STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
HAINES CITY HMA, LLC, d/b/a HEART OF FLORIDA REGIONAL MEDICAL CENTER,
Petitioner,
vs.
AGENCY FOR HEALTH CARE ADMINISTRATION,
Respondent.
/ SEBRING HOSPITAL MANAGEMENT ASSOCIATES, LLC, d/b/a HIGHLANDS REGIONAL MEDICAL CENTER,
Case No. 13-0166CON
vs.
Petitioner,
Case No. 13-0167CON
AGENCY FOR HEALTH CARE ADMINISTRATION,
Respondent.
/
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its designated Administrative Law Judge, R. Bruce McKibben, held the final hearing in the above-styled cases on August 19-20 and 22-23, 2013, in Tallahassee, Florida.
APPEARANCES
For Petitioners: Geoffrey D. Smith, Esquire
Susan C. Smith, Esquire Smith and Associates
2873 Remington Green Circle Tallahassee, Florida 32308
For Respondent: Lorraine M. Novak, Senior Attorney
Fort Knox Building III, Mail Stop 3 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3
Tallahassee, Florida 32308 STATEMENT OF THE ISSUES
This proceeding concerns Heart of Florida’s Certificate of Need (CON) Application No. 10163 in which it seeks to add up to
14 Comprehensive Medical Rehabilitation (CMR) beds to its existing acute care hospital in Polk County (District 6), and Highlands Regional’s CON Application No. 10165 seeking to add up to seven CMR beds to its existing acute care hospital located in Highlands County (District 6). The CON Applications submitted by Heart of Florida and Highlands Regional were comparatively reviewed with the following co-batched applications to establish new inpatient CMR units in District 6: HealthSouth Rehabilitation Hospital of Polk County, LLC (CON #10162), and Lakeland Regional Medical Center, Inc. (CON #10164).
On December 7, 2012, the Agency for Health Care Administration (“AHCA”) preliminarily approved CON Application No. 10164, submitted by Lakeland Regional Medical Center, Inc., and denied all other co-batched applications. Each of the denied
applicants filed a Petition for Formal Administrative Hearing to contest the denial of its application. The matters were consolidated into a single proceeding at DOAH. However, the files on Lakeland Regional and HealthSouth Rehabilitation were closed as of April 8, 2013, when the present Petitioners withdrew their opposition to approval of CON 10164 and HealthSouth voluntarily dismissed its petition for formal hearing.
The issues remaining in this matter are whether the CON applications filed by Heart of Florida and Highlands Regional in Agency for Health Care Administration (AHCA or the Agency) District 6, satisfy, on balance, the applicable statutory and rule review criteria sufficiently to warrant approval and, if so, whether either or both of the applications should be approved.
PRELIMINARY STATEMENT
On December 11, 2012, AHCA published its decisions on batched CON applications for hospitals seeking comprehensive medical rehabilitation services in the September 2012 batching cycle. Notification was published in the Florida Administrative Register, Volume 38, Number 88. Each of the Petitioners’ CON applications was denied by AHCA. Each Petitioner timely filed a petition for formal administrative hearing to contest the decision.
The final hearing was held on the dates set forth above. At final hearing, Heart of Florida called three witnesses:
Ann Barnhart, chief executive officer of Heart of Florida’s central Florida market; Donnie Breeding, chief nursing executive officer; and Patricia Greenberg, health care consultant. Heart of Florida’s Exhibits 1-5, 6a, 6b, 7-12, 12a-z, and 19 were admitted into evidence. Highlands Regional called two witnesses: Brian Hess, chief executive officer; and Patricia Greenberg.
Highlands Regional’s Exhibits 1-11, 11a-z, 11aa-af, and 17 were admitted into evidence. AHCA called one witness: Jeff Gregg, director of Florida Center for Health Information & Policy Analysis. AHCA’s Exhibits 1-6 were admitted into evidence.
Upon completion of the final hearing, the parties advised that a transcript of the proceeding would be ordered. The parties, by rule, have ten days from the date the transcript is filed at DOAH to submit proposed recommended orders (PROs). The Transcript was filed at DOAH on September 16, 2013. The parties filed an agreed motion for additional time to file their PROs.
