those rates do not have to b e the same as the fee -
3279for - service outpatient reimbursement rates, although they are
3288influenced by the fee - for - service rates, and it is not uncommon
3302for them to be stated as a percentage of the fee - for - service
3317rates. By law, managed care contract rates can not exceed 120
3328percent of the fee - for - service rates unless the MCO gets
3341permission from AHCA, as provided in section 409.975(6).
3349Currently , rates paid by MCOs for Medicaid hospital outpatient
3358services average about 105 percent of the fee - for - service
3370reimb ursement rates. AHCA has indicated that it would not expect
3381or like to see the contract rates much higher than that. It is
3394not clear whether that still is AHCAÓs position. If higher rates
3405were negotiated, the impact of fee - for - services rate adjustments
3417on managed care rates could be reduced or even eliminated.
342730. The effect of the existing and proposed rules on the
3438Petitioners through their effect on how fee - for - service
3449reimbursement rates are calculated is not disputed. With the
3458transition to manage d care, the effect is greater and clearly
3469substantial. The recurring MTA reductions enacted by the
3477Legislature through 2014, which total $224,015,229 (after taking
3487into account $10,656,238 that was reinstated, and $4,068,064 that
3500was added in consideratio n of trauma centers), are being spread
3511over fewer fee - for - service occasions of service, especially for
3523cuts 7 and 8, which significantly lowers the fee - for - service
3536outpatient reimbursement rates calculated under the proposed
3543rule.
354431. The Petitioners Ó ob jections to the validity of the
3555proposed and existing rules can be summarized as follows : a lack
3567of legislative authority for r ecurring (i.e., cumulative) MTA
3576reductions ; a failure to adopt a fixed methodology to calculate
3586individual hospital outpati ent r eimbursement rate adjustments
3594resulting from MTA reductions; specifically, a failure to derive
3603the number of fee - for - service occasions of service used in
3616calculating individual hospital outpatient reimbursement rate
3622adjustments in the same manner every yea r; conversely, a failure
3633to increase the occasions of service used to calculate individual
3643hospital outpatient reimbursement rate adjustments resulting from
3650cuts 1 through 4 ; a failure of the unit cost cap in the existing
3664rule to specify how it is applied; a failure of the unit cost cap
3678in the proposed rule to compare the 2011 unit cost to the current
3691cost, calculated by dividing the total dollar amount of Medicaid
3701payments made to all hospitals by AHCA by the number of Medicaid
3713occasions of service for all hospitals, including in childrenÓs
3722and rural hospitals ; and proposed rule Ós deletion of the language
3733in the e xisting rule stating that a rate adjustment or denial can
3746be appealed in accordance with Florida Administrative Code R ule
375628 - 106 and section 120. 57.
3763CONCLUSIONS OF LAW
376632. Any person who is substantially affected by a rule or
3777proposed rule can petition DOAH for a final order that the rule
3789or proposed rule is an invalid exercise of delegated legislative
3799authority. § 120.56(1)(a), Fla. Stat. The Petitioners are
3807substantially affected and have standing.
381233. The Petitioners have the burden to prove by a
3822preponderance of the evidence that the existing rule is invalid ,
3832in whole or in part, as to the objections raised in the
3844petitions . § 120.56(3) , Fla. Stat. AHCA has the burden to prove
3856by a preponderance of the evidence that the proposed rule is not
3868invalid , in whole or in part, as to the objections raised in the
3881petitions; the proposed rule is not presumed to be valid or
3892invalid. § 120.56(2), Fl a. Stat.
389834. The Petitioners contend that the existing and proposed
3907rule s are invalid exercises of delegated legislative authority
3916because: they exceed the legislative grant of rulemaking
3924authority; they enlarge, modify, or contravene the specific
3932provi sions of law implemented; they are vague; they fail to
3943establish adequate standards for agency decisions, or vest
3951unbridled discretion in the agency; and they are arbitrary (i.e.,
3961not supported by logic or the necessary facts) or capricious
3971(i.e., adopted without thought or reason, or is irrational).
