17-002675 Elizabeth Wright vs. Department Of Management Services, Division Of State Group Insurance Status: Closed Recommended Order on Friday, August 11, 2017.

Summary: Petitioner's stay at a skilled nursing facility was primarily for rehabilitation, which was not a covered benefit under the state health insurance plan. Recommend denial of claim for coverage.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

ELIZABETH WRIGHT ,

Petitioner ,

vs . Case No . 17 - 2675

DEPARTMENT OF MANAGEMENT

SERVICES , DIVISION OF STATE

GROUP INSURANCE ,

Respondent .

_______________________________/

RECOMMENDED ORDER

Pursuant to notice , a formal administrative hearing was

conducted before Administrative Law Judge Mary Li Creasy of the

Division of Administrative Hearings ("DOAH") by video

teleconference with locations in Lauderdale Lakes and

Tallahassee , Florida , on July 14 , 2017 .

APPEARANCES

For Petitioner: Bradley Seldin, Esquire

The Seldin Law Firm, P.A.

1000 5th Street, Suite 200

Miami Beach, Florida 33139

For Respondent: Anita J. Patel, Esq uire

Department of Management Services

4050 Esplanade Way, Suite 160

Tallahassee, Florida 32399

STATEMENT OF THE ISSUE

Whether Petitioner ' s stay at The Rehabilitation Center at

Hollywood H ills LLC ( " Rehab Center " ) , a skilled nursing facility ,

is a covered benefit pursuant to the State of Florida Employees '

HMO Plan ( " Plan " ) administered by AvMed .

PRELIMINARY STATEMENT

Petitioner was a State of Florida employee who was insured

through the Pl an . Petitioner is seeking coverage for two stays

at the Rehab Center , a skilled nursing facility , from October 17 ,

2016 , to November 11 , 2016 , and from November 15 , 2016 , to

January 14 , 2017 . Respondent denied the request for coverage on

the basis that the stays at the Rehab Center were primarily for

the purpose of rehabilitation , and therefore , not a covered

benefit .

Petitioner timely contested the denial of benefits , and a

Request for Administrative Hearing was filed with Respondent on

January 19, 2017 . Respondent referred the case to DOAH on May 9,

2017.

On July 14 , 2017 , the final hearing was held as scheduled .

Petitioner presented the testimony of Petitioner , Elizabeth

Wright 1/ ; Petitioner ' s daughter , Marie Wright ; and Petitioner ' s

sister , Lorrain e Simpson . Respondent presented the testimony of

Edwin Rodriguez , M . D . ; Claudia Martinez ; Carol Cordoba ; and Kathy

Flippo , registered nurse . Petitioner ' s E xhibits 1 through 4 were

admitted into evidence . Respondent ' s Ex hibits 1 through 15 were

admitted into evidence .

Neither party ordered the transcript of the proceedings .

Both parties timely filed proposed recommended orders , which were

considered in the preparation of th is Recommended Order . Unless

otherwise indicated , citations to the Florida Statut es or rules

of the Florida Administrative Code refer to the versions in

effect during the last quarter of 2016 .

FINDING S OF FACT

1 . Respondent is the state agency charged with

administering the state employee health insurance program

pursuant to s ection 1 10 . 123 , Florida Statutes .

2 . At all times material hereto , Petitioner was a member of

the Plan . AvMed is the third party administrator for the Plan at

issue in this cause . As the third party administrator , AvMed

provides utilization and benefit manageme nt services .

3 . On or about September 21 , 2016 , Petitioner suffered a

hemorrhagic cerebral vascular accident , commonly referred to as a

stroke , while in her home . Petitioner was transported to Jackson

Memorial Hospital for treatment .

4 . Petitioner was discharged from Jackson Memorial Hospital

on October 17 , 2016 . Upon discharge on October 17 , 2016 ,

Petitioner was admitted to the Rehab Center .

5 . On October 11 , 2016 , AvMed received a pre - authorization

request for inpatient admission for rehabilitative services at

the Rehab Center from Petitioner ' s medical provider . On the same

day , AvMed denied the request for pre - authorization on the basis

that an inpatient admission to the skilled nursing facility for

the purpose of rehabilitation is not a covered b enefit . A copy

of the denial letter was sent to Petitioner , the physician that

made the request for coverage , the Rehab Center , and was provided

to the family at the hospital by a case manager .

