STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
MEDICAL PERSONNEL POOL OF ) TAMPA/ST. PETERSBURG, INC., ) SARASOTA DIVISION, )
)
Petitioner, )
)
vs. ) Case No. 85-1400
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
) MEDICAL PERSONNEL POOL OF ) TAMPA/ST. PETERSBURG, INC., ) POLK COUNTY, )
)
Petitioner, )
)
vs. ) Case No. 85-1401
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
) MEDICAL PERSONNEL POOL OF ) TAMPA/ST. PETERSBURG, INC., ) HILLSBOROUGH COUNTY, )
)
Petitioner, )
)
vs. ) Case No. 85-1403
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
)
ADVENTIST HEALTH SYSTEM/SUNBELT ) INC., d/b/a WALKER MEMORIAL ) HOSPITAL, )
)
Petitioner, )
)
vs. ) Case No. 85-1502
)
DEPARTMENT OF HEALTH AND )
REHABILITATIVE SERVICES, )
)
Respondent. )
)
RECOMMENDED ORDER
Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, K. N. Ayers, held a consolidated hearing in the above-styled cases on November 12-13, 1985, at Tallahassee, Florida.
APPEARANCES
For Petitioner: Thomas D. Watry, Esquire MMP 1200 Carnegie Building
133 Carnegie Way Atlanta, Georgia 30303
For Petitioner: W. David Watkins, Esquire Walker 2700 Blair Stone Road, Suite C
Tallahassee, Florida 32301
For Respondent: William L. Hyde, Esquire
300 East Park Avenue Tallahassee, Florida 32301
By Petitions for Formal Administrative Proceedings dated March 15, 1985, Medical Personnel Pool of Tampa/St. Petersburg, Inc. (hereinafter referred to as MPP), Petitioner, contests the denial of its application for certificates of need to establish licensed home health agencies to serve eligible patients in Manatee, Polk, and Hillsborough Counties, Florida. These petitions are assigned Case Nos. 85-1400, 85-1401, and 85-1403, respectively. By Amended Petition for Final Administrative Hearing dated April 10, 1985, Adventist Health Systems/Sunbelt, Inc., d/b/a Walker Memorial Hospital (hereinafter referred to as Walker), Petitioner, contests the denial of its application to establish a home health agency in Highlands County, Florida.
This petition is Case No. 85-1502.
All of these applications are for certificates of need to establish home health agencies in District VI and all were reviewed by the Department of Health and Rehabilitative Services in the same batching cycle. Since there are no subdistricts in District VI, these cases were consolidated for a comparative hearing.
At the commencement of the hearing MPP dismissed its application in Case No. 85-1400 and no evidence was presented respecting this application. This leaves MPP with two applications for certificates of need to establish a home health agency in Polk County and Hillsborough County certified eligible to serve Medicare and Medicaid patients. Thereafter, MPP presented two witnesses, Walker presented four witnesses, DHRS presented one witness, and 18 exhibits were admitted into evidence. Proposed findings submitted by the parties have been considered. Specific rulings on each proposed finding is contained in Appendix A attached hereto and made a part hereof.
FINDINGS OF FACT
MPP presently provides home health services to residents of Hillsborough and Polk Counties from its offices located in Tampa and Lakeland. Without these certificates of need herein requested MPP is not authorized to provide home health services to Medicare and Medicaid eligible persons. MPP is qualified to provide the proposed services.
Walker is a non-profit 122-bed acute care community hospital located in Avon Park, Highlands County, Florida. Walker has provided health care services to residents of Highlands County since 1947. Although Walker does not currently provide home health services in Highlands County, it is fully qualified to provide the proposed services.
Home health agencies (HHA) differ significantly from other health care providers chiefly in the fact that they are labor intensive and not capital intensive services. Most home health agencies contract with nurses, therapists, and other personnel to provide the services on an as-needed basis. Once an office is established with the necessary communications and accounting facilities, expansion of the agency is accomplished merely by signing up as many nurses, therapists, etc., as is needed to provide home health services as required. Theoretically, one home health agency could provide all of the services required in a district, subject only to the travel time needed for the in-home provider to reach the patient and the accessibility of the agency office to the hospital or doctor prescribed in the home health treatment. A proposed rule
prevents this from occurring by the rule formula which limits the divisor in the formula (number of expected medical care visits per agency per year) to 21,000 expected visits per agency, which is then multiplied by a constant. Thus, if there were only one home health agency in a district and it was providing 65,000 home Medicare visits per year, use of the proposed rule methodology would show a need for additional HHAs.
