STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AACTION HOME HEALTH CARE, )

INC., et al., )

)

Petitioner, )

)

vs. ) Case No. 96-4067

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

) NURSING UNLIMITED 2000, INC., )

)

Petitioner, )

)

vs. ) Case No. 96-4070

)

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Administrative Law Judge, Mary Clark, held a formal hearing in the above-styled consolidated cases on October 14 through 16, 1997, in Tallahassee, Florida.

APPEARANCES

For Petitioner Michael Manthei Aaction Home Broad and Cassel

Health Care, 1130 Broward Financial Center Inc.: 500 East Broward Boulevard

Fort Lauderdale, Florida 33394

For Petitioner R. David Prescott

Nursing Rutledge, Ecenia, Underwood Unlimited 2000, Purnell & Hoffman, P.A. Inc.: Suite 420

215 South Monroe Street Tallahassee, Florida 32301

For Respondent: Moses E. Williams

Office of the General Counsel

Agency for Health Care Administration Post Office Box 14229

Tallahassee, Florida 32317-4229 STATEMENT OF THE ISSUES

Whether the applications for certificates of need to establish Medicare-certified home health agencies filed by Aaction Home Health Care, Inc. (Aaction) and Nursing Unlimited 2000, Inc. (Nursing Unlimited), on balance, satisfy the applicable review criteria so as to entitle either or both to award of a certificate of need.

PRELIMINARY STATEMENT

The Agency for Health Care Administration (AHCA or the Agency) reviewed and preliminarily denied on July 2, 1996, six applications for certificates of need (CON) to establish Medicare-certified home health agencies in AHCA Health Planning District 11. All six applicants filed petitions for formal administrative hearings which were referred to the Division of Administrative Hearings (DOAH) and were consolidated for hearing

as reflected in the above style. Four of the six original petitioners for a formal administrative hearing voluntarily dismissed or had dismissed their petitions prior to final hearing. Remaining for resolution in this proceeding are the CON applications of Aaction and Nursing Unlimited.

Aaction called as its witness Mark Richardson, expert in health care planning, home health planning, and numeric need methodology. Aaction’s exhibits 1-3 and 5 were received in evidence. Exhibit no. 4, taken under advisement at hearing, is now received in evidence.

Nursing Unlimited's witnesses were: Aida Salazar-Rebull, expert in home health care administration and operations; and Michael L. Schwartz, expert in health care planning, health care administration, and health care finance. Nursing Unlimited’s Exhibits 1-6 were received in evidence.

AHCA called as its witness James B. McLemore, Jr., accepted at the hearing as an expert in health care planning. AHCA’s Exhibits 1-4 and 7-8 were received in evidence.

The transcript of the proceeding was filed on November 19, 1997, and the parties filed their proposed recommended orders on December 1, 1997.

As required by a pre-hearing order, the parties filed a Joint Prehearing Stipulation on September 24, 1997. The Joint Prehearing Stipulation includes the following statement of those facts which are admitted and require no proof at hearing:

1. The letters of intent of both Aaction and Nursing Unlimited are complete, including all mandatory content items, and were timely filed with AHCA and the local health council.

   
   

2. The CON applications and omissions responses of both Aaction and Nursing Unlimited are complete, including all mandatory application content items, and were timely filed with AHCA and the local health council.

   
   

3. AHCA published no fixed need pool applicable to this proceeding or these applicants.

   
   

4. The applicants each, on balance, satisfy or meet the preferences of the applicable district health plan. Section 408.035(1)(a), Florida Statutes, and Rule 59C-1.030(2)(c), Florida Administrative Code.

   
   

5. The applicants each, on balance, satisfy or meet the preferences of the state health plan. Section 408.035(1)(a), Florida Statutes, and Rule 59C-1.030(2)(c), Florida Administrative Code.

   
   

6. The applicants each have a history of providing quality care and have demonstrated the ability to provide quality care. Section 408.035(1)(c), Florida Statutes.

   
   

7. The applicants each addressed that there were no reasonable alternatives to its proposed project. Section 408.035(1)(d), Florida Statutes.