The undersigned entered an Order extending the time for filing PROs to October 18, 2013. Each party timely submitted a PRO and each was considered in the preparation of this Recommended Order.
FINDINGS OF FACT
Stipulated Facts as set forth in PreHearing Stipulation
Both Heart of Florida and Highlands Regional have the ability to provide quality of care and have a record of providing quality of care to their patients. Section 408.035(l)(c),
Florida Statutes, is not in dispute and not an issue in this proceeding. (Unless specifically stated otherwise herein, all references to Florida Statutes will be to the 2013 version.)
Both Heart of Florida and Highlands Regional have the resources and funds for capital and operating expenditures, for project accomplishment and operation; therefore, section 408.035(1)(d) is not in dispute and not an issue in this proceeding.
While Heart of Florida and Highlands Regional's proposed salaries on schedule 6 of their respective CON Applications are appropriate and reasonable, the level of staffing necessary and required for a small unit, while still remaining financially feasible remains at issue in this proceeding.
Heart of Florida and Highlands Regional's proposed facility costs and design are reasonable and not at issue in this proceeding.
Both Heart of Florida and Highlands Regional are financially feasible in the short term to operate the CMR beds proposed in their respective CON Applications; therefore, section 408.035(l)(f) is not at issue with respect to short term financial feasibility. The issue of short-term financial feasibility is not in dispute and not an issue in this proceeding.
Both Heart of Florida and Highlands Regional are financially feasible in the long term to operate the CMR beds proposed in their respective CON Applications in accordance with section 408.035(l)(f); however, AHCA has concerns over the appropriate staffing level for small CMR units and thus the issue of how Heart of Florida and/or Highlands Regional's long-term financial feasibility could be impacted if additional staff are required remains at issue in this proceeding.
Both Heart of Florida and Highlands Regional propose appropriate costs and methods of proposed construction for their respective CMR projects, including the costs and methods of energy provision and the availability of alternative, less costly, or more effective methods of construction; therefore, section 408.035(l)(h) is not in dispute and not an issue in this proceeding.
The past and proposed provision of health care services to Medicaid patients and the medically indigent by both Heart of Florida and Highlands Regional is appropriate; therefore, section 408.035(1)(o) is not in dispute and is not an issue in this proceeding.
The CON Applications of both Heart of Florida and Highlands Regional contained the required application content under section 408.037.
In the CMR project proposals of both Heart of Florida and Highlands Regional, CMR services will be provided in separately organized units within their respective facilities, which are both Class 1 acute care hospitals; therefore, Florida Administrative Code Rule 59C-1.039(3)(a) and (b) is not in dispute and not an issue in this proceeding.
Both Heart of Florida and Highlands Regional propose to participate in the Medicare and Medicaid programs and, therefore, rule 59C-1.039(3)(e) is not in dispute and is not an issue in this proceeding.
Both project proposals of Heart of Florida and Highlands Regional provide that CMR services will be provided under a medical director of rehabilitation who is a board- certified or board-eligible physiatrist and has had at least two years of experience in the medical management of inpatients requiring rehabilitation services; therefore, rule 59C- 1.039(4)(a) is not in dispute and is not an issue in this proceeding.
Both Heart of Florida and Highlands Regional propose to provide the following services provided by qualified personnel: rehabilitation nursing, physical therapy, occupational therapy, speech therapy, social services, psychological services, or orthotic and prosthetic services. As such, rule 59C-1.039(4)(b) is not in dispute and is not an issue in this proceeding.
Both Heart of Florida and Highlands Regional propose to serve Medicaid-eligible patients in their respective CMR programs.
The proposed CMR programs of both Heart of Florida and Highlands Regional provided program descriptions for:
Age groups to be served;
Specialty inpatient rehabilitation services to be provided, if any;
Proposed staffing, including qualifications of the medical director, a description of staffing appropriate for any specialty program, and a discussion of the training and experience requirements for all staff who will provide comprehensive medical rehabilitation inpatient services;
A plan for recruiting staff, showing expected sources of staff;
Expected sources of patient referrals;
Projected number of CMR inpatient services patient days by payer type, including Medicare, Medicaid, private insurance, self-pay and charity care patient days for the first 2 years of operation after completion of the proposed project;
Admission policies of the facility with regard to charity care patients.