6 . Despite notice of the denied pre - authorization by AvMed ,

six days later , on October 17 , 2016 , Petitioner was admitted into

the Rehab Center . Petitioner remained at the facility until

November 11 , 2016 .

7 . While at the facility , Petitioner experienced pain and

swelling in her right leg and was transferred to Memorial

Hospital on November 11 , 2016 , on an emergency basis . Petitioner

had a deep vein thrombosis (" DVT ") blood clot and had a DVT

filter inserted . Petitioner remained at the hospital until

November 15 , 201 6 .

8 . Although Petitioner was not actually "discharged" from

the Rehab Center prior to her emergency admission to Memorial

Hospital, Memorial Hospital submitted a pre - authorization request

to return Petitioner to the Rehab Center for the purpose of

rehabilitation . On November 15 , 201 6 , AvMed denie d the request

on the basis that inpatient stays for the purpose of

rehabilitation are not a covered benefit . A copy of the denial

letter was provided to Petitioner , the requesting physician , the

Rehab Center , and was provided to the family by the case man ager

at the hospital .

9 . Despite being provided notice of the denial by AvMed , on

November 15 , 201 6 , Petitioner transferred back to the Rehab

Center where she remained until discharge on January 14 , 2017 .

10 . On November 30 , 2016 , Petitioner , by and thr ough her

daughter , submitted a request for a Level I A ppeal to AvMed . In

the request for the Level I Appeal , Petitioner ' s daughter stated

it is " very important that [Petitioner] gets proper

rehabilitation care . . . [p]lease advise if rehab treatment will

be covered ." The Level I Appeal r equest only included an

attachment of the denial of pre - authorization for the stay

commencing in November 2016 . There was no indication that

Petitioner was appealing the pre - authorization denial from

October . However , P etitioner referenced both denials in the

Level II Appeal request ; therefore , both stays were considered on

the Level II Appeal , and both stays are being addressed in this

action .

11 . Pursuant to the plan document , rehabilitative services

is a covered ben efit but is subject to certain restrictions .

Specifically , the Plan states , in pertinent part:

Rehabilitative services shall not be covered

when:

The Health Plan member was admitted to a

Hospital or other facility primarily for the

purpose of providing r ehabilitative services ;

or

The rehabilitative services maintain rather

than improve a level of physical function , or

where it has been determined that the

services shall not result in significant

improvement in the Health Plan Member ' s

condition within a 60 - day period .

Resp . Ex . 1 , at 46 (emphasis added) .

12 . The Plan defines " Other Health Care Facility " as

follows:

Any licensed facility , other than acute care

Hospitals and those facilities providing

services to ventilator dependent patients ,

which provi des inpatient services such as

skilled nursing care and rehabilitative

services .

Resp . Ex . 1 , at 9 .

1 3 . The Rehab Center is an " other health care facility "

pursuant to the terms of the Plan . The Rehab Center provides

skilled care , including skilled nurs ing and rehabilitation

services .

14 . Skilled nursing facilities provide two types of

services . The first type of service is custodial care .

Custodial care is when a person lives in the facility for reasons

other than healthcare needs . The second type o f service is

skilled care . There are two types of skilled care: skilled

nursing services and rehabilitation services . Skilled nursing is

applicable when a patient needs the services of someone with

medical licensure equal to or greater than a licensed r egistered

nurse , and those services are needed on a daily basis . An

example of skilled nursing services is administration of

intravenous medication , wound care , tracheotomy care , and

assistance with a ventilator . On the other hand , rehabilitation

service s do not require the services of a medical professional

with a minimum licensure of registered nurse . Rather ,

rehabilitation services are comprised of physical therapy ,

occupation al therapy , and speech therapy .

15 . O ccupational therapy is a covered benef it per the Plan

only if the therapy is provided as a home health service , a

hospice service , or as treatment for Autism Spectrum Disorder .

The occupational therapy services received by Petitioner were in

a skilled nursing facility and were not for the pur pose of

treatment of Autism ; therefore , the therapy would not be a

covered service under the Plan .

16 . The Level I Appeal was reviewed by Edwin Rodriguez ,

M . D . , a Medical Director at AvMed . Dr . Rodriguez specializes in

internal medicine , the practice of medical care for the adult

population . Approximately 60 to 65 percent of the practice of

internal medicine is geriatric medicine , which is the specialty

that focuses on medical care for the elderly . As a practicing

physician , Dr . Rodriguez has worked in a skilled nursing

facility . A primary function of Dr . Rodriguez ' s current position

is utilization management . Utilization management includes the

process of reviewing a request for coverage to determine whether

the service is a covered benefit pursuant t o the Plan and , if it

is a covered benefit , reviewing the service for medical

appropriateness .

