STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
PLANTATION GENERAL HOSPITAL ) LIMITED PARTNERSHIP, d/b/a )
PLANTATION GENERAL HOSPITAL, ) Case Nos. 03-1868 through 03-1880;
) 03-1885 through 03-1890;
Petitioner, ) 03-1892 through 03-1909;
) 03-1918 through 03-1919;
vs, ) 03-1928 through 03-1935;
) 03-2681; 03-2981 through
AGENCY FOR HEALTH CARE ) 03-2991; 03-2993; 03-3465
ADMINISTRATION, ) through 03-3467; 03-3971;
) 03-3974; 04-1555; 04-1557
Respondent. ) through 04-1559; 04-1562;
) 04-1564; 04-1580 through
04-1584; and 04-1882 RECOMMENDED ORDER
Pursuant to notice, a formal hearing was held in these cases before Larry J. Sartin, an Administrative Law Judge of the Division of Administrative Hearings, in Tallahassee, Florida, on September 8 through 10, 2003.
APPEARANCES
For Petitioners in Case Nos. 03-1868 through 03-1869; 03-1871
through 03-1880; 03-1885 through 03-1890, 03-1892 through
03-1909; 03-1918 through 03-1919, 03-1928 through 03-1935,
03-2981 through 03-2991, 03-3971; 03-3974; 04-1555; 04-1557
through 04-1559; 04-1562; 04-1564; 04-1580 through 04-1584;
and 04-1882:
Steven T. Mindlin, P.A.
Rose, Sundstrom & Bentley, LLP 2548 Blairstone Pines Drive Tallahassee, Florida 32301
For Petitioners in Case Nos. 03-1870, 03-2993, and 03-3467:
Michael J. Glazer, Esquire Ausley & McMullen
Post Office Box 391 Tallahassee, Florida 32302
For Petitioners in Case Nos. 03-2681, 03-3465, and 03-3466: Jonathan L. Rue, Esquire
Parker, Hudson, Rainer & Dobbs, LLP
1500 Marquis Two Tower
285 Peachtree Center Avenue, Northeast Atlanta, Georgia 30303
For Respondent: Eric H. Miller, Assistant General Counsel Grant Dearborn, Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Station No. 3 Tallahassee, Florida 32399-5403
STATEMENT OF THE ISSUES
The issues for decision in these cases, based upon the relief sought by Petitioners1 in their Petitions for Formal Administrative Hearing, are: whether Petitioners are entitled to "full credit or refunds of Medical Assistance Trust Fund assessments" paid by Petitioners to Respondent, the Agency for Health Care Administration, and if so, the amount of the refund each Petitioner is entitled to; whether Respondent denied the requested credit or refunds by an unadopted rule which constitutes an "invalid exercise of delegated legislative authority"; and whether Petitioners are entitled to reasonable costs and attorneys' fees pursuant to Section 120.595, Florida Statutes (2004).
PRELIMINARY STATEMENT
Cases Filed and Agreed-Upon Procedures
On various dates beginning in September 2002 each of the Petitioners filed a request with Respondent seeking the refund of Public Medical Assistance Trust Fund assessments paid by Petitioners and alleged to be overpayments. Those refund requests were denied in part by Respondent by letters dated February 21, 2003, and thereafter.
In response to the February 21, 2003, denial letters, each Petitioner timely filed a Petition for Formal Administrative Hearing (hereinafter referred to as the "Petition") with Respondent. On May 20, 2003, Respondent, by Notice, filed 51 of the Petitions with the Division of Administrative Hearings (hereinafter referred to as "DOAH"). Those Petitions were designated Case Numbers 03-1868 through 03-1880, 03-1885 through
03-1909, 03-1918 through 03-1919, and 03-1925 through 03-1935 (hereinafter referred to as the "Initial 51 Cases"). Some of the Initial 51 Cases were assigned to various Administrative Law Judges, but, when it was determined that the cases were related, the Initial 51 Cases were all assigned to the undersigned.
On May 22, 2003, Respondent filed AHCA's Motion for Consolidation seeking consolidation of the Initial 51 Cases. On May 28, 2003, the Petitioners in the Initial 51 Cases filed a Response in Opposition to AHCA's Motion for Consolidation and
Request for a Hearing on the Motion. Consequently, a motion hearing was conducted by telephone to consider the Motion for Consolidation and to establish procedures to be followed in hearing and deciding the cases. On June 12, 2003, following the motion hearing, an Order of Consolidation and Establishing Style was entered. Pursuant to the June 12, 2003, Order, the Initial 51 Cases were ordered consolidated, the use of a simplified style of these cases was ordered, and the procedures for the disposition of the Initial 51 Cases agreed to by the parties and the undersigned was memorialized:
. . . (1) that the [Initial 51 Cases] would be consolidated for a hearing on a legal issue which is central to all the cases; (2) that a preliminary ruling informing the parties of how this forum will decide the central legal issue would be entered following the consolidated hearing on the legal issue; and (3) that, to the extent then necessary, the cases would be heard separately to resolve the remaining factual issues involved only in individual cases.
Subsequent to the consolidation of the Initial 51 Cases, additional Petitions were received by Respondent which it filed with the DOAH. Some of those additional cases were filed prior to the hearing on the legal issue which is central to all the cases (hereinafter referred to as the "Central Legal Issue"), some were filed subsequent to the hearing, but before the preliminary ruling informing the parties of how the Central Legal Issue would be resolved was entered, and a few were filed after that preliminary
ruling was entered. The parties agreed that, regardless of when the additional cases were filed, they should be consolidated with the Initial 51 Cases and subject to the procedures for the disposition of the Initial 51 Cases established in the Order of Consolidation entered June 12, 2003.
The case numbers of cases filed after the filing of the Initial 51 Cases, when they were filed, and when they were consolidated are as follows: (1) Case Number 03-2681, filed July 22, 2003, added by a Second Order of Consolidation and
Establishing Style entered July 29, 2003; (2) Case Numbers 03-2981 through 03-2993, filed August 19, 2003, added by a Third Order of Consolidation and Establishing Style entered August 21, 2003; (3)
Case Numbers 03-3465 through 03-3467, filed on September 22, 2003, added by a Fourth Order of Consolidation and Establishing Style entered October 1, 2003; (4) Case Numbers 03-3970 through 03-3977, filed on October 23, 2003, added by a Fifth Order of Consolidation and Establishing Style; (5) Case Number 03-4497, filed on
December 2, 2003, consolidated in the preliminary ruling informing the parties of how the Central Legal Issue would be resolved;
(6) Case Numbers 04-1555 through 04-1564, and 04-1582, filed on April 26 and 27, 2004, added by a Sixth Order of Consolidation and Establishing Style; (7) Case Numbers 04-1580 through 04-1581, and 04-1583 through 04-1854, filed on April 27, 2004, added by a Seventh Order of Consolidation and Establishing Style; and Case
Number 04-1882, filed on April 27, 2004, added by an Eighth Order of Consolidation and Establishing Style.
Beginning with Case Number 03-3466 and subsequently filed cases, Respondent filed AHCA's Answer to Petitions. Respondent raised as a defense to the amounts being sought by the Petitioners in those cases the provisions of Section 215.26(2), Florida Statutes.
Step One of the Agreed Procedure; Hearing on the Central Legal Issue
The portion of the final hearing dedicated to the resolution of the Central Legal Issue was originally scheduled by a Notice of Hearing entered June 13, 2003, for August 4 through 8, 2003. On June 23, 2003, an Order Granting Continuance and Re-Scheduling Hearing was entered granting a Joint Unopposed Motion for Continuance and re-scheduling the hearing for September 8 through 12, 2003.
Pursuant to an Order of Pre-Hearing Instructions entered June 13, 2003, as modified by an Order Granting Motion to Modify Pre-Hearing Order entered August 18, 2003, the parties filed a Joint Pre-Hearing Stipulation on September 3, 2003. Facts
stipulated to in the Pre-Hearing Stipulation have been included in this Recommended Order, to the extent relevant to the resolution of the Central Legal Issue.
On the date the hearing commenced, September 8, 2003, Petitioners filed Petitioners' Motion to Exclude Witness. Argument
on the Motion was heard at the commencement of the hearing. In the Motion, Petitioners sought to exclude the testimony of a potential witness for Respondent, Carlton D. "Dyke" Snipes, whose name had not been disclosed to Petitioners consistent with the Order of Pre- Hearing Instructions.2 Respondent had informed Petitioners of the additional potential witness on September 3, 2003, a day after the deadline for such disclosure and several days after depositions had been completed. After hearing argument of the parties, Respondent was ordered to make Mr. Snipes available for deposition to determine if there would be any actual prejudice to Petitioners if Mr. Snipes were allowed to testify. His deposition was taken on September 8, 2003, during a recess of the hearing. Ultimately, Respondent decided not to call Mr. Snipes to testify.
During the hearing, Petitioners presented the testimony of Sarah Fitzgerald3 and Tony Swinson. Petitioners' Exhibits numbered
1 through 4, 8, 8A through 8H, 9, 11 through 34, 35 through 37, 40, 40A through 40O, 41, 41A through 41I, 42, 42A through 42H, 43, 43A through 43I, 44, 44A through 44G, 45, 45A through 45G, 46, 46A through 46D, 47A through 47J, and 48 through 50 were offered and admitted into evidence. Petitioners' Exhibits numbered 5, 38, and
39 were either withdrawn or not offered.
Respondent presented the testimony of Kenneth Thurston.4 Respondent also presented the testimony of Mr. Swinson.
Respondent's Exhibits numbered 3, 5 through 17, and 20 through 22
were offered and admitted into evidence. Part of Respondent's Exhibit numbered 24, consisting of the audited financial statements of Mt. Sinai Medical Center for fiscal year 2002, was admitted into evidence but for the limited purpose of corroborating the testimony of Mr. Thurston. Respondent's Exhibits numbered 19, 23, 25 through 27, and the rest of 24 were either withdrawn or not offered.
Official recognition was requested and taken of Respondent's Exhibits numbered 1, 2, 4 and 18.
Objections to the admissibility of exhibits and the attendant rulings are reflected in the two-volume Transcript of the hearing. Step Two of the Agreed Procedure: Entry of the Preliminary Order
The Transcript of the hearing was filed with the DOAH on September 30, 2003. On November 19, 2003, Respondent filed AHCA's Motion to Correct Errors in Official Transcript. In the Motion, counsel for Respondent listed a number of what he believed were errors in the Transcript with suggested corrections, and requested an order be entered incorporating the suggested corrections.
Petitioners filed Petitioners' Response to AHCA's Motion to Correct Transcript. No authority was cited by Respondent which supported its request. Nor was the undersigned aware of any authority which would allow this forum to modify the official transcript prepared by an authorized court reporter. The only authority found by the undersigned supported the denial of Respondent's request: Section 90.108(2), Florida Statutes (2003), provides that a "report of a
court reporter, when certified to by the court reporter as being a correct transcript of the testimony and proceedings in the case, is prima facia a correct statement of such testimony and proceedings." Respondent's recollection alone would not appear to overcome this presumption of correctness. The request was, therefore, denied.
By Notice of Filing of Transcript entered September 30, 2003, the parties were informed that their proposed orders and briefs were to be filed on or before November 14, 2003. Petitioners timely filed Joint Proposed Findings of Fact, Conclusions of Law and Preliminary Recommended Order of Petitioners and Petitioners' Memorandum of Law. Respondent timely filed Respondent's Preliminary Proposed Recommended Order. Those pleadings were fully considered in rendering the Preliminary Order and the entry of this Recommended Order.
The Preliminary Order, completing the second step of the procedure memorialized in the June 12, 2003, Order was entered on December 23, 2003. The Central Legal Issue was preliminarily addressed in that Order and the parties were ordered to complete the following tasks intended to complete the third step of the procedure:
Upon entry of this Preliminary Order, the parties shall attempt to determine the specific amount of any refund each Petitioner may be entitled to and to resolve any other outstanding issues in these cases. All parties are charged with this responsibility;
On or before February 18, 2004, the parties shall inform the undersigned in writing as to the status of their efforts to determine the amount of each Petitioners' refund, if any, whether additional time is required to resolve any outstanding issues, and whether any additional hearing will be necessary; and
The Findings of Fact and Conclusions of Law of this Preliminary Order will be included, along with additional findings of fact and conclusions of law relevant to this matter, in a Recommended Order when it is determined that issues related to the actual amount of any refund have been resolved by the parties or through additional hearing.
Concluding the third and final step of the agreed procedure proved to be more complex than had been anticipated. The difficulty was caused because the undersigned informed the parties through the Preliminary Order that the undersigned's resolution of the Central Legal Issue (hereinafter referred to as the "Imposition Method") was not one of the resolutions advocated by either of the parties.
