21-000442MTR Armando R. Payas, As Guardian Ad Litem For E.R., A Minor, Jennett Camacho, Individually And On Behalf Of E.R., A Minor vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Tuesday, June 1, 2021.

Summary: Petitioners showed, by clear and convincing evidence, that AHCA's Medicaid lien should be reduced, pursuant to pro rata allocation.

S TATE OF F LORIDA

D IVISION OF A DMINISTRATIVE H EARINGS

A RMANDO R. P AYAS , A S G UARDIAN A D

L ITEM F OR E.R., A M INOR , J ENNETT

C AMACHO , I NDIVIDUALLY A ND O N

B EHALF OF E.R., A M INOR ,

Petitioners ,

vs. Case No. 21 - 0442MTR

A GENCY F OR H EALTH C ARE

A DMINISTRATION ,

Respondent .

/

F INAL O RDER

Pursuant to notice, a hearing was conducted by Zoom Conference in this

case , pursuant to sections 120.569 and 120.57(1), Florida Statutes (2020), 1 on

April 13, 2021, before Administra tive Law Judge ("ALJ") Cathy M. Sellers.

A PPEARANCES

For Petitioner: Carlos R. Diez - Arguilles, Esquire

Maria D. Tejedor, Esquire

Diez - Arguilles & Tejedor

505 North Mills Avenue

Orlando, Florida 32803

For Respondent: Alexander R. Boler, Esquire

2073 Summit Lakes Drive, Suite 300

Tallahassee, Florida 32317

1 All references to chapter 120 are to the 2020 codification.

S TATEMENT O F T HE I SSUE

The issue to be determined is the amount to be paid , pursuant to

section 409.910(17)(b), Florida Statutes, from the proceeds of a third - party

settlement, in full satisfaction of the agency's Medicaid lien . 2

P RELIMINARY S TATEMENT

On March 24, 2021, Petitioner Armando Payas, as Guardian Ad Litem for

E.R., and Petitioner Jenne t t Camacho, indiv idually and on behalf of E.R.,

filed an Amended P etition for Hearing to Allocate the Settlement Recovery

and Reduce the Amount of the Lien Asserted by the Agency for Health Care

Administration (Medicaid), to determine the amount to be paid to

Respondent, t he Agency for Health Care Administration ("AHCA") , in full

satisfaction of the Medicaid lien that AHCA has asserted against E.R.Ôs

confidential settlement in a medical malpractice action .

A Protective Order was entered on April 13, 2020, keeping confiden tial

Petitioners ' Exhibit No. 2, as required by the third - party settlement

agreement ; and Petitioners ' Exhibit Nos. 3, 4 , and 10, and Respondent's

Exhibit A, which contain personal health information protected from

disclosure by federal law.

The final he aring was scheduled for, and held on , April 13, 2020.

Petitioners presented the testimony of Maria D. Tejedor and Todd E.

Copeland . Petitioners' Exhibit Nos. 1 and 4 were admitted i nto evidence

2 All references to chapter 40 9 are to the 2020 version, which was in effect at the time that

the underlying third - party medical malpractice case settled. AHCA's right to reimbursement

from third - party benefits vests when the third - party settlement agreement is executed . The

date on wh ich AHCA's right to reimbursement vests, in turn , determines the version of

section 409.910 that applies in proceedings to determine the portion of the

third - party settlement payable to AHCA in satisfaction of its Medicaid lien . See Julio Cesar

Cabrera v. Ag. for Health Care Admin ., 2021 WL 1152328 , at *2 (Fla. 1st DCA Mar. 26,

2021); Eady v. State , Ag. for Health Care Admin. , 279 So. 3d 124 9, 1250 n.1 (Fla. 1st DCA

2019) (citing Suarez v. Port Charlotte HMA, LLC , 171 So. 3d 740 (Fla. 2d DCA 2015)) .

without objection; Petitioners ' E xhibit Nos. 2, 3, and 10 were admitted into

evidence over objection ; and official recognition was taken of Petitioners '

Exhibit Nos. 5 through 9. AHCA did not present witnesses or tender exhibits

for admission into the record.

The one - volume Transcript was filed at the Division of Administrative

Hearings (" DOAH ") on April 30, 2021. T he parties timely fi led their P roposed

F inal O rders ("PFOs") on May 10, 2021. B oth PFOs have been duly

considered in preparing this Final Order.