3980§ 120.52(8)(b) through (e), Fla. Stat.
398635. As for the first ground for alleged invalidity, it is
3997clear that n either existing nor proposed rule 59G - 6.030 exceeds
4009the grant of legislative authority. Section 4 09.919 authorizes
4018AHCA to Ðadopt any rules necessary to comply with or administerÑ
4029sections 409.901 through 409.920 Ðand all rules necessary to
4038comply with federal requirements.Ñ Sections 409.905(6)(b),
4044409.908 (1)(f)1., and 409.908 are statutes implemente d by existing
4054and proposed rule 59G - 6.030 that specifically address the
4064establishment of Medicaid hospital outpatient reimbursement
4070rates. I t is clear from the statutes that Medicaid hospital
4081outpatient reimbursement is subject to limitations and directio ns
4090in the GAA s . See §§ 409.902(1), 409.905(6)(b) , and
41004 09.908 (2)(b) , Fla. Stat.
4105MTA Reductions
410736 . As for the other grounds for alleged invalidity , with
4118respect to the MTA reductions, the Petitioners seem to contend,
4128on the one hand, that the implemen ting statutes and GAAs required
4140AHCA to adopt a detailed, fixed methodology that would determine
4150how it would apply each MTA reduction to individual hospital
4160rates going forward. Specifically, t hey cr iticize AHCA for
4170making change s in the way individual hospital reimbursement rates
4180were reduced in response to c uts 7 and 8 .
419137 . S ection 409.905(6)(b) require s AHCA to Ðimplement a
4202methodology for establishing base reimbursement rates for
4209outpatient services for each hospital based on allowable costs,
4218as d efined by the agency.Ñ Section 409.908 requires AHCA to
4229reimburse Medicaid providers Ðaccording to methodologies set
4236forth in the rules of the agency and in policy manuals and
4248handbooks incorporated by reference therein.Ñ As reflected in
4256the Findings of Fact, the GAAs directed AHCA to Ðimplement a
4267recurring methodologyÑ and to Ðreduce individual hospital rates
4275proportionatelyÑ until the required savings were achieved.
428238. It is clear that the MTA reductions imposed by the GAAs
4294were recurring in the sens e that they were cumulative , but AHCA
4306did not interpret the language in the statutes and GAAs to mean
4318that AHCA was required to adopt a detailed, fixed methodology
4328that could never change . T he versions of rule 59G - 6.030 adopted
4342up to and including the exi sting rule did little more than
4354restate language in the statutes and GAAs. The details
4363incorporated in proposed rule 59G - 6.030 apparently were
4372introduced in an effort to address some of the objections raised
4383in the petitions in DOAH cases 16 - 6398RX throug h 16 - 6414RX . The
4399changes made in the calculation s applied to cuts 7 and 8 to
4412determine the individual hospital Ós reimbursement rate
4419adjustments from those cuts were done, without objection from the
4429hospitals, to comply with legislative intent. E ach versi on of
4440rule 59G - 6.030, with its incorporated Outpatient Plan , has been
4451accepted and essentially ratified by the Legislature as being
4460consistent with the legislative intent . Deference is given to an
4471agencyÓs long - standing statutory interpretations, especial ly
4479those accepted and ratified by the Legislature year after year.
4489See Jax Liquors v. Div. of Alcoholic Bev erages & Tobacco , 388
4501So. 1306, 1308 (Fla. 1st DCA 1980); Austin v. Austin , 350 So. 2d
4514102, 104 (Fla. 1st DCA 1977), cert. den. , 357 So. 2d 184 (Fla .
45281978).