The Response to the Preliminary Order; Request to Present Additional Evidence and Argument
On February 19, 2004, Petitioners filed a Motion to Permit Consideration of Additional Evidence and Argument. In this Motion the Petitioners summarized the unanticipated impact of the Preliminary Order:
At the hearing in September, two methodologies for implementing the amendments to Section 395.701, Florida Statutes adopted in Chapter 2000-256, Laws of Florida, were presented by the Parties. One of these methodologies represented the Petitioner's
position regarding the interpretation of the relevant law; the other methodology constituted the Agency's interpretation. In his Preliminary Order, the ALJ rejects both of these methodologies, and instead utilizes a different methodology, which relies upon the date of "imposition" of the PMATF [the Public Medicaid Assistance Trust Fund] as discussed more fully in the Preliminary Order.
Petitioners then requested that they be given an opportunity
to
present additional evidence relating to the following question: What would be the result of applying the "imposed" methodology, enunciated for the first time in the Preliminary Order, on PMATF collections in the State's fiscal year 7/1/00-6/30/01?
Petitioners went on in their Motion to present argument5 as to why they believed the presentation of additional evidence was proper and, in further support therefore, filed an affidavit of Sarah Fitzgerald.
Respondent filed AHCA's Response in Opposition to Motion to Permit Consideration of Additional Evidence and Argument.
Respondent addressed the Petitioners' various arguments and suggested that the relief suggested in the Motion was "unnecessary or premature "
On March 4, 2004, an Order Concerning Motion to Permit Consideration of Additional Evidence and Argument was entered. Recognizing the unanticipated impact of the Preliminary Order raised by Petitioners in their Motion, it was concluded that:
both parties should be given an opportunity to present further argument concerning the methodology which the undersigned has concluded is contemplated by Section 395.701, Florida Statutes, as amended. Additional evidence, however, does not appear to be necessary. The conclusions reached in the preliminary order are essentially legal conclusions based upon the unambiguous language of Section 395.701, Florida Statutes, as amended. Extrinsic evidence is not, therefore, necessary.
In light, however, of the manner in which this matter has progressed, the parties will be given an opportunity to proffer any additional evidence they believe is relevant to the proper resolution of the issues concerning the proper methodology. That evidence may be presented by a proffer of what . . . counsel believe the evidence would prove or by deposition testimony. Once additional evidence has been proffered by the parties, legal argument may then be filed in writing or by oral argument addressing the methodology recognized in the preliminary order.
The parties were then ordered to confer and agree upon the following:
Whether additional evidence to be proffered will be presented by counsel or by deposition. The additional proffered evidence shall be filed on or before a date to be agreed upon by the parties, but no later than April 7, 2004;
Whether additional argument concerning the methodology outlined in the preliminary order will be made in writing or orally. Additional argument is to be filed or made on a date to be agreed upon by the parties, but no later than April 21, 2004.
On March 19, 2004, Petitioners filed a Joint Status Report indicating that a conceptual framework for the proffer of
additional evidence had been agreed upon. It had been agreed that Petitioners would proffer additional evidence by deposition; Respondent had not yet decided whether to proffer additional evidence. Petitioners requested that the due date for the proffer, April 7, 2004, be extended until April 16, 2004. Finally, it was reported that the parties had not yet agreed on the manner in which additional argument would be made.
When the foregoing request for additional time was inadvertently not ruled on, Petitioners filed a Joint Request for Additional Time and Clarification of Upcoming Procedures.
Petitioners reported that depositions had been completed on
April 12, 2004, and that they were awaiting transcription thereof. Petitioners requested that the due date for filing the transcribed deposition testimony be extended to April 23, 2004. Petitioners also reported that the parties were unable to agree whether argument should be oral, as desired by Petitioners, or written, as desired by Respondent, and requested that the undersigned resolve this conflict.
On April 19, 2004, an Order Granting Joint Request for Additional Time and Clarifying Procedures was entered. The parties were given until April 23, 2004, to file the proposed proffered evidence. The parties were also informed that, absent agreement, additional argument was to be made in writing. They were given until May 1, 2004, to indicate whether additional argument would be
made orally or in writing and to suggest a mutually agreeable reasonable time to make oral arguments or file written arguments.
The Deposition of Sarah Fitzgerald and the Deposition of Robert Ducasse were filed respectively by Petitioners on April 22, 2004, and Respondent on April 23, 2004. The Depositions have not been considered in rendering this Recommended Order.
On April 29, 2004, Petitioners reported in a Joint Status Report that the parties had not been able to agree on the method by which additional argument would be made and, therefore, consistent with the April 19, 2004, Order Granting Joint Request for Additional Time and Clarifying Procedures, argument would be filed in writing on or before May 14, 2004.
On May 14, 2004, Petitioners' Additional Written Argument, and AHCA's Argument Supporting Implementation of 395.701, Florida Statutes (2000), by Clearly Stated Statutory Methodology, Supporting Admissibility of Proffered Testimony, and Opposing Admission of Testimony Proffered by Petitioners were filed. These pleadings have been fully considered in rendering this Recommended Order.
In its Additional Written Argument, Petitioners have raised the following arguments as to why they believe the Imposition Method is incorrect:
Most significantly, Petitioners argue that the Imposition Methodology is inconsistent with the legislative appropriation of
$28.3 million contained in Chapter 2000-256, Section 21, Laws of Florida;
The conclusions contained in the Preliminary Order concerning when the rate reduction is to be implemented are inconsistent and incorrect;
How the Imposition Method should be applied to hospitals with an April 30, May 31, and June 30, 2000, fiscal year end is uncertain;
Even if the Legislature intended that the assessment is to be "imposed" when all of the conditions for imposition have occurred, the Imposition Method fails to take into account all of those conditions; and
The Imposition Method is inconsistent with prior agency action.
Petitioners also argue in their Additional Written Argument that the proffered deposition and affidavit of Sarah Fitzgerald should be admitted into evidence and that the deposition of Robert Ducasse should be rejected as having no probative value.
In its additional argument Respondent first argues that no additional evidence is necessary or appropriate and essentially supports the conclusions of the Preliminary Order. Respondent also addresses the issue raised by Petitioners concerning the application of the Imposition Method to hospitals with an April 30, May 31, or June 30, 2000, fiscal year end, argues that the
deposition and affidavit of Ms. Fitzgerald should not be admitted, and argues that the deposition of Mr. Ducasse should be admitted and that Mr. Ducasse should be accepted as an expert in Florida tax implementation and tax administration.
All of the arguments raised by the parties have been fully considered and, to the extent necessary, have been addressed in this Recommended Order. As for the additional proffered evidence, it is hereby concluded that it should not be admitted.
Step Three of the Agreed Procedure; Determining that Actual Amount of Each Petitioners' Refund
In response to the portion of the Preliminary Order which required the parties to report, on or before February 18, 2004, the status of their efforts to determine the "amount of each Petitioners' refund, if any, whether additional time is required to resolve any outstanding issues, and whether any additional hearing will be necessary", Petitioners filed a Joint Status Report on February 12, 2004. It was represented in this Report that the parties were moving forward in good faith to determine the specific amount of refund due each Petitioner consistent with the Imposition Method, but that additional time was required to complete the process. An Order Extending Time to Resolve Issues was entered in response to the request for additional time, establishing April 30, 2004, as the next reporting date.
Status reports on the resolution of the foregoing issue were essentially abated while the issues concerning the proffer of
additional evidence and argument was resolved. In the Joint Status Report filed on April 29, 2004, resolving the proffer issue, Petitioners requested that the parties be given until May 31, 2004, to file a further status report concerning the actual calculation of refunds and any estimate of additional hearing time that might be required to resolve any dispute about the calculation. This request for additional time was granted, with a status report required on or before June 1, 2004, by Order Extending Time to Resolve Issues.
On June 30, 2004, Petitioners filed a Joint Status Report requesting an additional 30 days. This request was granted and the next status report was ordered to be filed on or before August 9, 2004. A Joint Status Report was filed on August 9, 2004.
On August 5, 2004, Petitioners filed a Motion to Bifurcate.
Petitioners argued, among other things, that until these cases become final, the correct methodology to be utilized in determining the amount of each Petitioners' refund will not be known.
Therefore, in order to avoid calculating the refunds based upon the Imposition Method, and facing the possibility of having to redo the calculations based upon a different methodology utilized by Respondent and/or the courts, Petitioners argued that the actual calculation of the amount of each Petitioners' refund should be abated, and that the Central Legal Issue be severed and presented
to Respondent for determination by recommended order. Respondent filed AHCA's Response in Opposition to Motion to Bifurcate.6
After hearing oral argument on the issue, an Order Denying Motion to Bifurcate was entered. It was recognized, however, in the Order that, although the undersigned lacked authority to grant the requested relief, the suggested bifurcation had merit and would benefit all parties. Therefore, the parties were ordered, on or before September 27, 2004, to
inform the undersigned in writing how they intend to proceed to resolve these cases. The parties may attempt to agree on the application of the methodology of the Preliminary Order or the parties may also attempt to agree on the application of other alternative methodologies, and proceed to hearing for only those Petitioners for which the parties are unable to agree. The parties may also agree to select one or more Petitioners, separate them from these proceedings, apply the methodology or methodologies to them, and issue a recommended order on those Petitioners while placing the others in abeyance. The parties may also suggest other agreed-upon resolutions.
On September 27, 2004, Respondent filed AHCA's Report on Case Procedure and Petitioners filed a Joint Response to Order.7 Respondent reported that it believed a case management conference "to schedule . . . discovery and hearings as necessary to resolve the remaining issues of disputed fact . . ." was necessary. In its Status Report, Petitioners indicated that the remaining issues had not yet been resolved and that they intended to file a motion to select four Petitioners, accounting for nuances relating to
different fiscal year ends, attempt to agree on the refunds for those hospitals, bifurcate those cases, and then ask that a recommended order be entered as to only those Petitioners. The other cases would then be placed in abeyance until the bifurcated cases were finalized.
On October 4, 2004, Petitioners indeed filed a Motion to Sever and Abate. Respondent filed AHCA's Limited Opposition to Motion to Sever and Abate. Respondent argued that the Motion should be denied, or, if not, that the severance should be limited to three specific cases. On October 13, 2004, the Motion to Sever and Abate was denied:
This forum does not have the authority to grant the specific relief requested by Petitioners or force Respondent to stand by its oral representation. The forum does have the authority, however, to sever any case for which there are no remaining issues of disputed fact. Therefore, if there are any cases in this consolidated group which no longer require hearing, they may be severed and a recommended order entered on them. The parties may also indicate that any case is ready for final hearing and, after completion of the final hearing, they may be severed and a recommended order entered.
Based upon the foregoing, it would not be appropriate at this time to order abatement. The question of abatement may, however, be revisited if any case or cases are severed in the future.
On January 21, 2005, Michael J. Glazer, counsel for some of Petitioners, filed a letter representing on behalf of the parties that they were "nearing completion of a review of all of the
numbers for the petitioners that remain in [these cases]."
Mr. Glazer further reported that the parties believed that they would "reach a stipulation as to all of the numbers, including calculations based upon the different variations of the methodologies that have been considered." Mr. Glazer requested that a status conference be scheduled in early February.
In response to Mr. Glazer's letter, a status conference was scheduled for February 3, 2005. The day of the conference a Stipulation was filed by the parties. Among other things, the parties reported the following:
The Parties have compiled, reviewed, and exchanged documents regarding the specific amount of refunds which would be due to each of the Petitioners under various potential methodologies either advocated by the parties or articulated by the Administrative Law Judge.
The Parties have agreed upon a series of documents relating to each Petitioner, which consist of source documents and calculations regarding the amount of refund to which each Petitioner would be due, under the various methodologies. . . .
. . . .
The Parties stipulate that these five notebooks [containing the calculations referenced in paragraph 2] should be entered into the record of the above-captioned case.
The five notebooks referenced in the Stipulation (hereinafter referred to as the "Refund Calculation Notebooks) are hereby admitted as Joint Composite 1.
In the Stipulation, the parties further represented:
With the admission of the notebooks into evidence, the Parties believe that the record contains the documentary evidence needed for the entry of a Recommended Order by the Administrative Law Judge. . . .
With this additional evidence and the appropriate explanation, the parties believe there are no additional disputed issues of material fact which would require additional hearings in the above-captioned case.
The conference was conducted as scheduled, with all parties being represented. At the conference, the evidenced contained in the Refund Calculation Notebooks8 was explained and it was agreed that it was time for the entry of a recommended order.
On March 24, 2005, an Order to Review Portions of the Recommended Order was entered. Pursuant to this Order, the parties were given an opportunity to review and comment in writing on the Preliminary Statement of the Recommended Order (up to the portion of the Preliminary Statement which ends before this paragraph) and proposed findings of fact concerning the Refund Calculation Notebooks. The parties were also given the opportunity by the March 24, 2005, Order to provide clarification as to whether issues related to Respondent's unadopted rule and affirmative defense were still at issue.
Petitioners and Respondent filed responses to the March 24, 2005, Order. The parties pointed out several non-substantive errors, which have been corrected. Petitioners clarified a question in the Order concerning Exhibit 11 of the Refund
Calculation Notebooks and indicated that issues raised by them concerning Respondent's unadopted rule required resolution.
Respondent indicated that the issue of its affirmative defense required resolution only if the undersigned concluded that the Imposition Method should be applied to Petitioners with a June 20, 2000, fiscal year end in the manner advocated by Petitioner and then only as to Leesburg Regional Medical Center, Petitioner in DOAH Case No. 04-1882.