F INDINGS O F F ACT

The Parties

1. Petitioner Armando R. Pa yas is a court - appointed guardian ad litem for

E.R., a minor. Petitioner Jennett Camacho is E.R.'s mother .

2. Respondent, AHCA, is the state agency that administers the Medicaid

program in Florida. § 409.902, Fla. Sta t .

Stipulated Facts

3. In the underly ing medical malpractice action, Petitioners alleg ed that

the liable third party negligently failed to provide proper prenatal care,

ide ntify and treat prenatal stress, and timely orde r a Caesarian section

delivery. Petitioners asserted that this caused E.R . to suffer severe and

permanent brain damage, which, in turn, resulted in substantial expenses

being incurred for E.R.'s medical and nursing care.

4. As stated above, Camacho is E.R.'s mother.

Facts Based on Evidence Adduced at the Final Hearing

5. E.R . is a minor child for whom M edica id paid medical expenses for

treatment of a range of substantial and severe injuries and conditions that

resulted from inadequate prenatal care , prenatal stress , and birth distress.

6. E.R. is profoundly and permanently disabled. She has hypoxic brain

damage; is paralyz ed and wheelchair - bound; has a seizure disorder; is

visually impaired ; and is hearing impaired. She is unable to verbally

communicate, and requires gastric tube feeding, diaper changes, and total

assistanc e with transfers in and out of her wheelchair. She will never be able

to live independently, and she is , and will be , completely dependent , at all

times, on the care of others for her survival , currently and for the rest of her

life .

7. Medicaid first mad e payments for E.R.'s medical care in 2011, shortly

after her birth .

8. Petitioners initiated a medical malpractice action against one or more

medical providers which ultimately was settled in 2020, for the total amount

of $4,990,000.00.

9. $3,326,833. 00 of this settlement was allocated to E.R. , with the

remainder allocated to Camacho. 3

10 . AH CA has asserted a Medicaid lien, in the amount of $885,738.23,

against the portion of the settlement allocated to E.R . 4

11 . If the formula in section 409.910 (11)(f) is applied to the $3,326,833.00

in settlement proceeds allocated to E.R., then the full amount of the

$885,738.23 Medicaid lien should be paid to AHCA. 5

1 2 . Maria Tejedor, the lead attorney representing E.R. in the underlying

medical malpractice case, testified regarding the value of E.R.'s medical

malpractice claim.

1 3 . Tejedor is a Florida Bar Board - certified a ttorney in civil trial practice

with over 20 years of experience in medical malpractice matters,

3 This proceeding solely addresses the portion of the settlement allocated to E.R. that should

be paid to Medica id in satisfaction of its lien.

4 AHCA may assert a lien only on past medical expenses. Giraldo v. Ag. for Health Care

Admin. , 248 So. 3d 53, 56 (Fla. 2018).

5 As discussed below, the formula in section 409.910(11)(f) creates a presumptive "default

allocation" of the third - party settlement proceeds. This presumptive allocation may be

rebutted in an administrative proceeding Ð such as this proceeding Ð bro ught under

section 409.910(17)(b) , to contest the amount designated as recovered medical expenses

under the formula.

focusing primarily on civil actions involving infants and children who have

sustained brain damage. She has extensive experience in the valuation of

these types of cases.

1 4 . Based on her experience with similar cases involving children who

have sustained brain damage as a result of medical malpractice, Tejedor

testified that an estimate of $5,000,000.00 for the value of E.R.'s case is very

conservative, and that the full value of E.R.'s case is $24,146,546.57.

1 5 . Based on E.R.'s medical history and prognosis , and on her ( Tejedor's )

exper ience in valuing medical malpractice cases and allocating settlement

amounts, Tejedor testified that the full value of the medical malpractice case

would properly be allocated as follows: $17,065,739.00 for future medical

expenses; $1,128,000.00 for lost e arnings' capacity; $5,000,000.00 for pain

and suffering; $885,738.23 for the Medicaid lien; and $67,069.34 for a

children's medical services lien.

