STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

NORTH BROWARD HOSPITAL DISTRICT, )

d/b/a Broward General Medical Center, ) North Broward Medical Center, Coral ) Springs Medical Center and Imperial ) Point Medical Center, )

)

Petitioner, )

)

vs. ) CASE NO. 89-2714H

) HEALTH CARE COST CONTAINMENT BOARD, )

)

Respondent. )

)

RECOMMENDED ORDER

THIS CAUSE came on for formal hearing on September 22, 1989 and reconvened on September 26, 1989, in Tallahassee, Florida, before Stephen F. Dean, Hearing Officer.

APPEARANCES

FOR PETITIONER: Patrick J. Phelan, Jr., Esq.

and David Eastman, Esq.

Parker, Skelding, Labasky & Corry

P.O. Box 669 Tallahassee, FL 32303

FOR RESPONDENT: Robert D. Newell, Jr., Esq.

Newell & Stahl, P.A. 817 North Gadsden Street

Tallahassee, FL 32303-6313 STATEMENT OF THE ISSUES

It has been stipulated between the parties that the disputed questions of material fact and law at issue in this proceeding are as follows:

1. Whether the Petitioner, NORTH BROWARD HOSPITAL DISTRICT, is a unit of the local government.

2. Whether the tax-revenues received are "unrestricted grants" within the plain and ordinary meaning of the term.

   
   

3. Whether the Respondent has a long-standing policy of including all revenues within the charity care element.

   
   

4. Whether the Respondent's proposed construction and application of the phrase "unrestricted grants from local governments" is clearly erroneous.

PRELIMINARY STATEMENT

The Petitioner controverts the manner in which the Respondent computed Petitioner's maximum allowable rate increase by a timely filed request for an administrative hearing. A formal hearing was held on September 22 and 26, 1989 in Tallahassee, Florida. The transcript was prepared on October 23, 1989. The time for filing proposed recommended orders was extended several times and the proposed recommended orders were eventually filed on November 14, 1989. The proposed findings of the parties were read and considered. Adoption and rejection of the specific proposed findings is stated in Appendix A to this order. The time for preparation of the Recommended Order was waived. The Petitioner presented the testimony of Mr. Reginald Watkins, Chief Financial Officer of the Petitioner, and Mr. Chris Lloyd, Controller of the Petitioner. The Respondent presented the testimony of Mr. James Bracher, Executive Director of the Respondent, and Mr. Duane Ashe, Regulatory Analyst for the Respondent.

FINDINGS OF FACT

1. Petitioner, NORTH BROWARD HOSPITAL DISTRICT, is an independent special taxing district created by special act of the Florida legislature, Chapter 27-438, Laws of Florida, (1951). The Petitioner encompasses a geographic area which covers the northern two-thirds of Broward County, bordering Palm Beach County to the north, Collier and Hendry County to the west, the Atlantic Ocean to the east, and a line roughly along the Dania Cutoff Canal to the south. (Petitioner's Ex. 1, Sections 1 and 2)

   
   

2. The Petitioner provides health care services within the district. Petitioner is governed by a Board of Commissioners, who are authorized and empowered to establish, construct, operate and maintain public hospitals and related support facilities for the preservation of the public health and welfare of the inhabitants of the Petitioner. (Petitioner's Ex. 1, Sections 4 and 6; T. Watkins, Vol. I, pg. 26). The District may levy up to 2.5 mils of ad valorem taxes to support these purposes.

3. The Hospital District currently owns and operates four public, nonprofit medical centers: Broward General Medical Center, North Broward Medical Center, Coral Springs Medical Center and Imperial Point Medical Center.

   
   

4. The medical centers do not exist as separate corporations (T33, 34, Vol. I), nor do they have boards of directors independent from the Petitioner. (T19, Vol. I). The policy and routine operation of each medical center is controlled by the Chief Executive Officer of the North Broward Hospital District. (T20, Vol. I). The district is not regulated by Chapter 395 or Chapter 407, Florida Statutes.