The Health Care Services at Issue
AHCA is the state agency responsible for, inter alia, managing the certificate of need program whereby health care providers may seek approval for certain regulated health care
services. One such service is comprehensive medical rehabilitation, a level of comprehensive in-patient rehabilitation for persons with certain designated diagnoses and treatments. In furtherance of its duties, AHCA develops and publishes a need for new CMR beds in each of the 11 service districts around the State. Interested applicants for new CMR beds may apply by filing a CON application in response to the published need. In the event there is no need, an applicant may seek approval for new CMR beds by way of “not normal” circumstances.
As set forth in Florida Administrative Code Rule 59C- 1.002(41), “Tertiary health service” means:
[A] health service which, due to its high level of intensity, complexity, specialized or limited applicability, and cost, should be limited to, and concentrated in, a limited number of hospitals to ensure the quality, availability, and cost effectiveness of such service. Examples of such service include, but are not limited to, organ transplantation, specialty burn units, neonatal intensive care units, comprehensive rehabilitation, and medical or surgical services which are experimental or developmental in nature to the extent that the provision of such services is not yet contemplated within the commonly accepted course of diagnosis or treatment for the condition addressed by a given service. . . .
CMR programs are a tertiary health service. As such, CMR beds are regulated by AHCA. In order to qualify for placement in a CMR bed, a patient must require substantial
rehabilitation. To ensure that CMR providers do not inappropriately admit patients that could be treated in a less acute setting, the Center for Medicare and Medicaid Services (CMS) has established eligibility criteria for CMR patients. At least 60% of all patients in a CMR unit must have a primary diagnosis within one of 13 medical conditions, often referred to as CMS-13 categories. Those conditions include active polyarticular rheumatoid arthritis, amputation, brain surgery, burns, congenital deformity, fracture of femur, hip or knee-joint disease, spinal cord injury, stroke, and systematic vasculidities with joint inflammation. Patients with those conditions very often need extensive rehabilitation before resuming normal activities of life. Patients without a CMS-13 diagnosis but having other comorbidities such as age, obesity, and/or high blood pressure may also qualify for CMR services. To be admitted to a CMR program, the patient must be sick enough to need an acute care setting, but well enough to endure three hours a day of rehabilitative therapy, including at least two types of therapy, e.g., speech, occupational, or physical.
In this proceeding, there was no published need for new CMR beds in District 6 for the September 2012 batching cycle.
The bed need calculation by AHCA resulted in a finding of a net need of minus 48 CMR beds, rounded up to zero. Each of the
applicants attempted to prove a need for its proposed project by way of not normal circumstances.
District 6 includes five counties: Hillsborough, Polk, Manatee, Highlands, and Hardee. There are almost 2.3 million residents, half of them residing in Hillsborough County. There are over 600,000 residents of Polk County, 330,000 in Manatee County, 100,000 in Highlands County, and 25,000 in Hardee County. Of those counties, Highlands, Manatee and Polk have the highest percentage of elderly.
There are four existing CMR providers in District 6, accounting for 173 licensed CMR beds. Two of the providers are in Hillsborough County: Tampa General Hospital with 59 beds, and Florida Hospital Tampa with 30 beds. Blake Hospital in Manatee County has 28 beds. In Polk County there are two approved providers: Winter Haven Hospital has 24 beds currently licensed and Lakeland Regional Hospital is approved to license 32 beds.
Heart of Florida
Heart of Florida is a 193-bed acute care hospital located in Davenport, Polk County, Florida. It is a joint venture and is owned by Health Management Associates, Inc. and a number of physicians. The doctors own only 2.14% of the property. The hospital offers a full spectrum of healthcare services and is supported by nearly 200 specialists and subspecialists. Heart of Florida is a designated stroke center,
has an accredited chest pain center, an orthopedic center, and a joint replacement program. The hospital currently provides skilled outpatient and inpatient therapy services.