1 6 . The underlying medical malpractice case settled for substantially less

than its full value due to the r isks and challenges in going to trial Ð

specifically, the defenses that some o f E.R.'s injuries may be attributable to

her premature birth, and whether the statute of limitations had expired prior

to commencement of the medical malpractice action.

1 7 . The $4,990,000.00 settlement , including the allocation of

$3,326,833.00 to E.R., was determined to be fair an d reasonable, and was

approved by the court in which the medical malpractice action was brought .

1 8 . The $ 3,326,833.00 settlement amount recovered by E.R. constituted

13.7 percent of the full value of $24,146,546.57 for t he case.

1 9 . Using the pro rata method to allocate the $3,346 , 833.00 settlement to

future medical expenses, lost earnings, pain and suffering, the children's

medical services lien, a nd the Medicaid lien , 13.7 percent is multiplied by the

full value allocated to each of these categories of damages and expenses , as

discussed above, to determine the portion of the $3,326,833.00 settlement

that is allocated to each of these categories .

20 . Pertinent to this proceeding, 13.7 percent of the $885,738.23 Medicaid

lien yields $121,346 .13. Pursuant to the pro rata allocation method, this is

the amount payable to Medicaid in full sati sfaction of its Medicaid lien in this

case .

2 1 . Tejedor tes tified, and the case law bears out, that Florida courts and

ALJs consistently have accepted the pr o rata allocation method as a

reason able, fair, and accurate method ology , consistent with Arkansas

Department of Health and Human Services v. Ahlborn , 547 U.S . 2 68 (2006),

for allocating the settlement proceeds when the underlying third - party action

is settled for less than the full value of the case.

2 2 . Todd Copeland testified as an expert in the valuation of damages in

medical malpractice actions and resol ution of healthcare liens.

2 3 . Copeland has practiced law for 29 years, representing injured parties

in medical malpractice, personal injury, products liability, negligent security,

and premises liability cases. He has testified as an expert between 10 a nd 20

times over the past ten years regarding the valuation of damages and liens in

medical malpractice cases.

24. He testified that $24,146 , 546.57 is a conservative estimate of the full

value of the underlying medical malpractice case . In formulating hi s expert

opinion, C opeland relied on the report of Petitioners' non - testifying expert,

Dr. Anthony Rodriquez, M.D.; E.R.'s medical records; his own

communications with E.R.'s guardian ad litem; Tejedor's opinion regarding

the present value of future medica l expenses, lost earnings, and E.R.'s pain

and suffering in this case ; jury verdicts in similar medical malpractice cases;

his own professiona l experience regarding the valuation of medical

malpractice cases; and the amount of the Medicaid lien.

25 . Copel and confirm ed that the pro rata method of allocating the

settlement proceeds to each specific category of damages and expenses ( i.e.,

future medical expenses, pain and suffering, lost earnings' capacity, and the

Medicaid and children's medical services lie n s , discussed above ) proportional

to the amount allocated to that specific category if the total value of the case

had been recovered in the third - party settlement, is a fair and reasonable

method for allocating the settlement proceeds. He further confirme d that the

pro rata methodology is consistent with that ratified by the U.S. Supreme

Court in Ahlborn .

26 . Copeland opined, based on the application of the pro rata allocation

met hod to this case, that AHCA is entitled to payment of 13.7 percent of the

$8 85,738.23 , or $121,346.13, in satisfaction of its Medicaid lien.

C ONCLUSIONS O F L AW

27 . DOAH has jurisdiction over the parties to, and subject matter of, this

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

28 . Petitioner s bear t he burden of proof, by clear and convincing evidence ,

to show that the amount payable to AHCA in satisfaction of its Medicaid

lien is less than $885,738.23 that would be due if the formula in

section 409.910(11)(f) were applied in this proceeding. Gallardo v. Dudek , 963

F.3d 1167 , 1182 ( 11th Cir. 2020)(burden of proof is on the party disputing the

amount to be paid in satisfaction of a Medicaid lien , by clear and convincing

evidence).

29 . Medicaid is a joint federal - state cooperative program that helps

part icipating states provide medical services to residents who cannot afford

treatment. Ahlborn , 547 U.S. at 275. The federal Medicaid Act ("Act") governs

regulation of the Medicaid program, and it mandates that states that

participate in the program comply wi th federal Medicaid statutes and

regulations. Id. at 275. As a condition for receipt of federal Medicaid funds,

states are required to seek reimbursement for medical expenses incurred on

behalf of beneficiaries who later recover from a third party. Id. at 276.