FINDINGS OF FACT
The Parties.
Each of the Petitioners is a hospital licensed in the State of Florida. Petitioners have standing to participate in this proceeding.
Respondent, the Agency for Health Care Administration (hereinafter referred to as the "Agency"), is the agency of the State of Florida charged with the responsibility for, among other things, management of the Public Medical Assistance Trust Fund (hereinafter referred to as the "PMATF").
The PMATF.
Establishment and Purpose of the PMATF
The PMATF, which was established by the Legislature in 1984, is provided for, and its purpose described in, Section 409.918, Florida Statutes (2004):
It is declared that access to adequate health care is a right which should be available to all
Floridians. However, rapidly increasing health care costs threaten to make such care unaffordable for many citizens. The Legislature finds that unreimbursed health care services provided to persons who are unable to pay for such services cause the cost of services to paying patients to increase in a manner unrelated to the actual cost of services delivered.
Further, the Legislature finds that inequities between hospitals in the provision of unreimbursed services prevent hospitals that provide the bulk of such services from competing on an equitable economic basis with hospitals that provide relatively little care to indigent persons. Therefore, it is the intent of the Legislature to provide a method for funding the provision of health care services to indigent persons, the cost of which shall be borne by the state and by hospitals that are granted the privilege of operating in this state.
All moneys collected pursuant to s. 395.701 shall be deposited into the Public Medical Assistance Trust Fund, which is hereby created.
Moneys deposited into the Public Medical Assistance Trust Fund shall be used solely for the purposes specified by law. [Emphasis added].
Funding of the PMATF
Funding of the PMATF is provided for, in relevant part, by Section 395.701(2), Florida Statutes (2004). Section 395.701(2), Florida Statutes (2004), provides that all hospitals, with a few exceptions not relevant to this matter, are responsible for the partial funding of the PMATF.
The following definitions pertinent to assessments of PMATF funds from Florida hospitals are provided in Section 395.701(1), Florida Statutes (2004):
For the purposes of this section, the term:
"Agency" means the Agency for Health Care Administration.
"Gross operating revenue" or "gross revenue" means the sum of daily hospital service charges, ambulatory service charges, ancillary service charges, and other operating revenue.
"Hospital" means a health care institution as defined in s. 395.002(11), but does not include any hospital operated by the agency or the Department of Corrections.
"Net operating revenue" or "net revenue" means gross revenue less deductions from revenue.
"Total deductions from gross revenue" or "deductions from revenue" means reductions from gross revenue resulting from inability to collect payment of charges. Such reductions include bad debts; contractual adjustments; uncompensated care; administrative, courtesy, and policy discounts and adjustments; and other such revenue deductions, but also includes the offset of restricted donations and grants for indigent care.
In addition to amounts paid into the PMATF by hospitals, funds, referred to as "matching" funds, are also paid into the PMATF by the Federal government.
The Rate of, and Basis for, the PMATF Assessment
In providing for the imposition of a PMATF assessment against hospitals, the Legislature has established a rate of assessment and designated what that rate is to be assessed against, or the hospital's assessable basis.
Prior to the 2000 legislative amendment of Section 395.701(2), Florida Statutes, which is at issue in these cases, the rate of assessment established by the Legislature was 1.5 percent.
The Legislature has also provided that the assessable basis is a hospital's "net operating revenue."
The Legislature has defined "net operating revenue" for purposes of the PMATF assessment as a hospital's "gross revenue less deductions from revenue." § 395,701(1)(d), Fla. Stat. (2004). "Gross revenue" is defined as "the sum of daily hospital service charges, ambulatory service charges, ancillary service charges, and other operating revenue," more commonly referred to as inpatient services revenue, outpatient services revenue, and other operating revenue. § 395.701(1)(b), Fla. Stat. (2004).
Prior to the amendment of Section 395.701(2), Florida Statutes, adopted during the 2000 legislative session at issue in these cases, the PMATF assessment was imposed on a hospital's "net operating revenue" at the same rate regardless of whether the revenue was derived from inpatient services, outpatient services, or other operating services.9
Hospital PMATF Reporting Requirements
Hospitals in Florida are required to provide extensive financial information to the Agency utilizing the Florida Hospital Uniform Reporting System, Florida Administrative Code Chapter 59E-5 (hereinafter referred to as "FHURS"). In particular Florida
Administrative Code Rule 59E-5.201, provides that "[e]ach hospital shall submit to the Agency, not more than 120 days subsequent to the end of its fiscal year, its prior year report for the fiscal year then ended."
A hospital's FHURS report (hereinafter referred to as "Prior Year Report") is received and processed by the Agency's Financial Analysis section, which is contained in the Agency's Bureau of Health Facility Regulation. Once received, Financial Analysis is required to review the report and determine if the report is "accepted" or "not accepted." Fla. Admin. Code R. 59E- 5.204(3). Financial Analysis is required by Florida Administrative Code Rule 59E-5.204(3) to notify the submitting hospital as to whether its Prior Year Report has been accepted or not within 90 days after the report is received by the Agency.
Prior Year Reports contain, in addition to numerous other items of financial information, the information required by the Agency to actually calculate the amount of a hospital's PMATF assessment.
The Agency's Determination of the Amount of a Hospital's PMATF Assessment; Hospital Notification
Once a hospital's fiscal year has ended and it has filed its Prior Year Report, Section 395.701(2), Florida Statutes (2004), charges the Agency with the responsibility for calculating and collecting the hospital's PMATF assessment.
Pursuant to Florida Administrative Rule 59E-5.605(1), it is contemplated that the Agency's Bureau of Health Facility Regulation, through its Financial Analysis section, will make the calculation of the amount of a hospital's PMATF assessment and "certify" that amount to the Agency's Bureau of Finance and Accounting (hereinafter referred to as the "Bureau of F&A").
The financial information necessary to calculate a hospital's PMATF assessment is obtained from the hospital's Prior Year Report. This information may be obtained before Financial Analysis has decided whether a Prior Year Report will be accepted or not.
Once informed by Financial Analysis of the PMATF assessment, the Bureau of F&A is then responsible for notifying the hospital of the amount of the assessment and then collecting the hospital's payment thereof. Florida Administrative Code Rule 59E- 5.605(3) provides that, once a hospital is notified of its assessment the hospital "[m]ay request a hearing pursuant to Section 120.57, F.S." The request for hearing is to be made "[w]ithin 21 days of receipt of notification of the assessment amount . . . ." Fla. Admin. Code R. 59E-5.605(3).
Section 395.701(2), Florida Statutes (2004), provides that the Bureau of F&A is to certify the amount of a hospital's PMATF assessment "[w]ithin 6 months after the end of each hospital fiscal year . . ." and, therefore, it is contemplated that the
calculation by the Agency of the PMATF assessment will be accomplished within the same period of time.
Payment and Deposit of PMATF Assessments
Section 395.701(2), Florida Statutes (2004), provides that, once the Agency has calculated a hospital's PMATF assessment and notified the hospital thereof, the hospital will pay the assessment to the Agency as follows:
The assessment shall be payable to and collected by the agency in equal quarterly amounts, on or before the first day of each calendar quarter, beginning with the first full calendar quarter that occurs after the agency certifies the amount of the assessment for each hospital.
§ 395.701(2), Fla. Stat. (2004).
All PMATF assessments received by the Agency are to be deposited into the PMATF. Id.
Application of Section 395.701, Florida Statutes (1999), to a Hypothetical Hospital, Using the 1999 Rate of Assessment and Assessable Basis
In an effort to demonstrate how Section 395.701, Florida Statutes, is intended to operate, the following hypothetical may be helpful. Assume a hospital has a fiscal year ending December 31, 1999, and, during that fiscal year, it had net operating revenue of
$10,000,000.00. Applying the PMATF assessment rate prior to the 2000 amendment of Section 395.701(2), Florida Statutes (1999), at issue in these cases, which was 1.5 percent, the hypothetical
hospital's PMATF assessment would be $150,000.00 and the assessment would be payable in equal quarterly amounts of $37,500.00.
The hypothetical hospital would be subject to the following time-lines relevant to the assessment and payment of its PMATF1:
Fiscal year end: December 31, 1999;
1999 Prior Year Report due: April 30, 2000;
Agency notification to the hospital that the Prior Year Report is accepted or not accepted: July 29, 2000;
and
Certification of the PMATF assessment: June 30, 2000;
Time to request an administrative hearing: July 21, 2000;
Quarterly payments of the PMATF assessment due: July 1,
2000, October 1, 2000, January 1, 2001, and April 1, 2001. Application of Section 395.701(2), Florida Statutes, in Reality
While the hypothetical application of Section 395.701(2), Florida Statutes (1999), supra, is consistent with the statute and applicable rules, in reality the times-lines noted in paragraph 23 are inconsistent with actual practices of hospitals and the Agency. These inconsistencies are relevant to the extent that they ultimately impact the actual payment and receipt of PMATF funds from hospitals, which in turn has some bearing on the resolution of these cases.
First, a Prior Year Report for a December 31, 1999, fiscal year-end hospital would not likely have been filed on or before April 30, 2000.11 Even though Prior Year Reports are generally required to be filed within 120 days after the end of a hospital's fiscal year, hospitals often request and are granted extensions of time to file the reports.
Secondly, the Agency would not have been likely to determine by July 29, 1999, whether a Prior Year Report for a December 31, 1999, fiscal year-end hospital was accepted or not accepted. Even after a hospital has filed its Prior Year Report, it is often determined that additional information is necessary before the Agency can proceed. Requesting and obtaining this additional information can delay the time when a Prior Year Report is actually "accepted" or "not accepted."
Thirdly, as a result of the fact that the applicable statute and rules do not require that a hospital's Prior Year Report be accepted or not accepted prior to the certification of a PMATF assessment and due to delays in the filing of Prior Year Reports and the Agency's acceptance thereof, the Agency is not able to base its calculation of a PMATF assessment on an accepted Prior Year Report in the great majority of instances. Approximately 70 percent of Petitioners had their 2000 fiscal year Prior Year Reports used to calculate the amount of their PMATF assessments before those reports had been accepted or not accepted. The fact
that Prior Year Reports have not been "accepted" or "not accepted" does not in practice, however, delay the Agency's calculation of the PMATF assessment. In practice, the Agency determines that the Prior Year Report is provisionally accepted and goes forward with the calculation of the PMATF assessment without regard to whether Financial Analysis has completed its review of the Prior Year Report.
Fourthly, although it is contemplated that the Agency's Financial Analysis section is to calculate and certify the amount of a PMATF assessment to the Bureau of F&A, the Bureau of F&A actually makes the calculation.
Fifthly, the Agency has abandoned the practice, required by Section 395.701(2), Florida Statutes, of "certifying" the amount of a hospital's PMATF assessment. Instead, the Agency simply sends an invoice to the hospital which informs the hospital of the amount of its quarterly assessment.12 The Agency does not notify the hospital in the invoice of any point of entry or time constraint on requesting an administrative hearing to challenge the invoice.
Due to some of the foregoing described practices, in reality the actual payment of the assessment by a hospital of its PMATF assessment is likely to be significantly later than contemplated by the statute. For example, Petitioners' Exhibit numbered 8 is an example of the actual experience of one of Petitioners, Brandon Hospital. Despite the fact that this
hospital's fiscal year ended December 31, 1995, the invoice for its PMATF assessment for that year was dated March 2, 1998, and its first quarterly payment was not due until April 3, 1998, more than two years after the end of its fiscal year.
Summary
Based upon the foregoing, it is clear that the Legislature, prior to its amendment of Section 395.701, Florida Statutes, during the 2000 session, and as implemented by relevant rules of the Agency, had established the following necessary components of the PMATF assessment:
Who the PMATF assessment is imposed on: hospitals;
The rate of the PMATF assessment: 1.5 percent;
The assessable basis for the PMATF assessment: annual net operating revenue (inpatient, outpatient, and other incomes) actually experienced during the hospital's previous fiscal year;
Who provides the information necessary to compute annual net operating revenue: hospitals;
Who calculates the PMATF assessment: the Agency;
How a hospital learns of its PMATF assessment: the Agency is supposed to "certify" the assessment, but in reality merely invoices the hospital; and
When a PMATF assessment is payable: in quarterly installments beginning with the first full calendar quarter after
the Agency "certifies" (invoices, in practice) the amount of the assessment.
The one necessary component of the PMATF assessment which Section 395.701, Florida Statutes, both before or after its amendment in 2000, does not specifically state is the exact point in time that the PMATF assessment is to be imposed. In other words, while the statute specifically states that the rate of assessment is "1.5 percent," it does not specifically state that the assessment will be imposed "at one second after the end of the hospital's fiscal year" or other equivalent language. This lack of a specific "statement," however, does not mean that the determination of when a PMATF assessment is intended by the Legislature to be imposed, the dispositive issue in these cases, is not clear from the language of the statute.13 That intent, which is concluded to be unambiguous, will be discussed, infra.
The 2000 Legislative Change to the PMATF; Chapter 2000- 256, Laws of Florida.
