STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION BARTOW REGIONAL MEDICAL CENTER, Petitioner, PROVIDER NO.: 120413 AHCA NO.: 15-236MPF v. RENDITION NO.: AHCA- (1. - 04o’ ‘S-MDA AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the “= day of M aur , 2019, in Tallahassee, Leon County, Florida. MARY AYHEW, SECRETARY der Agenty for Health Care Administration Bartow Regional Medical Center vs. Agency for Health Care Administration (AHCA No.: 15-236MPF) Final Order Page 1 of 3 Filed May 21, 2019 10:21 AM Division of Administrative Hearings A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A 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 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. Copies furnished to: Bartow Regional Medical Center Joanne B. Erde Attn: Hospital Administrator DUANE MORRIS LLP 2200 Osprey Blvd. 200 South Biscayne Boulevard, Suite 3400 Bartow, FL 33830 Miami, Florida 33131 (U.S. MAIL) jerde@duanemorris.com (E-Mail) Joseph M. Goldstein, Esquire Bureau of Health Quality Assurance Shutts & Bowen LLP Agency for Health Care Administration 200 East Broward Blvd., Suite 2100 (E-Mail) Fort Lauderdale, FL 33301 jgoldstein@shutts.com (E-Mail) Shena L. Grantham, Esquire Division of Health Quality Assurance MAL & MPI Chief Counsel Bureau of Central Services Shena.Grantham@ahca.myflorida.com CSMU-86@ahca.myflorida.com (E-Mail) (E-Mail) Stefan Grow, General Counsel Division of Administrative Hearings Agency for Health Care Administration The Desoto Building (E-Mail) 1230 Apalachee Parkway Tallahassee, FL 32399-3060 Lisa Smith, Bureau Chief MPF Agency for Health Care Administration (E-Mail) Bartow Regional Medical Center vs. Agency for Health Care Administration (AHCA No.: 15-236MPF) Final Order Page 2 of 3 CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy of the foregoing has been Tarspes to the Ai named addressees by U.S. Mail or other designated method on this the day of aq, : 2019. RichardJ- Shoop, Esquire Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, MS #3 Tallahassee, Florida 32308-5403 (850) 412-3689/FAX (850) 921-0158 Bartow Regional Medical Center vs. Agency for Health Care Administration (AHCA No.: 15-236MPF) Final Order Page 3 of 3 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION BARTOW REGIONAL MEDICAL CENTER, PROVIDER NO.: 120413 Petitioner, AHCA NO.: 15-236MPF vs. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / Petitioner, BARTOW REGIONAL MEDICAL CENTER (“BARTOW”), and Respondent, the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “Agency”), by and through the undersigned, hereby stipulate and agree as follows: 1. The parties enter into this Agreement for the purpose of memorializing the resolution of this matter. 2. BARTOW is a Medicaid provider in the State of Florida, provider number 120413, and was a provider during the relevant period. 3. In its Notice of Agency Action dated February 13, 2015 (the “Notice”), the Agency notified BARTOW that “all cost reports, desk or onsite audits of cost reports, audited per diem reimbursement rates calculated by AHCA, or adjustments to audited per diem reimbursement rates calculated by AHCA relating to the Medicaid inpatient and outpatient reimbursement rates identified in the Exhibit “A” attached thereto were final as that term is [as used in Fla. Stat. §409.905, the Florida Title XIX Inpatient and Outpatient Hospital Bartow Regional Medical Center vs. Agency for Health Care Administration {AHCA No.: 15-236MPF) Settlement Agreement Page 1 of 6 Reimbursement Plans], and therefore not subject to further re-opening or adjustment.” A copy of the Notice is attached hereto as Exhibit “A.” 4. In response to the Notice, on March 13, 2015, BARTOW filed a Petition for Formal Administrative Hearing (“Petition”). A copy of the Petition is attached hereto as Exhibit “B.” The Petition sought an order determining that all of the inpatient and outpatient rates set forth in the Notice were neither correct nor final and that many of the cost reports that the rates were based upon were subject to reopening and adjustment and that the Agency correct these rates and reimburse BARTOW for Medicaid services rendered during these rate semesters based upon the corrected rates. 5. In order to resolve this matter without further administrative proceedings, and based upon additional information reviewed during the pendency of litigation, BARTOW and AHCA agree with the IP-New Rates and the OP-New Rates (‘Revised Rates”) and the IP- Impact of Rate Change and OP-Impact of Rate Change (“payments”) as included in the attached Exhibit “C” (the “Revised Rates and Payments”). AHCA agrees to promptly make payment in the total arnount of $194,711.89, but no later than 90 days after the entry of the Final Order, which shall be entered no later than 90 days after this Agreement is fully executed by the Parties. Further, AHCA agrees to promptly re-process all paid outpatient claims for services rendered during the period July 1, 2012 through June 30, 2014 solely to apply the OP-New Rates set out on Exhibit “C,” in accordance with applicable law. 6. BARTOW and AHCA agree that the Revised Rates as shown on Exhibit “C” supersede the rates set out in the Notice at Exhibit “A” and shall be final and not subject to re- opening or adjustment. Such finality, however, may not affect any reconciliation that AHCA Bartow Regional Medical Center vs. Agency for Health Care Administration {AHCA No.: 15-236MPF) Setilement Agreement Page 2 of 6 may have to make as a matter of law as a result of Medicaid Disproportionate Share Hospital (DSH) Payments. 7. The Parties agree that the completion of the actions set forth in paragraph 5, above, resolve and settle this case completely and release each other from any administrative or civil liabilities arising from the matters raised in the Petition. Such resolution, however, shall not prevent AHCA from recovering any overpayment as authorized by law and consistent with this Settlement Agreement. Further, such release shall not prevent AHCA, the United States, Medicaid Fraud Control Unit, or any other non-signatory to this Agreement from pursuing any action relating to fraud against BARTOW in accordance with law. Lastly, such release shal! not prevent BARTOW from recovering any funds erroneously recouped by AHCA while reprocessing the claims to apply the Revised Rates as described in paragraph 5, supra. 8. This settlement does not constitute an admission of wrongdoing or error by either party with respect to this case or any other matter. 9. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. 10. This Agreement shall be construed in accordance with the provisions of the laws of Florida. The exclusive venue for any action arising from this Agreement shall be in Leon County, Florida. 