20-004322 Lifestream Behavioral Center, Inc. vs. Department Of Children And Families Status: Closed Recommended Order on Monday, February 1, 2021.

Summary: Petitioner failed to demonstrate that the Department's action in correcting scores on a competitive application for methadone MAT services was arbitrary, capricious, or contrary to law.

S TATE OF F LORIDA

D IVISION OF A DMINISTRATIVE H EARINGS

L IFESTREAM B EHAVIORAL C ENTER , I NC . ,

Petitioner ,

vs. Case No. 20 - 4322

D EPARTMENT OF C HILDREN A ND

F AMILIES ,

Respondent,

and

M ETRO T REATMENT OF F LORIDA , L.P .,

Intervenor .

/

R ECOMMENDED O RDER

Pursuant to notice, a final hearing was conducted in this case on

December 1, 2020, via Zoom teleconference in Tallahassee, Florida, before

Lawrence P. Stevenson, a duly - de signated Administrative Law Judge (ÑALJÒ)

of the Division of Administrative Hearings (ÑDOAHÒ) .

A PPEARANCES

For Petitioner LifeStream Behavioral Center, Inc. (ÑLifeStreamÒ):

Brittany Adams Long, Esquire

Radey Law Firm, P.A.

301 South Bronough Street, Suite 200

Tallahassee, Florida 32301

For Respondent Department of Children and Families (ÑDCFÒ or Ñthe

DepartmentÒ):

William D . Hall, Esquire

Daniel R yan Russell, Esquire

John L. Wharton, Esquire

Dean Mead and Dunbar

106 East College Avenue, Suite 1200

Tallahassee, Florida 32301

For Intervenor Metro Treatment of Florida, L.P. (ÑMetroÒ):

Mia L. McKown, Esquire

Eddie Williams , II , Esquire

Holland & Knight , LLP

315 South Calhoun Street, Suite 600

Tallahassee, Florida 32301

S TATEMENT OF T HE I SSUE

The issue is whether the DepartmentÔs intended award allowing Metro to

proceed to licensure for a methadone Medication - Assisted Treatment (ÑMATÒ)

facility in Lake County violated Florida Administrative Code Rule 65D -

30.0141 , was arbitrary or capricious, or was otherwise unlawful as alleged in

LifeStreamÔs Petition fo r Administrative Hearing (ÑPetitionÒ).

P RELIMINARY S TATEMENT

On July 10, 2020, the Department issued its Notice of Intended Award for

Lake County (ÑNoticeÒ) stating that Metro was the intended awardee of the

right to apply for licensure to operate a metha done MAT facility in Lake

County. The Notice was based on an adjustment the Department made to the

scores that an independent evaluation team had awarded to the applicants.

The independent evaluation team had awarded the highest score to

LifeStream, with M etro finishing in second place.

LifeStream timely filed its Petition. On September 29, 2020, the

Department referred the case to DOAH for the assignment of an ALJ and the

conduct of a formal hearing. Metro filed a Notice of Intervention and

Appearance on September 30, 2020. The case was scheduled for hearing on

November 30 and December 1, 2020. On November 20, 2020, the parties filed

a joint motion requesting that the first day of the hearing be canceled. Based

on the motion, an Order was entered reschedu ling the hearing for

December 1, 2020.

On November 23, 2020, the parties submitted a Joint Pre - h earing

Stipulation that has been used in the preparation of this Recommended

Order. At the hearing, LifeStream presented the testimony of Christopher

Weller, M anager of the Licensure and Designation Unit within the

DepartmentÔs Office of Substance Abuse and Mental Health. Mr. Weller was

also a witness for the Department, which presented no other witnesses.

Metro presented the testimony of William Sutton, General Counsel for

MetroÔs parent entity, Colonial Management Group, LP.

Joint Exhibits 1 through 18 were admitted into evidence. Joint Exhibit 15

was the deposition testimony of Ute Gazioch, Director of the DepartmentÔs

Office of Substance Abuse and Mental Hea lth. 1 Joint Exhibit 16 was the

deposition testimony of Mr. Weller. Joint Exhibit 17 was the deposition

testimony of Roger Balettie, Project Manager for ISF, Inc., the company that

performed the independent evaluations of the applications.

LifeStreamÔs Ex hibits 1 through 9 were admitted into evidence. The

DepartmentÔs Exhibits 1 through 26 were admitted into evidence. Metro

offered no exhibits of its own but adopted those of the Department. There

were no objections to any of the exhibits.

1 The parties jointly designated pages 2 through 26 as the portions of Ms. GaziochÔs

deposition that are relevant to this proceeding.

The one - volume T ranscript of the final hearing was filed with DOAH on

December 18, 2020. Two joint motions to extend the time for filing p roposed

r ecommended o rders were granted. In accordance with the second Order

granting extension, the parties filed their Proposed Reco mmended Orders on

January 11, 2021. The Proposed Recommended Orders have been duly

considered in the writing of this Recommended Order.

All statutory references are to the 2020 edition of the Florida Statutes,

unless otherwise indicated.

R ule 65D - 30.01 4 is titled ÑStandards for Medication - Assisted Treatment

for Opioid Use Disorders.Ò At the time the Department made its need

determination in this case, subsection (3) of that rule provided the process for

determining the need for MAT providers. After the need determination , but

before the proposed awards in this case, the rule was amended to delete the

need determination process. The operative language was re - adopted in a new

rule 65D - 30.0141, titled Ñ Needs Assessment for Medication - Assisted

Treatment for Opioid Use Disorders.Ò The new rule is used as the point of

reference in this Recommended Order, but the operative language is the

same in both iterations.

F INDINGS OF F ACT

Based on the evidence adduced at hearing, and the record as a whole, the

following Findings of Fact are made:

P ARTIES

1. Petitioner LifeStream is a Florida not - for - profit corporation and

provider of substance abuse treatment. LifeStream applied for the ability to

proceed to licensure to provide methadone MAT services in Lake County.

2 . The Department is the agency with regulatory authority over the

provision of substance abuse services. § 397.321(1), Fla. Stat. The

DepartmentÔs duties include, but are not limited to, the licensing and

regulation of the delivery of substance abuse servi ces, including clinical

treatment and clinical treatment services such as Ñmedication - assisted

treatment for opiate disorder.Ò ££ 397.321(1) and (6); and 397.311(26)(a)7.,

Fla. Stat. The Department also promulgates rules governing substance abuse

providers . § 397.321(5), Fla. Stat.

3. Metro is a provider of care for opioid use disorder treatment and

operates methadone medication treatment centers nationwide, including in

the state of Florida. Metro applied for the ability to proceed to licensure to

provide methadone MAT services in Lake County.