   
   

5. Each hospital is separately licensed under Chapter 395, Florida Statutes, and regulated under the Health Care Cost containment Act of 1988, Section 407.001 et seq., Florida Statutes, and the rules and policies of the HCCCB. Each medical center has a different Medicare, Medicaid and Blue Cross provider number. (T34, Vol. I).

   
   

6. The district, through its four medical centers, renders virtually all the indigent health care and related services provided within the district and is the second largest indigent care provider in the state.

   
   

7. The term "local government" is used in Section 407.002(17), Florida Statutes, but it is not expressly defined in Chapter 407.

   
   

8. The Respondent, Health Care Cost Containment Board (HCCCB), is an agency of the State of Florida which operates pursuant to the Health Care Cost Containment Act of 1988, Chapter 407.001, Florida Statutes. Prior to the enactment of this statute, the Respondent operated as the Hospital Cost Containment Board under the Health Care Cost Containment Act of 1979, Section 395.501, et seq., Florida Statutes. The Respondent regulates the rate of increase of hospital rates within the state.

   
   

9. The HCCCB regulates hospital rates through a comprehensive program which requires hospitals to submit detailed reports on forms provided by the HCCCB and in accordance with rules and regulations promulgated by the HCCCB. The HCCCB conducts an annual hospital budget review through a review of financial data submitted by licensed hospitals pursuant to the HCCCB's uniform financial reporting system.

   
   

10. A licensed hospital may avoid the necessity of detailed budget review by submitting an annual budget letter which proposes an increase in its average gross revenues per adjusted admission

    in an amount less than or equal to the "maximum allowable rate of increase" or "MARI".

    
    

11. Prior to 1988, the maximum allowable rate of increase was computed with a formula in which the MARI consisted of an inflation component, the "market basket index," and additional percentage points added to reflect the highest costs of the Florida specific experience.

    
    

12. The statute was amended to address the impact of indigent care with the adoption of the current formula for calculating the MARI provided in Section 407.002(17), Florida Statutes (1988).

    
    

13. The statutory provision at issue in this proceeding is Section 407.002(17), Florida Statutes (1988), which provides as follows:

    
    

    (17) "Maximum allowable rate of increase" or "MARI" means the maximum rate at which a hospital is normally expected to increase its average gross revenues per adjusted admission for a given period. The board, using the most

    recent audited actual experience for each hospital, shall calculate the MARI for each hospital as follows: the projected rate of increase in the market basket index shall be divided by a number which is determined by subtracting the sum of one-half of the proportion of Medicare days plus the proportion of Medicaid days and the proportion of charity care days from the number one. Two percentage points shall be added to this quotient.

    The formula to be employed by the board to calculate the MARI shall take the following form:

    MARI = NHIPI + 2

    1-[(Me x .5) + Md + Cc]

    where:

    MARI = maximum allowable rate of increase applied to gross revenue.

    NHIPI = national hospital input price index, which shall be the projected rate of change in the market basket index.

    Me = proportion of Medicare days, including when available and reported to the board Medicare HMO days, to total

    days.

    Md = proportion of Medicaid days, including when available and reported to the board Medicaid HMO days, to total days.

    Cc = proportion of charity care days to total days with a 50-percent offset for restricted grants for charity care and unrestricted grants from local governments. (emphasis added).

    
    

14. To calculate "Cc" requires a 50% adjusting offset of the credit for grants restricted to charity care and unrestricted grants from the local government. (T161, Vol. I). The HCCCB seeks to apply this provision to monies used by the Petitioner to cover losses occasioned by its hospitals rendering care to indigents.

    
    

15. All financial activities of the Petitioner are conducted by the District's Division of Financial Services, which is located within the District's administrative offices. (T. Watkins, Vol. I, pg. 45). The Division maintains the District's bank accounts and performs all accounting and related financial services for each of the District's medical centers. (T. Watkins, Vol. I, pgs. 32-37; Vol. II, pg. 77; T. Lloyd, Vol. I, pg. 97).