452939 . T he Petitioners also contend, inconsistently, that the
4539existing and proposed rules are invalid with respect to the MTA
4550reductions because AHCA has not changed the calculations it
4559always has applied to cuts 1 through 4 to determine the
4570indivi dual hospitalsÓ reimbursement rate adjustments from those
4578cuts . They contend that the provision of Medicaid outpatient
4588services through MCOs has reduced fee - for - service reimbursement
4599rates more than intended by the Legislature because the recurring
4609and cu mulative MTA reductions , especially in cuts 1 through 4 ,
4620are being spread over fewer fee - for - service occasions of service.
463340 . In contrast to cuts 7 and 8, there has been no apparent
4647legislative intent for AHCA to change the calculations it always
4657has a pplied to cuts 1 through 4 to determine the individual
4669hospitalsÓ reimbursement rate adjustments from those cuts. To
4677the contrary, the actions of the Legislature in the 2016 session
4688support and ratify the agencyÓs interpretation of the legislative
4697intent . Id.
470041 . Even if the legislative intent were less clear, and
4711would allow for the interpretation of the statutes and GAAs
4721proposed by the Petitioners, AHCAÓs interpretation is reasonable.
4729Neither existing nor proposed rule 59G - 6.030 enlarges, modifies,
4739or contravenes the specific provisions of law implemented ; n or is
4750the existing or proposed rule arbitrary or capricious.
475842 . As for the other grounds for invalid ity with respect to
4771the MTA reductions, proposed rule 59G - 6.030 clearly is not vague;
4783does not fail to establish adequate standards for agency
4792decisions; and does not vest unbridled discretion in the agency.
4802See State Dep't of Fin. S er vs. v. Peter R. Brown Const r ., Inc. ,
4818108 So. 3d 723, 728 (Fla. 1st DCA 2013) (a rule is vague, fails
4832to establi sh adequate standards for agency decisions, or vests
4842unbridled discretion in the agency if it forbids or requires the
4853performance of an act in terms that are so vague that persons of
4866common intelligence must guess at its meaning and differ as to
4877its applic ation). Existing rule 59G - 6.030 has less detail,
4888making it more vulnerable to the PetitionersÓ arguments, but it
4898essentially uses the language of the statutes and GAAs, and has
4909been accepted and ratified by the Legislature, which preserves
4918its validity as to the s e objection s .
4928Unit Cost Cap
493143 . In the existing rule, the unit cost cap language
4942reiterates the language of the st atutes and GAA verbatim. It
4953does not enlarge, modify, or contravene the specific provisions
4962of section 409.908 and the GAAs bei ng implemented .
497244 . In the proposed rule, the unit cost cap language
4983specifies how AHCA has been applying the unit cost cap since
49942011 . It is not clear from the evidence why AHCA made this
5007choice, but it may have been done because the GAAs excluded
5018ch ildrenÓs and rural hospitals from the MTA reduction of cuts 7
5030and 8. There is no evidence to suggest that the Legislature
5041disagreed with how AHCA has been interpreting the unit cost cap.
5052To the contrary, the actions of the Legislature during the 2016
5063ses sion support and ratify the agencyÓs interpretation.
507145. Deference is given to AHCAÓs interpretation of the unit
5081cost cap . See Jax Liquors v. Div. of Alcoholic Bev erages &
5094Tobacco , supra ; Austin v. Austin , supra . The unit cost cap
5105language in the prop osed rule does not enlarge, modify, or
5116contravene the specific provisions of section 409.908 and the
5125GAAs being implemented ; and it is not arbitrary or capricious.
513546 . As for the other grounds for invalidity with respect to
5147the unit cost cap , proposed rule 59G - 6.030 clearly is not vague;
5160does not fail to establish adequate standards for agency
5169decisions; and does not vest unbridled discretion in the agency.
5179See State Dep't of Fin. S er vs. v. Peter R. Brown Const r ., Inc. ,
5195supra . Existing rule 59G - 6.030 has less detail, making it more
5208vulnerable to the PetitionersÓ arguments, but it uses the
5217language of the statutes and GAAs, and has been accepted and
5228ratified by the Legislature, which preserves its validity as to
5238these objections.