The Relevant Changes in Section 395.701(2), Florida Statutes
During the 2000 legislative session, Chapter 2000-256, Laws of Florida, the "Patient Protection Act of 2000" (hereinafter referred to as the "Act"), was passed.
Relevant to this proceeding, the Act modified Section 395.701(2), Florida Statutes (1999), as follows:
(2)(a) There is imposed upon each hospital an assessment in an amount equal to 1.5 percent of the annual net operating revenue for
inpatient services for each hospital, such revenue to be determined by the agency, based on the actual experience of the hospital as reported to the agency. Within 6 months after the end of the each hospital fiscal year, the agency shall certify the amount of the assessment for each hospital. The assessment shall be payable to and collected by the agency in equal quarterly amounts, on or before the first day of each calendar quarter, beginning with the first full calendar quarter that occurs after the agency certifies the amount of the assessment for each hospital. All moneys collected pursuant to this subsection shall be deposited in the Public Medical Assistance Trust Fund.
(b) There is imposed upon each hospital an assessment in an amount equal to 1 percent of the annual net operating revenue for outpatient services for each hospital, such revenue to be determined by the agency, based on the actual experience of the hospital as reported to the agency. Within 6 months after the end of the each hospital fiscal year, the agency shall certify the amount of the assessment for each hospital. The assessment shall be payable to and collected by the agency in equal quarterly amounts, on or before the first day of each calendar quarter, beginning with the first full calendar quarter that occurs after the agency certifies the amount of the assessment for each hospital. All moneys collected pursuant to this subsection shall be deposited in the Public Medical Assistance Trust Fund.
[Emphasis in original; words and letters underlined denote additions to Section 395.701(2), Florida Statutes.].
Of significance to the resolution of these cases, the Legislature, in passing the Act, made the following changes in the PMATF, and no others:
First, the 1.5 percent PMATF assessment rate was limited to net operating revenue from inpatient services;
Secondly, the rate imposed on net operating revenue from outpatient services was reduced from 1.5 percent to 1.0 percent; and
Finally, the imposition of the PMATF assessment on other operating revenue was eliminated.
Also of significance to the resolution of these cases, is the fact that the Legislature, in passing the Act, did not make any change to the following necessary components of the PMATF assessment:
Who the PMATF assessment is imposed on;
Who provides the information necessary to compute net operating revenue;
Who calculates the PMATF assessment;
How a hospital learns of its PMATF assessment; and
When a PMATF assessment is payable.
Of greatest significance to the resolution of these cases, is the fact that the Legislature, in passing the Act, did not make any change or even discuss when it intended for a PMATF assessment to be imposed.
The Effective Date of the Act Generally, and the Changes to the PMATF in Particular
Section 64 of the Act provides that "except as otherwise provided herein, this Act shall take effect on July 1, 2000."
Section 22 of the Act provides the following concerning the effective date of the relevant changes to the PMATF:
The amendments to Sections 395.701 and 395.701(5), Florida Statutes, by this Act shall take effect only upon the Agency for Health Care Administration receiving written confirmation from the Federal Health Care Financing Administration that the change outlined in such amendments will not adversely affect the use of the remaining assessments as state match for the State's Medicaid Program.
The effect of Section 22 of the Act was to require that the Agency, as a condition upon the imposition of the changes to the PMATF, seek and obtain assurances from the Federal Health Care Financing Administration (hereinafter referred to as "HCFA"), that the reduction in the rate of the PMATF assessment on outpatient revenues and the other PMATF changes would not have any adverse effect on the amount of "matching funds" which the Federal government would pay to Florida's Medicaid Program.
On or about June 9, 2000, the Agency sought the required assurances contemplated by the Act from HCFA. Those assurances were received prior to July 1, 2000.14
Based upon the foregoing, there is not dispute in these cases that the effective date of the reduction in the rate of the PMATF assessment on revenue from outpatient services, the elimination of the PMATF on other operating revenue, and the other PMATF changes included in the Act was July 1, 2000.
The $28.3 Million Appropriation of PMATF Funds
When considering the adoption of the changes to the PMATF ultimately made by the Legislature during the 2000 legislative
session, the Legislature realized that the reduction of the rate of the PMATF applicable to a hospital's net operating revenue from outpatient services, from 1.5 percent to 1.0 percent (hereinafter referred to as the "Reduced Rate") and the elimination of the PMATF assessment on other operating revenue would cause a significant reduction in the total payments made to the PMATF by hospitals and, consequently, the amount of matching funds from the Federal government. The Legislature also realized that the reduction would begin to occur during the state's fiscal year beginning July 1, 2000, the effective date of the Act. It was also realized that the reduction in PMATF funds would be a recurring one.
In recognition of the need to continue to fund the PMATF and to avoid the loss of Federal matching funds, the Legislature attempted to make up for the loss in PMATF funds by including the following in the Act:
Section 20 - The Legislature shall appropriate each fiscal year from either the General Revenue Fund or the Agency for Health Care Administration Tobacco Settlement Trust Fund, an amount sufficient to replace the funds lost due to reduction by this Act of the assessment on other health care entities under Section 395.7015, Florida Statutes, and the reduction by this Act on the assessment on hospitals under Section 395.701, Florida Statutes, and to maintain federal approval of the reduced amount of funds deposited into the Public Medical Assistance Trust fund under Section 395.701, Florida Statutes, as state match for the state's Medicaid Program.
Section 21 -There is hereby appropriated the sum of $28.3 million from the General Revenue
Fund to the Agency for Health Care Administration to implement the provisions of this Act relating to the Public Medical Assistance Trust Fund, provided, however, that no portion of this appropriation shall be effective that duplicates a similar appropriation for the same purpose contained in other legislation from the 2000 Legislative Session that becomes law.
Thus, the Legislature indicated its intention to replace the recurring loss of PMATF collections from hospitals caused by the Act and provided for the replacement of funds expected to be lost during the first fiscal year for which the changes were effective, the July 1, 2000 to June 30, 2001, fiscal year.
The $28.3 million appropriation was arrived at by first estimating the total collections projected to be made during the state's fiscal year beginning July 1, 2000, of PMATF assessments without the modifications to the PMATF adopted in the Act, and then estimating the extent to which those collections would be reduced as a result of the modifications to the PMATF. Total PMATF collections projected for the fiscal year, without the modifications adopted in the Act, were estimated to be $84.9 million and it was estimated that approximately one-third of projected collections, or $28.3 million, would be lost as a result of the modifications to the PMATF.15
The Agency did not suggest to the Legislature that the
$28.3 million appropriation was excessive and yet, when the amount of the appropriation approved by the Legislature is compared with
the amount which the Agency has argued in these cases hospitals should receive in refunds, the amount of the appropriation is excessive. The Agency has made no effort to explain its apparent inconsistent positions.16
The Agency's Analysis of the Act
On May 31, 2000, following the passage of the Act but before it became law, the Agency submitted a bill analysis and economic impact statement on the Act to the Office of the Governor, accompanied by a cover letter under the signature of the then Agency Secretary, Ruben King-Shaw, Jr. In the cover letter, Mr. King-Shaw recommended that the Governor sign the Act into law.
In the Agency's analysis of the Act, the Agency describes the changes to the PMATF adopted in the Act, including the Reduced Rate, and suggests that the fiscal impact of the provisions of the Act related to the PMATF would be a $23.1 million17 reduction in PMATF assessment revenues during the state's fiscal year beginning July 1, 2000. Explaining the projected loss, the Agency stated the following:
The reduction in the rate of assessments outlined above will mean that approximately
$28.3 million in revenue will be lost to the Public Medical Assistance Trust Fund.
Alternative state funding will be required. If the alternative state funding is not appropriated, the Medicaid Program will be required to reduce services by $65.2 million ($28.3 million state, and $36.9 million federal matching funds). The bill provides for an appropriation from the general revenue fund of
$28.3 million to replace the funds lost due to the repeal of the assessments.
Petitioners' Exhibit 2, Bate Stamp Page 2-19.
The Agency's analysis of the Act also contains, beginning at Bate Stamp Page 2-32 of Petitioners' Exhibit 2, a "Fiscal Impact on State Agencies/Funds" section describing the projected financial impact of the Act. Among other things, this Fiscal Impact section notes that, during the state's fiscal year beginning on the effective date of the Act, the projected loss of just over $28.3 million in total PMATF assessment collections from hospitals expected during that fiscal year would be made up for by the $28.3 million appropriated by the Legislature in the Act.
Again, the Agency's analysis is inconsistent with the position it was later to take and the position it now takes in this proceeding as to when the Reduced Rate should apply to PMATF assessments. The Agency's analysis is, however, consistent with the conclusion that the Reduced Rate was to have an immediate impact on PMATF assessment collections during the state's fiscal year beginning on the effective date of the Act. Again, the inconsistency in the Agency's position in these cases with the analysis provided to the Governor was not explained by the Agency during the hearing of these cases.
The Agency's Changed Interpretation of the Act.
Although the Agency's analysis of the Act's impact on the PMATF provided to the Office of the Governor suggests that it
believed that the Reduced Rate would have an impact during the fiscal year beginning July 1, 2000, the Agency did not take any immediate steps to implement the Reduced Rate and ultimately changed its position on the issue before it could do so.
When exactly the Agency decided to interpret the changes to the PMATF of the Act differently from the position it took during the legislative session and its analysis provided to the Office of the Governor has not been explained by the Agency. Nevertheless, at some point after its analysis was provided to the Office of the Governor, the Agency did indeed formulate an inconsistent interpretation. In an e-mail dated November 2, 2000, Lamon Lowe of the Agency's Medicaid office reported the following to Chris Augsburger, head of the Agency's Financial Analysis
section:
Dyke asked me to notify you about the Agency's position on the date that the reduction of assessments from 1.5% to 1.0% for the PMATF would go into effect. Dyke had a recent conversation with Secretary King-Shaw. Per Secretary King-Shaw, any revenue earned after July 1, 2000, would be assessed at the new rate of 1.0%.
Petitioners' Exhibit 4, Bate Stamp Page 4-1. Based upon this e-mail, it appears that the Agency's position taken in this proceeding was formulated at some time immediately before the e-mail was sent by Mr. Lowe.
Despite the fact that the position of the Agency reflected in Mr. Lowe's e-mail is inconsistent with the position
taken by the Agency in its analysis of the Act, the Agency gave no explanation of the e-mail or its meaning at the hearing of these cases.
Social Services Estimating Conference of November 9, 2000.
On November 9, 2000, the Agency, through Tony Swinson, Senior Management Analyst Supervisor for the Agency, attended a meeting known as the Social Services Estimating Conference18 (hereinafter referred to as the "SSE Conference").
The purpose of the SSE Conference held on November 9, 2000, was to compare the state's fiscal year 2000-2001 projected expenditures to appropriations and to estimate and project Medicaid fund needs for the state's fiscal year 2001-2002.
At the time of the SSE Conference held on November 9, 2000, the Agency projected a $519 million deficit in Medicaid services to individuals and a $640 million deficit in all Medicaid services for the state's fiscal year beginning July 1, 2000. These projections are contained in the report, Respondent's Exhibit 22, prepared by the SSE Conference. These findings suggest a motive for the change in the Agency's position: the need to deal with what was projected to be a significant deficit in funds available to meet Medicaid expenditures. The change in Agency position allowed the use of the $28.3 million appropriation to the PMATF, the continued collection of PMATF funds from hospitals during the
fiscal year beginning July 1, 2000, and federal matching funds on both amounts.
At some time after issuance of the SSE Conference's report of its November 9, 2000, meeting, the Agency, through
Mr. Swinson, added the following footnote to the report on what has been marked as page 3 of Respondent's Exhibit 22:
The estimated expenditures for FY 2000-2001 assume the $28.3 million in General Revenue appropriated to replace the revenue lost from reductions in assessments deposited into the Public Medical Assistance Trust Fund will be available for use even though the implementation of the reduction in assessment will be based on provider net operating revenues earned after June 30, 2000. Revenue to the PMATF will not be impacted until FY 2001-2002 if the reduced assessment rate is implemented for revenues earned after June 30, 2000.
A similarly worded footnote was added to the SSE Conference's report on what has been marked as page 9 of Respondent's Exhibit 22:
The Agency has implemented the reduction in the rate of the assessment on net operating revenues for hospital outpatient services and for other health care facilities authorized by HB 2339 by interpreting that the reduced rates apply to net operating revenues earned after June 30, 2000. Because of the timing of the receipt of provider financial reports by the Agency and the certification of the revenues, the projection above assumes that PMATF revenues will not be impacted until FY 2001- 2002.
While the footnotes, although stated with what appears to be some doubt as to their accuracy, are consistent with the
Agency's position in these cases, the Agency gave no explanation as to why they were added after the SSE Conference had ended and its report had been prepared. In light of the fact that the footnotes were added not too long after the first evidence of the formulation of the Agency's current position was reported in Mr. Lowe's November 2, 2000, e-mail to Mr. Augsburger, it is inferred that the Agency added the footnotes in an effort to bolster its changing position on the issue of how to implement the changes to the PMATF adopted in the Act.