17 . In Dr . Rodriguez ' s opinion , Petitioner ' s stays at the

Rehab Center commencing in October and in November were primarily

for the purpose of rehabilitation , a nd therefore , not a covered

benefit .

18 . Dr . Rodriguez testified that the discharge summary from

Jackson Memorial Hospital indicated that Petitioner needed

rehabilitation services . Specifically , the discharge summary

recommended a " protracted rehab cours e in the setting of a

skilled nursing facility ." The discharge summary also

recommended physical therapy , occupational therapy , and speech

therapy as follow - up care . Dr . Rodriguez testified that the

Jackson Memorial Hospital discharge summary did not ind icate any

need for skilled nursing .

19 . The discharge summary indicated that at the time of

discharge , Petitioner had a new onset of Atrial Fibrillation

( " AF ib" ) , a resolved urinary tract infection , and a F oley

catheter . Dr . Rodriguez testified that none of these conditions

required skilled nursing . Dr . Rodriguez testified that

Petitioner ' s AF ib was rate - controlled , meaning it was stabilized ,

and therefore , did not require skilled nursing care .

20 . The discharge summary indicated Petitioner had a

urinar y tract infection , which had resolved at the time of

discharge . Dr . Rodriguez testified that a urinary tract

infection does not require skilled nursing unless intravenous

antibiotics are required . There was no evidence that Petitioner

was taking any intr avenous medications . All of the medications

listed in the medical records from Jackson Memorial Hospital ,

Memorial Hospital , and the Rehab Center were oral medications

that did not require any skilled care . Dr . Rodriguez further

testified that although t he discharge summary indicated that

Petitioner had dysphagia , or difficulty swallowing , that

Petitioner passed a swallow test prior to discharge from Jackson

Memorial Hospital .

21 . Dr . Rodriguez testified that Petitioner ' s Foley

catheter did not require s killed nursing . A Foley catheter is a

thin tube that goes directly into the bladder through the

urethr a . A Foley catheter does not require skilled care , in

fact , many people leave skilled nursing facilities with Foley

catheters . Dr . Rodriguez testified that Petitioner ' s specific

medical conditions and physical limitations did not require

skilled care for the Foley catheter . Petitioner ' s catheter was

to be changed once per month , and according to the Rehab Center

records , the catheter was changed on an o utpatient basis by a

physician located outside of the Rehab Center . Furthermore ,

pursuant to the Plan , catheter care is considered " custodial

care " and is excluded from coverage .

22 . Dr . Rodriguez testified that the records from the Rehab

Center for the stay commencing in October indicate Petitioner ' s

stay was for rehabilitation services , specifically occupational

therapy , speech therapy , and physical therapy . The records

include an occupational therapy care plan , occupational therapy

progress notes , and a speech therapy plan for treatment . The

records further include progress notes that include an

" assessment and plan " to address the hemorrhagic cerebral

vascular accident to include physical therapy and occupational

therapy . Dr . Rodriguez testified tha t the records did not

indicate any need for skilled nursing care .

23 . Dr . Rodriquez testified that the records from the Rehab

Center for the stay commencing in November also evidence that

Petitioner was primarily receiving rehabilitative services ,

specifi cally physical therapy and occupational therapy services .

Petitioner presented to the Rehab Center with motor control

deficits , right - side balance hemiplegia , balance deficits ,

impaired coordination , poor functional activity tolerance , and

poor safety awar eness . A physical therapy plan was completed in

order to address these issues . Petitioner also presented with a

decline in her functioning activities of daily living , such as

self - feeding and functional mobility . An occupational therapy

plan was complet ed in order to address these issues .

Dr . Rodriguez testified that there was no documentation as to

the need for skilled nursing care .

24 . The claim forms submitted by the Rehab Center to AvMed

also indicate that Petitioner was primarily receiving

rehabi litation services , specifically physical therapy ,

occupational therapy , and speech therapy .

25 . On December 1 , 2016 , AvMed denied the Level I Appeal on

the basis that the inpatient stay commencing in November for the

purpose of rehabilitation is not a cov ered benefit .

