STATE OF FLORIDA Aor, DIVISION OF ADMINISTRATIVE HEARINGS Vi ADVENTIST HEALTH SYSTEM/ SUNBELT, INC., d/b/a FLORIDA HOSPITAL, Petitioner, vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION and THE NEMOURS FOUNDATION, Respondents. ORLANDO REGIONAL HEALTHCARE SYSTEM, Petitioner, vs. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION and THE NEMOURS FOUNDATION, Respondents. ___/ pe ope “anges? q ay 12 DOAH Case No. 07-3478CON AHCA Case No. 2007008096 CON No. 9978, 9979 and 9980 DOAH Case No. 07-3479CON AHCA Case No 2007008095 CON No. 9978 DOAH Case No. 07-3480CON AHCA Case No. 2007008079 CON No. 9979 DOAH Case No. 07-3481CON AHCA Case No. 2007008082 CON No. 9980 FINAL ORDER THE STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (hereinafter the “Agency”), having reviewed all matters of record including CON Application Nos. 9978, 9979 and 9980; and having entered into a Settlement Agreement with Petitioners, ORLANDO REGIONAL HEALTHCARE SYSTEM (hereinafter “ORHS”) and ADVENTIST HEALTH SYSTEM/SUNBELT, INC. d/b/a/ FLORIDA HOSPITAL (hereinafter "Florida Hospital"), and = with Intervenor, THE NEMOURS FOUNDATION (hereinafter "Nemours"), which Agreement is attached hereto as Exhibit 1; and being otherwise well advised in the premises: | It is ORDERED and ADJUDGED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. Upon full execution of this Agreement, the Agency agrees to issue a Certificate of Need for each of the CON projects applied for in CON applications No. 9978, 9979 and 9980, with the following conditions appearing on each: A. Nemours will locate the Nemours Orlando Children’s Hospital (“NOCH”) in the Lake Nona area of Orange County, in ZIP code 32824 or 32827. B. Nemours will provide at least 54 percent of NOCH’s total patient days to Medicaid/Medicaid HMO patients or patients | qualifying for charity care. Cc. Nemours will accept Medicaid (non-HMO) reimbursement for its patients at an adjusted rate which is the average of the rates received by the two existing Class II children's hospitals in Florida, All Children's Hospital and Miami Children's Hospital; subject to the approval of such an adjusted rate by the Centers for Medicare and Medicaid Services ("CMS"). If CMS does not approve such an adjusted rate, then NOCH will be reimbursed at the regular Medicaid rate which it would otherwise receive as a new children's hospital. D. Nemours will subsidize any shortfalls in revenues over expenses which are incurred at NOCH. E. Nemours will add at least 50 employed full-time equivalent subspecialist physicians new to District 7 within 5 years of opening. F. Nemours will provide a clinical program to transport patients in need of specialized services from other hospitals and emergency rooms in Florida to NOCH. G. Nemours will apply for and, when approved by the Accreditation Council for Graduate Medical Education, fund seven different subspecialty fellowship positions through the appropriate processes with graduate medical educational organizations. H. Nemours will provide a minimum of $3,000,000 annually to clinical outcomes/clinical research. I. Nemours will create dedicated space on the NOCH campus for research integrated with the hospital. Clinical research will be based near the point of care, across the continuum. Nemours physicians will participate in leading research programs. J. Nemours will create an advisory board with child advocacy organizations in Florida to identify patient populations for whom special programs and facilities will be offered. This advisory board will be convened no later than the first year of operation of NOCH. The above conditions apply regardless of whether Nemours constructs and operates one, two, or all three of the projects for which it is receiving CONs; however, the conditions remain quantitatively the same and are not additive or multiplied by the number of CONs issued. 3. The above-styled case is hereby closed. RE . DONE and ORDERED this _/7 day of _@@40***,7_, 2008, in Tallahassee, Leon County, Florida. Andrew C. Agwunobi, M.D., Secretary Agency for Health Care Administration NOTICE OF RIGHT TO JUDICIAL REVIEW A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named persons and entities by U.S.