The Agency's Implementation of the Act.
Despite the fact that the Agency suggested in its analysis of the Act that the loss of PMATF revenues would be experienced during the state's fiscal year beginning July 1, 2000, and did not apparently change its position until the fall of that year, the Agency continued to calculate, bill, and collect hospital PMATF assessments after July 1, 2000, at the 1.5 percent rate of assessment (hereinafter referred to as the "Old Rate").
In fact, the Agency continued to calculate, bill, and collect PMATF assessments from hospitals at the Old Rate and, imposed the Old Rate on the hospital's total net operating revenue, through December 31, 2002. The Agency did so even though the Agency now takes the position that hospitals' should have begun to benefit from the Reduced Rate beginning with April 1, 2001, invoices.
In the early fall of 2002 a meeting was held between the Agency and hospital representatives to discuss the fact that the Agency had not yet implemented the Reduced Rate. The issue for resolution in these cases was not discussed in the meeting. The only matter discussed was the fact that the Agency had taken no steps to apply the Reduced Rate.
Subsequent to the Agency's meeting with hospital representatives, a memorandum dated November 25, 2002, was sent to "all hospital PMATF facilities" with quarterly PMATF invoices due January 1, 2003. The memorandum evidenced the Agency's first effort to apply the Reduced Rate, but even then, only partially.19 Even though the Agency realized at the time it sent the memorandum that hospitals were entitled to the full benefit of the Reduced Rate and the other changes to the PMATF adopted in the Act, the Agency, because of the lack of available PMATF funds, simply authorized some hospitals, although not all,20 to take a partial credit against their PMATF payments beginning with the January 1, 2003, quarterly payment.
Hospital Refund Requests and the Agency's Denial Thereof.
Beginning in September 2002 Petitioners filed requests with the Agency seeking a refund of alleged PMATF overpayments made by them since July 1, 2000. Those refund requests were calculated consistent with the position of Petitioners taken in these cases
concerning the proper implementation of the PMATF modifications of the Act.
The refund requests filed by Petitioners in these cases were filed pursuant to Section 215.26, Florida Statutes, and utilized a form previously accepted by the Agency for requests for refunds of overpayments.
The Agency responded21 to the refund requests of Petitioners by letter (hereinafter referred to as the "Refund Denial Letter"). The Refund Denial Letter sent to each Petitioner was substantially identical to Petitioners' Exhibit 8D.
The Refund Denial Letter included the following:
No refunds will be made for assessments on net operating revenues for outpatient services earned prior to July 1, 2000. All revenue earned in this period was correctly assessed at 1.5%.
. . . .
This constitutes AHCA’s final determination as to the impact of the effective date of Laws of Florida, Chapter 2000-256, §16, and the period subject to the reduced rate of assessment on net operating revenue for outpatient services. This is not a final determination as to the availability or amount of a refund for a particular hospital. Those whose substantial interests are affected by the Agency’s final determination may request a hearing pursuant to
§120.569, Florida Statutes. Only AHCA’s final determination about the impact of the effective date of the statute is subject to administrative challenge at this time. A petition for administrative hearing must comply with the requirements of Florida Administrative Code, Rule 28-106.201. The petition must be received at the address specified below no
later than twenty-one (21) days from receipt of this letter. Failure to timely file a petition shall constitute a waiver of the right to a hearing. . . . [Emphasis in original].
Petitioners filed Petitions for Formal Administrative Hearing in response to the Agency's refund denial letters.
The Central Legal Issue: How to Apply the Reduced Rate.
The Central Legal Issue:
There is no dispute that on July 1, 2000, and thereafter, the rate of the PMATF assessment applicable to a hospital's net operating revenue from outpatient services was reduced from
1.5 percent, the Old Rate, to 1.0 percent, the Reduced Rate.
The first issue for decision in these cases, which was first addressed in the Preliminary Order, is how exactly the Reduced Rate is to be implemented in practice. To the extent that other changes to the PMATF included in the Act impact the amount of the refunds sought by Petitioners, the conclusions concerning the application of the Reduced Rate reached in this Recommended Order apply equally.
Petitioners' Position in These Cases
It is the position of the Petitioners' that the Reduced Rate should apply to all PMATF assessment quarterly payments made
by a hospital on or after July 1, 2000, regardless of when the hospital's fiscal year ended or when the hospital's net operating revenue was actually earned. Petitioners' position has been referred to throughout this proceeding as the "Invoice" method.
In support of their position, Petitioners argue that the focus of the analysis required in these cases (the determination of legislative intent) should be the Act and, in particular, the Legislature's decision to appropriate $28.3 million to make up with what was believed would be the fiscal impact of the Act. In Petitioners' Additional Written Argument, Petitioners argue the following:
The clearest statement regarding what the Legislature intended when it amended [Section] 395.701(2) is the language of Section 21 of Chapter 2000-256, Laws of Florida. The Legislature specifically appropriated those funds necessary to offset the anticipated reduction in PMATF collections in the fiscal year that began on the day the new law was effective, July 1, 2000. The estimate of a
$28.3 [million] impact, as demonstrated at Hearing, was based upon the work of the PMATF Task Force. (Pet. Ex. 15, 16). The agency itself expected, when it recommended that the Act be signed by the Governor, that the effect of the rate reduction would be a $28.3 million reduction in PMATF collections from providers for the state fiscal year beginning July 1, 2000. (Pet. Ex. 2).
Petitioners also suggest that the change in the Agency's position as evidenced in Mr. Lowe's e-mail, the footnotes to the SSE Conference report, and the Agency's implementation of the Act, all suggest that the Agency's position is incorrect.
Finally, Petitioners have relied upon a number of extrinsic facts which they argue support their interpretation of how the Reduced Rate should be applied. Those extrinsic facts, which have been discussed in detail in Petitioners' Joint Proposed
Findings of Fact, Conclusions of Law and Preliminary Recommended Order of Petitioners, include the following general subjects:
The Agency's treatment of PMATF assessments for hospitals that closed before making all of their quarterly payments;
The Agency's treatment of a hospital's legal liabilities for purposes of the PMATF;
The Agency's application of the PMATF to new hospitals;
and
The types of Prior Year Reports accepted by the Agency in
the past.
The Agency's Position in These Cases
It is the Agency's position that the Reduced Rate should apply to all PMATF assessments on net operating revenue from outpatient services earned on or after July 1, 2000, regardless of when a hospital's fiscal year ends or when the hospital actually makes a quarterly payment. In essence, the Agency's position assumes that the PMATF "accrues" continuously during a hospital's fiscal year and that it does so at the rate then in effect. Pursuant to this argument, which was referred to throughout this proceeding as the "Earned" method, every dollar of revenue from outpatient services earned by a hospital on or before June 30, 2000, is subject to the PMATF at the Old Rate and, every dollar of revenue from outpatient services earned by the same hospital on or after July 1, 2000, is subject to the PMATF at the Reduced Rate.
In addition to arguing that the language of the statute and the Act clearly support its position, the Agency has argued that its position is supported by "agency expertise" and a general accounting principle, described as "the 'matching principle' under accrual accounting, in which the revenue and expense effects of an economic event are realized and recorded contemporaneously."
To explain the "matching principle" under accrual accounting, the Agency presented the testimony of Mr. Thurston, who opined that the PMATF liability attaches as dollars are earned, although the final calculation of the assessment does not occur until the end of the hospital's fiscal year. Mr. Thurston opined, as an expert in public accounting, that when an economic event occurs in business, the financial implications of that event should be recorded both from the revenue and expense side, an idea he characterized as a basic "matching" concept, when the economic event occurs. Applying this theory to Section 395.701(2), Florida Statutes, Mr. Thurston suggested that the PMATF constitutes an expense against revenues as they are earned and, therefore, the expense should be matched contemporaneously with the revenue.
Resolution of the Central Legal Issue: How the Legislature Intended the Reduced Rate to be Applied or the Proper Application of Section 395.701(2), Florida Statutes (2000).
Where to Look To Determine Legislative Intent
Ultimately, the resolution of in these cases depends upon a determination of legislative intent. That determination first
requires a decision on where to look for the Legislature's intent: the Act; the language of Section 395.701, Florida Statutes, as amended; the history of the PMATF; the Agency's implementation of the PMATF, including the matters described in Finding of Fact 73; accounting principles; or some combination of these sources and/or others.
Petitioners argue that it is the Act, or more precisely, the $28.3 million appropriation which the Legislature provided for which should be reviewed to determine legislative intent. While Petitioners' position was rejected in the Preliminary Order and is rejected in this Recommended Order, if Petitioners' are correct, that it is the Act and the history surrounding its adoption that controls the determination of legislative intent in this proceeding, then Petitioners are entitled to the refunds, calculated pursuant to the Invoice method, which they seek.
The $28.3 million appropriation is essentially the same as the total amount of the reduction in PMATF assessments which hospitals should have seen during the fiscal year 2000-2001 if the Legislature intended that the Reduced Rate was to be applied consistent with the Invoice method. This fact is undisputed. This fact, coupled with the fact that the Agency did nothing to discourage the Legislature from making the appropriation, the fact that the Agency supported the notion that the reduction in assessments would be $28.3 million when it supported the Act with
the Office of the Governor, and the fact that the Agency failed to explain at hearing why it took the various positions it did or why it changed those positions, further supports the position of Petitioners.
As discussed more fully, infra, it has been concluded, however, that it is not the Act or the Legislature's actions while adopting it that should be the central focus of the determination of legislative intent in these cases. Instead, it has been concluded that the main focus of the determination of legislative intent should be the language of Section 395.701, Florida Statutes (2000). The fact that this focus will likely result in a significant inconsistency between the fiscal impact of the methodology recognized in this Recommended Order, the Imposition Method, and the $28.3 million appropriation may be disconcerting, but, if the correct focus for the determination of legislative intent is the language of Section 395.701, Florida Statutes (2000), that inconsistency simply cannot be avoided.
Legislative Intent, Based Upon Section 395.701, Florida Statutes (2000).
The ultimate resolution of these cases turns on the determination of one significant necessary component of the PMATF assessment which is not as specifically stated by the Legislature in Section 395.701(2), Florida Statutes, as the other necessary components of the PMATF such as, for example, who the assessment is imposed upon (hospitals).22 That component of the PMATF assessment
is the moment when the Legislature intended that a PMATF assessment is deemed to actually be imposed.
The exact point in time when the Legislature intended for the assessment to be imposed is significant, because, until the PMATF assessment is actually imposed, the rate of the PMATF assessment and the revenues or assessable basis upon which the rate is to apply, have little bearing. It simply does not matter under the law, what the rate of assessment or the assessable basis of a PMATF assessment is until it is time for the PMATF assessment to be imposed.
While the Legislature has not specifically stated that the assessment is to be imposed at "X" point in time, it does not mean that legislative intent is not clear. Based upon the language of Section 395.701, Florida Statutes (2000), read as a whole, it is clear that the Legislature intended that the PMATF assessment is to be imposed, and, indeed, can only finally and accurately be imposed, when the condition or conditions established by the Legislature for the imposition of the assessment have all occurred. Although described as two conditions in the Preliminary Order, there is actually only one condition that has been established by the Legislature for the imposition of the PMATF assessment: the hospital must have an "annual net operating revenue" which in turn must be based upon the "actual experience of the hospital . . . " from its just completed fiscal year. This condition can occur only
at the end of the hospital's fiscal year. The condition will not occur during the year as the hospital earns a dollar of revenue or when the hospital actually pays its PMATF assessment. The PMATF was not intended, therefore, to be "imposed" during a hospital's fiscal year as argued by the Agency. Nor did the Legislature intend that the imposition of the assessment must wait until a hospital is required to actually make its quarterly payment, as argued by Petitioners.
The precise time when the condition for imposition of the PMATF assessment has been met and, thus, when the PMATF assessment is intended by the Legislature to be imposed, takes place immediately after the end of the hospital's fiscal year for which the PMATF assessment is made. It is only at that time that a hospital has an "annual net operating revenue" which can be "based on the actual experience of the hospital . . . ." Thus, if a hospital's fiscal year ends on June 30, 2000, the PMATF assessment for that hospital's 1999-2000 fiscal year may only be assessed immediately after its fiscal year ends at midnight, or as July 1 begins.
The Invoice Method is Inconsistent with the Imposition Method
In order to accept the Invoice Method, it would be necessary to find that the Legislature intended that a PMATF assessment is considered imposed when a hospital makes each payment. Any PMATF payment made by a hospital on or after July 1, 2000, would be subject to the Reduced Rate and any payment made by the same hospital before July 1, 2000, would be subject to the Old Rate. Accepting this position defies logic. Regardless of when a PMATF payment is made, all events contemplated by Section 395.701(2), Florida Statutes (1999 and 2000), for imposition of the assessment have occurred. When information necessary to actually compute the amount of the assessment is provided to the Agency by a hospital, when the Agency actually computes the assessment and informs the hospital of the amount of the assessment, and when the hospital actually makes the payments are not events contemplated or required by Section 395.701(2), Florida Statutes (2000), for the assessment to be considered imposed.