5240Appeal Rights
52424 7 . Pr oposed rule 59G - 6.030 deletes the language in
5255e xisting rule 59G - 6.030 stating that a rate adjustment or denial
5268can be appealed in accordance with rule chapter 28 - 106 and
5280section 120.57. Regardless whether the appeal rights language is
5289in the proposed rule , the available appeal rights will be
5299determined based on the correct interpretation of rule chapter
530828 - 106, chapter 120 , and section 409.908(1)(f)1. That issue is
5319now on appeal to the First District Court of Appeal. The
5330deletion of the appeal rights lan guage does not render the
5341proposed rule invalid.
5344DISPOSITION
5345Based on the foregoing Findings of Fact and Conclusions of
5355Law, the petitions are denied.
5360DONE AND ORDERED this 1 8 th day of April , 2017 , in
5372Tallahassee, Leon County, Florida.
5376S
5377J. LAWRENCE JOHNSTON
5380Administrative Law Judge
5383Division of Administrative Hearings
5387The DeSoto Building
53901230 Apalachee Parkway
5393Tallahassee, Florida 32399 - 3060
5398(850) 488 - 9675
5402Fax Filing (850) 921 - 6847
5408www.doah.state.fl.us
5409Filed with the C lerk of the
5416Division of Administrative Hearings
5420this 1 8 th day of April , 2017 .
5429COPIES FURNISHED:
5431Kyle L. Kemper, Esquire
5435Sundstrom & Mindlin, LLP
54392548 Blairstone Pines Drive
5443Tallahassee, Florida 32301
5446(eServed)
5447Stuart Fraser Williams, General Counsel
5452A gency for Health Care Administration
5458Mail Stop 3
54612727 Mahan Drive
5464Tallahassee, Florida 32308
5467(eServed)
5468Shena L. Grantham, Esquire
5472Agency for Health Care Administration
5477Mail Stop 3
54802727 Mahan Drive
5483Tallahassee, Florida 32308
5486(eServed)
5487Thomas M. Hoele r, Esquire
5492Agency for Health Care Administration
5497Mail Stop 3
55002727 Mahan Drive
5503Tallahassee, Florida 32308
5506(eServed)
5507Michael J. Glazer, Esquire
5511Ausley McMullen
5513123 South Calhoun Street
5517Tallahassee, Florida 32302
5520(eServed)
5521Eugene Dylan Rivers, Esquire
5525Aus ley & McMullen, P.A.
5530123 South Calhoun Street
5534Post Office Box 391
5538Tallahassee, Florida 32302
5541(eServed)
5542Daniel Elden Nordby, Esquire
5546Shutts & Bowen LLP
5550215 South Monroe Street , Suite 804
5556Tallahassee, Florida 32301
5559(eServed)
5560Joseph M. Goldstein, Esquire
5564Shutts & Bowen LLP
5568Suite 2100
5570200 East Broward Boulevard
5574Fort Lauderdale, Florida 33301
5578(eServed)
5579Dan Daley, Esquire
5582Shutts & Bowen LLP
5586Suite 2100
5588200 East Broward Boulevard
5592Fort Lauderdale, Florida 33301
5596(eServed)
5597Christopher Charles Kokoruda, Esquire
5601Miami - Dade County
5605West Wing, Suite 109
56091611 Northwest 12th Avenue
5613Miami, Florida 33136
5616(eServed)
5617Seann M. Frazier, Esquire
5621118 North Gadsden Street
5625Tallahassee, Florida 32302
5628(eServed)
5629Laura E. Wade, Esquire
5633Miami - Dade County
5637West Wing, Suite 109
56411161 Northwest 12th Avenue
5645Miami, Florida 33136 - 100
5650(eServed)
5651Stephen A. Ecenia, Esquire
5655Rutledge, Ecenia, & Purnell, P.A.
