17-000473RP St. Vincent&Apos;S Medical Center, Inc., D/B/A St. Vincent&Apos;S Medical Center Riverside, St. Luke&Apos;S-St. Vincent&Apos;S Healthcare, Inc., D/B/A St. Vincent&Apos;S Medical Center Southside And St. Vincent&Apos;S Medical Center-Clay County, Inc., Et Al vs. Agency For Health Care Administration
 Status: Closed
DOAH Final Order on Tuesday, April 18, 2017.


View Dockets  
Summary: Rule and proposed rule incorporating methodology for determining Medicaid outpatient hospital reimbursement rates were not invalid. Petitions denied.

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.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 05/31/2019
Proceedings: Transmittal letter from Claudia Llado forwarding the Transcripts and Exhibits to the agency.
PDF:
Date: 05/17/2019
Proceedings: Mandate
PDF:
Date: 05/17/2019
Proceedings: Mandate
PDF:
Date: 05/17/2019
Proceedings: Mandate
PDF:
Date: 05/17/2019
Proceedings: Mandate
PDF:
Date: 05/17/2019
Proceedings: Mandate
PDF:
Date: 05/17/2019
Proceedings: Mandate filed.
PDF:
Date: 05/03/2019
Proceedings: Opinion filed.
PDF:
Date: 05/01/2019
Proceedings: Opinion
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: Invoice for the record on appeal mailed. (17-0474) CGH Hospital
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: Invoice for the record on appeal mailed. (17-0472) Sacred Heart
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: 06/09/2017
Proceedings: Invoice for the record on appeal mailed. (17-0467, Bayfront)
PDF:
Date: 06/09/2017
Proceedings: Index (of the Record) sent to the parties of record. (17-0467)
PDF:
Date: 05/30/2017
Proceedings: Directions to Clerk (filed in Case No. 17-000559RP).
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: 04/19/2017
Proceedings: Order Granting Leave to Withdraw as Counsel.
PDF:
Date: 04/18/2017
Proceedings: DOAH Final Order
PDF:
Date: 04/18/2017
Proceedings: Final Order (hearing held February 23, 2017). CASE CLOSED.
PDF:
Date: 04/14/2017
Proceedings: Unopposed Motion to Withdraw as Counsel for Agency for Health Care Administration filed.
PDF:
Date: 03/27/2017
Proceedings: Notice of Filing Petitioner's Proposed Final Order filed.
PDF:
Date: 03/27/2017
Proceedings: AHCA's Proposed Final Order filed.
PDF:
Date: 03/23/2017
Proceedings: Order Clarifying Due Date for Proposed Final Orders.
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: 02/22/2017
Proceedings: Notice of Taking Telephonic Deposition Duces Tecum filed.
PDF:
Date: 02/22/2017
Proceedings: Final Joint Pre-hearing Stipulation filed.
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: Notice of Taking Deposition Duces Tecum (Jennifer Hinson) filed.
PDF:
Date: 02/10/2017
Proceedings: Notice of Taking Deposition Duces Tecum (J Meerschaert) 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: Lee Health'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 Response to Request for Production from AHCA filed.
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: 02/08/2017
Proceedings: Notice of Appearance (Marc Ito) filed.
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: Order of Pre-hearing Instructions.
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).
PDF:
Date: 01/24/2017
Proceedings: Notice of Appearance (Dan Daley) filed.
PDF:
Date: 01/24/2017
Proceedings: Notice of Appearance (Joseph Goldstein) filed.
PDF:
Date: 01/24/2017
Proceedings: Notice of Appearance (Daniel Nordby) filed.
PDF:
Date: 01/24/2017
Proceedings: Order of Assignment.
PDF:
Date: 01/23/2017
Proceedings: Rule Challenge transmittal letter to Ernest Reddick from Claudia Llado copying Ken Plante and the Agency General Counsel.
PDF:
Date: 01/19/2017
Proceedings: Petition Challenging Proposed and Existing Rule filed.

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

Related Florida Statute(s) (12):