30 . The Act contains a general anti - lien provision that protects Medicaid

recipients by prohibiting state Medicaid agencies from imposing liens against

a recipient's property. 42 U.S.C. § 1396p(a)(1).

31 . However, the Act also contains a narrow exce ption to this anti - lien

provision which requires states to seek reimbursement for their Medicaid

expenditures by pursuing payment from third parties who are legally liable

for a Medicaid recipient ' s medical expenses. Ahlborn , 547 U.S. at 284 - 85.

States are preempted from taking any portion of a Medicaid beneficiary's

third - party tort judgment or settlement not designated for medical care. Id. ;

Wos v. E.M.A. , 568 U.S. 627, 630 (2013).

32 . The Act limits the portion of a recipient's tort recovery on which a

s tate can impose a lien to past medical expenses only . Giraldo v. Ag. for

Health Care Admin ., 248 So. 3d 53, 56 (Fla. 2018)(" Giraldo II ")(emphasis

added).

33 . To comply with the Act's requirement that states seek reimbursement

for Medicaid expenditures from judgments or settlements paid by third

parties to Medicaid recipients, Florida enacted section 409.910, the Medicaid

Third - Party Liability Act.

3 4 . Section 409.910(6)(c) creates an automatic lien, on behalf of AHCA , on

a judgment or settlement paid by a third party to a Medicaid recipient for the

amount of medical care furnished by Medicaid to the recipient. The lien

attaches automatically when a recipient first receives treatment for which

AHCA may be obligated to provide medical assistance under the Me dicaid

program.

3 5 . Section 409.910(11)(f) establishes a formula for determining the

amount owed to AHCA in satisfaction of its Medicaid lien. This statute

states, in pertinent part:

(11) The agency may, as a matter of right, in order

to enforce its rig hts under this section, institute,

intervene in, or join any legal or administrative

proceeding in its own name in one or more of the

following capacities: individually, as subrogee of

the recipient, as assignee of the recipient, or as

lienholder of the co llateral.

* * *

(f) Notwithstanding any provision in this section to

the contrary, in the event of an action in tort

against a third party in which the recipient or his

or her legal representative is a party which results

in a judgment, award, or settlement from a third

party, the amount recovered shall be distributed as

follows:

1. After attorneyÔs fees and taxable costs as defined

by the Florida Rules of Civil Procedure, one - half of

the remaining recovery shall be paid to the agency

up to the t otal amount of medical assistance

provided by Medicaid.

2. The remaining amount of the recovery shall be

paid to the recipient.

3. For purposes of calculating the agencyÔs recovery

of medical assistance benefits paid, the fee for

services of an attorney retained by the recipient or

his or her legal representative shall be calculated

at 25 percent of the judgment, award, or

settlement.

4. Notwithstanding any provision of this section to

the contrary, the agency shall be entitled to all

medical coverage be nefits up to the total amount of

medical assistance provided by Medicaid. For

purposes of this paragraph, Ñmedical coverageÒ

means any benefits under health insurance, a

health maintenance organization, a preferred

provider arrangement, or a prepaid health clinic,

and the portion of benefits designated for medical

payments under coverage for workersÔ

compensation, personal injury protection, and

casualty.

3 6 . This formula creates a presumptive "default allocation" of third party

proceeds subject to a Medi caid lien where, as here, AHCA does not

participate in the settlement. See Roberts. v. Albertson's Inc. , 119 So. 3d 457,

465 - 66 (Fla. 4th DCA 2012); Ag. for Health Care Admin. v. Riley , 119 So. 3d

514, 516 (Fla. 2d DCA 2013).

3 7 . Consistent with the holdin g in Wos that the Act's anti - lien provision

preempts state statutes that create a conclusive presumption regarding the

amount of medical expenses for which the state is entitled to reimbursement,

the Florida Legislature enacted section 409.910(17)(b), whic h creates an

administrative process under chapter 120 to contest the amount designated

as recovered medical expense damages payable to AHCA pursuant to the

formula in section 409.910(11)(f). See Delgado v. Ag. for Health Care Admin. ,

237 So. 3d 432, 435 (F la. 1st DCA 2018); Mobley v. Ag. for Health Care

Admin. , 181 So. 3d 1233, 1235 (Fla. 2015).