S TATUTORY AND R EGULATORY F RAMEWORK AND N EEDS A SSESSMENTS

4. The substance abuse regulatory scheme in Florida is designed to

provide a statewide system of care for the prevention, treatment, and

recovery of children a nd adults with serious substance abuse disorders.

Substance abuse providers, which include methadone MAT clinics, are

subject to a strict statutory, regulatory, and licensing scheme, which provides

direction for a continuum of community - based services incl uding prevention,

treatment, and detoxification services. See chs. 394 and 397, Fla. Stat.

5. MAT is Ñthe use of medications approved by the United States Food and

Drug Administration, in combination with counseling and behavioral

therapies, to provide a h olistic approach to the treatment of substance

abuse.Ò £ 397.311(27), Fla. Stat.

6. The Department is responsible for the licensure and oversight of all

MAT providers in the state. See § 397.321, Fla. Stat.

7. Further, the Department is required to Ñdeterm ine the need for

establishing providers of [MAT]Ò on an annual basis. New MAT providers

may only be established in the state in response to a determination and

publication of such need by the Department. § 397.427(2), Fla. Stat.

8. R ule 65D - 30.0141 provide s the process for determining the need for

MAT providers, as follows , in relevant part:

(1) Determination of Need.

(a) The Department shall annually perform the

assessment detailed in the ÑMethodology of

Determination of Need Methadone Medication -

Assiste d Treatment,Ò CF - MH 4038, May 2019,

incorporated by reference and available at

http://www.flrules.org/Gateway/reference.asp?No=

Ref - 11993. The Department shall publish the

results of the assessment in the Florida

Administrative Register by June 30. Faciliti es

owned and operated by the Florida Department of

Corrections are exempt from the needs assessment

process. However, these facilities must apply for a

license to deliver this service.

(b) The publication shall direct interested parties to

submit a letter of intent to apply for licensure to

provide medication - assisted treatment for opioid

use disorders to the Regional Office of Substance

Abuse and Mental Health where need has been

demonstrated.

1. The publication shall provide a closing date for

submissio n of letters of intent.

2. Interested parties must identify the fiscal year of

the needs assessment to which they are responding

and the number of awards they are applying for per

county identified in the assessment in their letter

of intent.

(c) Within seven (7) business days of the closing

date, the Regional Office shall notify parties who

submitted a letter of intent on how to proceed.

1. If the number of letters of intent equals or is less

than the determined need, parties shall be awarded

the opport unity to proceed to licensure by

completing an ÑApplication for Licensure to Provide

Substance Abuse ServicesÒ form, C&F - SA

Form 4024, May 2019, incorporated by reference

and available at

http://www.flrules.org/Gateway/reference.asp?No=

Ref - 11996 .

2. If th e number of letters of intent exceeds the

determined need, parties shall be invited to submit

a ÑMethadone Medication - Assisted Treatment

(MAT) Application to Proceed to Licensure

ApplicationÒ form, CF - MH 4041, May 2019,

incorporated by reference and availa ble at

http://www.flrules.org/Gateway/reference.asp?No=

Ref - 11995. Applications may not be rolled over for

consideration in response to a needs assessment

published in a different year and may only be

submitted for a current fiscal year needs

assessment.

a. The Department shall utilize an evaluation team

made up of industry experts to conduct a formal

rating of applications as stipulated in the

ÑMethadone Medication - Assisted Treatment (MAT)

Application EvaluationÒ form, CF - MH 4040, May

2019, incorporated b y reference and available at

http://www.flrules.org/Gateway/reference.asp?No=

Ref - 11994. The evaluation team members shall not

be affiliated with the Department, current

methadone medication - assisted treatment

providers operating in Florida, or the applican ts.

b. The selection of a provider shall be based on the

following criteria:

(I) Capability to Serve Selected Area(s) of Need and

Priority Populations. Area(s) of Need are the

counties identified as having a need for additional

clinics. Priority Populati ons are pregnant women,

women with young children, and individuals with

financial hardships;

(II) Patient Safety and Quality

Assurance/Improvement;

(III) Scope of Methadone Medication - Assisted

Treatment Services;

(IV) Capability and Experience; and

(V ) Revenue Sources.

c. Applicants with the highest - scored applications

in each county shall be awarded the opportunity to

apply for licensure for the number of programs

specified in their letter of intent to meet the need of

that county. If there is unmet need, the next

highest scored applicant(s) will receive an award(s)

based on the remaining need and the number of

programs specified in their letter of intent. This

process will continue until the stated need is met.

Regional offices shall inform the highe st - scoring

applicant(s) in writing of the award.

d. All awarded applicants must submit a letter of

intent to apply for licensure to the appropriate

regional office within 30 calendar days after the

award. If an applicant declines an award or fails to

subm it the letter of intent within the specified

time, the Department shall rescind the award.

After the Department rescinds the original award

for that selected area of need, the applicant with

the next highest score shall receive the award.

(2) Awarded appl icants must receive at least a

probationary license within two (2) years of receipt

of an award letter connected to their ÑMethadone

Medication - Assisted Treatment (MAT) Application

to Proceed to Licensure ApplicationÒ form, CF - MH

4041. If an applicant fail s to obtain a probationary

license within the specified time, the Department

shall rescind the award. See Rule 65D - 30.0036,

F.A.C. for licensure application requirements.

Applicants may submit a request to the State

Authority and Substance Abuse and Mental Health

Program Office for an exception if unable to meet

timeframes due to a natural disaster that causes

physical damage to the applicantÔs building(s).

Proof of natural disaster and impact on physical

property must accompany the request. Upon receipt

of the request for exception and accompanying

proof, a one - time extension shall be granted for six

(6) months. Providers who are delayed for a reason

other than a natural disaster may petition the

Department for a rule waiver pursuant to Section

120.542, F.S È.

9. In brief, potential applicants are directed to submit letters of intent to

apply for a methadone MAT services license for any county in which the

DepartmentÔs process demonstrates a need. Should the number of letters of

intent received for a certain county be less than or equal to the need found in

that county, the potential applicants may proceed directly to licensure. In the

event the number of letters of intent is greater than the need found in a

particular county, then potential applicants must s ubmit an application form

to the Department. The application form is adopted by reference in the rule

as Form CF - MH 4041.