11. This Agreement constitutes the entire agreement between BARTOW and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between BARTOW and AHCA other than as set forth herein. No Bartow Regionat Medica! Center vs. Agency for Health Care Administration {AHCA No.: 15-236MPF) Settlement Agreement Page 3 of 6 modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties. 12. This is an Agreement of Settlement and Compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 13. BARTOW expressly waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or rules of the Agency regarding this proceeding and any and all issues raised herein regarding this proceeding; provided, however, BARTOW does not waive its right to enforce this Agreement or to challenge any errors resulting from the application of the July 1, 2012 and July 1, 2013 Revised Rates to the outpatient claims for that period. BARTOW further agrees that it shall not challenge or contest any Final Order entered in this matter that is consistent with the terms of this Agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 14. The parties agree to bear their own attorney’s fees and costs. 15. This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it. 16. To the extent that any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement; provided, however, if any provision of Bartow Regional Medica! Center vs. Agency for Health Care Administration (AHCA No.: 15-236MPF) Settlement Agreement Page 4 of 6 this Agreement regarding the payments required herein is prohibited by law, this Agreement is null and void and of no further effect, and AHCA agrees that it will send this appeal back to DOAH for hearing at the request of BARTOW. 17. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators. representatives and trustees. 18. Al times stated herein are of the essence of this Agreement. 19. The parties acknowledge that AHCA’s payments required pursuant to the terms of this Agreement are subject to and contingent upon the review and approval of the Chief Financial Officer pursuant to his authority as set forth in the Florida Constitution and section 17.03, Florida Statutes, which provides in pertinent part: “The Chief Financial Officer of this state, using generally accepted auditing procedures for testing or sampling, shall examine, audit, and settle all accounts, claims, and demands, whatsoever, against the state, arising under any law or resolution of the Legislature, and issue a warrant directing the payment out of the State Treasury of such amount as he or she allows thereon.” Should the Chief Financial Officer not approve such payments, then this Agreement shall be null and void and of no further effect, and AHCA shall immediately refer the matter to DOAH for a formal administrative hearing. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart; provided, however, if AHCA does not execute the agreement within 90 days of execution by the hospital, such hospital may, in its sole discretion, withdraw its acceptance of the agreement at any point thereafter. [SIGNATURE PAGES FOLLOW] Bartow Regional Medical Center vs. Agency for Health Care Administration (AHCA No.: 15-236MPF) Settlement Agreement Page 5 of 6 BARTOW REGIONAL MEDICAL CENTER BY: yt Lest Dated: Maret 1% Prifit name and title BY: Neca avon iss “sy Waray x Nous (Print Name and Title) AGENCY FOR HEALTH CARE ADMINISTRATION 2727 Mahan Drive. Bldg. 3. Mail Stop #3 Tallahassee. FL 32308-5403 Siete po oo Dated: s|S , Stefan R. GrowNesquire SCQ. Dated: S { t : General Counsel Beth Kidder Deputy Secretary for Medicaid Tom Wallace ADS, Medicaid Final \ List Smith\ » 2019 2019 2019 Lux Dated: u/s . 2019 ce & Analytics Mf L{ | ( . Dated: , 2019 Bureau Chief. Bureay of Medicaid Program Finance ; Kor Ve or Dated: H| | 2019 Shena L. Grantham ne -_ Dated: 3 /y~ , 2019 Joseph/M. Goldstein Shut & Bowen, AHCA Outside Counsel FILDOCS 7486865 5 Bartow Regional Medical Center vs. Agency for Health Care Administration (AHCA No.: 1§-236MPF) Settlement Agreement Page 6 of 6 EXHIBIT “A” 03/13/2015 12:44 FAX 18059602201 BUANE WORRIS LLP MIA 017/023 RIOK SCOTT GOVERNOR ELIZABETH DUDEK SECRETARY February 13, 2045 Certified Mail Receipt No: 917199 9991 7033 2244 g3g2 Bartow Memorial Hospital a*attany EEesnpybtsl galaaatealiets stars 2200 Usprey Bivd, Bartow. Florida 33830 Reference(s): Notice of Agency Action Historical Medicaid Inpatient and Outpatient Hospital Reimbursement Rates Medicaid Provider Number 120413 Section 409.905, Florida Statutes and Florida’s Medicaid inpatient amd outpatient hospital reimbursement plans provide, in relevant part, the following with regard to. hospital cost reports and Medicaid reimbursement rates for inpatient or outpatient hospital services: The agency [AHCA] may not make any adjustment to a hospimal’s @® reimbursement more than 5 years after a hospital is notified of an audited rate established by the agency. The prohibition against adjustments more than S$ ycars after notification is remedial and applies to actions by providers involving Medicaid claims for hospital servi Effective October 1, 2013, for cost reports received priar to October 1, 2003, all desk or onsite audits of these cost reports shall be final and not subject to reopening. For cost reports received on or after October 1, 2003, all desk or onsite audits of these cost Teports shail be final and shall not be reopened past three years of the date that the audit adjustments are noticed through a revised per diem rate completed by the agency," In accordance with these provisions, AHCA has determined that all cost reports, desk or Onsite audits of cost reports, audited per diem reimbursement rates calculated by AHCA, or adjustments to audited per diem reimbursement rates calculated by AHCA relating to the XXXIIL incorporated by reference in 59-G 6.030, Fla. Admin. Code (“Outpatient Plan”), ™ Inpatient Plan § IV(H\3); Outpatient Plan $ IV(GX5). "® Inpaticnt Plan §§ 1d), I(F), TV(H)(3); Outpatient Plan §§ H(F), IV(G)(5). 