21-001380MTR Armando R. Payas, Esquire, Guardian Ad Litem For A.D.J., Jr., Carvetta Taylor; And Arthur D. Jamison, Sr.; Individually, And On Behalf Of A.D.J., Jr., A Minor vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Tuesday, August 3, 2021.

Summary: Petitioner proved, 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 , E SQUIRE , G UARDIAN

A D L ITEM F OR A.D.J., J R ., C ARVETTA

T AYLOR ; A ND A RTHUR D. J AMISON , S R .;

I NDIVIDUALLY , A ND O N B EHALF OF

A.D.J., J R ., A M INOR ,

Petitioners ,

vs. Case No. 21 - 1380 MTR

A GENCY F OR H EALT H 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 120.56 9 and 120.57(1), Florida Statutes (2020), 1 on

June 17 , 2021, before Administra tive Law Judge ("ALJ") Cathy M. Sellers.

A PPEARANCES

For Petitioner: Carlos R. Diez - Arguilles, Esquire

Maria D. Tejedor, Esquire

Diez - Argu e lles & Tejedor , P.A.

505 North Mills Avenue

Orlando, Florida 32803

For Respondent: Alexander R. Boler, Esquire

Suite 300

2073 Summit Lakes Drive

Tallahassee, Florida 32317

1 All references to chapter 120 are to the 2020 codificatio n .

S TATEMENT OF T HE I SSUE

The issue to be determined is the amoun t 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 April 23 , 2021, Petitioner Armando Payas, as Guardian Ad Lite m for

A.D.J. , Jr. , and Petitioner s Carvetta Taylor and Arthur D. Jamison, Sr. ,

individually and on behalf of A.D.J., Jr., filed a P etition to Allocate the

Settlement Recovery and Reduce the Amount of the Lien Asserted by the

Agency for Health Care Administ ration (Medicaid [ ) ] , to determine the

amount to be paid to Respondent, the Agency for Health Care Administration

("AHCA") , in satisfaction of the Medicaid lien that AHCA has asserted

against A.D.J., Jr.'s, settlement in a medical malpractice action .

The final hearing was scheduled for, and held on , June 17, 2021 .

Petitioners presented the testimony of Maria D. Tejedor , who testified as a

fact and expert witness, and Todd E. Copeland , who testified as an expert

witness . Petitioners' Exhibit Nos. 1 and 7 th rough 12 were admitted i nto

evidence without objection; and Petitioners ' Substitute E xhibit No. 2 and

Exhibit Nos. 3 , 4, 5, and 10 were admitted into evidence over objection .

AHCA did not present any witnesses or tender any exhibits for admission

into the record.

2 All references to chapter 409 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 which AHCA's right to reimbursement vests, in turn , determines the version of

section 409.91 0 that applies in proceedings to determine the portion of the t hir d - party

settlement payable to AHCA in satisfaction of its Medicaid lien . See Cabrera v. Ag. for Health

Care Admin ., 315 So. 3d 140, 142 (Fla. 1st DCA 2021); Eady v. State , Ag. for Health Car e

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)) .

Pursuant to Petitioners' motion, a Protective Order was entered on

July 16, 2021, keeping confidential Petitioners' Substitute Exhibit No. 2, as

required by the third - party settlement agreement.

The one - volume Transcript was filed at the Divis ion of Administrative

Hearings (" DOAH ") on July 13, 2021 . Pursuant to motion, the deadline for

filing proposed final orders was extended to July 28, 2021. T he parties timely

fi led their P roposed F inal O rders ("PFOs") on July 28 , 2021 , and b oth PFOs

have be en duly considered in preparing this Final Order.

F INDINGS O F F ACT

The Parties

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

A.D.J., Jr., a minor. Petitioner s Carvetta Taylor and Arthur D. Jamison, Sr.,

are A.D.J., Jr.'s, pare nts .

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

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

Stipulated Facts

3. In the underlying 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 A.D.J., Jr., to suffer severe and

permanent brain damage, whic h resulted in substantial expenses being

in curred for his medical and nursing care.

4. There also is a separate cause of action asserted on behalf of A.D.J.,

Jr's., parents, Carvetta Taylor and Arthur Jamison, for their own injuries for

their loss of services, earnings, companionship, society, and affection of

A.D.J., Jr., and for the value and expense of A.D.J., Jr.'s, hospitalizations and

medical and nursing care, in the past and future.

5. As a result of th e alleged third - party negligence, Petitioner A.D.J., Jr.,

sustained severe and permanent brain damage, including hypoxic ischemic

encephalopathy and neurodevelopment disorder. As a result of those

permanent injuries, A.D.J., Jr., requires medical care and treatment for the

rest of his life.