10. The rule requires the Department to Ñutilize an evaluation team made

up of industry experts to conduct a formal rating of applicat ionsÒ to

determine which applicant, or applicants, may proceed to licensure in a

particular county. Such evaluators Ñshall not be affiliated with the

Department, current methadone [MAT] providers operating in Florida, or the

applicants.Ò

11. The scoring fo rm that the evaluators must use is incorporated by

reference in the rule as Form CF - MH 4040 (ÑScoring FormÒ). The Scoring

Form requires that each application be Ñindependently scored by each

member of the evaluation team.Ò It also mandates that the Ñsame s coring

principles must be applied to every application received.Ò T he Scoring Form

expressly states that Ñno attempt by Department personnel, or other

evaluators or other persons to influence an evaluatorÔs scoring shall be

tolerated.Ò

12. There are five g eneral ÑCriteriaÒ in the Scoring Form upon which

applicants are scored, with a number of subsections within each criterion . An

application could be awarded a maximum of 220 points. The evaluators were

to assign a score ranging from zero to five for each su bsection, with some

subsections receiving an additional Ñweighted valueÒ (in which the score

given would be multiplied by two). The Department gave the weighted values

to provisions upon which it placed a Ñpremium.Ò

13. The ÑGeneral InstructionsÒ section of the Scoring Form provides what

an applicant must demonstrate to earn a particular score:

Superior (5 points): the application demonstrates or

describes extensive competency, proven

capabilities, an outstanding approach to the subject

area, innovative, practical and effective solutions,

full responsiveness to the question, a clear and

comprehensive understanding of the requirements

and planning for the unforeseen.

Good (4 points): the application demonstrates or

describes clear competency, consistent ca pability, a

reasoned approach to the subject area, feasible

solutions, extensive but incomplete responsiveness

to the question, and a sound understanding of the

requirements.

Adequate (3 points): the application demonstrates

or describes fundamental compe tency, adequate

capability, a basic approach to the subject area,

apparently feasible but somewhat unclear

solutions, partial responsiveness to the question, a

fair understanding of the requirements and a lack

of staff experience and skills in some areas.

Poor (2 points): the application demonstrates or

describes little competency, minimal capability, an

inadequate approach to the subject area, infeasible

or ineffective solutions, somewhat unclear,

incomplete or non - responsive to the question, a lack

of un derstanding of the requirements and a lack of

demonstrated experience and skills.

Insufficient (1 point): the application demonstrates

or describes a significant or complete lack of

understanding, an incomprehensible approach, a

significant or complete la ck of skill and experience

and extensive non - responsiveness to the question.

Not Addressed (0 points): the application

demonstrates or describes [that the] criteria is not

addressed, approach is not described, complete non -

responsiveness to the question.

14. Criterion Five of the Scoring Form concerns ÑRevenue Sources.Ò It

contains two subsections, each worth zero to five points and each given

Ñweighted value,Ò meaning that a perfect score for each subsection would

earn 10 points, or a total of 20 points for Criterion Five. Subsection one asked

the following question:

1. How well did the organization detail its accepted

forms of payment for treatment services? At a

minimum, the response should describe the

procedure for each payment method offered:

Asses s a point for each accepted form of payment (5

maximum points)

Self - Pay (1 point)

One form of Private Insurance (1 point)

Multiple forms of Private Insurance (1 point)

Medicaid (1 point)

Scholarship or Sliding Fee Scale (1 point)

15. While other sect ions of the Scoring Form permit the evaluator to

subjectively evaluate the responsiveness of the answer, subsection one of

Criterion Five is manifestly objective. It directs the evaluator to award one

point for each of the five accepted forms of payment ad dressed by the

applicant, up to the maximum of five points.

16. Subsection two of Criterion Five asks, ÑHow well does the application

detail how the organization will determine if its pricing is competitive?Ò This

subsection was also worth five points and allowed the evaluator to

subjectively address the quality of the applicantÔs response.

17. Christopher Weller, Manager of the Licensure and Designation Unit

within the DepartmentÔs Office of Substance Abuse and Mental Health,

testified that Florida MAT pro viders historically have accepted only out - of -

pocket payment s for their services, meaning that those who could not afford

to pay cash or credit were often left untreated. The Department wanted to

ensure that the need for MAT services would be met and that no one needing

such services would be priced out of treatment. Therefore, the Department

included Criterion Five in the application and gave it weighted value to

encourage providers to accept multiple forms of payment.

18. The Department completed a needs assessment and published it in the

June 20, 2020, edition of the Florida Administrative Register. The

Department then announced that it would begin accepting applications to

proceed to licensure. The needs assessment indicated a need for one new

MAT clinic in Lake County.

19. Pursuant to rule 65D - 30.041(1)(c)2.a., the Department contracted with

an outside provider to evaluate the applications received for counties

throughout the state, including Lake County. T hat provider, iSF, established

four teams of thr ee evaluators to score the applications and divided the

counties with need among the teams. Each evaluation team consisted of a

medical professional, a public health policy professional, and an academic

professional. Applicant names were redacted so evalua tors would not know

the identity of the applicant they were scoring. Each iSF evaluator

independently evaluated the various applications.

T HE L AKE C OUNTY A PPLICATIONS

20. LifeStream and Metro both timely submitted letters of intent and

applications for th e new methadone MAT clinic needed in Lake County. Four

other entities also applied for the one available license in Lake County.

21. LifeStreamÔs response to subsection one of Criterion Five provided as

follows:

Our organization has developed a detailed

Fi nancial Assistance Policy (FAP) that provides

assistance to all individuals served, including

insured, uninsured and underinsured individuals

whose family income is less than or equal to 240%

of the Federal Poverty Level without discrimination

on grounds o f race, sex, national origin, di sa bility,

sexual orientation, immigration status, religious

preference, or any other grounds unrelated to an

individualÔs need for the service or the availability

of the service needed for emergency and medically

necessary c are. Furthermore, all individuals served

receive a financial screening by staff knowledgeable

of the various funding mechanisms in an effort to

identify the best form of payment. No one is turned

away for services due to their inability to pay.

As a compr ehensive provider with a sound financial

infrastructure, our organization is able to accept

several forms of payment for any of the services

provided. This includes self - pay, private insurance

(both one form and multiple forms), Medicaid and

scholarship or sliding scale fee. All the individuals

served are charged based upon a board of directors

approved charge master which ensures that all

individuals are charged the same fees for the same

services. Discounts are available for individuals

who qualify for fi nancial assistance using a sliding

fee discount. Our organization provides payment

flexibility, including payment plans/options. In

addition, our staff are trained to assist individuals

in obtaining benefits and coverage as appropriate

to meet any ongoing needs for treatment.

Self - Pay : The proposed clinic will conduct a

financial screening in order to determine if an

individual qualifies for any of the organizationÔs

accepted forms of payment for treatment services.