38 . Section 409.910(17)(b) states:

(b) If federal law limits the agency to

reimbursement from the recovered medical expense

damages, a recipient, or his or her leg al

representative, may contest the amount designated

as recovered medical expense damages payable to

the agency pursuant to the formula specified in

paragraph (11)(f) by filing a petition under chapter

120 within 21 days after the date of payment of

funds to the agency or after the date of placing the

full amount of the third - party benefits in the trust

account for the benefit of the agency pursuant to

paragraph (a). The petition shall be filed with the

Division of Administrative Hearings. For purposes

of c hapter 120, the payment of funds to the agency

or the placement of the full amount of the third -

party benefits in the trust account for the benefit of

the agency constitutes final agency action and

notice thereof. Final order authority for the

proceedings specified in this subsection rests with

the Division of Administrative Hearings. This

procedure is the exclusive method for challenging

the amount of third - party benefits payable to the

agency. In order to successfully challenge the

amount designated as re covered medical expenses,

the recipient must prove, by clear and convincing

evidence, that the portion of the total recovery

which should be allocated as past and future

medical expenses is less than the amount

calculated by the agency pursuant to the form ula

set forth in paragraph (11)(f). Alternatively, the

recipient must prove by clear and convincing

evidence that Medicaid provided a lesser amount of

medical assistance than that asserted by the

agency.

3 9 . Pursuant to section 409.910(17)(b), Medicaid r ecipients who assert

that the amount payable to satisfy AHCA's Medicaid lien should be reduced

are entitled to present evidence in an administrative forum to show that the

lien amount exceeds the amount recovered , in a third party settlement or

judgment , f or past medical expenses. When such evidence is introduced, the

ALJ must consider it in determining whether the Medicaid lien should be

reduced. See Harrell v. Ag. for Health Care Admin. , 143 So. 3d 478, 480 (Fla.

1st DCA 2014).

40 . The First District Co urt of Appeal, in Eady v. State, Agency for Health

Care Administration , 279 So. 3d 1249 ( Fla. 1st DCA 2019), determined Ð

under circumstances comparable to those in this case, where the Medicaid

recipient presented expert testimony regarding the appropriate share of

settlement funds to be allocated to past medical expenses and the agency did

not present evidence to refute the experts' opinions Ð that utilizing the pro

rata allocation method for determining the amount of the third - party

recovery to be allocated to past medical expenses not only was appropriate,

but was required under the circumstances. Id. at 1259. Citing Giraldo II , the

court in Eady determined, as a matter of law, that the ALJ was not

authorized to reject uncontroverted testimony where there is no reasonable

basis in the evidence for doing so. Id .

4 1 . Since Eady , Florida courts consistently have held that where a

Medicaid recipient presents unrebutted competent substantial evidence to

show that the pro rata allocation method supports a reducti on of the

Medicaid lien as calculated under the formula in section 409.910(11)(f), it is

reversible error for an ALJ to reject the use of such methodology in

determining the amount of the Medicaid lien pursuant to

section 409.910(17)(b), unless there is a reasonable basis in the evidentiary

record for doing so. See, e.g., Bryan v. Ag. for Health Care Admin. , 291 So. 3d

1033, 1036 (Fla. 1st DCA 2020); Mojica v. Ag. for Health Care Admin. , 285

So. 3d 393, 398 (Fla. 1st DCA 2019); Larrigui - Negron v. Ag. for He alth Care

Admin. , 280 So. 3d 550 (Fla. 1st DCA 2019).