8. Subsections 408.035(1)(e), (f), (g), (j), (k), (m), and (o); and subsections 408.035(2) and

(3) are not applicable to the home health projects proposed in this case.

1. The applicants each have the manpower, management personnel and the financial resources to establish and operate their respective projects. Section 408.035(1)(h), Florida Statutes.

   
   

2. Each proposed project is deemed financially feasible in the immediate and long term. Section 408.035(1)(i), Florida Statutes.

3. Neither of the proposed projects would adversely impact the costs of providing health services proposed by the applicants. Section 408.035(1)(l), Florida Statutes.

   
   

4. The applicants each propose to provide health care services to Medicaid patients and the medically indigent. Section 408.035(1)(n), Florida Statutes.

The parties further stipulated that the sole CON review criteria and issues of fact which remain to be litigated are:

The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing home health care services in District 11. Section 408.035(1)(b), Florida Statutes.

The parties also stipulated that the sole issue of law which remains for determination by the Administrative Law Judge is:

Whether, on balance, the CON application of Aaction and the CON application of Nursing Unlimited satisfy the applicable review criteria so as to entitle each to award of a CON.

FINDINGS OF FACT

The Applicants

1. Nursing Unlimited 2000, Inc., was formed for the purpose of obtaining a certificate of need for a Medicare certified home health agency, and to serve as the entity into which would be merged certain existing licensed non-Medicare certified home health agencies in Dade County. Aida Salazar-Rebull is a co- founder, director, officer, and shareholder of Nursing Unlimited, and she currently owns, operates, and serves as the administrator

   of LTC Professional Consultants, Inc. (LTC), a licensed non- Medicare certified home health agency in Dade County.

   Ms. Salazar will serve as Nursing Unlimited’s administrator, and after CON approval will merge LTC into Nursing Unlimited and continue its current operations. Elia Murias is also a co- founder, director, and shareholder of Nursing Unlimited, and she currently owns and operates Nursing Love & Care, a licensed non- Medicare certified home health agency in Dade County. Upon CON approval, Ms. Murias, a registered nurse, will serve as Nursing Unlimited’s director of nursing, and will merge the operations of Nursing Love & Care into Nursing Unlimited.

2. For the past 12 years LTC has provided home health care services directly to Medicaid and private pay patients, and to Medicare patients through contracts with Medicare certified agencies. LTC is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), which accreditation will be transferred to Nursing Unlimited. Since its inception, the number of patients served by LTC has increased every year. LTC enjoys an excellent reputation among local health care providers and patients. LTC’s continual growth over the past ten years, coupled with the letters of support in the application, demonstrate a record of providing high quality care to underserved communities and population subgroups. LTC currently provides home health services in northwest, west central, central, and east central Dade County, and as Nursing

   Unlimited will serve the same geographic area. LTC places particular emphasis on its service to underserved population subgroups such as Hispanics, Haitians, Blacks, low-income clients, and HIV-positive patients. Nursing Unlimited will continue to serve those population subgroups.

3. Although approximately 53 percent of the Dade County population is Latin, only two of the over 30 existing Medicare certified home health agencies are Latin owned and operated. LTC and Nursing Love & Care are Latin owned and operated, as would be Nursing Unlimited. The entire staff of LTC is bilingual, and some staff are multi-lingual, as would be the staff of Nursing Unlimited. Approval of Nursing Unlimited's application would enhance the availability and accessibility of services to the Latin community.

4. Aaction Home Health Care, Inc. (Aaction), is an existing home health care agency providing services in Dade County since approximately 1988. Like Nursing Unlimited, Aaction's target population is the Hispanic community of Miami and Hialeah.

5. The geographical area which Aaction now serves and will continue to serve at an enhanced level, if approved, is a low- income, high crime and low education area. Aaction's success in those difficult areas is based on its ability to recruit and retain indigenous staff who know the problems.

6. Over 30 letters of recommendation and support, mostly from Hispanic physicians, are attached to Aactions's application

   and attest to the agency's past and anticipated future service in the community. Aaction has applied for JCAHO accreditation.