2727 Mahan Orive « Mall Stop 23 Tallahassee, FL 32908 AHGCA. MyFlorida.com USs 19/219 12:49 FAR 13099802201 QUANE MORRIS LLP MIA Ig) 018/023 Medicaid inpatient and outpatient reimbursement rates identified in the attached Exhibit A are “final” as that term is used in the provisions quoted above, and therefore not subject to further re~ Opening or adjustment, ne cited in thie antiga ennta ich wnder certs) a RAT as tants hae ae eT AHCA’s determination that Writhout pefudic tr or Entation ots yons bor hale catdenat tn cuba enwrted coe soport OF request corrections or adjustments to reimbursement rates in accordance with, and subject to any limitations in, the provisions authorizing such adjustments in the authorities cited herein. If AHCA enters an order determining the reimbursement rates identified in Exhibit A are final, that determination of finality will apply only to a reimbursement rate as currently established and as reflected in Exhibit A, and will not preclude your hospital from requesting the re-opening of a cost report or the correction or adjustment of a reimbursement rate if your hospital was entitled to such sdjastments both price to and after the entry of AHICA’s onder Getcrmining the finality of the rate 48 currently calculated and as reflected in Exhibit A. For audited reimbursement rates listed in Exhibit A which your hospital is not currently entitled to have re-opened under any other provisions set forth im the authorities cited above, any requests for cost report re-opening or adjustments to such rates before they become final as a matter of law must be in the form of a request for a hearing challenging the Agency action described in this notice, and must be made in strict compliance with the directions in this notice and the enclosed Notice of Administrative Hearing and Mediation Rights within twenty-one (21) days of your receipt of this letter, or else your hospital's opportunity to challenge this Agency action before it becomes final will be lost. ‘The Agency nction/determination of finality described in this notice only applies to audited reimbursement rates listed in Exhibit A. It does not apply to any rates included in Exhibit A that are preliminary or wnaudited as of the date of this notice. When final, audited reimbursement rates are established for any currently unaudited rate semesters included in Exhibit A, a separate Notice of Agency Action and Notice of Administrative Hearing ond Mediation Rights will be sent with notice of those audited rates. Pursuant to §120.57, Fla. Stat., you have the right to request a formal or informal hearing challenging the determinations set forth in this letter and Exhibit A to same. If a petition for a formal hearing is made, the petition must be made in compliance with Rule 28-106.201, Fla. Admin. Code. Please note that Rule. 28-106.201(2) specifies that the petition must contain a concise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days of your receipt of this notice, and that failure to timely request a hearing shall be deemed a waiver of your right to a hearing. For more information regarding your hearing and mediation rights, please see the enclosed Notice of Administrative Hearing and Mediation Rights form, If you wish to request an administrative hearing, you must carefntly follow all of the directions for doing so set out in that form, O ™ For example, Inpatient Pian § TV(H); Outpatient Plan § IV(G) 03/13/2015 12:46 FAX 18059602201 DUANE MORRIS LLP NIA Notice of Administrative Hearing and Mediation Rights WRS/oa. 013/023 Vas 1d/ZUID 12.46 FAK lguoyBUZZO1 UUANE MORRIS LLP NIA 1g 920/023 CE OF ADMINISTRATIVE HEAR AND MEDIATION RIGHTS Vou rs hare ake sinht to request am ddminiowetive heolag te Sections 190.560 and 19f £7, Flaride Gtatiten If with ve hearing parsus the anclared Nevice af & formal adeninistrath heariog purnusat fo Section 120.57(), Statutes, If you do not dispute dispute the facts stated in the Notice of Agency Action, but are additional reasons to grant the relief you seek, you may Te Asfonaal nbnisistetice nh pursuant to Section 120.57(2), Florida Statutes, Additionally, Birstant to Section 120.5 Florida Statutes, mediation may be available if you have chosen a administrative hearing, as discussed more fully below. Your written an administrative hearing must conform to the requirements of either Ts ae 6201 2) tn fae 28-1063016), Fn Fh Cure Aduunastation Code, 520) iri be Agency no later than 2} Gaye tir the day you reoetved the Notice of Agency: Action, The for filing the written request for an administrative hearing is: Richard J. Shoop, Esquire Agency Clerk Agency for Health Care Administration © 2727 Mahan Drive, Mail Stop #3 Florida 32308 Fax: (850) 921-0158 The request must be legible, on 8 4 by 11-inch white paper, and contain: L Zour name, adres, tel hone number, any Agoncy identifying uumber on the Notice of Ageacy Aciog, if aown and name, address, and telephone number of your representative, if any; An explanation of how your substantial interests will be affected by the action described in the Notice of Agency Action; A statement of when and bow you received the Notice of For a request for formal hearing, a statement of all disputed space of raberial . Fora set fo formal Reming, tSaternent fal ited sc of mei fg as the and statutes which entitle you to relief; For # request for formal hearing, whether you request mediation, if it is available; . For request for informal hearing, what bases support an adjustment to the amount owed to the Agency; A demand for relief. ,A formal hearing will be held if there are disputed issucs of material fact. Additionally, mediation may be available in conjunction with a formal hearing. Mediation is a way to use a noatral third party to assist the parties in a legal or administrative proceeding to reach a settlement of case, if you and the Agency agree to mediation, it does not mean that you Bive up the right to a hearing, Rather, you and the Agency will try to settle your case first with eo NR WAY w Facebook.cam/AHCAFiorida Youtubs.com/AHCAFlorida Twitter.com/AHGA_FL StdeShare.nevAHCAFlarida 2727 Mahan Oriva » Mail Stop 23 Tallahassee, Fl. 32908 AHCA. MyFlorida.com 03/18/2015 12:48 FAX 13059602201 DUANE NORRIS LLP MIA Exhibit A CDE_RATE_TYPE . 012041300 BARTOWHMA,UC outpatient , 912041200 _ BARTOW HMA, LLC _ oo. inpatient br204 BARTOW HIMA, LLC ‘inpatient "198 EFFECTIVE DATE :teg10101 | atient 19010101 991 wee ~ -foazt01 8920101 021/023 FIVS RATE “60.84 611.22 72.02 vse IS/ZVID 12540 FAR 18059802207 DUANE MORRIS LLP MIA 022/023 Exhibit A | | RFFECTIVE weal Fv ee ; bE. COC RATE TYPE: i -. 19970101 744.87. 19970101 | 48.72 «78781, COMnait PATE . 19000101 _ 19990101 . fapaent = 19890701 807,¢ Outpatient =» 19980701 62.44 Outpatient = 20000701 56.41. ..tnpatient 20010101 838.88 Outpatient = 20010101 87.35 vuriusevis te.) CHA foyuaDVEecut UUANE MUKKLS LLP MLA Wozsso23 FRFECTIVE NARAE E 3 FIVINUS RATE ov 20000301 .. Mpatient = 20080701 ., Outpatient — 20080701 So “Ingationt 20100701 1,013.56" “Inpatient” 20110101 Outpatient "20110701" * ‘inpatient "20110701 © EXHIBIT “B” Udy IB/ZVID 12138 FRX 13059802201 DUANE MORRIS LLP MIA ig) 002/623 : STATE OF FLORIDA ACENCY CLERK AGENCY FOR HEALTH CARE ADMINISTRATION OMAR 13 PI: 52 BARTOW REGIONAL MEDICAL CENTER, Petitioner, vs. CASE No. AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / PETITION FOR FORMAL ADMINISTRATIVE HEARING Petitioner, Bartow Regional Medical Center (“Petitioner”), by and through its undersigned counsel submits this Petition (“Petition”) to the Agency for Health Care Administration (hereafter “the Agency” or “AHCA”) for a formal administrative hearing and says as follows: 1. This Petition is filed pursuant to §§120.569 and 120.57(1), Fla. Stats., and §§ 28- 106 et seq., Florida Administrative Code (“F.A.C.”). 