Although both Petitioners challenged DHRS' non-rule policy in determining the need for HHAs in District VI, all of the need calculations they submitted are predicated upon the need methodology as contained in proposed Rule 10-5.11(14), F.A.C., modified by the Petitioners using 1983 use rates and disregarding the "crossover" agencies. No need calculations based on any other methodology were presented.
The methodology in the proposed rule provides [N]eed equals the [G]ross number of HHAs to be allocated in the district less the number of [L]icensed and approved HHAs in the district, or N = G - L. "G" is itself expressed by the formula MV x (A+B)/S where:
MV = The 1982 statewide mean number of visits per Medicare home health care service user across age groups (31.5)
A = The projected district population of persons 65 years or older times the Medicare home health services utilization rate standard for that population group [POPA x .0506];
B = The projected district population of persons less than 65 years of age who are estimated to be disabled times the Florida home health services utilization rate standard for disabled medical beneficiaries [POPB x .01755 x
.0297];
S = The number of expected Medicare visits per agency per year. This number is obtained by adding to the base agency size of 9,000 visits per year an additional number of visits equal to the total number of Medicare visits in the projected year, divided by the base agency size, multiplied by a factor denoted as C. C is a standard which is set at 270 for applications
timely filed in calendar years 1984 and 1985; 225 for applications timely filed
in calendar years 1986 and 1987 and 180 for applications timely filed in calendar year 1988 or beyond.
However, if the result of the calculation of S exceeds 21,000 visits projected, S shall be assigned a value of 21,000.
The methodology employed in need calculation is based on a number of factors. MV (31.5) is a standard which is based on information obtained from the Health Care Finance Administration (HCFA) for Florida in 1982. If this standard is recomputed using 1983 HCFA data, MV is 33.3. The second, the Medicare home health care utilization rate standard (.0506), is also based on information reported by HCFA for Florida for 1982. The estimate for the proportion of the Florida population which is disabled (.01755) was also derived from the 1982 data for Florida, as was the factor which specifies the home health services utilization standard for disabled Medicare beneficiaries (.0297).
The base agency size (9,000 visits annually), which is used in determining "S", the number of expected Medicare visits per agency per year, was developed by the HRS Office of Comprehensive Health Planning, based on a statistical analysis of data related to agency size, relative efficiency in terms of cost, and economies of scale. That analysis revealed that, in the range of about 9,000 visits, the first reasonable economies of scale begin to accrue in the operation of a home health agency. Therefore, this level of service provision was selected as the agency standard. The maximum level "S" can reach (21,000 visits annually) was found to be the point at which the major economies of scale appear to have been achieved. Thus, this level was selected as the maximum for the agency standard. The values as selected for "C" represent 3.0 percent, 2.5 percent, and 2.0 percent of the base agency size standard (9,000 visits annually). This factor is used to adjust "S" over time, its effect is that of increasing the number of home health agencies, which are projected as needed, gradually over a three-year period. It was selected as a standard based upon HRS' policy to encourage the development of health care markets in an orderly manner and to avoid the disruptive impact of a flood of new service providers immediately. The "C" factor changes over a time, which means that "S" will grow smaller and thus the gross number of agencies will increase. Thus, even MPP's expert witness agrees that the rule is not frozen. Rather, it is dynamic, though conservative, in effect. In fact, the result of the calculations of "G" (gross number of agencies) approximates
the current, existing inventory of home health care agencies in Florida.
The Local Health Plan for District VI makes no provision for establishing subdivisions within the district. Accordingly, an HHA located in any county in District VI can serve the entire district subject only to geographical limitations.
There are 16 HHAs domiciled in District VI and six HHAs domiciled in adjacent districts but licensed to serve a contiguous county in District VI. These so-called crossover agencies presently serve or are licensed to serve Medicare patients in District VI. Counting these crossover agencies and the number of existing agencies, there are 22 licensed and approved HHAs in District VI. Using the proposed rule methodology and applying the estimated population for 1987 (two years from date of hearing) gives a calculated gross need of 19. Under the proposed rule methodology, there is presently a surplus of three HHAs in District VI.