   Need Analysis

   
   

7. The review of CON applications must be in context with the criteria set forth in Section 408.035(1), Florida Statutes. Pursuant to the parties’ prehearing stipulation, both applicants satisfy all of the applicable review criteria, except this:

   The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing home health care services in District 11. Section 408.035(1)(b), Florida Statutes.

   
   

8. Aaction and Nursing Unlimited both contend there is a need in District 11 for at least two new or additional Medicare certified home health agencies. Each asserts that both CON applications can and should be approved; their respective applications are not mutually exclusive, and accordingly, they need not be comparatively reviewed with one another.

9. The focus of the sole remaining criterion at issue, Subsection 408.035(1)(b), is on existing home health care providers. As acknowledged by AHCA in its State Agency Action Report (SAAR), in pure numbers the instant CON application proposals would increase availability and access in District 11.

10. There is no AHCA rule formula or methodology to determine a numeric need, nor is there a fixed need pool applicable to this proceeding. In the absence of an Agency numeric need rule, the applicants each proposed reasonable need

    methodologies within their applications. AHCA did not propose any need methodology at hearing.

11. AHCA's former home health agency numeric need methodology rule was invalidated because it was anti-competitive, understated potential actual need, and failed to consider health care economics, efficiency and cost containment. Principal Nursing v. AHCA, DOAH No. 93-5711RX (Final Order January 26, 1994); AHCA v. Principal Nursing Services, Inc., 650 So. 2d 1113 (Fla. 1st DCA 1995) (Affirmed the Final Order as to the need methodology, but reversed as to other portions of the rule unrelated to the issues here).

12. Nursing Unlimited, through Michael Schwartz, applied the invalidated need methodology to demonstrate that even under that excessively conservative approach, at least 2 additional home health agencies are needed in District 11. When the applications were filed the most current home health visit utilization data was for calendar year 1994. The number of visits in 1994 was divided by the age 65+ population to determine a use rate, i.e., the number of home health visits per 100,000 population. The 1994 use rate was applied to the projected age 65+ population growth for the three horizon years of 1995-1997, a projection of 102,039 more patient visits in 1997 than there were in 1994, based on population growth alone. Next, Mr. Schwartz determined a cost-efficient agency size (CEAS) by determining from a review of District 11 existing home health agencies the

    point at which the average cost per home health visit was less than the statewide average cost per visit. In this case, the result was a CEAS of 34,973, which was divided into the number of projected new visits in the horizon year 1997 resulting from population growth alone, which calculation shows a numeric need for three new home health agencies in District 11. At the time the CON application was filed there was one approved, but not yet licensed home health agency, which was subtracted by the applicant from the net need figure, thus resulting in a net need for two new agencies.

13. The recent historical data shows that home health care visits have been on the increase, both in terms of visits per 100,000 population and in terms of visits per patient. The amount of time spent by patients in the hospital is decreasing, which translates into increased need by patients for visits from home health agencies. The need for home health will continue to increase because it is a cost-effective alternative to nursing home placement and hospital care. Home health care services are less costly than care received in hospitals, in nursing homes, or on an outpatient basis. Thus, allowing greater access to home health services should reduce the overall cost of health care to payors, including Medicare.

14. To address this trend Michael Schwartz offered a realistic, yet still conservative, numeric need projection which assumes an increased use rate beyond that which is based on

    population increase alone. Mr. Schwartz considered the cumulative increase in visits that occurred over the three-year period 1991-1994 and projected this forward to the horizon year of 1997. Although federal Health Care Finance Agency (HCFA) data suggests that visits will grow nationally at seven percent per year. Mr. Schwartz assumed only a seven percent increase over three years, which resulted in a growth of approximately 180,124 visits by 1997, and which divided by the CEAS yields a need for

    5.2 new agencies. In hindsight, the conservative nature of this projection is apparent from a review of utilization data which has become available since the filing of the CON application. For example, rather than a growth in visits of 180,000 over the period 1995-1997, there was an actual increase of over 410,000 visits in 1995 and 1996 alone. Utilization data for 1997 is not yet available.