2. The name and address of the State Agency affected is the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 21, Tallahassee, FL 32303. 3. The name of the Petitioner is set forth above. For purposes of this proceeding, its address and phone number is that of undersigned counsel. 4. The Agency’s file number on this matter is 120413, the Petitioner’s Medicaid Provider Number. 5. On February 19, 2015, Petitioner received AHCA’s February 13, 2015 letter determination (“February Letter”) that all of the Petitioner’s inpatient and outpatient ratcs from January 1, 1985 through June 30, 2014 listed on Exhibit A of the February Letter (“Exhibit A”) 1DM215804587,1 08/19/2018 12:39 FAX 13059602201 DUANE MORRIS LLP MIA 004/023 PINALITY OF RATES The Agency is governed by the Florida Title XIX Inpatient Hospital Reimbursement Plan (“Inpatient State Plan” or “ISP”) in setting of rates for inpatient services (“inpatient rate”) and the Florida Title XIX Inpatient Hospital Reimbursement Plan (“Outpatient State Plan” “OSP”) in the setting of outpatient rates. AHCA sets each hospital's inpatient and outpatient rates based upon the hospital’s annual cost report, which every hospital participating in the Medicaid Program must submit to AHCA no Jater than five months after the close of the hospital’s fiscal year. ISP $1(A). Both the Inpatient Sate Plan and the Outpatient State Plan are incorporated by reference into Florida Administrative Code Rule 59G-6.020 and 59G-6.030, respectively, (referred to collectively as “AHCA's rules” or the “Reimbursement Plans”). 5. AHCA sets each hospital’s inpatient and outpatient rates based upon the hospital's annual cost report, which every hospital participating in the Medicaid Program must submit to the Agency no later than five months after the close of the hospital’s Medicaid fiscal year, ISP & I(A). 9, The Inpatient State Plan’ specifically provides for appeals of inpatient and outpatient rates and cost reports, as follows: II(F) Appeals For audits conducted by AHCA, a concurrence letter that states the results of an audit shall be prepared and sent to the provider, showing all adjustments and changes and the authority for such. Providers shall have the right to a hearing in accordance with Section 28-106, F.A.C, and Section 120.57, Florida Statutes, for any or all adjustments made by AHCA. For cost reports received on or after October !, 2003, all desk or onsite. audits of these cost reports shall be final and shall not be reopened past three years of the date that the audit adjustments are noticed through a revised per diem rate completed by the Agency. ' The Outpatient State Plan contains similar provisions at I(T), T1(F), IV(G), (H) & (1). DM2\5504587 1 03/13/2015 12:40 FAX 10. 13059602201 DUANE MORRIS LLP WIA IV(H)* The prospectively determined individual hospital's rate shall be adjusted only under the following circumstances: \. An error was made by the fiscal intermediary or AHCA in the calculation of the hospital's rate. * * * * * 3. Further desk or on-site audits of cost reports used in the establishment of the prospective rate disclose material changes in these reports. For cost reports received on or after October 1, 2003, all desk or onsite audits of these cost reports shall be final and shall not be reopened past three years of the date that the audit adjustments are noticed through a revised per diem rate completed by the Agency, Liffective October 1, 2013, for cost reports received prior to October 1, 2003, all desk or onsite audits of these cost reports shall be final and not subject to rcopening. (emphasis added), IV(I) Any rate adjustment or denial of a rate adjustment by AHCA may be appealed by the provider in accordance with Section 120.57, Florida Statutes. 065/023 Effective for rates set on or after July 1, 2011, AHCA was directed to implement a new reimbursement methodology for establishing inpatient rates, which among other things, only permitted AHCA to issue new rates annually rather than semi-annually, and to establish new time frames for the setting and adjusting the new rates. § 409,905(5)(c)(2011). This new Teimbursement methodology was implemented in version XXXVIII of the Inpatient Reimbursement Plan, effective July 1, 2011, as follows: 1(M)_ Effective July 1, 2011, the Agency shall implement a methodology for establishing base reimbursement rates for each hospital based on allowable costs, as defined by the Agency. Rates shall be calculated annually and take effect July 1 of each year based on the most recent complete and accurate cost report submitted by each hospital. Adjustments may not be made to the 2 Due to changes in version LX of the Inpatient State Plan, the sections IV(H) and (1) are not sections V(B)(7) & (8). "The Outpatient State Plan bas a similar provision at I(O) and IV(C). 19M2N5504 587.0 03/13/2015 12:40 FAX 13059602201 DUANE MORRIS LLP MIA I) 006/023 rates after September 30 of the state fiscal ycar in which the rate takes effect. Errors in cost reporting or calculation of rates discovered after September 30 must be reconciled in a subsequent rate period. The agency may not make any adjustment to a hospital’s reimbursement rate more than 5 years after a hospital is sete el wee dled sede webbed Ly Hew ugeeeys Phew pele secret tT Beer ce hospital's reimbursement rate more than 5 years after a hospital is notified of an audited rate established by the agency is remedial and shall apply to actions by providers involving Medicaid claims for hospital services, Hospital rates shall be subject to such limits or ceilings as may be established in law or described in the agency's hospital reimbursement plan. Specific cxcmptions to the limits or ceilings may be provided in the General Appropriations Act, 1], Based upon the provisions set forth above, cost reports received by AHCA on or after October 1, 2003, are subject to reopening and adjustment for three years after they are noticed through a revised per diem rate completed by the Agency and are not final until that three year period is over. Cost reports that were received by AHCA prior to October 1, 2003 are final and were not subject to further reopening as of October 1, 2013.