Individuals will be offered two payment options, by

the day or by the week. The fee will include dosing,

treatment services and ancillary services.

Individuals will be offered the ability to pay using

cash or credit card. The organization also has a

mechanism to bill the individual if that is hi s/her

preference. This allows the individual to pay for

services in a manner that meets his/her current

ability and timeframe.

Private Insurance (One or Multiple Forms) : Our

organization has numerous contracts with private

insurance providers. This includ es major providers

such as Aetna, Blue Cross/Blue Shiled, Cigna,

Magellan, Tricare, PsycCare, United Health Care

and Value Options to name a few. In order to

ensure that our organization has the ability to bill

private insurance for these services, staff w ill

possess the appropriate credentials, training and

experience to allow them to be paneled by the

insurance providers. In addition, our organization

has staff that conduct financial assessments in

order to determine the best funding source for the

servic es provided. They are experienced and

knowledgeable about the various private insurance

plans and have the ability to determine if one or

multiple forms of insurance will be utilized.

Medicaid : Our organization is an established

Medicaid provider and has the ability to bill

Multiple Medicaid Associations (MMAs) as a result

of having contracts with several of the

organizations such as Prestige, Wellcare, United

Healthcare and Sunshine. All of our sites and

appropriate staff have the proper credentials to bi ll

for Medicaid services. In addition, the treatment

services and ancillary services we propose to offer

will be Medicaid credentialed in order to bill for

those services as well.

Scholarship or Sliding Fee Scale : As stated earlier,

our organization has e xtensive experience working

with indigent individuals. As a result of a financial

assessment, the level of discount for which an

individual is eligible is determined based upon the

individualÔs family income and family size as a

percentage of the FPL. Our developed policies and

procedures define the meaning of Ñuninsured,Ò

Ñunderinsured,Ò Ñfamily income,Ò and ÑFederal

Poverty Level.Ò

All of our financial policies are listed on our website

that address payment for treatment services and

are provided in deta il for the people we serve.

22. MetroÔs response to subsection one of Criterion Five provided as

follows:

To facilitate the ease of payment by individuals in

need of treatment and to minimize financial

barriers to treatment, we offer a wide array of

p ayment options that include:

1. Self - Pay Ð Patients with the financial capacity to

pay for their own treatment may pay using cash,

credit card, Apple Pay, and/or debit card. Upon

receiving the medication portion of their treatment,

self - pay patients either tender cash to clinic staff

for the cost of treatment or, alternatively, provide a

credit card, Apple Pay, or debit card that is entered

into a card processing terminal for verification and

transaction authorization.

2. Private Insurance Ð We accept multipl e forms of

private insurance as we are in network with many

private insurers (including, but not limited to,

Beacon Health, Triwest, United/Optum, and

Aetna). Also, we have established single case

agreements with private insurers with whom we

are not yet i n - network so that the cost to each

patient is minimized and keeps the patient in

treatment. Procedurally, patients present their

private insurance information to clinic staff who

verify eligibility, benefits, and individual financial

responsibility (e.g., deductibles, co - pays, co -

insurance). A patientÔs financial responsibility, if

any, is collected from the patient pursuant to their

insurerÔs benefit design, and the treatment services

are billed to their health insurer. An assignment of

benefits is signed by the patient to permit us to bill

and collect directly from their health insurer.

3. Medicaid Ð Opioid Use Disorder treatment is a

covered benefit under Florida Medicaid. As a

result, all of our existing clinics are enrolled in the

Florida Medicaid networ k. If our organization is

awarded the clinic for this county, we would

immediately enroll this clinic in the Florida

Medicaid program. Patients covered by Florida

Medicaid simply present their Medicaid card to

clinic personnel who are able to immediately v erify

active coverage. Upon verification of coverage, the

patient completes an assignment of benefits and is

treated without any financial outlay. Treatment

services received by the patient are then billed to

Florida Medicaid directly for as long as the

in dividual remains Medicaid eligible.

4. Sliding Fee Scale Ð Patients without the financial

capacity to pay for their own treatment, or are

without Florida Medicaid or private health

insurance coverage, may qualify for our Sliding Fee

Scale. The Sliding Fee S cale offers discounted fees

to patients in need of treatment. Eligibility is

determined based on Federal poverty guidelines,

household income, and the number of people in the

patientÔs household. Patients who are eligible for

the Sliding Fee Scale must sim ply provide the

following financial data as a part of their

application:

a. Pay stubs for at least the last six months;

b. A copy of their most recent federal income

tax return;

c. Proof of current living situation (such as

lease documents, or utility bills in t he

patientÔs name);

d. A financial attestation signed by the

patient, which our clinic will provide.

Upon the establishment of a patientÔs eligibility,

the patientÔs cost of treatment is reduced to the

discounted fee per the Sliding Fee Scale. In the

event that a patientÔs financial status changes, the

patient must inform clinic staff of the changes. At a

minimum, the clinic staff will review financial

status with the patient every six (6) months.

Financial status may be reviewed at the request of

the patien t or clinic at any time.

5. Grants Ð Our organization routinely pursues,

and has secured, grant funding to cover the cost of

treatment for patient who are [sic] unable to pay

for their treatment and who do not have insurance.

Grant finds are awarded through regional

Managing Entities. Available grant funds are

sought to cover [the] cost of care for eligible

patients receiving treatment at our clinics. As

mentioned, our organization is currently the

recipient of grant funds from multiple Managing

Entities in the State of Florida. Eligible patients

must simply provide the following financial data as

a part of their application:

a. Pay stubs for at least the last six months;

b. A copy of their most recent federal income

tax return;

c. Proof of current living situation (such as

lease documents, or utility bills in the

patientÔs name);

d. A financial attestation signed by the

patient, which our clinic will provide.

Upon the establishment of a patientÔs eligibility,

the patientÔs cost of treatment is reduced in

accordance with the grant guidelines. In the event

that a patientÔs financial status changes, the

patient must inform clinic staff of the changes. At a

minimum, the clinic staff will review financial

status with the patient every six (6) months.

Financial status may be reviewed at the request of

the patient or clinic at any time.

6. Credit Ð Patients with the financial capacity to

pay for their own treatment via cash, credit card,

and/or debit card occasionally find themselves in

need of treatment but, for a variety o f reasons, are

unable to pay. Our organization empowers its clinic

Program Directors (i.e., the on - site clinic managers)

to extend credit to patients in such situations for a

short period (typically one day) with the

understanding that the patient will rep ay the

credit amount extended in short order. Upon

receiving credit authorization, the patient receives

all medically necessary treatment as may be

required.