15. Aaction presented three separate need methodologies in its application prepared by Mark Richardson. The first two methodologies applied a static use rate based on visits in 1994 to the projected population to determine total visits at the planning horizon. Recognizing that cost efficiencies maximize at an approximate range between 30,000 and 90,000 visits per year, Aaction divided the total projected visits by a conservative CEAS of 50,000. These methodologies yielded a need in District 11 for two additional home health agencies at the planning horizon. Using a CEAS of 30,000 visits would yield a need for three

    agencies instead of two. AHCA has recently determined that static use rates are inappropriate. (Allstar Care, Inc., etc. vs. AHCA, DOAH No. 96-4064, Final Order November 4, 1997).

    Nonetheless, application of over-conservative methodologies in this case can help counter the agency's unsubstantiated assertion that many visits are fraudulent or unnecessary.

16. In its third methodology, Aaction assumed more realistically that home health use rates would continue to increase as suggested by historic data. In order not to overstate the potential growth rate, Aaction used a rate equal to one-half of the 1993-94 actual growth rate. Utilizing a 50,000 visit CEAS, this methodology yields a need of 7 to 9 new home health agencies in District 11 at the planning horizon. Using a 30,000 visit CEAS yields a net need for over 15 new home health agencies.

17. Recalculating the need formulas by application of the now available 1995 and 1996 data, using a growth rate at 50 percent of the actual rate, and a CEAS of 50,000 visits, results in a need for 7 to 8 new agencies. If the static use rate were applied, the need would be 5 to 6 new agencies. Application of Aaction’s initial need methodologies with a static use rate based on 1996 utilization data yields a need for over 5 new agencies when a 50,000 visit CEAS is used. If a 30,000 visit CEAS is utilized, these methodologies yield a net need for 9 new home health agencies. Applying Aaction’s third methodology (i.e.,

    utilization projected to increase at 50 percent of the actual increase between 1995 and 1996) yields a net need for over 7 or over 12 new agencies, depending on whether a 50,000 visit or 30,000 visit CEAS is applied.

18. There are other indications of need for additional home health agencies in District 11. For example, a review of 1996 utilization data reveals that District 11 has only 1.7 home health agencies per 100,000 population, which is the lowest ratio of any district in the state. The average of all districts is

    2.4 home health agencies per 100,000 population.

    
    

19. Both applicants proposed fair and reasonable need methodologies which demonstrate a need in District 11 for at least 2 additional home health agencies, and potentially more. There is, therefore, a need for at least 2 more Medicare- certified home health agencies in District 11.

20. Approval of both applications will increase the availability and accessibility of home health services in the proposed service areas within Dade County. Home health services are typically delivered in close proximity to the location of the agency and providers. Nursing Unlimited’s agency location is in the center of a large Latin and Haitian population, with the nearest Medicare certified home health agency approximately 15 miles away. Aaction's commitment is to a population that is difficult to serve. Local population accessibility to the

    proposed home health services would be increased by approval of both applications.

21. Medicare-certified agencies apply their own admission criteria and decide whether to accept patients, leaving some patients in need and without access to services in the applicants' service area. An informal survey directed by Michael Schwartz suggests there are existing agencies which refuse to treat AIDS patients, that do not provide services at night and on weekends, and that refuse to treat people in poverty areas. The targeted Medicare-eligible population would enjoy enhanced accessibility and availability of home health services by both applicants, if approved.

22. The addition to the district of a Medicare-certified home health agency (Nursing Unlimited) which utilizes a JCAHO- approved centralized case management system would also tend to enhance the availability, accessibility, and adequacy of services provided in the district.

23. When non-Medicare-certified agencies receive a request to care for Medicare patients, the request must be forwarded to a Medicare-certified entity, which in turn will contact the patient. The non-Medicare agency may then be authorized under subcontract to contact and serve the patient and to bill the Medicare-certified agency for its services. In turn, the Medicare-certified agency will add on its overhead and forward a higher bill to Medicare. This process also results in delays in

    patient treatment. Approval of these applications would likely result in better patient care, without delays, and at lower costs. AHCA has determined that eliminating such subcontract arrangements will eliminate an unnecessary level of administrative costs. AHCA also discourages subcontract arrangements which remove direct control of patient care from the Medicare certified entity. See Allstar Care, supra.