26 . By letter dated December 5 , 2016 , a request for a

Level II Appeal was submitted by Petitioner's daughter, Marie

Wright . The letter requests coverage for acute rehabilitation .

The letter specifically alleged that AvMed refused to " grant

[Petitioner] acute and skilled rehabilitation to put [Petitioner]

on her feet again ." Ms . Wright states that she wants Petitioner

to " receive the Acute Rehabilitation [Petitioner] so desperately

needs and deserves ."

27 . As supportive documentation for t he Level II Appeal

request , Ms . Wright attached a physical therapy evaluation from

Memorial Hospital .

28 . Kathy Flippo , a registered nurse and employee of

Respondent , reviewed the Level II Appeal . Ms . Flippo ' s opinion

was that the stays at the Rehab Cent er were primarily for

purposes of rehabilitation . Ms . Flippo testified that the focus

of the treatment at the Rehab Center for both stays was

rehabilitation services to provide assistance and/or training

with activities of daily living , such as moving in bed , getting

out of bed , and feeding . Ms . Flippo testified that she reviewed

the records from Jackson Memorial Hospital , the Rehab Center , and

Memorial Hospital , and there was no indication that Petitioner

needed skilled nursing services . Ms . Flippo test ified that

Petitioner ' s medications were all oral and the Foley catheter did

not require skilled care . Ms . Flippo testified that the

statements of Petitioner ' s representative , Ms . Wright , further

confirmed that the intent was for Petitioner to receive

reh ab ilitation at the Rehab Center .

29 . By letter dated December 21 , 2016 , Respondent notified

Petitioner of the decision to deny the claim as a non - covered

service .

30 . Ms . Wright testified that her mother needed total care

for all of her needs and was not in need of rehabilitation

services until after Petitioner ' s discharge from the Rehab Center

on January 14 , 2017 . Ms . Wright testified that she did call

PeopleFirst to request a change in Petitioner ' s health plan as

rehabilitation services were not covere d under the current AvMed

plan . Ms . Wright stated that she did not recall the timeframe of

the call but that she was asking about the possibility of

changing the plan , not because Petitioner needed rehab ilitation

" right then and there , " but that she was l ooking at " options for

down the road ."

31 . However , the call records from PeopleFirst evidence

that Ms . Wright contacted PeopleFirst on October 19 , 2016 , in an

effort to " upgrade " Petitioner ' s insurance to a plan that covers

rehabilitation services . Duri ng the call , Ms . Wright was

informed that any changes to the plan would not take effect until

January 1 , 2017 . In response , Ms . Wright stated , " Ok , so that

won ' t help us , I mean it could help us for her second step of

rehab but it is not going to help us now . Right now we are you

know stuck in the middle between acute rehab and Avmed and

Medicare so I was hoping that I could just fix it by upgrading

her plan if it was going to work immediately ."

32 . Furthermore , Ms . Wright ' s own statements in the Level I

Appeal r equest dated November 30 , 201 6, and the Level II Appeal

request dated December 5 , 2016 , both indicate that M s . Wright ' s

intent was to secure coverage for rehab ilitation services well

before Petitioner ' s discharge on January 14 , 2017 .

33 . Petition er ' s sister , Lorraine Simpson ' s , call to

PeopleFirst also confirms that Petitioner was placed in the Rehab

Center for the purpose of obtaining rehabilitation services .

Ms . Simpson called PeopleFirst on December 27 , 2016 , in order to

upgrade Petitioner ' s p olicy . Ms . Simpson stated Petitioner

" needs rehab and no one is able to give it to her because she

hasn ' t got the coverage ."

34 . Additionally , the family placed calls to AvMed

regarding coverage of inpatient rehabilitation at a Rehab Center .

On October 8 , 2016 , three days prior to the pre - authorization

denial and seven days prior to admission to the Rehab Center ,

Ms . Simpson was notified that inpatient rehabilitation services

at a skilled nursing facility are not a covered benefit . On

October 14 , 2016 , three days before Petitioner was admitted to

the Rehab Center , Ms . Simpson again contacted AvMed and was

notified that the Plan does not cover inpatient admissions for

the purpose of rehabilitation .