* 12. ‘Neither the Inpatient State Plan nor the Outpatient State Plan include any other limitations upon rate adjustments unrelated to cost report reopening, nor do they otherwise address when a rate is final. As such, based upon existing rules and statutes, the inpatient and outpatient rates for services listed on Exhibit A are not final, and depending upon when the cost Teport was received by AHCA and when AHCA noticed the adjusted rate through a revised per diem rate, the cost reports that these rates were based upon may or may not be subject to reopening and adjustment. Effective for rates set for periods beginning on or after July 1, 2011, there are additional limitations upon correcting and adjusting rates and cost reports, including for * That would not apply to cost reports that were received prior to October 1, 2003, but for which the Agency had not yet issued a revised per diem rate based upon the audited cost report as of October 1, 2003. DM2\5504387.1 03/13/2015 12:41 FAX 13059802201 DUANE MORRIS LLP WIA 007/023 the.first time, a new five year limit upon adjusting reimbursement that runs from the date that the rate set under the new methodology is noticed-by the Agency.” Neither the rules nor the statute, however, address when the rate is final. 13. The Peliumy Letter viles gun of the provisions set firils heawiua and eoneludes: in avcordance with these provisions, ALLCA has detemuned that all cost reports, desk or onsite audits of cost reports, audited per diem teimbursement rates calculated by AHCA, or adjustments to audited per diem reimbursement rates calculated by AHCA relating to the Medicaid inpatient and outpatient reimbursement rates identified in the attached Exhibit A are ‘final’ as that term is used in the provisions quoted above, and therefore not subject to further reopening or adjustment. 14, AHCA’s determination in the February Letter, es set forth above, is erroneous. Exhibit A to the February Letter includes audited rates and unaudited rates, rates that were noticed by AHCA more than three years ago and rates that were noticed by AHCA less than three years ago, rates that were for services provided before July 1, 2011 and rates that were for services provided after July 1, 2011, These rates are based upon audited cost reports and unaudited cost reports, as well as cost reports that were received by AHCA both before and after October 1, 2003. The February Letter dos not take any of these facts into consideration in making its determination that all cost reports, audited cost reports, adjusted audited cost reports, audited rates and adjusted audited rates on Exhibit A are final and not subject to reopening and adjustment. 15. Based upon the authorities set forth herein, AHCA’s determinations in the February Letter that all of the rates listed on Exhibit A and the cost reports these rates are based — * Although this states that the remedial, Petitioner disputes that it is applicable to rates set under the prior methodology. DMa2\5504587.1 03/13/2015 12:41 FAX 13059602201 QUANE MORRIS LLP MIA 008/023 upon are final and are not subject to reopening and/or adjustment is in violation of its existing adopted rules, as follows: (a) _ All of Petitioner's unaudited rates and the cost reports that they are based upon are not final. chy Allul Petites anliterd tains thal were alice ly the: Aysncy less dean three years ago are not final and the cost reports that they are based upon are subject to reopening and adjustment. (c) All of Petitioner's adjusted audited rates that were noticed by the Agency less than three years ago arc not final and the cost reports that they are based upon are subject to reopening and adjustment. (d) All of Petitioner’s rates that are based upon a cost report that has been audited, but an audited rate has not been noticed by the Agency are not final. (¢) AHCA’s determinations in the February Letter and Exhibit A that any other of the rates listed on Exhibit A not discussed in the subsections (a) through (d), above, are final is inconsistent with its existing adopted rules and its past interpretation of same. 16. | AHCA’s new practice set forth in the February Letter is an unadopted rule and the Agency cannot rely upon this practice to determine that the rates set forth in Exhibit A are final. § 120.57(1(¢), Florida Statutes.’ If AHCA wants to rely upon this new practice to determine that rates are final, it must engage in rulemaking to adopt this new practice if it desires to rely upon it. § This is not a rule challenge pursuant to section 120.56, Florida Statutes. DM2\5506587,1 03/13/2015 12:41 FAX 13059602201 DUANE MORRIS LLP MIA gj 008/023 17. Petitioner maintains that the Agency’s determinations of finality set forth in the February Letter must be overtumed and an order be issued that these rates and cost reports are subject to reopening and adjustment and are not final as required by AHCA’s existing adopted cer. 10. TE dw awe IMemildied ua Galilis wand div wat avpeste they ae beced wpen == final and not subject to reopening or adjustment, Petitioner will be reimbursed significantly less reimbursement than it is entitled to receive. This number cannot be calculated within 21 days, but the impact would be substantial. DISPUTED RATES 19. Petitioner has not had adequate time to review all of the rates and cost reports identified in Exhibit A, and cannot file a petition(s) that address all of the errors in all of the rates within 21 days. However, Petitioner belicves, based upon information and belief, that its rates for rate semesters beginning on or after July 1, 2001, are erroneous for the reasons set forth below. Further determinations may be made based upon discovery in this matter. (a) An incorrect number of private room days are included on the audited cost feports for these rates semesters. Some of these errors were caused by AHCA’s agent, First Coast Services Options, Inc. (“FCSO”) during audit, and some were caused by the Petitioner. Additionally, some of the errors were caused by AHCA by taking the wrong number from the cost report in actually setting the rates. As a result of using the wrong number of private room days, the amount of routine costs that were apportioned to Medicaid costs on each cost report was erroncously low, This resulted in an erroncously low rates for each rate semester. DM2\5504587.1 03/18/2015 12:42 FAK 13059602201 DUANE MORRIS LLP MIA 010/023 (b) Concurrent baby days are not identified correctly on Paid Claim Listings (“PCLs”). As a result, the number concurrent and non-concurrent nursery days were included on the audited cost reports for these rates semesters wena cannes maeg Aa ceteeinnell oof