5660Suite 202
5662119 South Monroe Street
5666Tallahassee, Florida 32302 - 0551
5671(eServed)
5672Joanne Barbara Erde, Esquire
5676Duane Morris LLP
5679Suite 3400
5681200 South Biscayne Boulevard
5685Miami, Florida 33131
5688(eServed)
5689Jonathan L. Rue, Esquire
5693Parker, Hudson, Rainer
5696and Dobbs, LLC
5699Suite 3600
5701303 Peachtree Street Northeast
5705Atlanta, Georgia 30308
5708(eServed)
5709J. Stephen Menton, Esquire
5713Rutledge Ecenia, P.A.
5716119 South Monroe Street, Suite 202
5722Post Office Box 551 (32302)
5727Tallahassee, Florida 32301
5730(eServed)
5731Gabriel F.V. Warren, Esquire
5735Rutledge, Ecenia, & Purnell, P.A.
5740119 South Monroe Street, Suite 202
5746Post Office Box 551
5750Tallahassee, Florida 32301
5753(eServed)
5754M arc Ito, Esquire
5758Parker Hudson Rainer & Dobbs, LLP
5764Suite 750
5766215 South Monroe Street
5770Tallahassee, Florida 32301
5773(eServed)
5774Justin Senior, Secretary
5777Agency for Health Care Administration
5782Mail Stop 1
57852727 M ahan D rive
5790Tallahassee, Florida 32308
5793(eServed)
5794Ken Plante, Coordinator
5797Joint Administrative Procedures Committee
5801Room 680, Pepper Building
5805111 West Madison Street
5809Tallahassee, Florida 32399 - 1400
5814(eServed)
5815Ernest Reddick, Chief
5818Department of State
5821R.A. Gray Building
5824500 South Bronough Street
5828Tallahasse e, Florida 32399 - 0250
5834(eServed)
5835Anya Grosenbaugh
5837Department of State
5840R.A. Gray Building
5843500 South Bronough Street
5847Tallahassee, Florida 32399 - 0250
5852(eServed)
5853Kim Kellum, Esquire
5856Chief Medicaid Counsel
5859Agency for Health Care Administration
5864Mail Stop 3
5867272 7 Mahan Drive
5871Tallahassee, Florida 32308
5874(eServed)
5875NOTICE OF RIGHT TO JUDICIAL REVIEW
5881A party who is adversely affected by this Final Order is entitled
5893to judicial review pursuant to section 120.68, Florida Statutes.
5902Review proceedings are governed by the Florida Rules of Appellate
5912Procedure. Such proceedings are commenced by filing the original
5921notice of administrative appeal with the agency clerk of the
5931Division of Administrative Hearings within 30 days of rendition
5940of the order to be reviewed, a nd a copy of the notice,
5953accompanied by any filing fees prescribed by law, with the clerk
5964of the District Court of Appeal in the appellate district where
5975the agency maintains its headquarters or where a party resides or
5986as otherwise provided by law.
- Date
- Proceedings
- PDF:
- Date: 05/31/2019
- Proceedings: Transmittal letter from Claudia Llado forwarding the Transcripts and Exhibits to the agency.