24. District 11 home health visits increased by 410,000 visits in 1995 and 1996. A projection of 600,000 new visits during 1995 through 1997 is reasonable. Nursing Unlimited and Aaction each project approximately 25,000 visits during their second year of operation. Approval of these applicants would not adversely impact the utilization of existing home health providers in the district. Both applicants here will specifically enhance access by the needy Hispanic population.

25. AHCA offered no competent evidence to contradict the conclusions of the applicants' experts, nor did it effectively challenge the accuracy, validity, or reliability of the methodologies they employed.

26. AHCA's expert and sole witness, James McLemore, is an application review specialist who candidly admitted he has no experience in the development of need methodologies but relies instead on the expertise of health care planners such as Mr. Schwartz or Mr. Richardson. Mr. McLemore's anecdotal testimony regarding fraudulent or phantom visits, and AHCA's concern that

    both state and federal agencies are investigating fraud in the home health care business, raise compelling licensing issues but are insufficient to defeat otherwise convincing evidence in favor of these certificates of need.

    
    

    CONCLUSIONS OF LAW

    
    

27. The Division of Administrative Hearings has jurisdiction in this proceeding pursuant to Sections 120.569 and 120.57(1), Florida Statutes (Supp. 1996), and Section 408.039(5), Florida Statutes.

28. An applicant for a certificate of need must demonstrate entitlement to its award of the certificate. Boca Raton Artificial Kidney Center vs. Department of Health and Rehabilitative Services, 475 So. 2d 260 (Fla. 1st DCA 1985). A balanced consideration of applicable statutory and rule criteria must be made. Humana Inc. vs. Department of Health and Rehabilitative Services, 469 So. 2d 889 (Fla. 1st DCA 1985); Department of Health and Rehabilitative Services vs. Johnson Home Health Care, Inc., 447 So. 2d 361 (Fla. 1st DCA 1994). The weight to be given each criterion is not fixed but varies depending on the facts of each case. Collier Medical Center, Inc. vs. Department of Health and Rehabilitative Services, 462 So. 2d 83 (Fla. 1st DCA 1985). No single criterion, except perhaps the applicant’s financial inability, is outcome determinative. Beverly Savannah Cay Manor Inc. vs. AHCA, 19 FALR

    3583, 3598 (Final Order September 15, 1997); North Shore Medical Center, Inc. vs. AHCA, DOAH No. 92-4992 (Recommended Order September 9, 1993; Final Order November 8, 1993).

29. The findings of fact herein reflect the balanced consideration required by the cases and statutes. Application of the legal CON criteria to each of the applicants leads to the conclusion that each proposed project, on balance, satisfies or meets the applicable criteria so as to entitle each to a CON for a Medicare-certified home health agency in District 11.

30. As reflected in the Prehearing Stipulation, the parties agree that both applications meet or satisfy, the state health plan and district health plan preferences and all of the statutory and rule review criteria, except this one:

    The availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing home health care services in District 11. Section 408.035(1)(b), Florida Statutes.

    
    

    Both applications meet the overwhelming majority of all review criteria, and, on balance, should be approved.

31. AHCA has approved several home health agency applicants in circumstances where the applicants were unable to totally satisfy subsection §408.035(1)(b), but did satisfy most other criteria. Home Health Care Services vs. AHCA, DOAH Case No.

    96-4058 (Recommended Order June 27, 1997; Final Order September 16, 1997); Allstar Care, Inc. vs. AHCA, DOAH Case No. 96-4064 (Recommended Order September 3, 1997; Final Order

    November 6, 1997). Further, AHCA recently issued a final order approving a preliminarily-denied home health agency applicant even though there were no findings that existing district services lacked availability, quality, efficiency, appropriateness, utilization or adequacy. Shands Teaching Hospital and Clinics, Inc. vs. AHCA, DOAH Case No. 96-4075 (Recommended Order March 10, 1997; Final Order May 12, 1997).

    The foregoing cases demonstrate that the sole remaining criteria at issue here is not pivotal.