seating, tos veeemag, sree af eanncatrcint aan MULCUUCULcH nutscry days, Ure auivuil uf wusls appuitivusd ty hfydicald is erroncously low. Additionally, some of the errors were caused by AHCA by including the wrong number of days from the cost report when it set the rates. This resulted in an erroneously low tates for each rate semester. (c) The Petitioner’s nursery and NICU days are incorrectly identified on the PCL. Asa result, the number nursery and NICU days that were included on the audited cost reports for these rates semesters was erroneous. As a result of using the wrong number of nursery and NICU days, the amount of costs apportioned to Medicaid is erroneously low, As a result of using the wrong number of number nursery and NICU days, the inpatient perdiem is erroneously low. (d) ‘The Paid Claim Listings (“PCLs”) for services that AHCA provided to Petitioner each year were erroneous; it included truncated numbers for charges and days and summaries did not agree with the detailed information on the reports or failed to include days or charges completely. Additionally, it misclassifies the number of total days and Medicaid days as to whether they are routine, ICU, CCU or other. As a result, the amount of costs that were apportioned to Medicaid on each cost report OMa\$$04587,1 Vas 187 ZUIS 12:42 FAX 19059802201 DUANE MORRIS LLP MIA 911/023 upon which the rates were set was erroneously low, This resulted in an erroneously low rates for both inpatient and outpatient rates each rate semester. fe) AHCA ealenlated the Petitioners ontnatient rate using an incorrect number OF outpatient Cigims. KOT CHUN peru, ATLA LE MUL UNG WIG BULLER number of occurrences listed on the PCL and/or the Petitioner’s cost reports. By calculating the outpatient rate using an erroneously high number of outpatient services, the outpatient rate for each year is erroneously low. (f) | Worksheets C, G, G-1 and G-2 of the Petitioners cost reports included incorrect charges that were not corrected upon audit or were caused by FCSO etrors during audit. These incorrect charges resulted in less costs begin apportioned to Medicaid Costs, which resulted in inpatient and outpatient rates. Additionally, AHCA used charges for professional fees as occurrences of outpatient services in setting the outpatient rate. This resulted in rates being crroneously low rates for cach rate semester. 20. Petitioner is entitled to have its rates for the rate semesters beginning on or after July 1, 2001 adjusted pursuant to scctions II(F), IV(H)(1) & (3) of the Inpatient State Plan and 1(1), LIF), TV(G), (H) & (1) of the Outpatient State Plan. 21. Without these adjustments to its rates, Petitioner will be reimbursed substantially less than it is entitled to receive. 10 19M2\8$04587,1 Vor lofeVID 12.45 FAA 18VdNRUZZOI UUANE MORRIS LLP MIA Ig 01z/028 THE FEBRUARY LETTER IS ARBITRARY AND CAPRICIOUS AND AN ABUSE OF DISCRETION 22. AHCA’s new practice of requiring Petitioner to investigate over 100 inpatient and outpatient rates and approximately 25 cost renorta snanning more than 24 veara in a 21 dav perlod is wbilrary and capricigus and an abuse of discretion as applied to Petilioner 23. AHCA’s existing rules and statutes do not state when a vate is final. AHCA’s determination that over 100 rates are nowjer final as of an arbitrary point in time is without any basis and is not supported by logic or the necessary facts; it is without thought or reason and is irrational. Petitioner cannot review and investigate over 100 rates and approximately 25 cost reports within 21 days. 24, — The new imposition of a 21 day period to review over 100 historical rates is not reasonable or rational. As such, it is an abuse of discretion. 25. This Petition is timely filed. 26. Disputed issues of material fact include, but are not limited to, the following: (a) Whether Petitioner’s unaudited rates listed on Exhibit A are final, (b) Whether the cost reports that Petitioner's unaudited rates are based upon are subject to reopening and adjustment. (c) | Whether Petitioner’s audited rates listed on Exhibit A that were noticed by the Agency less than three years ago are final. (d) Whether the cost reports that Petitioner’s audited rates are based upon are subject to reopening and adjustment. (e) | Whether Petitioner’s adjusted audited rates listed on Exhibit A that were noticed by the Agency less than three years ago are final. 11 1M215504587 | OS/18/2Z015 12:43 FAX 27. OM2\5504587.1 13059602201 DUANE MORRIS LLP MIA 013/023 (f) Whether the cost reports that Petitioner's adjusted audited rates are based upon are subject to reopening and adjustment, (g) | Whether any of the rates listed on Exhibit A are final. thy Whether Patitinner’s rates for rate semesters hesinnine an ar after July 1. 2001 are erroneous as set forth in paragraph 19, above; (i) | Whether the errors in Petitioner’s rates for rate semesters beginning on or after July 1, 2001 as set forth in paragraph 19, above, were the fault of either AHCA and/or First Coast; G) Whether the Petitioner was paid less reimbursement for its rates for rate semesters beginning on or after July 1, 2001 than it was entitled to receive; (k) | Whether the Petitioner was paid substantially less reimbursement for its other audited and unaudited rates set forth above if these rates are determined to be final that it was entitled to receive; and (1) Other disputed issues of material fact may be determined as discovery and case preparation are undertaken. The ultimate facts that entitle Petitioner to relief are that: (a) Petitioner’s unaudited rates listed on Exhibit A are not final and the cost reports that these rates are based upon are subject to reopening and adjustment. (b) _Petitioner’s audited rates listed on Exhibit A that were noticed by the Agency less than three years ago are not final and the cost reports that Petitioner's audited rates are based upon are subject to reopening and adjustment. 