Under the proposed rule, these crossover agencies would have to apply for expedited review of an application to
establish an office in the county in which they are licensed but not domiciled. Exactly what this review will consist of is subject to some dispute. However, until the proposed rule goes into effect, there is no occasion for these crossover agencies to seek a certificate to do that for which they are currently licensed.
If the 1983 data from HCFA, which was the latest usage data available at the time of the hearing, is substituted for the 1982 data prescribed by the proposed methodology, and the overall district need is recomputed, an overall need of 21.63 is arrived at for District VI in 1987. This rounds off to 22 and is the same as the present number of licensed and approved HHAs in District VI.
Both Petitioners contend that the six crossover agencies should not be counted in the total number of licensed and approved HHAs in District VI because there is no guarantee they now serve or will ever serve patients in District VI. If these agencies are excluded, there is a clear need under the proposed rule methodology for the three HHAs here being applied for. Under the proposed rule, each of these crossover agencies must apply within a time certain (60 days) following the effective date of the proposed rule for certificates of need to open an office in the county for which they are licensed. These crossover agencies may have grandfather rights to serve Medicare patients in those counties in which they are licensed and, if so, these rights cannot arbitrarily be abrogated. Petitioners
especially contest counting the three Gulf Coast Home Health Services corporations as three crossover agencies because each of them is licensed to serve only Hillsborough County in District VI; because they have the same directors, corporate officers and owners; and because all of them would be unlikely to open additional offices in Hillsborough County. Nevertheless, each is a separate and distinct entity with its own corporate identity.
As such, each has the same right to serve Medicare patients in Hillsborough County as does Total Professional Care, Inc., another crossover agency so licensed. The services provided by these crossover agencies, insofar as they provided services to Medicare patients in the counties in District VI in which they are licensed, are included in the usage data obtained from HCFA. This usage data, mean number of visits (MV), is a principal factor in the numerator of the methodology formula above discussed. Thus, the district usage includes those services provided by these crossover agencies. No evidence was presented regarding the actual number of visits provided to District VI patients by these crossover agencies. Accordingly, it is inconsistent to accept the proposed rule methodology and exclude the crossover agencies in the count of existing agencies to determine the gross number of HHAs needed.
Respondent's contention that these crossover agencies are akin to health care providers who have been issued a CON but are not yet licensed and in operation is not fully concurred with. Those providers issued a CON are counted in the number of authorized and licensed beds before their facilities commence operations those facilities are usually capital intensive rather than labor intensive as are HHAs and a longer delay in commencing operations is required for those types of facilities than for an HHA due simply to the time needed to construct those facilities. In other respects, those approved but not yet licensed facilities are similar to these crossover agencies in that some of these crossover agencies may have grandfather rights to open an office in the county in District VI in which they are presently licensed. In this respect they are like the applicant who has been issued a CON to operate a nursing home but subsequently decides to forego construction because of unexpected costs or other reasons. Each would lose its right to operate the health care facility by reason of failure to timely comply with rule requirements. However, until such time as those rights are forfeited they should be counted in determining the number of beds or other health care facilities that are needed in, the district in the year those facilities are programmed to be in operation.
Changes in Medicare reimbursement to health care providers, principally hospitals, by the advent of the DRG (Diagnostic Related Group) has led to an increase in demand for
the services provided by home health agencies. This is especially true for surgery patients who can be released from a hospital sooner if dressing changes and nursing care can be provided at the patient's home. Under the DRG method of reimbursement, the hospital is paid a Flat fee for Medicare patients for a specific diagnosis and treatment. The sooner the patient can be released from the hospital, the less will be the cost to the hospital for providing treatment. If, for example, the cost for a hospital bed is $400 per day and the DRG for the patient's ailment is $2,000, if the patient is kept in the hospital for five days, the total payment received will exactly cover the cost of the room. If the patient is kept in the hospital more than five days the hospital will lose money, while if he is discharged before the five days the hospital will make a profit Walker's primary contention is that it should be allowed to operate an HHA so it can discharge surgical patients sooner and provide the needed care at the patient's home by persons supervised by the hospital doctors. This would allow Walker to make more profit and thereby have more funds available to take care of indigent patients.