35 . At no time was Petitioner or her family advised that

either stay at the Rehab Center would be covered . While

Ms . Wright and Ms . Simpson testified that Claudia Martinez with

AvMed notified them that the stay commencing in October would be

covered , Ms . Martinez testified that she did not tell Petitioner

or h er family that the stay would be covered and that , in fact ,

she told them that the request for pre - authorization was denied . 2/

Ms . Martinez further testified that Ms . Wright asked her about

changing the health plan since rehab ilitation services were not

c overed , and Ms . Martinez informed Ms . Wright to contact member

services . Ms . Martinez confirmed that AvMed does not have any

authorizations on file for the stays in question .

36 . Ms . Wright testified that AvMed ' s approval of 100 days

at the facility was documented in Petitioner ' s Exhibit 2 .

However , the form entitled " Insurance Co - Payment " is not a

document generated or used by AvMed . The document itself has the

name of the skilled nursing facility , The Rehabilitation Center

at Hollywood Hills LLC , on t he bottom . Furthermore , the document

states that the policy covers up to 100 days at a skilled nursing

facility , which corresponds with Medicare ' s maximum for coverage

as opposed to the State of Florida coverage for skilled nursing

which covers a maximum of 60 days in a skilled nursing facility .

37 . Due to Petitioner ' s age , she was eligible for Medicare .

The Plan provides for coordination of benefits when a member is

Medicare eligible . When the member is an active employee , the

Plan is typically the pri mary payor while Medicare is the

secondary payor . 3/ In a case for which the Plan is a primary

payor , and the medical claim at issue is not a covered benefit ,

Medicare is able to provide coverage for the claim . In this

case , Medicare covered a portion of Petitioner ' s stay at the

Rehab Center .

38 . Unlike the Plan at issue in this action , Medicare does

not limit or exclude coverage for rehabilitation stays in a

skilled nursing fa cility . Medicare covers up to 100 days in a

skilled nursing facility . Medicar e typically covers 100 percent

of the inpatient stay for the first 20 days . For days 21 through

100 , the member is responsible for a co - payment of $161 . 00 per

day .

CONCLUSIONS OF LAW

3 9 . DOAH has jurisdiction of the subject matter of and the

parties to t his proceeding . §§ 120 . 569 and 120 . 57(1) , Fla . Stat .

40 . Respondent is the state agency charged by the

L egislature with the duty to oversee the administration of the

state group insurance program . § 110 . 123 , Fla . Stat .

41 . The Plan is a health insuranc e benefit enacted by the

Florida Legislature and offered by Respondent . § 110 . 123 , Fla .

Stat .

42 . In an administrative proceeding , the party asserting

the affirmative of an issue has the burden to prove by a

preponderance of the evidence that it is entit led to the relief

sought . Alexander v . Dep ' t of Mg m t . S e rvs . , Case No . 13 - 2095 , RO

at 20 (Fla . DOAH Aug . 16 , 2013) ( citing Young v . Dep ' t of Cmty .

Aff . , 625 So . 2d 831 , 833 - 834 (Fla . 1993) ) ; Dep ' t of Transp . v .

J . W . C . Co . , 396 So . 2d 778 , 788 (Fla . 1st DCA 1981); Balino v .

Dep ' t of HRS , 348 So . 2d 349 , 350 (Fla . 1st DCA 1977) . Thus ,

Petitioner has the initial burden of demonstrating by a

preponderance of the evidence that she is entitled to the relief

sought . If Petitioner meets h er burden , the burden the n shifts

to Respondent to prove that the requested relief was not covered

due to a policy exclusion . Id . ( citing Herrera v . C . A . Seguros

Catatumbo , 844 So . 2d 664 , 668 (Fla . 3d DCA 2003) , and State

Comprehensive Health Ass ' n v . Carmichael , 706 So . 2d 319 , 320

(Fla . 4th DCA 1997) ) .

43 . The Plan provides coverage for rehabilitation services ;

however , there are several limitations on coverage .

Rehabilitative services are not covered when the member is

admitted to a skilled nursing facility primarily for the purpose

of providing rehabilitative services .

44 . Petitioner argues that the stays should be covered

because Petitioner was very sick and was in need of skilled care .

There is no dispute that Petitioner was sick and in need of

skilled care , the question here is whether that skilled care was

primarily rehabilitation or skilled nursing care .