12 Vas lssZVID 12:43 FAK 13NoNbOZZO1 UUANE MORRIS LLP MIA 914/023 (c) _ Petitioner’s adjusted audited rates listed on Exhibit A that were noticed by the Agency less than three years ago are not final and the cost reports that Petitioner’s adjusted audited rates are based upon are subject to reopening yer pte Gyctreantes wun oe: eeneeeee ee cee (e) The errors Petitioner's rates for rate semesters beginning on or after July 1, 2001 resulted from AHCA and/or FCSO’s error; (f) _Petitioner’s rates for rate semesters beginning on or after July 1, 2001 are correct; . (g) The errors in Petitioner's rates for rate semesters beginning on or after July 1, 2001 were the fault of AHCA and/or First Coast, (h) Petitioner was paid less reimbursement for its rates for rate semesters beginning on or after July 1, 2001 than it was entitled to receive; (i) Petitioner was paid substantially less reimbursement than it was entitled to | receive for its other audited and unaudited rates set forth above, if these rates are determined to be final. WHEREFORE, the Petitioner respectfully requests that: (1) AHCA forward this matter to the Division of Administrative Hearings for appointment of an Administrative Law Judge, (2) | That a formal administrative hearing be held pursuant to Section 120.57(1), Florida Statutes; (3) ‘That an order be entered determining that all of the inpatient and outpatient rates set forth in Exhibit A to the February Letter are not correct nor final and that many of the cost 13 1MA\S$04547.1 03/13/2015 12:44 FAX 13059602201 DUANE MORRIS LLP MIA 015/028 reports that the rates are based upon are subject to reopening and adjustment; AHCA adjust Petitioner’s rates for the rate semesters beginning on or after July 1, 2001 to correct the errors set forth herein. and that AHCA reimburse Petitioner for Medicaid services rendered during these rate semesters based upon rates that are. recalculated to reflect these. adjustments; and 14 THM2\5504587 1 03/13/2015 12:44 FAX 13059602201 QUANE MORRIS LLP MIA 016/023 (4) Petitioner is awarded such other and further relief, including attorney fees, as may be necessary to do justice under the circumstances, Respectfully submitted, DUANE MORRIS LIP jerdefduanemorris.com CERTIFICATE OF SERVICE Thereby certify that the foregoing instrument has been furnished via facsimile to Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Ft. Knox Building 3, 3" Floor, Tallahassee, Florida 32308, this | 3 day of March, 2015. 15 DM2\5504587.1 03/13/2015 12:44 FAX 13059602201 DUANE MORRIS LLP WIA 017/023 RICK SCOTT GOVERNOR ELIZABETH DUDEK SECRETARY February 13, 2045 Cortified Mail Receipt No.; 917199 9991 7033 2244 8382 Bartow Memorial Hospital afathass TEyonpyteal qtealsaabialerts tare 2200 Usprey Bivd, Bartow. Florida 33830 Referencefs): Notice of Agency Action . Historical Medicaid Inpatient and Outpatient Hospital Reimbursement Rates Medicaid Provider Number 120413 Dear Adrninistrator: Section 409.905, Florida Statutes and Florida’s Medicaid inpatient and outpatient hospital reimbursement plans provide, in relevant part, the following with regard to hospital cost reports and Medicaid reimbursement rates for inpatient or outpatient hospital services: The agency [AHCA] may not make any adjusiment to 2 hospital's reimbursement mor: than 5 years after a hospital is notified of an audited rate established by the agency. The prohibition against adjustments more than 5 years after notification is remedial and applies to actlons by providers involving Medicaid claims for hospital services. Effective October I, 2013, for cost reports received prior to October 1, 2003, all desk or onsite audits of these cost reports shall be final and not subject to reopening.’ For cost reports received on or after October 1, 2003, all desk or onsite audits of these cost reparts shall be final and shall not be reopened past three years of the date that the audit adjustments are noticed through a revised per diem rate completed by the agency.'® In accordance with these provisions, AHCA has determined that all cost reports, desk or Onsite audits of cost reports, audited per diem reimbursement rates calculated by AHCA, or adjustments to audited per diem reimbursement rates calculated by AHCA relating to the *" §6 409.905(5)(c)2 and (6)(b)2., Fla. Stat. (2013); Subsection I(M), Florida Title 1x Inpatient Hospital Reimbursement Plan, Version XXXIX, incorporated by reference in $9G-6.020, Fla. Admin. Code (“Inpatient Plan”); Subsection 1(O), Florida Title IX Qutpatient Hospital Reimbursement Plan, version XXIIL incorporated by reference in 59-G 6.030, Fla. Admin. Code (“Outpatient Plan”), ™ Inpatient Plan § IV(H)(3); Outpatient Plan § IV(GX35). "® Inpatient Plan §§ 1d), IICF), TV(4)(3); Outpatient Plan §§ WCF), IV(G)(5). 2727 Mahan Orive « Mall Stop 23 Tallahassee, FL 32308 AHGA. MyFlorida.com VSsId/ZVID 12549 FAK 13099802201 DUANE MORRIS LLP WIA Ig) 018/023 Medicaid inpatient and outpatient reimbursement rates identified in the attached Exhibit A are “final” as that term is used in the provisions quoted above, and therefore not subject to further re-~ opening or adjustment. anth nuthasitiar sited in this nating icine HR PAN auhenign ae fa vernen rere con Sages Sr aaGT RiOAaY Se Teen ial sopobangneat without prejudice ts or lnmatton on. yous hoon date euiement to nabnat eaended coat reports Or request corrections or adjustments to reimbursement rates in accordance with, and subject to any limitations in, the provisions authorizing such adjustments in the authorities cited herein. If AHCA enters an order determining the reimbursement rates identified in Exhibit A are final, that determination of finality will apply only to a reimbursement rate 2s currently established and as reflected in Exhibit A, and will not preclude your hospital from requesting the re-opening of a cost report or the correction or adjustment of a reimbursement rate if your hospital was entitled 10 suc’ adjustments both prior to and after the entry of AHCA’s order determining the finality of the rate as currently calculated and as reflected in Exhibit A. For audited reimbursement rates listed in Exhibit A which your hospital is not currently entitled to have re-opened under any other provisions set forth in the authorities cited above, any requests for cost report re-opening or adjustments to such rates before they become final as a matter of law must be in the form of a request for a hearing challenging the Agency action described in this notice, and must be made in strict compliance with the directions in this notice and the enclosed Notice of Administrative Hearing and Mediation Rights within twenty-one (21) days of your receipt of this letter, or else your hospital's opportunity to challenge this Agency action before it becomes final will be lost. The Agency action/determination of finality described in this notice only applies to audited reimbursement rates listed in Exhibit A. It does not apply to any rates included in Exhibit A that are preliminary or wandited as of the date of this notice. When final, audited reimbursement rates are established for any currently unaudited rate semesters included in Exhibit A, a separate Notice of Agency Action and Notice of Administrative Hearing and Mediation Rights will be sent with notice of those audited rates. Pursuant to $120.57, Fla. Stat., you have the right to request a formal or informal hearing challenging the