4 2 . The pro rata allocation method also consistently has been applied in

Medicaid third - party reimbursement challenges brought at DOAH under

section 409.910(17)(b) , to reduce the amount of AHCA's Medic aid lien . See,

e.g. , Shirley McBride, as Personal Representative of the Estate of Robin

McBride v. Ag. for Health Care Admin. , Case No. 20 - 5259MTR (Fla. DOAH

Mar. 9, 2021); Gregory McE lveen, through the Personal Representative of his

Estate, Daniel Hallup v. Ag. for Health Care Admin. , Case No. 2 0 - 4223MTR

(Fla. DOAH Feb. 2, 2021); Misty Mobley and Tavarius Sanders, Individually

and on Behalf of Tavarion Sanders, a Minor v. Ag. for Health Care Admin. ,

Case No. 20 - 4033 MTR (Fla. DOAH Dec. 21, 2020); Mitchell M iller v. Ag. for

Health Care Admin. , Case No. 2 0 - 3511MTR (Fla. DOAH O ct. 19, 2020); Mary

Bishop, by and through Guardian Nicole Milstead v. Ag. for Health Care

Admin. , Case No. 20 - 1526MTR (Fla. DOAH Sept. 23, 2020); Amy Lopez,

Individually and as Parent an d Natural Guardian of A.F., a Minor v. Ag. for

Health Care Admin. , Ca se No. 20 - 2124MTR (Fla. DOAH Sept. 3, 2020);

Valeria Alcala, a Minor, by Yobany E. Rodriguez - Camacho and Manuel E.

Alcala, as Natural Guardians and Next Friends v. Ag. for Health Care

Adm in. , Case No. 20 - 0605MTR (Fla. DOAH Aug . 18, 2020).

4 3 . Here, the competent substantial evidence establishes that the pro rata

allocation method is a fair and reasonable methodology for allocating

Petitioners ' third - party settlement proceeds , including t he amount payable to

AHCA in satisfaction of its Medicaid lien . As noted above, AHCA did not

present any countervailing evidence at the final hearing. Thus, there is no

evidentiary basis in the record for rejecting Petitioners' evidence, which, as

found ab ove, credibly and persuasively shows that the pro rata allocation

method is a fair and reasonable method for determining Petitioners' past

medical damages , for purposes of determining the amount payable to satisfy

AHCA's Medicaid lien. Pursuant to Eady and other case law cited above , it

would be reversible error for the undersigned to reject application of the pro

rata allocation method to Petitioners' third - party settlement recovery in this

case , for purposes of the amount of the settlement proceeds payabl e to AHCA

in satisfaction of its Medicaid Lien.

4 4 . Based on the foregoing, it is concluded that AHCA is entitled to a

payment of $121,346.13 in satisfaction of its Medicaid lien.

O RDER

Based on the foregoing Findings of Fact and Conclusions of Law, it i s

O RDERED that the Agency for Health Care Administration is entitled to

payment of $121 , 346.13 from Petitioners' third - party settlement proceeds in

satisfaction of its Medicaid lien.

D ONE A ND O RDERED this 1st day of June , 2021 , in Tallahassee, Leon

County , Florida.

S

C ATHY M. S ELLERS

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 June , 2021 .

C OPIES F URNISHED :

Maria D. Tejedor, Esquire Alexander R. Boler, Esquire

Diez - Arguelles & Tejedor , P.A. 2073 Summit Lake Drive , Suite 300

505 North Mills Avenue Tallahassee, Florida 32317

Orlando, Florida 32803

Carlos R. Diez - Arguelles, Esquire

Simone Marstiller, Secretary Diez - Arguelles & Tejedor, P.A.

Agency for Health Care Administration 505 North Mills Avenue

2727 Mahan Drive, Mail Stop 1 Orlando, Florida 32803

Tallahassee, Florida 32308

Thomas M. Hoeler, Esquire

James D. Varnado, General Counsel Agency for Health Care Administration

Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3

2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308

Tallahassee, Florida 32308

Shena L. Grantham, Esquire

Richard J. Shoop, Agency Clerk Agency for Health Care Administration

Agency for Health Care Administration Building 3, Room 3407B

2727 Mahan Drive, Mail Stop 3 2727 Mahan Drive ,

Tallahasse e, Florida 32308 Tallahassee, Florida 32308

N OTICE O F R IGHT T O J UDICIAL R EVIEW

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

review pursuant to section 120.68, Florida Statutes. Review proceedings are

governed by the Florida Rules of Appellate Procedure. Such proceedings are

commenced by filing the original notice of administrative appeal with the

agency clerk of the Division of Administrative Hearings within 30 days of

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

by any filing fees prescribed by law, with the cler k of the d istrict c ourt of

a ppeal in the appellate district where the agency maintains its headquarters

or where a party resides or as otherwise provided by law.