    
    

16. All expenses incurred by the medical centers are paid from the general operating fund of the Petitioner through the Division of Financial Services on checks issued in the name of the Petitioner. (T. Watkins, Vol. I, pg. 46). The Division of Financial Services also accounts for all District accounts receivable, as well as other operating and nonoperating revenues. (T. Watkins, Vol. II, pgs. 77-78). All funds of the District are commingled in one general operating account. (I)

    
    

17. The individual medical centers have no bank accounts of their own, and they can neither receive nor disburse monies on their own behalf. (T. Watkins, Vol. II, pgs. 77-78). All such transactions are carried out by the Division of Financial Services, on behalf of the District as a whole. (Id.)

    
    

18. The Division of Financial Services accounts for the District's revenues and expenses by way of a general ledger covering all financial activities of the District. Within this ledger are subaccounts for all cost and revenue centers, which are administered on a district-wide basis encompassing the four medical centers and related facilities. (T. Lloyd, Vol. I, pgs. 99-101; Petitioner's Ex. 4).

    
    

19. The Division of Financial Services also prepares all budgetary reports and related financial materials required by the

    Respondent and other regulatory entities. (T. Watkins, Vol. I, pg. 37). This include reports to the HCCCB.

    
    

20. For purposes of the HCCCB's annual budget review process, the District is required to treat the medical centers as separate entities and prepare individual financial statements. (T. Lloyd, Vol. I, pgs. 117-119). Accordingly, certain costs and revenues are accounted for on an institution-specific basis and are reflected in the profit and loss statements of each individual medical center. (T. Lloyd, Vol. I, pgs. 131-134). However, the District and its medical centers are one legal entity and, for other than HCCCB purposes, one accounting entity.

    
    

21. The Petitioner derives a large percentage of its revenues through direct charges to paying patients. The revenue generated by medical center operations makes up approximately 85% of the annual revenues available to the Petitioner. The District also raises revenues through its ad valorem taxation authority. Pursuant to its charter, the District is authorized to impose an annual levy not to exceed 2.5 mills on all taxable real property lying within its boundaries. (Petitioner's Ex. 1, Sections 26 and 27; T. Watkins, Vol. I, pgs. 26-27). The Board of Commissioners of the Petitioner determines the mileage rate to be imposed each year; and after notice and public hearings, the mileage rate is adopted by resolution. (T. Watkins, Vol. I, pgs. 28-29)

    
    

22. The ad valorem taxation mileage levied by the District is collected by the Broward County Tax Collector and distributed to the District as collected. (T. Lloyd, Vol. I, pgs. 102-103). The funds are received by the District and deposited into the District's general operating account on an accrual basis, where they are commingled with all other revenues received by the District. (T. Watkins, Vol. I, pgs. 89-90).

    
    

23. The District's revenues are restricted in their use by statute to the purposes of the District's enabling legislation. Revenues can be utilized only for purposes authorized by Section 25, Chapter 27438, Laws of Florida, (1951), which are limited to the provision of health care within the District. (T. Watkins, Vol. I, pgs. 32-33, 42-43; Petitioner's Ex. 1, Sections 4 and 6).

    
    

24. The Board of the Hospital District has authorized expenditures for a variety of uses, including the purchase of land, construction of facilities, equipment acquisition, capital improvements, and operating expenses. At any time the Board of the Hospital District may change its spending policies within the limits of the statute.

    
    

25. Every cost center within each hospital of the District is utilized to some extent in rendering indigent care. The costs

    for operating the medical centers include indigent care costs. Because of the accounting system generally used by hospitals, costs attributable to the care of any patient are not kept.

    Therefore, none of the payments made by the District for personnel, laboratories, medical supplies, food service, suppliers, and all other overhead expenses are directly attributable to any specific patient accounts. These costs are incurred by the various cost centers in the hospitals of District in the course of rendering health care to patients.

    
    

26. In the recent years, NBHD has used tax and other revenues used to pay for the costs incurred in providing indigent care by the District. (T. Lloyd, Vol. I, pg. 115). To derive the costs of indigent care, the charges of those patients meeting the state poverty guidelines are recorded in the gross revenues of each medical center together with the charges of paying patients. Each medical center then writes off as a loss all those charges occasioned in rendering health care to indigent patients and reports this write off by placing the amount of these charges in a variance account titled Indigent Care - Variance."