Walker presented several witnesses who averred that a hospital-associated HHA provides better care than does a free- standing HHA. All these witnesses are employees of Walker and this self-serving testimony is given little weight. Both the hospital-run HHA and the free-standing HHA will employ part-time workers to provide the home health care prescribed. There is no logical reason to assume the hospital-affiliated HHA will employ better qualified nurses, etc. to provide the home health services needed than will the free-standing HHA. Medicare reimburses hospital-based home health agencies at a higher level than free- standing HHAs. This is an add-on of approximately 13 percent over the reimbursement received by free-standing HHAs. This is based on the cost of providing services which is generally higher for hospital-based HHAs.
Walker also raised the issue of availability of occupational therapy, respiratory therapy, and medical-social workers. One of the two agencies operating in Highlands County, Highlands County HHA, does not provide these services. The other, Upjohn, is newly authorized to provide home health services in Highlands County. In other counties in Florida in which Upjohn is authorized to provide home health services it provides a broad range of services to home health patients including occupational therapy, respiratory therapy, and medical, social workers. Respondent's expert witness opined that such services were now available in Highlands County. This opinion was based in part on hearsay evidence that the witness received from an Upjohn representative that such services are provided.
No direct testimony was presented that Upjohn did, or did not,
provide the services not presently provided by Highlands County HHA. Accordingly, there was no credible evidence to rebut the opinion of HRS witnesses that these services are available in Highlands County.
MPP's offices are currently available on a 24-hour per day basis and this will continue if the application is granted. Walker is also available 24 hours per day and access to home health personnel will also be available. MPP has committed to allocate 2 percent of its gross annual visits from each office to Medicare patients. In addition, one totally uncompensated visit will be provided to an indigent for every 20 Medicare visits.
MMP presented no evidence that it is currently providing uncompensated services. Walker, which is a church owned and backed non-profit hospital, projects that 7.5 percent of its home health agency visits will be to indigent persons. This mirrors the current hospital-provided services to Medicaid patients.
Walker's primary contention, that because hospital- based HHAs provide better care or better supervised care doctors will be more willing to release patients sooner than they.: otherwise would if there is no hospital-based HHA available, is not supported by credible evidence. It is simply not credible that a nurse employed by a hospital-based HHA is more competent, trustworthy, or capable than is the same nurse when employed by free-standing HHA. The chance of losing hospital records when a patient is transferred to a free-standing HHA would appear no greater than when the patient is transferred to a hospital-based released from the hospital whether home health services is thereafter provided or not. In view of the confidentiality of patient records, it would be expected that these records be retained in the hospital files.
Absent a rule or policy to provide a methodology to determine need for additional HHAs, new applicants for certificates have a nearly impossible task of proving need if there are existing HHAs which oppose the application. This is so because of the nature of HHAs that they can expand to cover all needs simply by engaging more part-time personnel to provide the home health services needed in the community, county, or even district.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties to, and the subject matter of, these proceedings.
In the absence of a promulgated rule upon which to base a need methodology, the agency can rely on a policy which is
enunciated at the hearing. McDonald v. Department of Banking and Finance, 346 So. 2d 569 (Fla. 1st DCA 1977). However, the burden remains with the Petitioners to show a need exists for the proposed facilities. Balino v. Department of Health and Rehabilitative Services, 348 So. 2d 349 (Fla. 1st DCA 1977).
Since Petitioners have adopted the need methodology of the proposed rule to show a need exists for the CONs they seek, it is only their requested variations from the proposed rule that need to be considered. Those two variations are the use of 1982- versus 1983-based data to arrive at current usage rates and the exclusion of the crossover agencies in arriving at the number of HHAs providing services in District VI.
Use of 1983 data and the proposed rule instead of 1982 data results in a need of three additional agencies and, if the crossover agencies are counted, the methodology, as revised, still fails to demonstrate a need for additional HHAs in District in the use of 1982 data obtained from HCFA will not affect Petitioners' applications. All methodologies must start at some point, and subsequent thereto they can have other variables to provide for growth or they can change from year to year to reflect the most current usage data. Since the proposed rule methodology has another factor which will change each year for several years to provide for a gradual growth in the number of HHAs, using the 1982 data is not arbitrary and capricious and provides a rational basis for allowing a slow, but steady, growth of home health agencies in Florida.