- PDF:
- Date: 10/02/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (The Public Health Trust)
- PDF:
- Date: 09/25/2017
- Proceedings: Notice of Delay in Transmitting the Record to the District Court of Appeal. (The Public Health Trust)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (Sacred Heart Health System)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (Adventist Health System)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (Miami Beach Healthcare Group)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (Southern Baptist Hospital)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the District First Court of Appeal. (CGH Hospital)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (Cape Canaveral Hospital)
- PDF:
- Date: 08/22/2017
- Proceedings: Index, Record, and Certificate of Record sent to the First District Court of Appeal. (Bayfront HMA Medical Center)
- PDF:
- Date: 06/09/2017
- Proceedings: Invoice for the record on appeal mailed. (17-0560) Miami Beach Healthcare Group Hospital
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0560) Miami Beach Healthcare Group Hospital
- PDF:
- Date: 06/09/2017
- Proceedings: Invoice for the record on appeal mailed. (17-0559) Southern Baptist Hospital
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0559) Southern Baptist Hospital
- PDF:
- Date: 06/09/2017
- Proceedings: Invoice for the record on appeal mailed. (17-0496) The Public Health Trust
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0496) The Public Health Trust
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0474) CGH Hospital
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0472) Sacred Heart
- PDF:
- Date: 06/09/2017
- Proceedings: Invoice for the record on appeal mailed. (17-0469) Adventist Health
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0469) Adventist Health
- PDF:
- Date: 06/09/2017
- Proceedings: Invoice for the record on appeal mailed. (17-0468) Cape Canaveral
- PDF:
- Date: 06/09/2017
- Proceedings: Index (of the Record) sent to the parties of record. (17-0468) Cape Canaveral
- PDF:
- Date: 05/25/2017
- Proceedings: BY ORDER OF THE COURT: appellant has failed to tender the required $300.00 filing fee. (The Public Health Trust of Miami-Dade County, etc.)
- PDF:
- Date: 05/19/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2054 filed (Adventist Health System/Sunbelt, Inc., etc.).
- PDF:
- Date: 05/19/2017
- Proceedings: BY ORDER OF THE COURT: appellant is ordered to file an amended notice of appeal which sets forth the appellees in the case style.
- PDF:
- Date: 05/19/2017
- Proceedings: BY ORDER OF THE COURT: appellant is ordered to file an amended notice of appeal which sets forth the appellees in the case style.
- PDF:
- Date: 05/19/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2057 filed (Cape Canaveral Hospital, Inc., etc).
- PDF:
- Date: 05/19/2017
- Proceedings: BY ORDER OF THE COURT: appellant is order to file an amended notice of appeal which sets forth the appellees in the case style.
- PDF:
- Date: 05/19/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2053 filed (Bayfront HMA Medical Center, LLC, etc.).
- PDF:
- Date: 05/19/2017
- Proceedings: BY ORDER OF THE COURT: appellant is order to file an amended notice of appeal which sets forth the appellees in the case style.
- PDF:
- Date: 05/19/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2041 filed (CGH Hospital, Ltd., etc.).
- PDF:
- Date: 05/19/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2035 filed (The Public Health Trust of Miami-Dade County, etc.).
- PDF:
- Date: 05/18/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (Adventist Health System/Sunbelt, Inc. etc.).
- PDF:
- Date: 05/18/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (Cape Canaveral Hosital, Inc. etc.).
- PDF:
- Date: 05/18/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (Bayfront HMA Medical Center, LLC, etc.).
- PDF:
- Date: 05/18/2017
- Proceedings: BY ORDER OF THE COURT: appellant is ordered to file an amended notice of appeal which sets forth the appellees in the case style.
- PDF:
- Date: 05/18/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2040 (Sacred Heart Health, etc.) filed.
- PDF:
- Date: 05/18/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (CGH Hospital, etc.).
- PDF:
- Date: 05/18/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2034 filed (Miami Beach Healthcare Group, Ltd., d/b/a Aventura Hospital and Medical Center, etc.).
- PDF:
- Date: 05/18/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the District Court of Appeal this date (Sacred Heart Health, etc.).
- PDF:
- Date: 05/17/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (Southern Baptist Hospital of Florida d/b/a Baptist Medical Center Nassau, etc.).
- PDF:
- Date: 05/17/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (Miami Beach Healthcare Group, Ltd. d/b/a Aventura Hospital and Medical Center, etc.)
- PDF:
- Date: 05/17/2017
- Proceedings: Notice of Appeal filed and Certified copy sent to the First District Court of Appeal this date (Public Health Trust of Miami-Dade County, Florida).
- PDF:
- Date: 05/17/2017
- Proceedings: Acknowledgment of New Case, First DCA Case No. 1D17-2028 filed (Southern Baptist Hospital of Florida, d/b/a Baptist Medical Center, Nassau, etc.).