23. Both the LifeStream and Metro proposals appear to have described the

procedure for each of th e five payment methods listed and appear to be

entitled to the maximum score of five points according to the objective

standards set forth in subsection one of Criterion Five. At the very least, it

would be impossible to justify giving either proposal a sc ore of zero, which is

reserved for Ñcomplete nonresponsivenessÒ to the question.

24. LifeStreamÔs response to subsection two of Criterion Five provided as

follows:

In order to ensure that pricing is competitive, our

organization will review the current env ironment

using several data sources on a regular basis. This

will include the Department of Children and

Families, our state trade association, Florida

Behavioral Health association and discussions with

other providers. We also propose to conduct focus

gro ups with the individuals that we serve and our

stakeholders to collect input that will be part of

this review. On an annual basis, our organization

will conduct a pricing study to ensure that the

pricing is competitive.

As a safety net provider and an org anization

committed to serving individuals regardless of their

ability to pay, we feel that the input from those we

serve and our stakeholders is a critical piece in

determining if pricing is competitive. Our

organization will identify and provide solution s to

ensure that those that need care are able to receive

the care. We are dedicated to ensuring that the

pricing will be reasonable and that options are

identified and offered for low income/indigent

individuals. More importantly, our organization

will co mmit to supporting the people we serve

through a continuum of services that not only

addresses their opioid disorders, but also the social

determinants that may affect their successful

recovery. Our organization is a Medicaid provider

and also has access t o other funds to ensure that

individuals who need this service will receive it

regardless of their ability to pay.

25. MetroÔs response to subsection two of Criterion Five provided as

follows:

As a longstanding provider of Opioid Use Disorder

treatment se rvices in the State of Florida, our

organization is keenly aware of the need to

properly price our services given the circumstances

typically facing patients battling opioid addiction

which include, but are not limited to, financial

hardship. Consequently, we recognize that

appropriate pricing of our services is critical so as

to ensure that individuals in need of care do not

perceive that treatment for their disease is

unattainable. While a material and increasing

number of patients have their treatment pa id by

Medicaid, private health insurance, and grants (as

fully discussed in question 1 of Criteria 5), those

patients who pay for treatment out of their own

pockets routinely encounter financial barriers

which, unfortunately, result in them not seeking

tre atment, or leaving treatment prematurely.

Given our experience operating outpatient clinics in

Florida, our organization has developed a

substantial amount of year - by - year internal pricing

data, which includes specific market economic data,

that guides us in pricing our services within a

particular Florida region. This data, which is

updated annually, is measured against other payer

rates (such as Medicaid and private health

insurance), and compared to the rates we are paid

for opioid addiction treatment s ervices provided by

our clinics in other states. Taken together, this

data allows us to develop regional benchmarks that

we use to price our services fairly and

competitively, bearing in mind the financial

challenges typically encountered by opioid addicte d

patients. To be clear, this is a fluid process that

takes into account changing market conditions,

both inside and outside of Florida, regarding the

pricing of opioid addiction treatment. This allows

our organization to maintain a current view of

what pa tients can realistically afford to pay and,

when necessary, immediately adjust our pricing

expectations when the market data indicates that

such adjustments are needed to ensure continuity

of patient care.

In addition to our routine pricing analysis using

our historical internal data, we will, prior to

opening a new clinic in a particular area, conduct a

survey of other opioid treatment clinics within the

region (if any). This survey process not only allows

us to gain a better understanding of what the

pri cing for services is in that region, but helps us

identify any additional services that should be

offered to patients as part of our pricing structure.

Once these surveys are completed, we then use this

information, along with our internal analysis of

hist orical data, to price our treatment services

according to our planned treatment protocol (e.g.,

timely delivery of service, having the clinic open

seven (7) days per week, maintaining a Call Center

that is open and available to assist existing and

prospect ive patients 24 hours per day, 7 days a

week, etc.) and our analysis of specific market

dynamics (e.g., quality of care indicators,

availability of qualified clinical professionals,

attendant costs of support services in the particular

market, etc.). Final ly, to ensure our pricing

remains competitive, we repeat our outpatient

treatment clinic surveys at least annually for each

and every market in which our clinics operate , and

use this information, along with routine feedback

voluntarily provided by our exi sting patients, to

determine if our pricing remains appropriate given

the market where the clinic is located.

To be clear, we believe that our practice of

conducting outpatient clinic surveys relieve

patients of having to make pricing and service

comparis ons while trying to manage their disease.

Stated differently, patients can take comfort in

knowing that when they inquire as to our

treatment pricing, they will receive the identical

type and number of services that would typically be

offered by all simila rly - situated outpatient

treatment programs within their geographic region

at comparable prices. While this particular process

can be burdensome, we have found time and again

that the effort is worthwhile given the positive

patient feedback we routinely rec eive regarding the

value of services offered at our clinics.

If awarded the clinic license for this particular

county, we will deploy each of the aforementioned

pricing techniques (i.e., internal analysis of

historical pricing data, benchmarking using pub lic

and private payer rates from within and outside of

Florida, and regional pricing surveys) to develop

pricing for our services that will not only be

competitive, but affordable for the people within

the community in need of treatment. These

processes ha ve proved tremendously effective for us

thus far, and we fully expect them to be successful

within this particular county.

26. As noted above, subsection two allowed for a more subjective

evaluation of the applications. LifeStreamÔs response was shorter a nd more

general than MetroÔs, but both responses addressed similar themes and

procedures for ensuring competitive pricing at their clinics. Both proposals

showed the applicantsÔ understanding of the need for competitive pricing and

outlined their plans for setting their prices accordingly. Even allowing for the

subjectivity permitted by subsection two, it would be impossible to justify

giving either proposal a score of zero, which is reserved for Ñcomplete

nonresponsivenessÒ to the question.

S CORING OF THE L AKE C OUNTY A PPLICATIONS

27. As explained above, the applications were given to the four teams of

iSF evaluators for scoring. After the evaluators completed their review, iSF

provided the Department with a final report that explained the evaluation

proces s and provided a series of tables for each county that identified each

applicantÔs scores.

28. The Lake County applications were scored by ÑTeam TwoÒ of the iSF

evaluators. Team Two also reviewed applications for five other counties.

Team Two gave LifeStre am a total score of 633.5 for Lake County and gave

Metro a total score of 619 for Lake County.

29. Mr. Weller testified that one of his employees found a typographical

error in a spreadsheet that iSF produced for the Department. This error

prompted Mr. Wel ler to take a look at the scoring of the proposals by the iSF

evaluators.