From the Petitioners' point of view, the critical issue is the counting of these crossover agencies in the number of existing HHAs providing services in District VI. These agencies are presently licensed to serve residents in District VI and presumably are providing such services. The services they provide are included in those statistics obtained from HCFA to determine the number of visits made to residents of District VI. Since these agencies are licensed to serve counties in District VI, and presumably provide such services, they are existing agencies in District VI and are properly counted as such. Petitioners' arguments that some of these agencies may not obtain CONs to operate in District VI if the proposed rule becomes operative, is not meritorious. Until such time as the rule becomes effective, they do not have to apply for authority which they currently have. Petitioners' proposals to provide care to the indigent is meritorious: however, no evidence was submitted that MPP is currently providing care to the indigent from its existing facilities. Walker's contention that it can provide more care to the indigent if its application is granted is not credible. No discharged patients early whether they were cared for by a hospital-based HHA or by a free-standing HHA. The only difference is that they would not have the benefit of any profit
made by the free-standing HHA as they would if the HHA is hospital-owned.
Finally, Walker's contention that certain services are not currently available in Highlands County is at best equivocal. A representative of Upjohn, who was recently licensed to open a facility in Highlands County, did not testify in these proceedings. Walker's witness opined that Upjohn would not provide those services not presently provided by Highlands County HHA while HRS' witness opined that Upjohn would provide such services. At best, the evidence is an equipoise and Petitioners have failed to show such services are unavailable and will only be provided if a CON is issued to Walker.
From the foregoing it is concluded that Petitioners have failed to prove that a need exists for an additional HHA in District VI. It is
RECOMMENDED that the application of MPP and Walker for CONs to operate HHAs in District VI be denied.
ENTERED this 27th day of January, 1986, at Tallahassee, Florida.
K. N. AYERS Hearing Officer
Division of Administrative Hearings Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
FILED with the Clerk of the Division of Administrative Hearings this 27th day of January, 1986.
COPIES FURNISHED:
Thomas Watry, Esquire 1200 Carnegie Building
133 Carnegie Way Atlanta, Georgia 30303
David Watkins, Esquire Oertel & Hoffman, P.A.
2700 Blair Stone Road, Suite C Tallahassee, Florida 32301
William L. Hyde, Esquire
Culpepper, Pelham, Turner & Mannheimer Post Office Drawer 11300
Tallahassee, Florida 32302-3300
David H. Pingree, Secretary Department of Health and
Rehabilitative Services 1323 Winewood Boulevard
Tallahassee, Florida 32301
APPENDIX
Proposed findings submitted by MPP:
Contained in preamble.
Contained in preamble.
Contained in preamble.
Contained in preamble.
So far as necessary to conclusions reached, included in Hearing Officer Finding No. 1.
So far as necessary to conclusions reached, included in Hearing Officer Finding No. 1.
So far as necessary to conclusions reached, included in Hearing Officer Finding No. 1.
So far as necessary to conclusions reached, included in Hearing Officer Findings Nos. 1 and 3.
So far as necessary to conclusions reached, included in Hearing Officer Finding No. 17.
So far as necessary to conclusions reached, included in Hearing Officer Finding No. 1.
Rejected as uncorroborated hearsay.
Insofar as necessary to conclusions reached, included in Hearing Officer Finding No. 1.
Included in Hearing Officer Finding No. 17.
Accepted as testimony presented, but see Hearing Officer Finding No. 17.
Included in Hearing Officer Finding No. 4.
16-24. Accepted only insofar as included in Hearing Officer Findings Nos. 5, 6, and 7.
Rejected as opinion, not fact.
Included in Hearing Officer Finding No. 11.
As noted in Hearing Officer Finding No. 11, this finding is immaterial.
28-29. Included in Hearing Officer Findings Nos. 5, 6 and 7.
Accepted insofar as included in Hearing Officer Finding No. 12.
Accepted insofar as included in Hearing Officer Finding No. 12.
Accepted insofar as included in Hearing Officer Finding No. 12.
Accepted insofar as included in Hearing Officer Finding No. 12.
Accepted insofar as included in Hearing Officer Finding No. 12.
Rejected.
Accepted but not essential to results reached.
Accepted but not essential to results reached.