- PDF:
- Date: 04/14/2017
- Proceedings: Unopposed Motion to Withdraw as Counsel for Agency for Health Care Administration filed.
- PDF:
- Date: 03/22/2017
- Proceedings: Unopposed Motion for Clarification of Due Date for Proposed Final Orders filed.
- Date: 03/15/2017
- Proceedings: Transcript of Proceedings (not available for viewing) filed.
- Date: 02/23/2017
- Proceedings: CASE STATUS: Hearing Held.
- PDF:
- Date: 02/15/2017
- Proceedings: Respondent's Responses to Petitioner's First Request for Production filed.
- PDF:
- Date: 02/14/2017
- Proceedings: Respondent's Notice of Filing Responses to Petitioners' First Set of Expert Interrogatories filed.
- PDF:
- Date: 02/14/2017
- Proceedings: Supplemental Notice of Taking Deposition Duces Tecum (Change as to location only) filed.
- PDF:
- Date: 02/10/2017
- Proceedings: Baptist Hospital, Inc.'s Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/10/2017
- Proceedings: Mt. Sinai Medical Center's Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/10/2017
- Proceedings: Lakeland Regional Medical Center's Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/10/2017
- Proceedings: UF Health Gainesville's Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/10/2017
- Proceedings: UF Health Jacksonville's Response to Request for Production from ACHA filed.
- PDF:
- Date: 02/09/2017
- Proceedings: Petitioner's First Request for Production to Respondent (filed in Case No. 17-000559RP).
- PDF:
- Date: 02/09/2017
- Proceedings: Notice of Serving Petitioner's First Set of Expert Interrogatories to Respondent (filed in Case No. 17-000559RP).
- PDF:
- Date: 02/09/2017
- Proceedings: Petitioners' (Sacred Heart) Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/09/2017
- Proceedings: Petitioners' (Tenet) Notice of Service of Answers to First Set of Interrogatories from AHCA filed.
- PDF:
- Date: 02/09/2017
- Proceedings: Petitioners' (Tenet) Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/09/2017
- Proceedings: Mt. Sinai Medical Center's Notice of Serving Answers to Interrogatories from Agency for Health Care Administration filed.
- PDF:
- Date: 02/09/2017
- Proceedings: UF Health Gainesville's Notice of Serving Answers to Interrogatories from Agency for Health Care Administration filed.
- PDF:
- Date: 02/09/2017
- Proceedings: UF Health Jacksonville's Notice of Serving Answers to Interrogatories from Agency for Health Care Administration filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Lee Health's Notice of Serving Answers to Interrogatories from Agency for Health Care Administration filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' (Sacred Heart) Notice of Service of Answers to First Set of Interrogatories from AHCA filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Lakeland Regional Medical Center's Notice of Serving Answers to Interrogatories from Agency for Health Care Administration filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' (St. Vincent's) Response to Request for Production from AHCA filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Response to Respondent's First Request for Production filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Baptist Hospital's Notice of Serving Answers to Interrogatories from Agency for Health Care Administration filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Response to Request for Production from AHCA (filed in Case No. 17-000471RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Notice of Serving Answers to Respondent's First Set of Interrogatories (filed in Case No. 17-000471RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' (St. Vincent's) Notice of Service of Answers to First Set of Interrogatories from AHCA filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Notice of Service of Responses to Respondent's First Interrogatories filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' Response to Request for Production from AHCA (filed in Case No. 17-000470RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' Notice of Serving Answers to Respondent's First Set of Interrogatories (filed in Case No. 17-000470RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Response to Request for Production from AHCA (filed in Case No. 17-000469RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Notice of Serving Answers to Respondent's First Set of Interrogatories (filed in Case No. 17-000469RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner Public Health Trust of Miami-Dade County's Response to Request for Production (filed in Case No. 17-000496RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner Public Health Trust of Miami-Dade County's Notice of Serving Answers to Respondent's First Set of Interrogatories (filed in Case No. 17-000496RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Response to Request for Production from AHCA (filed in Case No. 17-000468RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' Notice of Serving Answers to Respondent's First Set of Interrogatories (filed in Case No. 17-000468RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioner's Notice of Serving Answers to Respondent's First Set of Interrogatories filed.