    
    

27. Each month the Board authorizes covering a percentage of the losses for indigent care at each medical center from the District's general cash account. The Board currently covers 90% of the total indigent care charges as reported in the Indigent Care Variance account. The 90 percent represents the Hospital District's determination of the approximate costs of providing indigent health care services. (T. Lloyd, Vol. I, pgs. 106-110) (T. Watkins, Vol. I, pg. 31). The medical centers do not receive compensation for indigent care on an individual- patient-account basis. (T. Lloyd, Vol. I, pg. 140; T. Watkins, Vol. II, pgs. 80- 81). The District does pay for losses attributable to rendering care to indigent patients with tax and other revenues. (See Paragraph 23, above, on commingling of funds.)

    
    

28. Once the expenditure is authorized by the Board, the District debits the general cash account of the District and credits the respective medical center's profit and loss statement. (T. Lloyd, Vol. I, pgs. 102-103 and 107). There is no transfer of funds because the District disburses funds from its general operating account to pay for all costs associated with the provision of health care for each medical center. This includes those costs incurred in rendering indigent care. (T. Lloyd, Vol. I, pg. 140; T. Watkins, Vol. I, pg. 117, Vol. II, pgs. 80-81).

    
    

29. The HCCCB has developed a Florida Hospital Uniform Reporting System pursuant to Chapter 407, Florida Statutes. The reporting system requires each hospital regulated by the Respondent to file detailed financial information in the manner and on the forms dictated by the HCCCB. The North Broward

    Hospital District has done the financial reporting for each of the individual medical centers. s a part of the reporting system, a

    C-4 worksheet containing a statement of all operating and all nonoperating revenue is prepared for each individual medical centers. Pursuant to the HCCCB's instructions, expenditure of tax revenue derived from special taxing districts are included on line 39(a) of the C-4 worksheet.

    
    

30. The HCCCB's reporting system does not correlate to the bookkeeping or accounting system of the Petitioner. The District only reports on tax revenue and its expenditure in the manner provided on the individual financial reports for each medical center because the Respondent requires it.

    
    

31. The description of accounts established under the HCCCB'S uniform reporting system includes two specific accounts applicable to the provision of charity care: account numbers 5960 and 5970. Account number 5960 is used to report charges for charity/uncompensated care complying with the requirements of the Hill/Burton Hospital and Medical Facilities Construction Plan. Account number 5970 is used to report the differential between the charge's for hospital services for charity/uncompensated care patients and the amount received from patients or on behalf of patients from governmental agencies in payment for such services. Lump-sum grants or subsidies received from governmental or voluntary agencies for the care of medically-indigent patients must be reported under "restricted donations and grants for indigent care" (Account 5970).

    
    

32. Account number 5970 entitled "Restricted Donations and Grants for Indigent Care" is used to report voluntary and governmental agency grants or subsidies for the care of unspecified medically indigent patients during the current reporting period.

    
    

33. Prior to 1988, the HCCCB adopted policies and rules that distinguished local government budgeted contributions given to a hospital from tax revenues received by a hospital. In addition, both legislation dealing specifically with charity care provided by hospitals and the rules adopted by the HCCCB implementing that legislation clearly distinguished taxing districts from other types of local government.

    
    

34. The distinction between tax revenues from a taxing district and contributions or grants received from a local government is evident in the policies and rules adopted by the Respondent since 1984.

    
    

35. The HCCCB, according to minutes of the meeting of October 30-31, 1984, considered and approved a review criteria for the

    statewide ranking of hospitals providing indigent care which clearly distinguished "tax revenues" from "budgeted contributions" from local governments. The HCCCB initially discussed a proposed formula which gave a 100% offset of "unrestricted tax revenues against bad debts plus charity care write-offs" but then adopted criteria which included a "fifty percent offset of unrestricted tax revenues and a fifty percent offset of unrestricted budgeted contributions against bad debts plus charity care write-offs net restricted donations and grants for charity care". (Petitioner's Ex. 5, pgs. 2-3).