Heart of Florida is proposing the establishment of a 14-bed CMR unit within the hospital plant. It is the intent of the hospital to convert 14 of its existing acute care beds into CMR beds. The beds will be located on the third floor of the facility in an area which until recently housed an obstetrics unit. The project would include renovation of the unit, including: conversion of existing semiprivate rooms into private rooms; renovation of existing space into a recreation/day room and occupational therapy space; modification of patient showers to provide side approach to the water closets; and creation of a training kitchen, bathroom and bedroom.
Heart of Florida set forth nine enumerated bases to establish the need for the CMR beds absent a fixed need pool. Each will be addressed below.
Number 1 -- There are only 24 licensed CMR beds in the entire county of 467,045 adults, a ratio of one bed per 19,460 adult residents. No credible evidence was presented that a certain ratio of CMR beds to adult population is necessary. Rather, Heart of Florida maintains that the ratio in its county is somehow pertinent. But not all adults need CMR services, nor does the ratio alone establish a “need” which cannot be addressed
by existing programs. Rehabilitation services can be met by sub- acute facilities in many instances. Where such services are provided is often a matter of patient choice and does not always involve CMR services.
Number 2 -- There are no beds in Heart of Florida’s service area, i.e., the area from which most of its residents come. There are four existing and one approved provider of CMR services in District 6: Winter Haven Hospital (17 miles from Heart of Florida); Bake Medical Center (96 miles); Tampa General Hospital (62 miles); and Florida Hospital Tampa (60 miles). An approved but not yet operational CMR program at Lakeland Regional is 29 miles from Heart of Florida. Lakeland Regional is the only one of the CMR programs that will be located in Polk County. However, the need for such services is determined on a district- wide, not county, basis. The average annual occupancy rate at Winter Haven Hospital, the closest facility, is 66%.
Number 3 -- Continuity of care is important. Heart of Florida would like for its physicians to be able to follow CMR patients by having them receive treatment at a unit located within the hospital. It is unlikely that physicians would travel to see their patients who go to Winter Haven or another CMR provider in the district. This desire for more continuous care, however, does not establish a need for services in the district.
Number 4 -- District 6 has one of the highest CMR occupancy rates of any district in the State, and it has the single lowest CMR discharge use rate per 1,000 population age 65 and older. This naked statistic or factoid does not, in and of itself, establish a need for CMR beds at Heart of Florida. There will always be one district with the highest CMR occupancy rate. There will always be one district with the lowest CMR discharge rate per 1,000 population. Absent a clinical correlation between those two facts, they fail to establish need for the CMR program at Heart of Florida.
Number 5 -- Heart of Florida is committed to fulfilling a continuum of care for its stroke patients. A CMR program on campus would help the hospital effectuate this commitment by adding CMR services to its treatment of stroke victims. However, this desire on Heart of Florida’s part does not establish a “need” for the program.
Number 6 -- There is a large percentage of elderly persons in Heart of Florida’s primary service area as compared to the State average. While this may be a fact, it is not an indicator of need for new CMR beds in the district.
Number 7 -- Heart of Florida would like a CMR program to complete its wide array of services available to its patients. Heart of Florida maintains that, “In light of the Affordable Care Act, the Applicant must position itself for the future where it
will be able to offer a full array of services to compete effectively in providing quality services.” The hospital’s desire to be more competitive in the market does not establish need for a CMR unit.
Number 8 -- Heart of Florida can support a CMR program from its own patient base. In fact, Heart of Florida fully expects that its CMR unit would be occupied by its own patients, not patients from other hospitals. That fact does not establish need in the district for a new program. In fact, its intention to serve only its own patients militates against a district-wide need for such services.
Number 9 -- There are no existing CMR beds in Heart of Florida’s primary service area, i.e., in the geographic area from whence most of its patients come. This fact does not address or support the need for CMR beds in the district.
The above-stated facts alleging need fall far short of establishing circumstances that warrant approval of Heart of Florida’s proposal. The facts distinguish Heart of Florida’s service area from other service areas around the State. The facts establish that Heart of Florida would enjoy having a CMR unit and that it would likely be profitable. But the facts do not establish need for a new program in the district.