45 . The overwhelming weight of the evidence supports a

finding that both stays at the Rehab Center were primarily for

the purpose of rehabilitation . The evidence p resented further

substantiates a finding that Ms . Wright 's and Ms . Simpson ' s

intent in placing Petitioner in the Rehab Center was to provide

rehabilitation services to Petitioner . The Level I and Level II

Appeal requests and the phone calls to AvMed and P eopleFirst all

indicate that Petitioner was placed in the facility , not only for

the primary purpose of rehabilitative services but for the sole

purpose of rehabilitation services . Additionally , the evidence

shows that Petitioner and/or her family were pl aced on notice

prior to each stay at the Rehab Center that the stays would not

be covered .

46 . It is important to note that the Plan requires pre -

authorization for stays at a skilled nursing facility . The

requirement of pre - authorizing stays serves to no tify members

before they incur the expense of a service , whether or not that

service is a covered benefit of the Plan . This allows the member

to make an informed decision regarding their medical care . In

the case of a denial , members are free to follow t hrough with the

medical service with an understanding that the Plan will not

cover associated expenses .

47 . On numerous occasions Petitioner and her family were

made aware that the stays at the Rehab Center would not be

covered . In the case of the Octobe r admission , they were made

aware several days prior to admission to the facility . In the

case of the November admission , they were made aware on the same

day as the request f or pre - authorization . Additionally ,

throughout the entire appeals process , Peti tioner remained at the

facility with the knowledge that the Plan was denying coverage

for the stays .

48 . Petitioner questions where the Plan wanted Petitioner

to go upon release from her admissions to Jackson Memorial

Hospital and Memorial Hospital . Impo rtantly , the ultimate

decision regarding need for treatment , the type of treatment

needed , and the appropriate level of treatment is a decision that

is made by the physician and the member . Respondent and AvMed

merely make decisions related to coverage un der the health plan .

49 . The fact that a service is recommended or is considered

to be medically necessary by a member ' s treating physician does

not mean that the service is a covered benefit pursuant to the

Plan . If that was the case , the insurance comp any would

ostensibly pay every claim submitted . Even if services are

determined to be medically necessary , they are not payable under

the P lan if the service is specifically limited or excluded .

Therefore , regardless of whether the rehabilitation services were

necessary in this case , it would not be a covered benefit due to

the applicable limitation/exclusion . It should be noted that

there were other options available to Petitioner , such as home

health services .

50 . The totality of the evidence in this c ase shows that

not only was the primary reason for the stay at the Rehab Center

for rehabilitation , it was the sole reason for her stay . As

such , the stays at the Rehab Center were a non - covered benefit ,

and Petitioner ' s request for coverage should be den ied .

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law , it is RECOMMENDED that the Department of Management

Services , Division of State Group Insurance , issue a final order

denying Petitioner ' s claim for coverage of the stays at The

Rehabilitation Center at Hollywood Hills LLC, and further ,

denying Petitioner ' s request for attorney ' s fees and costs .

DONE AND ENTERED this 11th day of August , 2017 , in

Tallahassee , Leon County , Florida .

S

MARY LI C REASY

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee , Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www . doah . state . fl . us

Filed with the Clerk of the

Division of Administra tive Hearings

this 11th day of August , 2017 .

ENDNOTE S

1/ Although Petit i oner appeared, was sworn, and was present for

the final hearing, she was physically unable to tes t ify.

2/ The undersigned does not attribute the contradiction to deceit

by Petiti oner's sister and daughter. Rather, it is clear that

th is was a highly stressful and emotional time for them as they

sought the best care possible consistent with Petitioner's

physician 's recommendation. It is possible that someone from the

Rehab Center erroneously informed the family that benefits were

pre - authorized through the Plan or that they simply

misunderstood .

3/ Due to Petitioner's decades of dedicated service to the State

as a professor who never took sick time, she had a significant

bank of leave available and she remained on the payroll as an

employee for an extended period of time after her stroke. This

resulted in the Plan being the primary insurance coverage for her

stays in the hospitals and the Rehab Center, rather than

Medicare.

COP IES FURNISHED:

Anita J . Patel , Esquire

Department of Management Services

4050 Esplanade Way , Suite 160

Tallahassee , Florida 32399

(eServed)

Bradley Seldin , Esquire

The Seldin Law Firm , P . A .

1000 5th Street , Suite 200

Miami Beach , Florida 33139

(eServed )

J. Andrew Atkinson, General Counsel

Office of the General Counsel

D epa r tment of Management Services

4050 Esplanade Way, S uite 160

Tallahassee, Florida 32399 - 0950

(eServed)

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit wr itten exceptions within

15 days from the date of this Recommended Order . Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case .