    
    

36. On December 13-14, 1984, the HCCCB met to discuss a number of matters, to include how the indigent care ranking methodology should be presented in-publications and whether the 50% offset figure for "unrestricted tax revenue and contributions" was the best indicator to use. The Board agreed to study the 50% offset after a study by the University of Florida was completed. (Petitioner's Ex. 6, pgs. 3-6).

    
    

37. The HCCCB adopted in 1984 a "Statement of Facts and Circumstances in Support of Amendments to Rule 4D-1.03 and 4D- 2.11" which discussed the ranking of hospitals based upon provision of indigent care. (Petitioner's Ex. 7). The proposed rule was published in Vol. 10, No. 32, Fla. Admin. Weekly. Petitioner's Ex. 8). The "Statement of Facts" included extensive analysis of including "unrestricted tax revenues" in the ranking statistic in order to "measure more accurately the burden of uncompensated indigent care". (Petitioner's Ex. 7, pg. 2). The Respondent considered tax revenues as a distinct type of revenue received by a hospital and used to offset the provision of charity care.

    
    

38. Since 1987, the HCCCB considered revenues derived from taxing districts distinct from revenues derived from local governments in a parallel program distributing funds from the Public Medical Assistance Trust Fund to hospitals which treat an excess of indigent patients. (T. Bracher, Vol. I, pg. 199). The statute establishing the trust fund distribution for 1987-88 was Chapter 87-92, Laws of Florida. The Respondent adopted Rule ION- 1.0075, Florida Administrative Code, in which the Respondent specifically distinguished between unrestricted revenues provided to a hospital from local governments and those provided from taxing districts. (T. Bracher, Vol. I, pg. 197).

    
    

39. In Chapter 88-294, Laws of Florida, the Legislature appropriated funds for the Public Medical Assistance Trust Fund for those hospitals which provided a disproportionate share of charity care. The Legislative definition of "charity care days" included an offset of 50% for "restricted and unrestricted

    revenues provided to a hospital by local governments or taxing districts". Chapter 88-294, Section 30, Laws of Florida.

    
    

    CONCLUSIONS OF LAW

    
    

40. The Division of Administrative Hearings has jurisdiction over the parties and the subject matter pursuant to Section 120.57, Florida Statutes.

    
    

41. The Respondent, Health Care Cost Containment Board (HCCCB), is charged with the regulation of health care price increases pursuant to Chapter 407, Florida Statutes (Supp. 1988).

    
    

42. North Broward Hospital District has standing to represent its constituent hospitals based upon the principles described in Florida Home Builders v. Department of Labor, 412 So.2d 351 (Fla. 1982).

    
    

43. North Broward Hospital District (NBHD), was created by special act-of the legislature, Chapter 27438, Laws of Florida (1951); Special Acts, Chapter 63-1192; Special Acts 69-914; Special Acts 81-354. The NBHD 15 directed by a board of commissioners each of whom is appointed by the governor of the state. Copies of these special acts, which are not readily available, are attached for reference purposes.

    
    

44. The purposes for which NBHD was created include construction, purchase, and operation of hospitals for the residents of the district. It is authorized to do various things, including but not limited to, employing people, owning property, leasing property, and issuing bonds. See Chapter 27438, Special Acts of 1951 as amended by Chapter 63-1192, Laws of Florida 1963.

    
    

45. The Board of Commissioners of NBHD is authorized to spend money only for the specific purposes of the act. See Section 25, Chapter 27438, law of Florida (1951.)

    
    

46. NBHD is specifically authorized by special act "to levy upon all the real and personal taxable property in said district a sufficient tax not to exceed three (3) mills necessary for the purposes herein granted, and to levy other lawful taxes to pay interest and provide and maintain a sinking fund for payment of interest and principal of the bonds provided for and authorized by this act." See Chapter 63-1192, Laws of Florida 1963, Section 4 which amended Section 26 of Chapter 27438, Special Acts of Florida 1951.