Heart of Florida is experiencing an average of 16% to 20% patient readmissions to the hospital. That is, that
percentage of patients who are discharged after treatment are having to be readmitted for further care related to the prior treatment. The benchmark for readmissions is about 10%. Under the Affordable Care Act, hospitals which do not meet the benchmark will be assessed a penalty. The hospital’s CEO and its chief nursing officer opined that an in-house CMR unit could help to reduce the readmission rate for some CMS-13 patients. The testimony was not adequately supported and was not persuasive.
Based on the total number of discharges from the hospital versus the number of rehabilitative patient discharges, it is not certain the CMR beds would have much impact on the readmission rate. And, even if the CMR unit did help Heart of Florida’s readmission experience, that does not constitute an additional need for the service in the district.
Highlands Regional
Highlands Regional is a 126-bed acute care hospital in Sebring, Highlands County, Florida. The hospital is owned by Health Management Associates, Inc. (HMA), which is also the primary owner of Heart of Florida. HMA is a Florida-based national operator of community hospitals and health services. It owns and operates 70 hospitals and health systems in 15 states around the country.
Highlands Regional proposes the development of a 7-bed CMR unit within its existing infrastructure in Sebring. The unit
would be located on the second floor of the hospital in space that was formerly utilized as a hospice. Each of the beds would be located in a private room with a private bath.
Highlands Regional sets forth seven bases which it believes justifies the approval of its project by establishing a need despite no fixed need pool. Each of those will be discussed herein.
Number 1 -- District 6 has one of the highest CMR occupancy rates of any district in the State, and it has the single lowest CMR discharge use rate per 1,000 population age 65 and older. As stated above in the discussion of Heart of Florida’s proposal, this statistic or factoid does not, in and of itself, establish a need for CMR beds. There will always be one district with the highest CMR occupancy rate. There will always be one district with the lowest CMR discharge rate per 1,000 population. Absent a clinical correlation between those two facts, they fail to establish need for the CMR program at Heart of Florida.
Number 2 -- Existing CMR beds are from 50 to 92 miles from Highlands Regional. The hospital is located in a relatively rural area, so longer travel is to be expected for its patients as compared to urban areas. Thus, patients discharged from Highlands County would have to travel farther than patients discharged from other hospitals around the State. However, this
fact only establishes that it is more inconvenient for some of Highlands Regional’s patients to get comprehensive medical rehabilitation services. Inconvenience does not establish a need for new beds.
Number 3 -- A seamless, uninterrupted continuity of care from the acute care setting to the post-acute CMR setting is not available to some residents in Highlands Regional’s primary service area. While it is clear that there is not a CMR unit near the hospital, there was no evidence provided that patients were not receiving the care they need. If an “uninterrupted continuity of care” standard was applied, then essentially every hospital in the state would “need” a CMR unit.
Number 4 -- There is a large percentage of elderly population in Highlands County compared to the State average. This fact does not warrant approval of a CMR unit.
Number 5 -- There is a gap in Highlands Regional’s continuum of care. Highlands Regional states that, “In light of the Affordable Care Act, the Applicant must position itself for the future where it will be able to offer a full array of services to compete effectively in providing quality services.” As stated above, the hospital’s desire to be more competitive in the market does not establish need for a CMR unit.
Number 6 -- Highlands Regional is able to fully support a CMR program based on its own internal volume of rehabilitation-
appropriate patients. This fact does not establish the need for a new CMR unit in the district. The HealthSouth application (10162) was approved despite its contention that patients from Highlands County are in a different medical market and that it would not likely serve patients from other counties. However, CMR proposals are currently approved by AHCA on a district-wide basis despite applicants’ remonstrations to the contrary.
Number 7 -- There are no existing CMR beds in Highlands County. There was no competent evidence presented to establish that every county in Florida must have a CMR program.
The above-stated facts alleging need fall far short of establishing circumstances that warrant approval of Highlands Regional’s proposal.