30. Mr. Weller noted what appeared to be an anomaly. He found a series

of scores in Lake County that went Ñ5, 5, 5, zero, 5, 5, which caught my eye as

unusual, and we discovered that the answers for both [subsections one and

two of Criterion Five] were different in Lake County compared to all of the

other ones that the particular evaluator scored for the other counties.Ò

31. A closer review of the scores revealed that each of the thr ee Team Two

evaluators gave LifeStream scores of five in both subsections of Criterion

Five in its Lake County application. Two of the three evaluators gave Metro

scores of five for both subsections of Criterion Five. However, the medical

professional on T eam Two gave Metro zeros in both subsections of Criterion

Five of its Lake County application.

32. The Criterion Five responses of LifeStream and Metro were essentially

identical in all of the six county applications reviewed by Team Two. In the

five count ies other than Lake County, all of the evaluators, including the

medical professional, gave both LifeStream and Metro scores of five for both

subsections of Criterion Five. It was only in Lake County that the medical

professional decided that MetroÔs ident ical response was completely

nonresponsive and deserving of zero points.

33. As found above, it is impossible to justify scores of zero for MetroÔs

responses to Criterion Five. It was also extremely unusual for the same

evaluator to give such radically dif ferent scores to the same response made in

different applications. Mr. Weller wanted an explanation. He asked iSF to

ask the medical evaluator to explain her reasoning for the inconsistency in

her scoring of MetroÔs Lake County application and to ask wheth er she

wished to amend her score for MetroÔs application.

34. On April 27, 2020, iSFÔs contract manager, Roger Balettie, sent an

email to the Team Two medical evaluator, Linda Saucier. The email

requested Ms. SaucierÔs response as to four scoring questions raised by the

DepartmentÔs review, including the following:

You have two applicant response questions

(Criteria 5 Questions 1 and 2) where an applicant

(DCF 12) has two different scores for the same

answer across six counties (one with 0s for each

questio n and five with 5s for each question, and

your notes are identical).

DCF would like for you to review the applicantÔs

C5Q1 and C5Q2 response (I will provide that

section for you) and confirm either that you

intended the 6 counties to be different, or that you

intended the 6 counties to have consistent scores

for those two questions (and provide those scores).

35. On May 1, 2020, Ms. Saucier responded as follows:

I just saw your email. It went to my spam folder. I

am extremely busy with work. But, I can te ll you

that the scores are different because of the county

or vicinity in which the clinic would be housed and

clinicians/service availability. ItÔs not a cookie

cutter process.

36. Later on May 1, 2020, Mr. Balettie sent an email asking Ms. Saucier

to co nfirm that she did not wish to consider changing her scores for any of the

four questions raised in his initial email, including Criterion Five in Lake

County. Ms. Saucier responded:

Correct. Roger, there are so many variables when

looking at the submissio ns. I have written and

reviewed grants and similar documents in my

position. I realized the proposals were the same for

each county, unfortunately not all of the counties

share the same similarities.

37. Read in the context of Criterion Five, it is clear that Ms. Saucier did

not bother even to look again at her work on these applications before

responding to Mr. Balettie. Her response is vague and defensive nonsense.

Lake County possesses no unique quality that would render MetroÔs pricing

strategy and acc epted forms of payment completely nonresponsive to

Criterion Five, particularly when Ms. Saucier herself found the same

responses ÑsuperiorÒ in five other counties. Moreover, subsection one of

Criterion Five did not give Ms. Saucier the discretion to award zero points to

an application that addressed the five listed forms of payment as MetroÔs

application manifestly did. She violated the instructions of the Scoring Form

and offered no real justification for doing so.

38. The Department reasonably believed that it was not possible to

rationalize the zeros that were given to MetroÔs Lake County response. The

Department reasonably believed there were no differences between counties

that would have any impact on pricing or payment methods.

39. William Sutton, General Counsel for MetroÔs parent entity, Colonial

Management Group, LP , testified that he personally worked on the

applications Metro filed for the 2018 - 2019 licensure process. Mr. Sutton

testified that the Ñforms of payment and the process [that Metro u ses] to

determine whether our pricing is competitive is consistent throughout the

state of Florida.Ò He noted that Metro currently has 80 clinics operating

throughout the country and t hat it is ÑcriticalÒ for the company Ñto have

processes in place to deal with those [payment and pricing] issues

consistently.Ò

40. After digesting the response from iSF, the Department concluded that

Ms. SaucierÔs scores of zero for Criterion Five of MetroÔs Lake County

application Ñcould not be justified.Ò Department personn el met to discuss

what action to take regarding the scoring discrepancy.

41. Eventually, the Department decided to override Ms. SaucierÔs scores

and to assign a score of five to both Criterion Five subsections in MetroÔs

Lake County application. The score of five was chosen because it was the

same score that Ms. Saucier assigned to all of MetroÔs other substantively

identical Criterion Five responses in the other five counties she reviewed.

The Department took this action Ñin the interests of fairness.Ò Th e

Department also believed that Metro would challenge any intended award if

the scores of zero were left unchanged and that Metro would likely prevail in

such a challenge. 2

42. The DepartmentÔs adjustment of the score gave Metro a total score of

639 point s, reflecting two double - weighted scores of five instead of two scores

2 Mr. Sutton testified that Metro indeed would have raised such a challenge.

of zero in the Criterion Five subsections. LifeStreamÔs total score in Lake

County remained 633.5 points. 3

43. On July 10, 2020, the Department published the Notice, which

declared its intention to award the new MAT license in Lake County to

Metro. The Notice explained the adjustment as follows:

During the review of the evaluators scoring process

by the Department, it was discovered that the

medical evaluator for Team Two provided score s of

zero for both responses in Criteria Five for

[MetroÔs] Lake County application. The two

questions responded to pertained to types of

payments accepted and competitive pricing. The

responses to these questions were identical to

MetroÔs responses in the other six applications

reviewed by the same medical evaluator. Each of

the responses in the other six applications were

awarded the full point values (5 points each) by the

medical evaluator. In addition, the same responses

were awarded either 4 or 5 poin ts by both the other

Team Two evaluators and by all the evaluators in

the other teams.

The scoring inconsistency resulted in MetroÔs Lake

County application losing 20 points (5 points for 2

questions, which were weighted by a factor of 2).

Correction of t he inconsistency results in Metro

having the highest scoring application. Upon the

Department learning of the scoring discrepancy,

the medical evaluator declined to amend the scores

and participate in the public meeting of the

evaluators.