    
    

47. The parties stipulated to the issues in this case. They are restated and discussed individually below.

    ISSUE I

    
    

48. Is the North Broward Hospital District a unit of "local government" as the term is used in Section 407.002(17), Florida Statutes (Supp. 1988)?

    
    

49. Chapter 407, supra, relates to the containment of hospital costs. Section 407.002(17), supra, states the equation for computing the maximum allowable rate of increase in hospital rates. This statute defines one of its terms, "Cc", as follows:

    
    

    Cc = proportion of charity care days to total days with a 50-percent offset for restricted grants for charity care and unrestricted grants from local governments.

    
    

50. "Local government" is not defined by Chapter 407, supra. Section 200.001(8), Florida Statutes, defines the basic units of local government found in our state. This statute differentiates between "County, ""Municipality," and "Special district." Special District is defined as a "local unit of special government . . . created pursuant to general or special law for the purpose of performing specialized functions within

    
    

51. Section 165.031, Florida Statutes,. defines "special district" as "a local unit of special government . . . created pursuant to general or special law for the purposes of performing prescribed, specialized functions . . . within limited boundaries."

    
    

52. Section 218.31, Florida Statutes, defines "special district" as a local unit of special government.

    
    

53. Chapter 189, Florida Statues, adopts the definitions of Section 218.31, Florida Statutes.

    
    

54. Section 159.27, Florida Statutes, defines "local agency" as any country, municipality or special district or other local governmental body.

    
    

55. In each instance above the legislature distinguished between counties and municipalities, the traditional units of local government, and "special districts" which are defined repeatedly as units of special government.

    
    

56. In a closely related law concerning distribution of money to hospitals with a high degree of indigent care, Section 30 of Chapter 88-294, Laws of Florida, the formula for allocation of funds defines charity care days as "the sum of the deductions from

    revenues for charity care minus 50 percent of restricted and unrestricted revenues provided to a hospital by local governments or tax districts, divided by gross revenues per adjusted patient days." (emphasis added)

    
    

57. From these statutes it is clear that the legislature recognizes a difference between "local governments" and "special districts." It is concluded that the term "local governments" used in Chapter 407, supra, referred to counties and municipalities and not special districts which are defined as units of special local government.

    
    

    ISSUE II

    
    

58. Are tax revenues received by a hospital "unrestricted grants" within the plain and ordinary meaning of the term?

    
    

59. The source of the grants is irrelevant. Section 407.001(17), supra, does not address the source of funding or revenue. It states that "Cc" equals the proportion of charity care days to total days with a 50 percent offset for restricted grants for charity care and unrestricted grants from local governments. The source of funding of the grants is irrelevant not only because it is not addressed by the statutes but also because the tax revenues are commingled with other revenues of the District in the account from which the disbursements are made.

    The question is whether the disbursement is a grant.

    
    

60. A "grant" is defined by Webster's New Collegiate Dictionary, 1975 Edition, as "something granted; especially, a gift for a particular purpose." "To grant" includes in its definition bestowing or transferring formally. A "gift" connotes something given voluntarily and without obligation. Any grant, restrict or unrestricted, would be a gift voluntarily and formally transferred.

    
    

61. Section 30 of Chapter 27438, Laws of Florida (1951) establishing the NBHD provides that (1) each hospital and clinic established under the act is for the use and benefit of the residents of the district, (2) residents shall be admitted to said hospitals and clinics and be entitled to such hospitalization under the districts rules and regulations, and (3) the hospital may treat without charge patients found by the Board to be indigent, but the Board may collect from patients financially able to pay.

    
    

62. The statute creates a right to hospitalization in residents of the district, to include, indigent care. The "may" is obligatory in this instance. The hospitals must treat indigent patients and the district must bear the costs of such care because

    it must pay its debts. The statute contemplates that the moneys collected from paying patients and tax revenues will be used to cover the losses occasioned from rendering to indigents. hospitalization which is a right of residents of the district.

    
    

63. NBHD could not make a grant or voluntary gift of money because it has a legal obligation to provide for charity care. The allocation of revenues to pay for losses occasioned for the treatment of indigent patients is not a charitable grant because neither providing the treatment nor paying the bills is voluntary.