Highlands Regional is experiencing an average of 16% readmissions to the hospital. The benchmark for readmissions is about 10%. Under the Affordable Healthcare Act, hospitals which do not meet the benchmark will be assessed a penalty. The hospital has about 9,000 discharges a year. Of those, about 277 were CMS-13 discharges. It is not clear that a CMR unit, even if it allowed for fewer readmissions to CMS-13 patients, would resolve Highlands Regional’s readmission problem.
Each of the applicants in this case sets forth facts showing that their patients have to travel farther than some other patients in Florida to access comprehensive medical
rehabilitation in a CMR unit. Each applicant’s physicians expressed frustration that their patients could receive better care in a CMR unit, but none testified that their patients were not now receiving adequate care. Each applicant established a strong desire for its own CMR unit and showed that the unit would be financially lucrative, but that is not a basis for approving a new unit.
Each applicant presented testimony from its physicians containing anecdotal hearsay from their patients concerning unwillingness to travel. There was no competent evidence that CMR services were not available, just that such services were farther away than patients were willing to travel. That inconvenience for patients does not establish a need for CMR services in the district.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to and the subject matter of this proceeding. §§ 120.569, 120.57(1), and 408.039(5), Fla. Stat.
As the applicants for a CON, Heart of Florida and Highlands Regional each has the burden of proving, by the preponderance of the evidence, entitlement to the CON. Boca
Raton Artificial Kidney Ctr., Inc. v. Dep't of Health & Rehab. Servs., 475 So. 2d 260 (Fla. 1st DCA 1985); § 120.57(1)(j), Fla.
Stat.
The award of a CON to an applicant must be based on a balanced consideration of all applicable and statutory rule criteria. Balsam v. Dep't of Health & Rehab. Servs., 486 So. 2d 1341 (Fla. 1st DCA 1986). "[T]he appropriate weight to be given to each individual criterion is not fixed, but rather, must vary on a case-by-case basis, depending upon the facts of each case." Collier Med. Ctr., Inc. v. Dep't of Health & Rehab. Servs., 462 So. 2d 83, 84 (Fla. 1st DCA 1985).
An administrative hearing involving disputed issues of material fact is a de novo proceeding in which the Administrative Law Judge independently evaluates the evidence presented. Fla. Dep't of Transp. v. J.W.C. Co., 396 So. 2d 778, 787 (Fla. 1st DCA 1981); § 120.57(1), Fla. Stat. The Agency's preliminary decisions on CON applications, including its findings in the SAAR, are not entitled to a presumption of correctness. Id.
Pursuant to the Agency's comprehensive medical rehabilitation rule need methodology, the Agency determined that there is no projected need for a new CMR program in District 6 for the applicable planning horizon. The need calculation was actually for a negative 48 beds, rounded up to zero.
The statutory review criteria are set forth in sections 408.035(1)(a) through (j). As shown by the Findings of Fact herein, both Heart of Florida and Highlands Regional generally satisfy the criteria and either one of them could be approved if
there was a numeric need under the fixed need pool or if there was a showing of special circumstances warranting a new CMR program in District 6.
There being no numeric need for a new CMR program in this case, Heart of Florida and Highlands Regional must establish the existence of special circumstances. The publication of fixed need is not determinative, and creates a rebuttable presumption as to need. Here, the published need of zero creates a rebuttable presumption of no need. The applicants may present evidence to rebut the presumption and demonstrate special circumstances that warrant approval of a CON in the absence of published need. See Humhosco, Inc. v. Dep't of Health and Rehab.
Servs., 476 So. 2d 258, 261 (Fla. 1st DCA 1985))(This was a hospital case wherein the court indicated that a lack of numeric need under the rule formula establishes a rebuttable presumption of no need); Humana, Inc. v. Dep't of Health and Rehab. Servs.,
469 So. 2d 889, 891 (Fla. 1st DCA 1985), a hospital case; and Balsam v. Dep't of Health and Rehab. Servs., supra, a hospital case.
Neither Heart of Florida nor Highlands Regional demonstrated sufficient special circumstances warranting approval of its application. The evidence presented was a general overview of the demographics and geographical situation of each applicant’s county vis-à-vis statistical comparison to other
Florida counties. There was also considerable evidence as to each applicant’s strong desire for a CMR program at its hospital. But the evidence fell woefully short of establishing a need for additional CMR beds at their respective hospital campuses.