6. AHCA, through the Medicaid program, paid $39,85 4.66 for A.D.J., Jr.'s,

medical care related to his claim against the liable third - parties in

Petitioners' medical malpractice action.

Facts Based on Evidence Adduced at the Final Hearing

7 . A.D.J., Jr. , is a minor child for whom M edica id paid medical e xpenses

for treatment for injuries resulting from third parties' failure to provide

proper prenatal care, identify and treat prenatal distress, and timely order a

Caesarian delivery.

8 . As stated above, as the result of this negligent treatment , A.D.J., Jr. ,

sustained severe and permanent brain damage, including hypoxic ischemic

encephalopathy and neurodevelopment disorder , which results in him

suffering from a seizure disorder . As a result of these injuries, he will require

a certain level of medical car e for the rest of his life. Additionally, his future

earnings capacity is negatively affected, due to cognitive impairment

resulting from his birth - related injuries.

9 . Medicaid first made payments for A.D.J., Jr.'s, medical care in 201 2 .

10 . Petitione rs initiated a medical malpractice action against one or more

medical providers . The action ultimately settled in 202 1 , for $775 ,000.00 .

1 1 . AH CA has asserted a Medicaid lien, in the amount of $39,854.66 against

the portion of the settlement allocated t o A.D.J., Jr. 3

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

Admin. , 248 So. 3d 53, 56 (Fla. 201 8) .

1 2 . If the formula in section 409.910 (11)(f) is applied to the settlement

proceeds allocated to A.D.J., Jr., then the full amount of the $39,864.66

Medicaid lien should be paid to AHCA. 4

1 3 . Maria Tejedor, the lead attorney representing A.D.J., Jr., and his

parents in the underlying medical malpractice case, testified regarding the

value of A.D.J., Jr.'s, medical malpractice claim.

1 4 . Tejedor is a Florida Bar Board - certified a ttorney in civil trial practice

with over 20 years of experi ence in medical malpractice matters, 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 5 . Based on Tejedor's experience with similar cases involving children

who have sustained brain damage as a result of medical malpractice, she

estimated that the full value of A.D.J., Jr.'s, medical malpractice case was

$21, 939 ,105.12.

1 6 . Based on A.D.J., Jr.'s, medical history , and on Tejedor's ex perience in

valuing similar medical malpractice cases and allocating settlement amounts,

she ( Tejedor ) testified that the $21,939,105.12 value of the medical

malpractice case would properly be allocated as follows: $ 15,694,185.50 for

future medical expense s; $ 1,204,418.00 for lost earnings' capacity;

$5,000,000.00 for pain and suffering; $ 39,854.66 for the Medicaid lien; and

$ 646.96 for a nother medical services lien.

1 7 . The underlying medical malpractice case settled for substantially less

than its full v alue , in part because the treating physician was uninsured, and

also because one of the birth - related injuries that A.D.J., Jr. , incurred,

4 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 brought under

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

under the formula.

attention deficit hyperactivity disorder, could partially be attributed to

A.D.J., Jr. , having inherited the conditio n.

18 . The $775,000.00 settlement amount constitutes 3.5 percent of the full

value of $21,939,105.12 of t he case.

1 9 . Using the pro rata method to allocate the $775,000.00 settlement to

future medical expenses, lost earnings, pain and suffering, the M edicaid lien ,

and the other medical services lien, the value allocated to each of these

categories of damages and expenses , discussed above, is multiplied by 3.5

percent , to determine the portion of the total settlement amount allocated to

each of these ca tegories .

20 . Multiplying 3.5 percent by $ 39,854.66 , which is the amount of the

Medicaid lien , yields $1,394.91. 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 testified, 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 a ctions and resolution 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 exp ert between 10 and 20

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

medical malpractice cases.

2 4 . He testified that $21,939,105.12 is a conservative estimate of the full

value of the underlying medical malpractice case . I n formulating his expert

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

Dr. Craig H. Lichtblau , M.D.; A.D.J., Jr.'s, medical records; his own

communications with A.D.J., Jr.'s, guardian ad litem; the very conservative

estimat e of A.D.J., Jr.'s, pain and suffering in this case ; jury verdicts in

similar medical malpractice cases; and his own professiona l experience

regarding the valuation of medical malpractice cases.

2 5 . Copeland confirm ed that the pro rata method of allocatin g 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 other medical services lien s ) proportional to the amount

allocated to that specifi c 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 confirmed that the pro rata

methodology is consistent with that ratified by the U .S. Supreme Court in

Ahlborn .

2 6 . Copeland opined, based on the application of the pro rata allocation

met hod to this case, that AHCA is entitled to payment of 3.5 percent of

$39,854.66 , which equals $1,394.91, in satisfaction of its Medicaid lien.