- PDF:
- Date: 02/08/2017
- Proceedings: Petitioners' in Case No. 17-0559RP Response to Request for Production from AHCA (filed in Case No. 17-000559RP).
- PDF:
- Date: 02/08/2017
- Proceedings: Notice of Serving Petitioners' Answers to Respondent's First Set of Interrogatories (filed in Case No. 17-000559RP).
- PDF:
- Date: 02/03/2017
- Proceedings: Preliminary Joint Pre-hearing Stipulation (filed in Case No. 17-000471RP).
- PDF:
- Date: 02/03/2017
- Proceedings: Respondent's Notice of Filing First Set of Interrogatories to Petitioners' filed.
- PDF:
- Date: 02/03/2017
- Proceedings: Respondent's First Request for Production to Petitioners filed. FILED IN ERROR - DUPLICATE
- PDF:
- Date: 02/03/2017
- Proceedings: Respondent's First Request for Production to Petitioners filed. FILED IN ERROR - DUPLICATE
- PDF:
- Date: 02/03/2017
- Proceedings: Respondent AHCA's (First) Request for Production to Petitioner's filed.
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Hearing (hearing set for February 23 and 24, 2017; 9:00 a.m.; Tallahassee, FL).
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Appearance (Dan Daley) (filed in Case No. 17-000560RP).
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Appearance (Dan Daley) (filed in Case No. 17-000559RP).
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Appearance (Dan Daley) (filed in Case No. 17-000558RP).
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Appearance (Joseph Goldstein) (filed in Case No. 17-000560RP).
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Appearance (Joseph Goldstein) (filed in Case No. 17-000559RP).
- PDF:
- Date: 01/25/2017
- Proceedings: Notice of Appearance (Joseph Goldstein) (filed in Case No. 17-000558RP).
- PDF:
- Date: 01/25/2017
- Proceedings: Order of Consolidation (DOAH Case Nos. 17-0467RP, 17-0468RP, 17-0469RP, 17-0470RP, 17-0471RP, 17-0472RP, 17-0473RP, 17-0474RP, 17-0496RP, 17-0558RP, 17-0559RP, 17-0560RP).
Case Information
- Judge:
- J. LAWRENCE JOHNSTON
- Date Filed:
- 01/19/2017
- Date Assignment:
- 01/24/2017
- Last Docket Entry:
- 05/31/2019
- Location:
- Tallahassee, Florida
- District:
- Northern
- Agency:
- Agency for Health Care Administration
- Suffix:
- RP
Counsels
-
Dan Daley, Esquire
Address of Record -
Joseph M. Goldstein, Esquire
Address of Record -
Shena L. Grantham, Esquire
Address of Record -
Thomas M. Hoeler, Esquire
Address of Record -
Kyle L. Kemper, Esquire
Address of Record -
Steven T. Mindlin, Esquire
Address of Record -
Daniel Elden Nordby, Esquire
Address of Record -
Stuart Fraser Williams, General Counsel
Address of Record -
Shena L. Grantham, Assistant General Counsel
Mail Stop 3
2727 Mahan Drive
Tallahassee, FL 32308
(850) 412-3630 -
Shena L. Grantham, Assistant General Counsel
Mail Stop 3
2727 Mahan Drive
Tallahassee, FL 32308
(850) 412-3630 -
Shena L Grantham, Esquire
Mail Stop 3
2727 Mahan Drive
Tallahassee, FL 32308
(850) 412-3630 -
Shena Grantham, Esquire
Address of Record -
Shena L. Grantham, Esquire
Address of Record