The Earned Method is Inconsistent with the Imposition Method
In order to accept the Earned Method, it would be necessary to find that the Legislature intended that a PMATF assessment is imposed at the time a hospital earns a dollar of applicable revenue in order to accept the Agency's position concerning how to apply the Reduced Rate. Any dollar of revenue for outpatient services earned by a hospital on or after July 1,
2000, would be subject to the Reduced Rate and any dollar of revenue for outpatient services earned by the same hospital before July 1, 2000, would be subject to the Old Rate. Neither of these findings is reasonable or supported by the language of Section 395.701, Florida Statutes.
Mr. Thurston's testimony was also not persuasive.
Mr. Thurston simply explained the accrual method of accounting, a method routinely followed by accountants and bookkeepers in reflecting the economic operations of individuals, businesses, and other entities. Mr. Thurston failed to explain, however, what the Agency relies on to support a conclusion that the Legislature intended for the PMATF to be applied consistent with that accounting method.
Additional "Conditions" for Imposition Suggested by Petitioners.
In Petitioners' Additional Argument, it has been argued that, if the Legislature truly intended that the Reduced Rate is to be applied when the PMATF assessment is imposed and that imposition of the assessment may only occur when all the conditions for imposition have been met, there are other conditions which must be met in order for the assessment to be imposed which the undersigned did not consider. In particular, Petitioners have suggested that two other conditions must be met before the PMATF assessment may be imposed:
The hospital's actual experience based upon its completed fiscal year must be 'reported to the agency;' and
Within six months after the end of the hospital fiscal year, the Agency shall certify the amount of the assessment for each hospital. [Footnote omitted].
The additional "conditions" suggested by Petitioners, while conditions for the actual payment or collection of a PMATF assessment, are not conditions which must be met in order for the assessment to be imposed on or owed by a hospital. Once a hospital realizes an “annual net operating revenue” no conditions for the imposition of the PMATF remain.
The Amount of Petitioners' Refunds.
Subsequent to the entry of the Preliminary Order on December 23, 2003, and the filing of the February 3, 2005, Stipulation, the parties were able to come to agreement as to the amount of refund which is due to each Petitioner based upon the three rate reduction application methodologies addressed in this Recommended Order: the Imposition Method; the Invoice Method; and the Earned Method. Those amounts are contained in the Refund Calculation Notebooks, Joint Composite Joint Exhibit 1.
Contained within the Refund Calculation Notebooks is a folder for each remaining Petitioner containing supporting data and the calculation of refunds based upon all three methodologies. The folders for each hospital include all source data required to calculate refunds as Exhibits 1 through 7, a list of all PMATF
payments as Exhibit 8, a summary of the foregoing data as Exhibit 9, the application of the Earned Method as Exhibit 10, a calculation of the refund due each Petitioner based upon
Attachment B of each Petitioner's Refund Request as Exhibit 11, the application of the Invoice Method as Exhibit 12, and the application of the Imposition Method as Exhibits 13 and 14.
The application of the Imposition Method contained on Exhibits 13 and 14 is the same except for hospitals with fiscal year-ends of May 31, June 30, and July 31. For those hospitals, the parties disagreed as to how the Imposition Method should be applied. Petitioners assert that those hospitals are entitled to refunds for their fiscal years ending in 2000 based upon the reduced rate while the Agency asserts that they are not.
Exhibit 13 for those hospitals reflects the amount of refund based upon the Imposition Method with no refund due for their fiscal year ending in 2000. Exhibit 14 for those hospitals reflects the amount of refund based upon the Imposition Method if they are entitled to any refund for their fiscal year ending in 2000.
Based upon the conclusions reached in this Recommended Order, the amount of refund due to Petitioners with fiscal year- ends of April 30 and May 31, 2000, is reflected in Exhibit 13. All events necessary for imposition of the PMATF assessment for these Petitioners for their fiscal year ending in 2000 occurred before the effective date of the Act. For Petitioners with June 30, 2000,
September 30, 2000, and December 31, 2000, fiscal year-ends, the amount of refund due to them is reflected in Exhibit 14.
The Agency's Alleged Unadopted Rule.
The Agency's Refund Denial Letter provides, in part, the following statement which Petitioners have argued in their proposed order constitutes an unadopted rule:
No refunds will be made for assessments on net operating revenues for outpatient services earned prior to July 1, 2000. All revenue earned in this period was correctly assessed at 1.5%.
. . . .
This constitutes AHCA’s final determination as to the impact of the effective date of Laws of Florida, Chapter 2000-256, §16, and the period subject to the reduced rate of assessment on net operating revenue for outpatient services.
The foregoing statement, while ultimately based upon the Agency's interpretation of Section 395.701(2), Florida Statutes (2000), does not express that interpretation. That interpretation is not explained in the quoted portion of the Refund Denial Letter or any other document offered by Petitioners. The statement quoted by Petitioners merely informs the entity to which it was sent that its requested refund was being denied. The Refund Denial Letter then goes on to inform the entity that the denial is "not a final determination as to the availability or amount of a refund for a particular hospital [but rather is preliminary agency action]" and
that the Agency's proposed decision could be challenged administratively.
The fact that the Agency was required to develop an interpretation of the applicable law when it made its preliminary decision to deny refund requests filed by Petitioners does not make the complained of "statement" of the Agency a rule. Nor does the fact that the Agency explicated that interpretation in its defense of its preliminary decision during these proceedings make is notice that it was denying Petitioners' request for refunds a rule. Petitioners have failed to prove any actual "statement" of the Agency of the interpretation of Section 395.701(2), Florida Statutes (2000), advanced in these proceedings, was published by the Agency.
The Refund Denial Letter does not contain an "agency statement" of "general applicability" which implements, interprets, and prescribes law. It merely announces proposed agency action.
The Agency's Refund Denial Letter is not a "rule," as that term is defined in Section 120.52(15), Florida Statutes (2004).
Leesburg Regional Medical Center.
Leesburg Regional Medical Center (hereinafter referred to as "Leesburg"), Petitioner in DOAH Case No. 04-1882, uses a July 1 to June 30 fiscal year for purposes of the PMATF.
Invoices sent to Leesburg by the Agency for PMATF assessments for quarterly payments due July 2000 through October 2002 were based upon a rate of 1.5% for inpatient and outpatient net operating revenue and other operating revenue. Leesburg paid these assessments.
Leesburg received the November 25, 2002, Memorandum described in paragraph 62, supra, on or about December 2, 2002. That Memorandum was the Agency's first attempt to apply, at least in part, the Reduced Rate.
In December 2003 Leesburg filed a refund request for what it believed were overpayments of its PMATF assessments due on and after July 1, 2000. The amount of the refund being sought by Leesburg was identified in a supplement to its refund request filed with the Agency in February 2004.
Leesburg refund request for payments attributable to the first two quarters (ending September 30 and December 31) of its fiscal year 2000-2001 (hereinafter referred to as the "Disputed Quarters") totaled $31,116.00.
While Leesburg Exhibit 8 of the Refund Calculation Notebooks indicates the total amount of Leesburg's PMATF assessments for the Disputed Quarters and the fact that those assessments were paid, the exhibit does not indicate when the payments were made. Nor was any other evidence presented to prove when the payments were actually made.
CONCLUSIONS OF LAW
Jurisdiction.
The DOAH has jurisdiction over the subject matter of this proceeding and of the parties thereto pursuant to Sections
120.569 and 120.57(1), Florida Statutes (2004).
Standing.
The parties agreed, and the evidence in these cases proved, that Petitioners all have standing to participate in this proceeding.
All of the Petitioners are seeking the repayment of PMATF assessment payments which the Agency has denied.
Burden and Standard of Proof.
The burden of proof in an administrative proceeding such as this, absent a statutory directive to the contrary, is on the party asserting the affirmative of the issue. Antel v. Department of Professional Regulation, 522 So. 2d 1056 (Fla. 5th DCA 1988); Department of Transportation v. JWC Company, Inc., 396 So. 2d 778 (Fla. 1st DCA 1981); and Bolino v. Department of Health and Rehabilitative Services, 348 So. 2d 249 (Fla. 1st DCA 1977).
In these cases, it is Petitioners that are asserting the affirmative of the ultimate issue in these cases: that they are entitled to a refund of PMATF assessment payments in the amounts asserted by them in their Petitions.
The resolution of the ultimate issue in these cases depends on the proper interpretation of Section 395.701(2), Florida Statutes (2000). Petitioners have alleged that the interpretation advanced by the Agency constitutes an unadopted rule and, therefore, the burden was on the Agency to prove that its actions in these cases were consistent with Section 120.57(1)(e), Florida Statutes, which it failed to do. The evidence, however, failed to prove that the specific statement complained of by Petitioners and, indeed, anything in the Refund Denial Letter, constitutes a "rule" as defined in Section 120.52(15), Florida Statutes. Regardless of where the burden of persuasion as to the proper interpretation of Section 395.701(2), Florida Statutes (2000), rested, the interpretation advanced by the Agency has been rejected.
Whether the Agency's interpretation of Section 395.701(2), Florida Statutes (2000), constituted an adopted rule or not, the ultimate burden of proving the amount, if any, of any refund due to each individual Petitioner remained with each Petitioner.
As to the standard of proof, Section 120.57(1)(h), Florida Statutes (2004), provides that "[f]indings of fact shall be based on a preponderance of the evidence, except in penal or licensure disciplinary proceedings or except as otherwise provided by statute."
The Determination of Legislative Intent.
While the parties agree that these cases turn on a determination of legislative intent, they disagree with where to look to determine that legislative intent. Petitioners have argued throughout this matter that what needs to be interpreted is the Act as it relates to the relevant changes to the PMATF contained therein. More precisely, Petitioners argue that the legislative history surrounding the Act is what determines legislative intent. Petitioners look only to the Act, or more precisely, the supporting history, in arguing that the Legislature intended that the Reduced Rate should be applied by the "Invoice" method.
If Petitioners were correct, that it is the history of the Act that is determinative of legislative intent in these cases, then their assertion that the Invoice Method applies to the determination of any refunds they may be entitled to is correct. It is concluded, however, that the position of Petitioners is not supported by the well-established rules of statutory construction. What actually governs legislative intent in these cases is the plain language of Section 395.701, Florida Statutes (2000).
The statutory analysis of Section 395.701, Florida Statutes (2000), begins with the proposition, oft-stated by the courts, that legislative intent is the polestar that guides the courts in construing any law, and that legislative intent must be determined primarily from the language of the law itself. State v.
Rife, 789 So. 2d 299 (Fla. 2001); Miele v. Prudential-Bache
Securities, Inc., 656 So. 2d 470 (Fla. 1995); and City of Tampa v. Thatcher Glass Corp., 445 So. 2d 578 (Fla. 1984).
Although the courts have often described various "rules of construction" utilized in gleaning legislative intent, the cardinal rule of construction is that such rules will not be utilized unless it is necessary to resolve an ambiguity in the language of the statute. See Satellite Television Engineering v. Department of General Services, 522 So. 2d 440 (Fla. 1st DCA 1988). Where there is no ambiguity in the language of the statute, but instead, the language of the statute is plain, "we need look no further than the statute itself." Department of Legal Affairs v. Sanford-Orlando Kennel Club, Inc., 434 So. 2d 879, 882 (Fla. 1983). Intent is to be determined primarily from the language of the statute, and the plain meaning of the statutory language is the first consideration. See Reynolds v. State, 842 So. 2d 46 (Fla. 2002); State v. J.M., 824 So. 2d 105 (Fla. 2002); Donato v.
American Telephone and Telegraph Co., 767 So. 2d 1146 (Fla. 2000); Moonlit Waters Apartments, Inc. v. Cauley, 666 So. 2d 898 (Fla.
1996); and St. Petersburg Bank & Trust Co. v. Hamm, 414 So. 2d 1071(Fla. 1982).
In determining whether the statutory language of a statute is plain and unambiguous on its face, all parts of the statute must be read as a whole to give full meaning and effect to
each provision. See Forsythe v. Longboat Key Beach Erosion Control
District, 604 So. 2d 452, 455 (Fla. 1992); and Blinn v. Florida Department of Transportation, 781 So. 2d 1103 (Fla. 1st DCA 2000). In Forsythe, the Court stated the following:
It is axiomatic that all parts of a statute must be read together in order to achieve a consistent whole. See, e.g., Marshall v.
Hollywood, Inc., 224 So.2d 743, 749 (Fla. 4th
DCA 1969), writ discharged, 236 So.2d 114
(Fla.), cert. Denied, 400 U.S. 964, 91 S.Ct.
366, 27 L.Ed.2d 384 (1970). Where possible, courts must give full effect to all statutory provisions and construe related statutory provisions in harmony with one another. E.g., Villery v. Florida Parole & Probation Commission, 396 So.2d 1107, 1111 (Fla. 1980). .
. .
604 So. 2d at 455.
The Blinn court summarized the principle that legislative intent is to be determined by reading a statute in pari materia as follows:
In construing a statute, the plain meaning of the statutory language is the first consideration. This rule of construction requires a straightforward consideration of each relevant sentence of the statute. See Acosta v. Richter, 671 So.2d 149, 153-154 (Fla.