C ONC LUSIONS O F L AW

2 7 . 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).

2 8 . Petitioner s bear the burden to prove , by clear and convincing evidence ,

that the amount p ayable to AHCA in satisfaction of its Medicaid lien is less

than the $ 39,854.66 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 pa rty disputing the amount to be

paid in satisfaction of a Medicaid lien , by clear and convincing evidence).

2 9 . Medicaid is a joint federal - state cooperative program that helps

participating states provide medical services to residents who cannot afford

tre atment. 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 with federal Medicaid statutes and

regulations. Id. 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

reci pients by prohibiting state Medicaid agencies from imposing liens against

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

3 1 . However, the Act also contains a narrow exception to this anti - lien

provision which requires states to seek reimbursement for th eir 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 judg ment or settlement not designated for medical care. Id. ;

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

3 2 . The Act limits the portion of a recipient's tort recovery on which a

state 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).

3 3 . 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 enac ted 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 Med icaid 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 Medicaid

program.

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

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 rights 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 collateral.

* * *

(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

follow s:

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 total 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 benefits up to the total amount of

medical assistance provided by Medicaid. For

purpo ses 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 Medicaid 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 holding in Wos that the Act's anti - lien provision

preempts state statutes that create a c onclusive presumption regarding the

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

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

administrative process under chapter 120 to contest the amount designa ted

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 (Fla. 1st DCA 2018); Mobley v. State, Ag. for Health Care

Admin. , 181 So. 3d 1233, 12 35 (Fla. 1st DCA 2015).

3 8 . 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 legal

representative, may contest the amount designated

as recovered me dical 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 th ird - 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 chapter 120, the payment of funds to the agency

or the placement of t he 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 Administrati ve 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 recovered medical expenses,

the recipient must prove, by clear and con vincing

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 formula

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

recipient mus t 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 recipients who assert

that the amount payable to satisfy AHCA's Medic aid 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 , for 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. State, Ag. for Health Care Admin. , 143 So. 3d 478, 480

(Fla. 1st DCA 2014).

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

Care Admin istration , 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 exp enses 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 re quired 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 reduction of the

Medicaid lien as calculated under the formula in se ction 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. State, Ag. for Health Care Admin. , 291 So. 3d

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

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

Health 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 Medicaid lien . See,

e.g. , Armando R. Payas, as Guardian Ad Litem for E.R., a Minor , Jennett

Camacho, Individually and on Behalf of E.R., a Minor v. Ag. for Health Care

Admin. , Case No. 21 - 0442MTR (Fla. DOAH Jun. 1, 2021); Shirley McBride,

as Personal Representative of the Estate of Robin McBride v. Ag. for Health

Care Admin. , Case No. 20 - 525 8 MTR (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 Tava rius 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 Miller v. Ag. for Health Care Admin. ,

Case No. 2 0 - 3511MTR (Fla. DOAH O ct. 19, 2020); Mary Bishop, b y and

through Her Guardian Nicole Milstead v. Ag. for Health Care Admin. , Case

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

as Parent and Natural Guardian of A.F., a Minor v. Ag. for Health Care

Admin. , Ca se No. 20 - 2124MTR (Fla. D OAH 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 Admin. , Case No.

20 - 0605MTR (Fla. DOAH Aug . 18, 2020).

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

allocation method is a reasonable methodology for allocating Petitioners '

third - party settlement proceeds , including the amount payable to AHCA in

satisfaction of its Medicaid lien .

4 4 . As noted above, AHCA did not pre sent any countervailing evidence at

the final hearing. Thus, there is no evidentiary basis in the record for

rejecting Petitioners' evidence, which, as found above, credibly and

persuasively shows that the pro rata allocation method is a fair and

reasonabl e method for determining Petitioners' past medical damages , for

purposes of determining the amount payable to satisfy AHCA's Medicaid lien.

4 5 . Pursuant to Eady and other case law cited above , it would be

reversible error for the undersigned to reject app lication of the pro rata

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

for purposes of the amount of the settlement proceeds payable to AHCA in

satisfaction of its Medicaid Lien.

4 6 . Based on the foregoing, it is conclude d that AHCA is entitled to a

payment of $1,394.91 in satisfaction of its Medicaid lien.

O RDER

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

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

payment of $ 1,394.91 from Petitioners' third - party settlement proceeds in

satisfaction of its Medicaid lien.

D ONE A ND O RDERED this 3rd day of August , 2021 , in Tallahassee, Leon

County, Florida.

S

C ATHY M. S ELLERS

Administrative Law Judge

12 30 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 3rd day of August, 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

S hena 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

Tallahassee, 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

revie w 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 Admi nistrative 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 clerk 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.