Rejected as unsupported by competent evidence.
Accepted but not essential to results reached.
Accepted but not essential to results reached.
Accepted but not essential to results reached.
Accepted but see Hearing Officer Finding No. 17. Proposed findings submitted by Walker:
1. Included in Hearing Officer Finding No. 2.
2-3. Included in preamble to Recommended Order.
Included in Hearing Officer Finding No. 5.
Included in Hearing Officer Finding No. 9.
Rejected. See Section 400.504, F.S.
Accepted. See Section 400.504, F.S.
Accepted but immaterial.
Accepted but immaterial.
Accepted.
Rejected as unsupported by competent evidence.
Rejected as unsupported by competent evidence.
Rejected as unsupported by competent evidence.
Rejected as unsupported by competent evidence.
Accepted but immaterial.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Accepted but immaterial.
Accepted but immaterial.
Rejected as unsupported by competent evidence.
Accepted but immaterial.
Rejected as unsupported by competent evidence
Rejected as unsupported by competent evidence
Accepted but immaterial.
Accepted but immaterial.
Accepted but immaterial.
Accepted as the same numbers given MV by proposed rule.
Rejected as not based on actual number of HHA visits of Highlands County patients referred to HHA by Walker.
Rejected. See No. 22 above.
Rejected as unsupported by competent evidence
Rejected as unsupported by competent evidence
Rejected as unsupported by competent evidence
35. | Accepted | but immaterial. |
36. | Accepted | but immaterial. |
37. | Accepted. | See Hearing Officer Finding No. 14 |
38. | Included | in Hearing Officer Finding No. 14. |
39. | Accepted | but immaterial. |
40. | Accepted | but immaterial. |
41. | Accepted | but immaterial. |
42. | Accepted | but immaterial. |
43. | Accepted | but immaterial. |
44. | Accepted | but immaterial. |
45. | Accepted | but immaterial. |
46. | Rejected | as unsupported by competent evidence |
47. | Accepted | but immaterial. |
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Accepted but immaterial.
Accepted but immaterial.
Rejected as unsupported by credible evidence.
Rejected as immaterial.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Accepted but immaterial.
Rejected as unsupported by credible evidence.
Rejected as unsupported by credible evidence.
Accepted but immaterial.
Accepted but immaterial.
Accepted but immaterial.
Accepted but immaterial.
Included in Hearing Officer Finding No. 17.
Included in Hearing Officer Finding No. 17.
Included in Hearing Officer Finding No. 17.
Accepted but immaterial.
Accepted but immaterial.
Accepted but immaterial.
Accepted but immaterial.
Included in Hearing Officer Finding No. 17.
Included in Hearing Officer Finding No. 17.
Included in Hearing Officer Finding No. 17.
Accepted but immaterial.
Included in Hearing Officer Finding No. 14.
Included in Hearing Officer Finding No. 17.
Accepted but immaterial.
Accepted but immaterial. Proposed findings submitted by DHRS:
Included in Hearing Officer Finding No. 1.
Included in Hearing Officer Finding No. 2.
Accepted.
Included in Hearing Officer Finding No. 8.
5. | Accepted | but immaterial. | |||
8. | Included | in Hearing Officer | Finding | No. | 9. |
7. | Included | in Hearing Officer | Finding | No. | 9. |
8. | Included | in Hearing Officer | Finding | No. | 12 |
9. | Included | in Hearing Officer | Finding | No. | 4. |
10. | Included | in Hearing Officer | Finding | No. | 5. |
11. | Included | in Hearing Officer | Finding | No. | 6. |
12. | Included | in Hearing Officer | Finding | No. | 6. |
13. | Included | in Hearing Officer | Finding | No. | 6. |
14. | Included | in Hearing Officer | Finding | No. | 7. |
15. | Included | in Hearing Officer | Finding | No. | 9. |
16. | Included | in Hearing Officer | Finding | No. | 9. |
Included in Hearing Officer Finding No. 11
Included in Hearing Officer Finding No. 11
Included in Hearing Officer Finding No. 16
| Issue Date | Proceedings |
|---|---|
| Jan. 27, 1986 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Jan. 27, 1986 | Recommended Order | Absent bed need rule agency can rely on policy enunciated at hearing. Burden of Petitioners to show need for home health agency. |