1996); Streeter v. Sullivan, 509 So.2d 268 (Fla. 1987). See also Kaiser Aluminum & Chemical Corp. v. Bonjorno, 494 U.S. 827, 110
S.Ct. 1570, 109 L.Ed.2d 842 (1990); Florida
State Racing Commission v. McLaughlin, 102 So.2d 574 (Fla. 1958)(the court may consider matters extrinsic to the statute to arrive at the meaning of the language employed by the legislature only when the language being construed is of doubtful meaning, or doubt is engendered by a seeming inconsistency with other parts of the same or a closely related
statute); Okeechobee Health Care v. Collins, 726 So.2d 775, 776 (Fla. 1st DCA 1998)(court
turns first to the plain language of the statute to ascertain meaning, but also must consider subsections of the same statute in pari materia); Mayo Clinic Jacksonville v. Department of Professional Regulation, Board of Medicine, 625 So.2d 918, 919 (Fla. 1st DCA
1993).
781 So. 2d at 1105.
In construing a sentence within a statute, the sentence is to be interpreted so as to give effect to every clause in the statute and to accord meaning and harmony to all of its parts. See
Acosta v. Richter, 671 So. 2d 149 (Fla. 1996); and State ex rel. City of Casselberry v. Mager, 356 So. 2d 267 (Fla. 1978). The statute should be read as a whole. State ex rel. Register v.
Safer, 368 So. 2d 620 (Fla. 3d DCA 1979). The analysis of a statute as a whole should also include consideration of the title of the statute. See Almerico v. RLI Insurance Company, 716 So. 2d 774 (Fla. 1998).
If legislative intent cannot be determined from the plain meaning of the statute, read in pari materia, then various principles of statutory construction and extrinsic aids have been used by the courts to determine legislative intent. These principles of statutory construction are to be used, however, only when legislative intent cannot be derived from the words it has used. As recognized by the Court in Tropical Coach Line, Inc. v. Carter, 121 So. 2d 779, 782 (Fla. 1960), there is no need to resort
to the principles of statutory construction unless legislative intent cannot be determined from the language it used:
If the language of the statute is clear and unequivocal, then the legislative intent must be derived from the words used without involving incidental rules of construction or engaging in speculation as to what the judges might think that the legislators intended or should have intended.
See also Florida State Racing Commission v. McLaughlin, 102 So. 2d 574 (Fla. 1958).
Two additional legal principles must also be considered in resolving this matter. One principle, a rule of statutory construction which applies in tax cases, is that, where there is doubt as to legislative intent, any ambiguity is to be construed liberally in favor of the taxpayer or citizen and strictly against the taxing authority. See New Sea Escape Cruises, Ltd. v. Department of Revenue, 823 So. 2d 161 (Fla. 4th DCA 2003); Florida Hi-Lift v. Department of Revenue, 571 So. 2d 1364 (Fla. 1st DCA 1990); and Department of Revenue v. Brookwood Associates, Inc., 324 So. 2d 184 (Fla. 1st DCA 1975).
The second principle, which is not limited in application to cases of legislative intent, is the principle that an agency's interpretation of a statute that it is charged with implementing is entitled to great deference. See Florida Hospital v. Agency for Health Care Administration, 823 So. 2d 844 (Fla. 1st DCA 2002); and Doyle v. Department of Business Regulation, 794 So.
2d 686 (Fla. 1st DCA 2001). This principle, however, does not require that such deference be extended where the agency's interpretation conflicts with the plain an ordinary meaning of the statute:
The standard of review of an agency decision based upon an issue of law is whether the agency erroneously interpreted the law and, if so, whether a correct interpretation compels a particular action. See §120.68(7)(d), Fla.
Stat. (1997); Southwest Florida Fla. Water Mgmt. Dist. V. Save the Manatee Club, Inc., 773 So.2d 594, 597 (Fla. 1st DCA 2000); Metro. Dade County v. Dep't of Envtl. Prot., 714 So.2d 512,
515 (Fla. 3d DCA 1998). In that the Legislature delegated to AHCA the power to enforce Section 395.0197(6), Florida Statutes (1997), we note that we are required to be highly deferential to the agency's interpretation of such statute. As the supreme court recently affirmed in Verizon Florida, Inc. v. Jacobs, 810 So.2d 906, 908 (Fla. 2002), an "agency's interpretation of the statute it is charged with enforcing is entitled to great deference." See also BellSouth Telecomms., Inc. v. Johnson, 708 So.2d 595, 596 (Fla. 1998). However, a court need not defer to an agency's construction or application of a statute if special agency expertise is not required, or if the agency's interpretation conflicts with the plain and ordinary meaning of the statute. Doyle v. Dep't of Bus. Reg., 794 So.2d 686, 690 (Fla. 1st DCA 2001).
Florida Hospital, 823 So. 2d at 847-848.
Applying the foregoing principles to this matter, when Section 395.701, Florida Statutes (2000), is read as a whole, including the title thereto, it is concluded that the language of the statute is plain on its face and lacks ambiguity.
Section 395.701, Florida Statutes, effective July 1, 2000, clearly evidences the following intended application of the PMATF:
The PMATF is assessed against hospitals;
The PMATF is imposed at the end of a hospital's fiscal
year when the hospital has an "annual net operating revenue" which is "based on the actual experience of the hospital ";
The PMATF is imposed at the Old Rate of 1.5 percent on the hospital's annual net operating revenue "for inpatient services" and at the Reduced Rate of 1.0 percent on the hospital's annual net operating revenue "for outpatient services";
The PMATF rate of assessment is imposed on the appropriate net operating revenue of the hospital;
The PMATF is determined from financial information filed with the Agency by the hospital after the close of the hospital's fiscal year;
The PMATF is calculated by the Agency and the Agency is to "certify" the amount of the assessment within six months of the end of the hospital's fiscal year;
The PMATF assessed against a hospital is to be paid in quarterly amounts on or before the first day of each calendar quarter, beginning with the first full calendar quarter that occurs after the agency certifies the amount of the assessment for each hospital"; and
All PMATF assessments paid to the Agency are to be deposited into the PMATF.
Applying the foregoing interpretation to this matter, there is no ambiguity as to when the changes to the PMATF, including the Reduced Rate, were intended by the Legislature to apply: those changes apply to any and all PMATF assessments "imposed" on or after July 1, 2000, despite the fact that the revenues included in the annual net operating revenue of a hospital were earned (the point the Agency has argued the assessment attaches) prior to July 1, 2000, and regardless of when information necessary to calculate the amount of the PMATF assessment is provided to the Agency, when the agency calculates and invoices the PMATF assessment, or when the PMATF assessment is actually paid (the point Petitioners have argued the assessment attaches).
Because Section 395.701, Florida Statutes (2000), lacks ambiguity, there is no need to resort to additional principles of statutory construction or extrinsic evidence. Nor is the Agency's interpretation of the law entitled to deference. Given the history of the Agency's interpretation of the Act, even if there were ambiguity as to legislative intent, the Agency's essentially unexplained wavering position in these cases should be accorded little deference.
The Amount of Refund Due.
The parties have stipulated, depending upon the conclusions reached in this Recommended Order, the amount of PMATF refund due to each Petitioner. Those amounts are contained in the Refund Calculation Notebooks, Joint Composite Joint Exhibit 1.
Petitioners with fiscal year-ends of April 30 and May 31, 2000, are entitled to the refund amounts reflected in Exhibit 13. All events necessary for imposition of the PMATF assessment for these Petitioners for their fiscal year ending in 2000 occurred before the effective date of the Act. Petitioners with June 30, 2000, September 30, 2000, and December 31, 2000,
fiscal year-ends are entitled to refunds of the amounts reflected in exhibit 14.
Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered by the Agency:
Concluding that the Legislature intended that the changes adopted in the Act are to be applied to Petitioners consistent with the Imposition Method described in this Recommended Order;
Providing that Petitioners, other than those with a June 30, 2000, fiscal year-end, are entitled to refunds of PMATF payments calculated on Exhibit 14 of the Refund Calculation Notebooks;
Providing that Petitioners with a June 30, 2000, fiscal year-end are entitled to refunds of PMATF payments calculated on Exhibit 14 of the Refund Calculation Notebooks.
DONE AND ENTERED this 23rd day of May, 2005, in Tallahassee, Leon County, Florida.
S
LARRY J. SARTIN
Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
(850) 488-9675 SUNCOM 278-9675
Fax Filing (850) 921-6847 www.doah.state.fl.us
Filed with the Clerk of the Division of Administrative Hearings this 23rd day of May, 2005.
ENDNOTES
1/ The names of all Petitioners have been included in Appendix A, attached to this Recommended Order.
2/ The Order of Pre-Hearing Instructions, as modified, required that the parties disclose the names and addresses of all witnesses at a meeting to be held on September 2, 2003.
3/ Ms. Fitzgerald was accepted as an expert in health care finance, accounting, and Public Medical Assistance Trust Fund regulation.
4/ Mr. Thurston was designated as Respondent's representative and was accepted as an expert in public accounting. Mr. Thurston, at the time, was an Assistant Deputy Secretary for Medicaid Finance for Respondent. While his regular duties and responsibilities did
not include management or oversight of the Public Medical Assistance Trust Fund, he had been assigned by the Secretary of Respondent to head up the implementation of the changes to the Public Medical Assistance Trust Fund at issue in these cases, and was, therefore, accepted as a spokesperson for Respondent.
5/ Among other arguments made to support their request to present additional evidence, Petitioners argued that the Preliminary Order contained certain errors which required rectifying. Those errors, to the extent necessary, have been corrected in this Recommended Order.
6/ In support of its opposition to the Motion to Bifurcate, Respondent attached two affidavits, two multi-page schedules, an information letter issued by Respondent in April 2003, excerpts from the FHURS Manual, and related rule amendment language. On August 26, 2004, Petitioners filed a Motion to Strike requesting that those attachments be stricken from the record. Respondent filed AHCA's Opposition to Petitioners' Motion to Strike. On September 24, 2004, the Motion to Strike was denied.
7/ Petitioners reported in a footnote that the content of the status report had not been agreed to by Respondent and, therefore, was being filed only on behalf of Petitioners.
8/ Two of the Refund Calculation Notebooks contain calculations for Petitioners that have some type of business or ownership relationship with HCA Health Services of Florida, Inc., all of which have calendar fiscal years. One notebook contains calculations for Petitioners that have some type of business or ownership relationship with Tenet Healthsystem Hospitals, Inc., all of which have May 31st fiscal year ends. Another notebook contains Petitioners with calendar fiscal years. Finally, one notebook contains three Petitioners with April 30th fiscal year ends, eight Petitioners with June 30th fiscal year ends, and 12 Petitioners with September 30th fiscal year ends.
9/ "Other operating revenue" includes revenues from services not directly related to patient care, such as cafeteria and gift shop revenues.
10/ In the Preliminary Order, the dates contained in subparagraphs
b. through f. were incorrect, as pointed out by Petitioners in their Motion to Permit Consideration of Additional Evidence and Argument. The dates have been corrected in this Recommended Order.
11/ This date has been corrected to reflect the changes made to paragraph 23.
12/ In the Preliminary Order, it was incorrectly stated that the invoice informs a hospital of the total amount of its assessment. This finding was incorrect, as pointed out Petitioners in their Motion to Permit Consideration of Additional Evidence and Argument, and has been corrected in this Recommended Order.
13/ In Petitioners' Additional Written Argument Petitioners suggest that this paragraph, as it appeared in the Preliminary Order, suggested that the question of when the Legislature intended that the PMATF assessment is to be imposed is ambiguous. This argument is rejected. While paragraph 32 of the Preliminary Order was poorly written, it was merely intended to point out that the Legislature's intent as to when the assessment is to be imposed is not as precise or as clear as other components of the PMATF assessment. That is not to say, however, that the Legislature's intent is not clear when Section 395.701, Florida Statutes, is considered as a whole.
14/ Petitioners' proposed finding of fact 12 is hereby accepted and incorporated into this Order.
15/ The estimated $84.9 million of PMATF collections for the fiscal year comes from the December 1, 1999, Report of the Public Medical Assistance Trust Fund Task Force, Petitioners' Exhibit 15, Bates Stamp Page 15-11. The estimate of the reduction in PMATF collections comes from the House of Representatives' final bill analysis of the 2000 Amendment, Petitioners' Exhibit 16, Bates Stamp Page 16-35.
The function of the PMATF Task Force and its report is explained in greater detail in Petitioners' proposed findings of fact 18 and 19. The findings in the House of Representatives' final bill analysis are explained in greater detail in Petitioners' proposed finding of fact 20 and 21. To the extent not inconsistent with the conclusions reached in this Order, those findings are accepted and incorporated herein by reference.
16/ In the Preliminary Order it was concluded that "[t]he $28.3 million appropriation is inconsistent with the position the Agency has now taken concerning when the Reduced Rate should apply to PMATF assessments." Petitioners have argued in Petitioners' Additional Argument that the $28.3 million appropriation is also inconsistent with the methodology which the undersigned concluded in the Preliminary Order was the appropriate method of applying the changes of the Act. Petitioners, therefore, argue that the additional evidence as to the dollar impact of the methodology of
the Preliminary Order which they have proffered, should be admitted.