The responses pr ovided by MetroÔs Lake County

application were identical to its six non - Lake

County applications assigned to Team Two, which

were awarded five points each, and identical to all

other responses provided by Metro. Thus, the

3 Metro could have received five fewer points through this correction and still received the

intended award. Ba sed on the scores possible and the double - weighting of this criterion , any

combination of (a) two scores of five, (b) one score of five and one score of four, (c) one score of

five and one score of three, or (d) two scores of four would have caused Metro t o jump past

LifeStream as the successful applicant.

recommendation is to override the scores and

award the licensure opportunity to Metro.

44. The DepartmentÔs actions in reviewing the scores awarded and

making the changes to MetroÔs Criterion Five scores were reasonable under

the facts and circumstances presented. LifeStream was unable to mount a

serious defense of Ms. SaucierÔs scoring or to offer any tangible evidence that

the Department was biased either against LifeStream or in favor of Metro. 4

45. LifeStreamÔs chief argument is that the Department deviated from its

own rule by reviewi ng the scores submitted by iSF, by asking iSF to inquire

as to aspects of the scores and suggesting the evaluator change them, and

most egregiously by changing MetroÔs score after the iSF evaluator declined

to amend her evaluation. This legal argument is d iscussed below.

C ONCLUSIONS OF L AW

46. The Division of Administrative Hearings has jurisdiction over this

case pursuant to sections 120.569 and 120.57(1), Florida Statutes.

47. LifeStream is substantially affected by the DepartmentÔs decision to

change th e score for MetroÔs Lake County application, which resulted in

proposed agency action that the ability to apply for the methadone MAT

services license in Lake County be granted to Metro rather than LifeStream,

despite th e fact that the iSF evaluation team awarded LifeStream the

highest score. LifeStream has standing to contest the DepartmentÔs proposed

agency action.

48. This is a de novo proceeding intended to formulate final agency action.

§ 120.57(1)(k), Fla. Stat.

4 While the iSF evaluators did not know the names of the companies whose applications they

were scoring, the Department was aware that it was acting on the application of Metro when

it made the decision t o change the scores. However, the credible evidence established that

the Department would have done the same thing had LifeStream or any other applicant been

in MetroÔs place.

49. LifeStream does not challenge the s cores it received in Lake County.

The only intended agency action it challenges is the DepartmentÔs decision to

override the two scores of zero that Metro received for Criterion Five in Lake

County. LifeStream has the burden to prove by a preponderance of the

evidence that such action was improper.

50. LifeStream alleges that the DepartmentÔs decision to override the

scores of zero violated the terms of rule 65D - 30.0141 and the Scoring Form

adopted by reference therein. It is not disputed that the Departmen t is

legally bound to follow its own rules. See Cleveland Clinic Fla. Hosp. v. Ag.

for Health Care Admin , 679 So. 2d 1237, 1242 (Fla. 1 st DCA 1996).

51. LifeStream contends that the DepartmentÔs actions violated rule 65D -

30.0141(1)(c)2., which provides as follows, in relevant part:

a. The Department shall utilize an evaluation team

made up of industry experts to conduct a formal

rating of applications as stipulated in the

ÑMethadone Medication - Assisted Treatment (MAT)

Application EvaluationÒ form, CF - MH 40 40, May

2019, incorporated by reference and available at

http://www.flrules.org/Gateway/reference.asp?No=

Ref - 11994. The evaluation team members shall not

be affiliated with the Department, current

methadone medication - assisted treatment providers

operating in Florida, or the applicants .

b. The selection of a provider shall be based on the

following criteria:

(I) Capability to Serve Selected Area(s) of Need and

Priority Populations. Area(s) of Need are the

counties identified as having a need for additiona l

clinics. Priority Populations are pregnant women,

women with young children, and individuals with

financial hardships;

(II) Patient Safety and Quality

Assurance/Improvement;

(III) Scope of Methadone Medication - Assisted

Treatment Services;

(IV) Capabil ity and Experience; and

(V) Revenue Sources.

c. Applicants with the highest - scored applications in

each county shall be awarded the opportunity to

apply for licensure for the number of programs

specified in their letter of intent to meet the need of

tha t county. ( e mphasis added) .

52. LifeStream contends that the DepartmentÔs actions violated several

provisions of the Scoring Form:

Applications shall be independently scored by each

member of the evaluation team. No collaboration is

permitted during the s coring process. The same

scoring principles must be applied to every

application received, independent of other

evaluators. Evaluators should work carefully to be

as thorough as possible in order to ensure a fair

and open process. No attempt by Department

personnel or other, evaluators or other persons to

influence an evaluatorÔs scoring shall be tolerated .

* * *

Evaluations will be conducted by an external team.

The team will be directed to evaluate and rank

applications submitted by county within a defi ned

evaluation period. Once the evaluation period has

concluded the external team will send completed

and scored evaluation forms to the Department. A

list of applicants, by ranking and county, will be

published on the departmentÔs website. Applicants

wi th the highest - ranking scores will be invited to

initiate the licensure application process. ( e mphasis

added) .

53. LifeStream argues that the rule states that a team of evaluators,

entirely independent of the Department, will rate the applications, and th at

the applicants awarded the highest scores by the team of evaluators Ñshall be

awarded the opportunity to apply for licensure.Ò The rule does not give the

Department authority to intervene in the scoring process or to substitute its

judgment for that of the evaluation team. LifeStream argues that the Scoring

Form itself supports its contention that Department personnel are to

maintain a hands - off role in the evaluation process. Under the rule and the

Scoring Form, the DepartmentÔs role is purely administr ative, not evaluative.

Therefore, Lifestream asserts that the Department violated its own rule by

changing the score on MetroÔs Lake County application.

54. As the Court recognized in Goodman v. Dep ar t ment of Law

Enf orcement , 203 So. 3d 909, 915 (Fla. 4 th DCA 2016), an agencyÔs attempt to

regulate for every possible contingency Ñwould swiftly devolve into a hopeless

endeavor.Ò The rule and Scoring Form are the DepartmentÔs effort to regulate

the scoring process in anticipation of reasonably foreseeable even ts. In this

instance, one occurrence the DepartmentÔs rule failed to anticipate was a

renegade evaluator. LifeStream argues that, having failed to spell out by rule

the actions it could take to correct the errors of such an evaluator, the

Department is now helpless to act.

55. Taken to its logical conclusion, LifeStreamÔs argument is that by

failing to adopt a rule explicitly anticipating that an independent evaluator

might choose to award points arbitrarily in disregard of the Scoring FormÔs

instructions, the Department has handcuffed itself and can do nothing to

correct the deviation from the requirements of the Scoring Form. Thus

phrased, it becomes apparent that LifeStreamÔs proposition is that the

DepartmentÔs rule prohibits the Department from enforci ng its rule. The

absurdity of that proposition is self - evident.