32. In Shands, the CON application was approved by AHCA's Final Order adopting recommended order conclusion of law paragraph 47:

    Shands failed to demonstrate that home health services in District 4 are not available, high quality, efficient, appropriate or adequate. Shands did demonstrate that approval of CON 8391 will make home health services more available. Subsection 408.035(1)(b).

    
    

    Like the Shands application, the Aaction and Nursing Unlimited applications meet the state and local health plan preferences and statutory criteria and both Aaction and Nursing Unlimited have proven that their approval will enhance access.

33. AHCA’s suggestion that there is no need for new agencies because there is sufficient capacity among existing providers has been rejected in AHCA’s Shands final order, at paragraph 21:

    The existing supply of comparable services in District 4 can theoretically and legally expand to provide the projected . . . visits in 1997. However, competition from new providers encourages quality improvements and maintains cost-efficient agency sizes.

    
    

    Moreover, if AHCA’s argument were correct, then no new agencies could ever be approved.

34. The applicants in this case will improve the availability, quality of care, efficiency, appropriateness, accessibility, extent of utilization, and adequacy of like and existing home health care services in District 11.

35. Aaction and Nursing Unlimited each offered reasonable numeric need methodologies with credible underlying assumptions which demonstrate a need for at least two additional agencies. Nursing Unlimited's numeric need formula prepared by Mike Schwartz very conservatively projects a need for more than two new agencies and suggests an optimum agency size of approximately 34,000 visits. Administrative Law Judge Maloney recently determined Mr. Schwartz' identical home health need methodology was reasonable, and stated at paragraph 197 of his recommended order:

    After taking note of the statistics for actual patient visit growth in District 2 from 1991 to 1994, Michael Schwartz began with a conservative number of 60,000 new patient visits per year, a number half of the growth for the lowest growth year of that time period. Multiplying that number times the three horizon years of 1994-97 equals 180,000 new patient visits from 1994 which yields a need for 5.2 agencies.

    Care First, Inc. vs. AHCA, DOAH Case No. 96-4053 (Recommended Order June 9, 1997). That need determination for 5.2 agencies translates to an average of 34,615 visits per agency. In another recent case, AHCA adopted Judge Maloney’s finding that "[p]revious studies, moreover, have shown that all economies of scale are realized at around 30,000 visits per year." AHCA then approved two new agencies in District III, after they were preliminarily denied on essentially the same grounds asserted by AHCA in the instant proceeding. Home Health Care Services, supra.

36. The question of whether these applications should be comparatively reviewed is rendered moot by the applicants’ demonstration of a need in excess of two new agencies. Once sufficient need has been established for the number of applicants, the only remaining issue is whether each applicant individually meets the applicable relevant criteria. In this case the applicants have met their burden.

RECOMMENDATION

Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED:

That the Agency for Health Care Administration enter its final order granting CON No. 8428 to Nursing Unlimited 2000, Inc. and CON No. 8432 to Aaction Home Health Care, Inc.

DONE AND ORDERED this 22nd day of December, 1997, in Tallahassee, Leon County, Florida.

MARY CLARK

Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(850) 488-9675 SUNCOM 278-9675

Fax Filing (850) 921-6847

Filed with the Clerk of the Division of Administrative Hearings this 22nd day of December, 1997.

COPIES FURNISHED:

Michael Manthei Broad and Cassel

1130 Broward Financial Center

500 East Broward Boulevard

Fort Lauderdale, Florida 33394

Moses E. Williams

Office of the General Counsel

Agency for Health Care Administration Fort Knox Building 3, Suite 3400

2727 Mahan Drive

Tallahassee, Florida 32308-5403

R. David Prescott Ruthledge Ecenia Underwood

Purnell and Hoffman, P.A. Post Office Box 551

Tallahassee, Florida 32302-0551

Jerome W. Hoffman, General Counsel Agency for Health Care Administration Fort Knox Building 3

2727 Mahan Drive

Tallahassee, Florida 32308-5403

Sam Power, Agency Clerk

Agency for Health Care Administration Fort Knox Building 3, Suite 3431

2727 Mahan Drive

Tallahassee, Florida 32308-5403

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 must be filed with the agency that will issue the Final Order in this case.

Docket for Case No: 96-004067CON

Orders for Case No: 96-004067CON