While Petitioners may indeed be correct as to any apparent inconsistency between the amount of the legislative appropriation and the amount of the actual reduction in the assessment of the PMATF as a result of the application of the methodology of the Preliminary Order, that inconsistency is not deemed relevant to the resolution of these cases. Unlike the Agency, the methodology of the Preliminary Order is not a methodology which is inconsistent with a methodology or position concerning the impact of a methodology previously taken or advocated by the undersigned.
Additionally, any inconsistency between the $28.3 million appropriation and whatever amount of refund hospitals are entitled to for the 2000-2001 fiscal year is one, if the conclusions of this Recommended Order are correct, not of the making of the undersigned. It is, instead, the result of inaccuracies in estimating the $28.3 million.
17/ The $5.2 million difference in the Agency's projected loss and the projected loss contained in the legislative analysis is attributable to losses from non-hospital health care facilities.
18/ The Social Services Estimating Conference is one of 12 groups established and governed by Sections 216.133 through 216.137, Florida Statutes, as the "consensus estimating conference." Each of the 12 conferences, including the Social Services Estimating Conference, is charged with the duty to meet and "develop official information within its area of responsibility as the conference determines is needed for purposes of the state planning and budgeting system." § 216.134(1), Fla. Stat. What constitutes "official information" is defined in Section 216.133(2), Florida Statutes, as "data, forecasts, estimates, analyses, studies, and other information which the principals of a consensus estimating conference unanimously adopt for purposes of the state planning and budgeting system."
19/ The Agency allowed a 40% reduction in the PMATF payment to be made in the quarter beginning January 1, 2003, rather than a complete refund or credit of the total amount of overpayment of PMATF a hospital may have made.
20/ Some hospitals had already filed refund requests prior to November 25, 2002. They had included with their refund request a Worksheet C-3a (rev.), which at the time had not yet been adopted by the Agency as a rule but was being considered for use in processing refund requests. Despite the fact that the worksheet
had not been formally adopted and hospitals had not been informed that they needed to seek refunds through its use, the Agency limited its partial application of the Reduced Rate by way of a credit to those hospitals that had already filed a Worksheet C-3a (rev.). See Petitioners' Proposed Findings of Fact 72 and 73 in the Joint Proposed Findings of Fact, Conclusions of Law and Preliminary Recommended Order of Petitioners.
21/ The date of the letters denying the refund requests of the various Petitioners is reflected in Attachment A to the Joint Prehearing Stipulation filed in these cases. Those dates are hereby incorporated into this Order by reference.
22/ In the Preliminary Order it was stated that the crucial component of the PMATF assessments was "not as clearly explained by the Legislature . . . ." This statement, while poorly written, was not intended to suggest that the question of when the Legislature intended that the PMATF assessment is to be imposed is ambiguous.
See endnote 13.
COPIES FURNISHED:
Steven T. Mindlin, P.A. John L. Wharton, Esquire Diane D. Tremor, P.A.
Rose, Sundstrom & Bentley, LLP 2548 Blairstone Pines Drive Tallahassee, Florida 32301
C. Gary Williams, Esquire Michael J. Glazer, Esquire Ausley & McMullen
Post Office Box 391 Tallahassee, Florida 32302
Grant P. Dearborn, Assistant General Counsel Agency for Health Care Administration
2727 Mahan Drive, Mail Station No. 3 Tallahassee, Florida 32399-5403
Jonathan L. Rue, Esquire
Parker, Hudson, Rainer & Dobbs, LLP 1500 Marquis Two Tower
285 Peachtree Center Avenue, Northeast Atlanta, Georgia 30303
Karen A. Putnal, Esquire
Parker, Hudson, Rainer & Dobbs, LLP The Perkins House, Suite 200
118 North Gadsen Street Tallahassee, Florida 32301
Alan Levine, Secretary
Agency for Health Care Administration Fort Knox Building, Suite 3116
2727 Mahan Drive
Tallahassee, Florida 32308
Richard Shoop, Agency Clerk
Agency for Health Care Administration 2727 Mahan Drive, Mail Station No. 3 Tallahassee, Florida 32308
William Roberts, General Counsel Agency for Health Care Administration Fort Knox Building, Suite 3431
2727 Mahan Drive
Tallahassee, Florida 32308
NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
All parties have the right to submit written 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.
APPENDIX A
DOAH CASE NO. PETITIONER
03-1868 Plantation General Hospital Limited Partnership, d/b/a Plantation General Hospital
03-1869 Shands at Lakeshore, Inc.
03-1870 CGH Hospital, Ltd., d/b/a Coral Gables Hospital; Tenet Healthsystem Hospitals, Inc., d/b/a Delray Medical Center,; FMC Hospital, Ltd., d/b/a Florida Medical Center; Tenet Good Samaritan, Inc., d/b/a good Samaritan Medical Center, Tenet Hialeah Healthsystem Hospitals, Inc., d/b/a Hialeah Hospital; Tenet Healthsystem Hospitals, Inc., d/b/a Hollywood Medical Center; Amisum (North Ridge Hospital), Inc., d/b/a North Ridge Medical Center; Tenet Healthsystem North Shore, Inc., d/b/a North Shore Medical Center; Palm Beach Gardens Community Hospital, Inc., d/b/a Palm Beach Gardens Medical Center; Lifemark Hospitals of Florida, Inc., d/b/a Palmetto General Hospital; North Miami Medical Center, Ltd., d/b/a Parkway Regional Medical Center; Pinecrest Rehabilitation Hospital, Inc., d/b/a Pinecrest Rehabilitation Hospital; Tenet St. Mary's, Inc., d/b/a St.
Mary's Medical Center; Tenet Healthsystem Hospitals, Inc.,/ d/b/a Seven Rivers Community Hospital; and Tenet Healthsystem Hospitals, Inc., d/b/a West Boca Medical Center
03-1871 Memorial Healthcare Group, Inc., d/b/a Memorial Hospital Jacksonville
03-1872 New Port Richey Hospital, Inc.
03-1873 North Florida Regional Medical Center, Inc.
03-1874 Galencare, Inc. d/b/a Northside Hospital
03-1875 HCA Health Services of Florida, Inc., d/b/a Oak Hill Hospital
03-1876 | Northwest Medical Center, Inc. |
03-1877 | Edward White Hospital, Inc. |
03-1878 | Sarasota Doctors Hospital, Inc., d/b/a |
Doctors Hospital of Sarasota | |
03-1879 | Doctors Osteopathic Medical Center, |
Inc., d/b/a Gulf Coast Hospital | |
03-1880 | Cedars Healthcare Group, Ltd., d/b/a |
Cedars Medical Center | |
03-1885 | Sun City Hospital, Inc., d/b/a South |
Bay Hospital | |
03-1886 | Southwest Florida Regional Medical |
Center, Inc. | |
03-1887 | Okaloosa Hospital, Inc., d/b/a Twin |
Cities Hospital | |
03-1888 | University Hospital, Ltd., d/b/a |
University Hospital and Medical Center | |
03-1889 | West Florida Regional Medical Center, |
Inc. | |
03-1890 | Columbia Hospital Corporation of South |
Broward, d/b/a Westside Regional | |
Medical Center | |
03-1892 | Orange Park Medical Center, Inc. |
03-1893 | Marion Community Hospital, Inc., d/b/a |
Ocala Regional Medical Center | |
03-1894 | Lawnwood Medical Center, Inc., d/b/a |
Lawnwood Regional Medical Center | |
03-1895 | Largo Medical Center, Inc. |
03-1896 | Columbia Hospital (Palm Beaches) |
Limited Partnership, d/b/a/ Columbia | |
Hospital | |
03-1897 | Notami Hospital of Florida, Inc., d/b/a |
Lake City Medical Center | |
03-1898 | Kendall Healthcare Group, Ltd., d/b/a |
Kendlal Medical Center | |
03-1899 | Columbia/JFK Medical Center Limited |
Partnership, d/b/a JFK Medical Center | |
03-1900 | Miami Beach Healthcare Group, Ltd., |
d/b/a Aventura Hospital and Medical | |
Center | |
03-1901 | Bay Hospital, Inc., d/b/a Gulf Coast |
Medical Center | |
03-1902 | Bartow Healthcare System, Ltd., d/b/a |
Bartow Memorial Hospital | |
03-1903 | Englewood Community Hospital, Inc. |
03-1904 | Fawcett Memorial Hospital, Inc. |
03-1905 | Fort Walton Beach Medical Center, Inc. |
03-1906 | HCA Health Services of Florida, Inc., d/b/a Blake Medical Center |
03-1907 | HCA Health Services of Florida, Inc., |
d/b/a Regional Medical Center Bayonet | |
Point | |
03-1908 | Tallahassee Medical Center, Inc., d/b/a |
Tallahassee Community Hospital | |
03-1909 | Galencare, Inc., d/b/a Brandon Regional |
Hospital | |
03-1928 | Shands Teaching Hospital and Clinics, |
Inc., d/b/a Shands at Live Oak | |
03-1929 | Shands Teaching Hospital and Clinics, |
Inc., d/b/a Shands at Starke | |
03-1930 | Shands Teaching Hospital and Clinics, |
Inc., d/b/a Shands Hospital at the | |
University of Florida | |
03-1931 | Osceola Regional Hospital, Inc., d/b/a |
Osceola Regional Medical Center | |
03-1932 | Columbia Palms West Hospital Limited |
Partnership, d/b/a Palms West Hospital | |
03-1933 | Okeechobee Hospital, Inc., d/b/a |
Raulerson Hospital | |
03-1934 | HCA Health Services of Florida, Inc., |
d/b/a Saint Lucie Medical Center | |
03-1935 | Putnam Community Medical Center, LLC, |
03-2681 | Lakeland Regional Medical Center, Inc., |
d/b/a Lakeland Regional Medical Center | |
03-2981 | Mount Sinai Medical Center of Florida, |
Inc., d/b/a Mount Sinai Medical Center | |
03-2982 | Wuesthoff Memorial Hospital |
03-2983 | Holmes Regional Medical Center, Inc. |
03-2984 | Cape Canaveral Hospital, Inc. |
03-2985 | Morton Plant Hospital Association, |
Inc., d/b/a Morton Plant North Bay | |
Hospital | |
03-2986 | Morton F. Plant Hospital Association, |
Inc., d/b/a Morton Plant Hospital | |
03-2987 | South Florida Baptist Hospital, Inc. |
03-2988 | Saint Joseph's Hospital, Inc. |
03-2989 | Saint Anthony's Hospital, Inc. |
03-2990 | Trustees of Mease Hospital, Inc., |
d/b/a Mease Hospital - Dunedin | |
03-2991 | Shands Jacksonville Medical Center, |
Inc. | |
03-2993 | Sacred Heart Hospital of Pensacola |
03-3465 | Baptist Hospital, Inc. |
03-3466 | Mercy Hospital, Inc. |
03-3467 | St. Vincent's Medical Center, Inc. |
03-3971 | Halifax Hospital Medical Center, d/b/a |
Halifax Medical Center | |
03-3974 | Bethesda Memorial Hospital |
04-1555 | South Broward Hospital District, d/b/a |
Memorial Regional Hospital | |
04-1557 | South Broward Hospital District, d/b/a |
Memorial Hospital Pembroke | |
04-1558 | South Broward Hospital District, d/b/a |
Memorial Hospital West | |
04-1559 | Adventist Health system, Inc., d/b/a |
Florida Hospital | |
04-1562 | Pasco HMA, Inc., d/b/a Pasco Regional |
Medical Center | |
04-1564 | Bayfront Medical Center, Inc. |
04-1580 | Bay Medical Center |
04-1581 | Orlando Regional Healthcare System, |
Inc., d/b/a Orlando Regional Medical | |
Center | |
04-1582 | Holy Cross Hospital, Inc. |
04-1583 | Winter Haven Hospital, Inc. |
04-1584 | North Brevard County Hospital District, |
d/b/a Parrish Medical Center | |
04-1882 | Leesburg Regional Medical Center, Inc. |
| Issue Date | Document | Summary |
|---|---|---|
| Jun. 28, 2006 | Agency Final Order | |
| May 23, 2005 | Recommended Order | The determination of the amount of refunds due to the medical facilities for the reduction in the rate which the Public Medical Assistance Trust Fund was assessed after the 2000 amendment to Section 395.701(2), Florida Statutes. |
SOUTH FLORIDA BAPTIST HOSPITAL, INC. vs AGENCY FOR HEALTH CARE ADMINISTRATION, 03-002981 (2003)
SAINT JOSEPH`S HOSPITAL, INC. vs AGENCY FOR HEALTH CARE ADMINISTRATION, 03-002981 (2003)
CAPE CANAVERAL HOSPITAL, INC. vs AGENCY FOR HEALTH CARE ADMINISTRATION, 03-002981 (2003)
SAINT ANTHONY`S HOSPITAL, INC. vs AGENCY FOR HEALTH CARE ADMINISTRATION, 03-002981 (2003)