By their nature, “not normal” circumstances are circumstances that are atypical. That is, they must be a departure from normal situations or facts. See Fla. Health Sci.
Ctr., Inc. v. AHCA, Case No. 00-481, (Fla. DOAH Mar. 30, 2001;
Fla. AHCA Aug. 6, 2001), per curiam aff’d, 827 So. 2d 984 (Fla. 1st DCA 2002). While both applicants showed differences between their county demographics and other Florida counties, they did not show that the provision of services to CMR patients was atypical from other locales. Although persons living in the applicants’ primary service areas might have to drive or be transported longer distances than other citizens of the State of Florida may be a fact, it is not a “not normal” situation for purposes of establishing need for new CMR programs in District 6.
There are other elements in Heart of Florida and Highlands’ applications that merit mention in regards to compliance with the CMR Inpatient Services rule, Florida Administrative Code Rule 59C-1.039 (the “Rule”).
Section (3)(c) of the Rule states that general hospitals providing CMR services “should normally have a minimum of 20 comprehensive medical rehabilitation inpatient beds.”
Neither applicant met this standard or explained a credible reason why rural hospitals should be exempt from the standard. Although AHCA has approved CMR units of less than 20 beds, there was insufficient evidence presented in this case to justify the smaller units.
Section (5)(c)5. of the Rule sets the desired average annual occupancy rate for CMR beds in a district at 85%. Neither applicant provided justification for adding beds to a district that did not have the prescribed level of occupancy.
Priority considerations for applicants seeking CMR beds is set forth in section (5)(g) of the Rule. Neither of the applicants is a disproportionate share hospital; neither is a designated trauma center. Both propose to serve Medicaid patients.
In section (6) of the Rule, the access standard is discussed. Under that section, CMR services should be available to patients within a maximum ground travel time of two hours. Although both applicants believe this standard to be unimportant, it still remains in the Rule and must be considered. There is no two-hour drive time problem for the two applicants’ patients.
All in all, there is not sufficient evidence that a need exists in District 6 for any additional CMR beds or that the proposals of Heart of Florida and Highlands meet the requirements for approval.
Based on the foregoing Findings of Fact and Conclusions of Law, it is
RECOMMENDED that a final order be entered by the Agency for Health Care Administration denying the CON applications of Haines City HMA, LLOC, d/b/a Heart of Florida Regional Medical Center (No. 10163), and Sebring Hospital Management Associates, LLC, d/b/a Highlands Regional Medical Center (No. 10165).
DONE AND ENTERED this 29th day of October, 2013, in Tallahassee, Leon County, Florida.
S
R. BRUCE MCKIBBEN Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
(850) 488-9675
Fax Filing (850) 921-6847 www.doah.state.fl.us
Filed with the Clerk of the Division of Administrative Hearings this 29th day of October, 2013.
COPIES FURNISHED:
Lorraine M. Novak, Esquire
Agency for Health Care Administration Fort Knox Building III, Mail Stop 3 2727 Mahan Drive, Suite 3431
Tallahassee, Florida 32308
Geoffrey D. Smith, Esquire Susan C. Smith, Esquire Smith and Associates Suite 201
2834 Remington Green Circle Tallahassee, Florida 32308
Richard J. Shoop, Agency Clerk
Agency for Health Care Administration Fort Knox Building III, Mail Stop 3 2727 Mahan Drive, Suite 3431
Tallahassee, Florida 32308
Elizabeth Dudek, Secretary
Agency for Health Care Administration Fort Knox Building III, Mail Stop 1 2727 Mahan Drive, Suite 3431
Tallahassee, Florida 32308
Stuart Williams, General Counsel Agency for Health Care Administration Fort Knox Building III, Mail Stop 3 2727 Mahan Drive, Suite 3431
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.
| Issue Date | Document | Summary |
|---|---|---|
| Dec. 13, 2013 | Agency Final Order | |
| Dec. 13, 2013 | Agency Final Order | |
| Oct. 29, 2013 | Recommended Order | Neither Petitioner proved by a preponderance of evidence the existence of circumstances warranting approval of their CON applications. |