    
    

64. Chapter 88-294, Laws of Florida, is a parallel statute relating to the distribution of funds from the Public Medical Assistance Trust Fund. In Chapter 88-294, supra, the legislature specifically designates revenues and does not mention grants, and differentiates between local governments and special districts by the inclusion of both.

    
    

65. Local governments did not have any obligation to provide medical care under common law and a transfer of funds for health care by a unit of local government would be a gift or grant. The inability of the hospital district to make a grant or gift for health care because of its obligation to provide health care is consistent with and buttresses the conclusion above that hospital districts are not units of local government. The sole purpose of the hospital district is to create and operate hospitals. There is no apparent intent on the part of the legislature to permit hospital districts to receive 50 percent credit for every dollar spent on "unrestricted grants from local governments."

    
    

66. It is concluded that an unrestricted grant from local government would not include moneys disbursed for the- operation of a hospital, to include treatment of indigents, made by a hospital district because the disbursement is not a "grant" and a hospital district is not a unit of "local government."

    
    

    ISSUE III

    
    

67. Did the Respondent have a long-standing policy of including all revenues within the charity care element?

    
    

68. How long the standing policy of the agency has existed is irrelevant if the stated policy is contrary-to the statute. In this case, Chapter 407, supra, does not speak in terms of "revenues" but in terms of "grants" from local governments. The statute is not concerned with the source of revenues. The statute includes "unrestricted grants from local governments" and "restricted grants for charitable care" in the MARI formula; however, as stated above, NBHD could not make a gift or grant of that which it was required to provide.

    ISSUE IV

    
    

69. Is the Respondent's construction and application of the phrase "unrestricted grants from local governments" clearly erroneous?

    
    

70. For the reasons discussed above, the agency's interpretation is contrary to the language of the statute and the legislative intent manifested therein.

RECOMMENDATION

Based upon the foregoing findings of fact and conclusions of law, it is recommended that the Health Care Cost Containment Board (HCCCB) enter its final order holding that:

1. The North Broward Hospital District is not a local government as that term is used in Chapter 407, Florida Statutes (Supp. 1988) but is a "local unit of special government," and

   
   

2. "Grants" are voluntary and formal gifts. The use of money to cover losses occasioned by rendering statutorily required care to indigents. is not a restricted or unrestricted grant from a hospital district obligated to provide such care.

It is unnecessary for the Board to address the remaining issues in its final order.

DONE and ENTERED this 12th day of January, 1990, at Tallahassee, Leon County, Florida.

STEPHEN F. DEAN

Hearing Officer

Division of Administrative Hearings, The DeSoto Building 1230 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

Filed with the Clerk of the Division of Administrative Hearings this 12th day

of January, 1990

APPENDIX TO RECOMMENDED ORDER

The following is a detailed of the consideration of the proposed findings:

Petitioner's Proposed Findings:

Paragraph 1 Adopted Paragraph 13

Paragraph 2 Adopted Paragraph 14

Paragraphs 3-6 Statement of Case

Paragraph 7 Statement of Issues

Paragraph 8 Preliminary Statement

Paragraph 9 Adopted Paragraph 1

Paragraph 10 Adopted Paragraph 2

Paragraph 11 Adopted Paragraph 3

Paragraph 12 Adopted Paragraph 6

Paragraph 13 Adopted Paragraph 21

Paragraph 14 Adopted Paragraph 9

Paragraph 15 Adopted Paragraph 9

Paragraph 16 Adopted Paragraph 10

Paragraph 17 Adopted Paragraphs 12,13

Paragraph 18 Adopted Paragraph 13

Paragraph 19 Adopted Paragraph 12

Paragraph 20 Adopted Paragraph 11

Paragraph 21 Adopted Paragraph 15

Paragraph 22 Adopted Paragraph 16

Paragraph 23 Adopted Paragraph 17

Paragraph 24 Adopted Paragraph 18

Paragraph 25 Adopted Paragraph 19

Paragraph 26 Adopted Paragraph 20

Paragraph 27 Adopted Paragraph 21

Paragraph 28 Adopted Paragraph 22

Paragraph 29 Adopted Paragraph 23

Paragraph 30 Adopted Paragraph 24

Paragraph 31 Adopted Paragraph 25

Paragraph 32 Adopted Paragraph 26

Paragraph 33,34 Adopted Paragraph 27

Paragraph 35 Adopted Paragraph 28

Paragraph 36 Adopted Paragraph 27

Paragraph 37 Adopted Paragraph 25

Paragraph 38 Irrelevant

Paragraph 39 Argument

Paragraph 40 Adopted Paragraph 29

Paragraph 41 Adopted Paragraph 29,30

Paragraph 42 Adopted Paragraph 31

Paragraph 43 Adopted Paragraph 32

Paragraph 44 Adopted Paragraph 33

Paragraph 45 1st sentence-Irrelevant; 2d sentence-Adopted Paragraph 34

Paragraph 46 Adopted Paragraph 35

HCCCB's Proposed Findings

Paragraph 6 Rejected as contrary to law because status as a governmental hospital is irrelevant.

Paragraph 7 Adopted Paragraph 21

Paragraph 28 Reject "admission."

Paragraph 29 Argument-basic facts are adopted in paragraphs 25,26,27, and 28.

Paragraph 30,31 Irrelevant.

Paragraph 32,33 Basic facts stated in Paragraphs 29-34.

Paragraph 34 Argument

Paragraph 35-40 Irrelevant-Argument.

Copies furnished to: Stephen Presnell, Esq.

Health Care Cost Containment Board Woodcrest Office Plaza

Building L, Suite 101

325 John Knox Road Tallahassee, FL 32303

Gary Walker, Director

Health Care Cost Containment Board Woodcrest Office Plaza

Building L, Suite 101

325 John Knox Road Tallahassee, FL 32303

Patrick J. Phelan, Jr., Esq. and David Eastman, Esq.

Parker, Skelding, Labasky & Corry

P.O. Box 669 Tallahassee, FL 32303

Robert D. Newell, Jr., Esq. Newell & Stahl, P.A.

817 North Gadsden Street Tallahassee, FL 32303-6313

=================================================================

AGENCY FINAL ORDER

=================================================================

STATE OF FLORIDA

HEALTH CARE COST CONTAINMENT BOARD

NORTH BROWARD HOSPITAL DISTRICT, d/b/a BROWARD GENERAL MEDICAL CENTER, NORTH BROWARD MEDICAL CENTER, CORAL SPRINGS MEDICAL CENTER and IMPERIAL POINT MEDICAL CENTER,

Petitioners,

vs. CASE NO. 89-2714H

HEALTH CARE COST CONTAINMENT BOARD,

Respondent.

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FINAL ORDER

THIS MATTER was heard by the Health Care Cost Containment Board on May 24, 1990, in Tallahassee, Florida. The parties had proceeded to formal hearing in this matter pursuant to Section 120.57(2), Florida Statutes, and a Recommended Order was entered by the Hearing Officer on January 12, 1990. Prior to the Board's consideration of the Recommended Order. Petitioner filed a Voluntary Dismissal of the case, with the request that the Board enter a final order closing the file. Having fully considered Petitioner's Voluntary Dismissal and being fully advised in the premises, it is

ORDERED and ADJUDGED that there now being no issues in dispute, this case is hereby DISMISSED and Use Board's file CLOSED.

This Order constitutes final agency action and becomes effective upon being filed with the Board Clerk.

The parties are notified that they may appeal this Order by filing a notice of appeal with the District Court of Appeal and a copy of Use notice of appeal with the Board's Clerk within thirty days of the effective date of this Order.

DONE and ORDERED this 29th day of June, 1990.

Helen Q. Ingram Chairman

Health Care Cost Containment Board

301 The Atrium

325 John Knox Road Tallahassee, Florida 32303

Copies furnished to:

David D. Eastman, Esquire Robert D. Newell, Esquire

Stephen M. Presnell, General Counsel Health Care Cost Containment Board

The Division of Administrative Hearings

Docket for Case No: 89-002714

Orders for Case No: 89-002714