56. The facts found above establish that the Department followed its

promulgated process. It hired outside evaluators and allowed them to submit

their scores without interference. When the Dep artment reviewed those

scores and found ones that facially violated the promulgated instructions in

the Scoring Form, it took the only reasonable step and overrode those scores.

It was more than reasonable for the Department to conclude that this was

the m ost equitable and legally appropriate action.

57. A more reasonable question for LifeStream to ask is whether there

was justification for changing MetroÔs scores of zero, meaning the applicant

did not address the criterion at all, to the maximum score of f ive, meaning

that the applicant made a ÑsuperiorÒ response. The Department indicated

that it based its decision on the scores awarded by Ms. Saucier for Criterion

Five in all five of MetroÔs other applications. The undersigned concludes that

the Department Ôs action was reasonable and declines to disturb it or engage

in a rescoring of MetroÔs application.

58. Even if the undersigned were to independently review MetroÔs

responses to Criterion Five and recommend a score, the result would be the

same. Subsecti on one of Criterion Five was to be scored objectively. The

Scoring Form instructed the evaluator to award one point for each of the five

accepted forms of payment addressed by the applicant, up to the maximum of

five points. There is no reasonable reading of MetroÔs response to subsection

one that yields any score other than five. Metro addressed each of the five

forms of payment in detail. Given the weighting factor of two, MetroÔs score

for subsection one could only be ten points.

59. With ten points in h and from subsection one, Metro would need only

six points (meaning, a score of three or higher multiplied by two) from its

response to subsection two to surpass LifeStreamÔs point total. A score of

three indicates an ÑadequateÒ response, described in the S coring FormÔs

instructions as Ñfundamental competency, adequate capability, a basic

approach to the subject area, apparently feasible but somewhat unclear

solutions, partial responsiveness to the question, a fair understanding of the

requirements and a lac k of staff experience and skills in some areas.Ò A score

of four indicates a ÑgoodÒ response: Ñ clear competency, consistent capability, a

reasoned approach to the subject area, feasible solutions, extensive but

incomplete responsiveness to the question, an d a sound understanding of the

requirements.Ò

60. MetroÔs response showed, at the very least, fundamental competency

meriting a score of three points. It would be more accurate to state that

MetroÔs response showed extensive but incomplete responsiveness a nd

consistent capability in the area of pricing, enough to earn a score of four

points. Thus, even if the undersigned were inclined to engage in rescoring

MetroÔs response to Criterion Five, the ultimate result of the award to Metro

would be the same.

61. An agency action is capricious if the agency takes the action without

thought or reason or irrationally. An agency action is arbitrary if it is not

supported by facts or logic. See Agrico Chem. Co. v. DepÔt of Envtl. Reg ., 365

So. 2d 759, 763 (Fla. 1st DCA 1978).

62. To determine whether an agency acted in an arbitrary or capricious

manner, it must be determined Ñwhether the agency: (1) has considered all

relevant factors; (2) has given actual, good faith consideration to those

factors; and (3) has used re ason rather than whim to progress from

consideration of these factors to its final decision.Ò Adam Smith Enter. v.

DepÔt of Envtl. Reg. , 553 So. 2d 1260, 1273 (Fla. 1st DCA 1989).

63. However, if a decision is justifiable under any analysis that a

reasona ble person would use to reach a decision of similar importance, the

decision is neither arbitrary nor capricious. Dravo Basic Materials Co. v.

DepÔt of Transp. , 602 So. 2d 632 n.3 (Fla. 2d DCA 1992).

64. The DepartmentÔs actions were not in any way illogic al or

unreasonable. Ms. Saucier, the Team Two medical evaluator, deemed two of

MetroÔs responses to be completely non - responsive to the questions posed.

The evidence demonstrated that Ms. SaucierÔs action s had no factual or legal

support and constituted a clear deviation from the instructions provided in

the Scoring Form, which was adopted by reference by rule 65D - 30.0141.

Further, Ms. Saucier also deemed identical responses from Metro to be

ÑsuperiorÒ in the five other counties she reviewed. Ms. SaucierÔs actions could

not be rationalized. Her response did not even attempt a logical explanation.

The DepartmentÔs decision to rescore MetroÔs response to Criterion Five in its

Lake County application was necessary and proper.

65. LifeStream has failed to carry its burden of showing that the

DepartmentÔs actions were arbitrary, capricious, or contrary to rule or

statute.

R ECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, the

undersigned hereby R ECOMMENDS that the Department of Childre n and

Families enter a final order awarding the right to proceed to licensure for a

methadone MAT facility in Lake County to Metro Treatment of Florida, L.P. ,

and dismissing the Petition for Administrative Hearing filed by LifeStream

Behavioral Center, Inc .

D ONE A ND E NTERED this 1st day of February , 2021 , in Tallahassee, Leon

County, Florida.

S

L AWRENCE P. S TEVENSON

Administrative Law Judge

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 1st day of February , 2021 .

C OPIES F URNISHED :

Daniel Ryan Russell, Esquire Brittany Adams Long, Esquire

Dean Mead and Hall Radey Law Firm, P.A.

Suite 1200 S uite 200

106 East College Avenue 301 South Bronough Street

Tallahassee, Florida 32301 Tallahassee, Florida 32301

Mia L. McKown, Esquire John L. Wharton, Esquire

Holland & Knight , LLP Dean Mead and Dunbar

Suite 600 Suite 1200

315 South Calhoun Street 106 East College Avenue

Tallahassee, Florida 32301 Tallahassee, Florida 32301

William D. Hall, Esquire Eddie Williams, III, Esquire

Dean Mead and Dunbar Holland & Knight, LLP

Suite 1200 Suite 600

106 East College Avenue 315 South Calhoun Str eet

Tallahassee, Florida 32301 Tallahassee, Florida 32301

Chad Poppell, Secretary Lacey Kantor, Agency Clerk

Department of Children and Families Department of Children and Families

Building 1 , Room 202 Building 2, Room 204Z

1 317 Winewood Boulevard 1317 Winewood Boulevard

Tallahassee, Florida 32399 - 0700 Tallahassee, Florida 32399 - 0700

Javier Enriquez, General Counsel

Department of Children and Families

Building 2, Room 204F

1317 Winewood Boulevard

Tallahassee, Florida 32399 - 0700

N OTICE OF R IGHT T O S UBMIT E XCEPTIONS

All parties have the right to submit writt en 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.