determinations set forth in this letter and Exhibit A to same. If a petition for a formal hearing is made, the petition must be made in compliance with Rule 28-106.201, Fla. Admin. Code. Please note that Rule 28-106.201(2) specifics that the petition must contain a coneise discussion of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days Of your receipt of this notice, and that failure to timely request a hearing shall be deemed a waiver of your right to a hearing. For more information regarding your hearing and mediation rights, please see the enclosed Notice of Administrative Hearing and Mediation Rights form, If you wish to request an administrative hearing, you must carefully foltow all of the directions for doing so set out in that form, O ™ For example, Inpatient Plan § IV(H); Outpatient Plan § IV(G) 03/18/2015 12:45 FAX 18059602201 DUANE MORRIS LLP MTA Bonclosures: Exhibit A Notice of Administrative Hearing and Mediation Rights WRS/ba 019/023 VS/1S/ZVID 12146 FAK 1e0dyseZzZ0T UUANE MORRIS LLP WIA Ig 020/023 punmuant to Sections 190.560 and Vou have the sight te request an adeninlewetive 19f 67, Flacide Gtatites tf yan with he fiche steak Ee the une the anclaced Nevies nf & Ha Action, you may request 3 hearing pursuant to Section 120.5 D, Statutes, if you do at pte het std i ho Nati of Agcy Aston, bt ec pre additional reasons to grant the relief you seek, you may SA tant tgaatsistetne purawant to Section 120,57(2), Florida Statutes, Additionally, sant to Section 150.575 Flora Florida Statutes, mediation may be available if you have chosen a administrative hearing, as discussed more fully below. Your written request for an administrative hearing must conform to the requirements of either Bale 21 ace z haere Fone fe Administrative iminisrative Code, md must be Richard J. Shoop, Esquire Agency for Health Care Administration ©) 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 Fax: (850) 921-0158 The request must be legible, on 8 4 by 11-inch white paper, and contain: 1, ‘Your name, address, telephone number, any Agency identifying number on the Notice of Agency Action, if known, and name, ¢, address, and telephone number of your representative, if any; 2. An An ox diecof Agcy Acton; in Agency Acti 3. {A satemnent of when ood how you received the Notice of Agenoy Actions 4. For a request for formal hearing, « statement ofall disputed issues of material fact; $8, For a request for formal hearing, a concise statement of the ultimate facts alleged, as well as the and statutes which entitle you to 6, For request for formal hearing, whether you request mediation, if it is available; 7. For @ request for informal what bases support an adjustment to the amount owed Bency; 8. A demand for reli JA formal hearing will be held if there are disputed issucs of material fact. Additionally, mediation may be available in conjunction with a formal hearing. Mediation is a way to use a eatral third party to assist the parties in a legal or administrative to reach a settlement of case. If you and the Agency agree to mediation, it not mean that you Bive up the right to a hearing, Rather, you and the Agency will try to settle your case first Facebook.cam/AHCAFiorida Youtvbe.com/AHCAFlorida Twittear.com/AKGA_FL ShdeShare.nevAHCAFlarida 2727 Mahan Orive « Mail Stop 23 Tallahassee, FL 32908 ARCA. MyFiotida.com 03/13/2015 12:48 FAX 13059602201 QUANE NORRIS LLP MIA 021/023 Exhibit A EFFECTIVE CDE RATE TyPe DATE PVs RATE. _ 19610101 . 600.86. 19010101 110.44 wae... dpatient 19910701 ~~ $08.02 .. . , Outpatient “19910701” 60.94 coe. patient” 19920101, 611.22 ceseues Outpatient, _ 19020101 72.02 __Mipatient 19020701 | "647.36 | coro comelfipationt 10930101 641.36 - eae ane Outpatient 10630101. «51,36 .. _feago7oi | * 733.4 _, 49960701 "47.83" 48.44 _ 74487. VoFIS/ZYID 1Z24f FAR 1909Nb0ZZ01 DUANE MORRIS LLP WIA (922/023 Exhibit A BFEECTIVE LUE RATE TYPE Tr LOMVIt PALE . 19870101 744.87. 19970101 ver turevia fe.4) PAA iouvuanvceyt UUANE MUKKLS LLP MLA Wy o23/0e9 JRFFECTIVE CDE RATE TYPE. | DATE FMAUS RATE - Mepatient "20100701 “inpatient 20110101 987.22 _ Outpatient 20110101, 56 Inpatient 20110701 EXHIBIT “C” Detail + Provid Rate Cost Report ; rovider Cost Report| Cost Report| Period | Rate Period| Year Ending | IP-Current| IP - New GOS in Rate | OP- Impact of Number Provider Name Year Begin | Year End Begin —nd Onty Rate Rate Rate Change 120413|Bartow Memo 10/1/1998| _9/30/1999| 7/1/2000) 12/31/2000 1999| $838.58 [ § 120413] Bartow Memot 10/1/1998] 9/30/1999 1/1/2001] 6/30/2001 S$ 838.58 |$ 120413] Bartow Memorial Hospital 10/1/1998] 9/30/1999] 7/1/2001] 12/31/2001 $797.02 [$ 120413] Bartow Memo: 10/1/1998] 9/30/1999} 1/1/2002] 3/31/2002 $_797.02|$ 120413| Bartow Memor 10/1/1998] 9/30/1999! 4/1/2002] 6/30/2002 $847.89 [$ 120413|Bartow Memorial Hospital 10/1/1998] 9/30/1999] 7/1/2002) 12/31/2002| $863.10 [$ 120413] Bartow Memorial Hospital 10/1/1999 9/30/2000) 1/1/2003 9/30/2003 $1,017.07 |$ 943.76 120413] Bartow Memorial Hospital 10/1/2001 9/30/2002) 10/1/2003) 12/31/2003 $938.02 |S 910.27 120413|Bartow Memorial Hospital 10/1/2001| 9/30/2002] 1/1/2004] 6/30/2004] $938.02] $ 910.27 120413] Bartow Memorial Hospital 10/1/2002] 9/30/2003| 7/1/2004] 12/31/2004] $_885.39|$ 868.21 120413|Bartow Memorial Hospital 10/1/2002] 9/30/2003 1/1/2005 6/30/2005 $905.80 |S 888.22 120413] Bartow Memorial Hospital 10/1/2003 9/30/2004] 7/1/2005] 12/31/2005, $938.67 |$ 918.32 120413] Bartow Memorial Hospital 10/1/2004] 3/31/2005| 1/1/2006 6/30/2006 $912.07|$ 928.09 120413|Bartow Memorial Hospital 10/1/2004] 3/31/2005| 7/1/2006] 12/31/2006 $ 880.89|$ 905.31 120413|Bartow Memorial Hospital 4/1/2005 3/31/2006] 1/1/2007] 6/30/2007| $_796.79|$ 831.66 120413 [Bartow Memorial Hospital 4/1/2005 3/31/2006] 7/1/2007] 12/31/2007 $804.26 [S$ 838.60 120413[Bartow Memorial Hospital 4/1/2006 3/31/2007| 1/1/2008] 6/30/2008 $ 852.22[$ 854.55 120413 [Bartow Memorial Hospital 4/1/2006|_3/31/2007| 7/1/2008] 12/31/2008| $ 816.84[$ 819.03 120413 [Bartow Memorial Hospital 4/1/2007| 3/31/2008] 1/1/2009 _ 2/28/2009 $828.53 /$ 814.39 120413|Bartow Memorial Hospital 4/1/2007| 3/31/2008] 3/1/2009] 6/30/2009 $796.01} $ 781.54 120413| Bartow Memorial Hospital 4/1/2007| 3/31/2008] 7/1/2009] 12/31/2009] $798.13 |S 783.72 120413] Bartow Memorial Hospital 4/1/2007| 3/31/2008) 1/1/2010] 6/30/2010 $798.48 |$ 784.06 120413|Bartow Memorial Hospital 4/1/2008| 3/31/2009] 7/1/2010] 12/31/2010) $1,013.56 | $ 1,011.68 120413] Bartow Memorial Hospital 4/1/2009] _3/31/2010| 1/1/2011] 6/30/2011) $ 99722|$ 966.78 120413|Bartow Memorial Hospital 4/1/2003] 3/31/2010{ 7/1/2011] 6/30/2012 $ 1,014.83 [$ 984.39 120413[Bartow Memorial Hospital 4/1/2010|3/31/2011| 7/1/2012| 6/30/2013 $1,429.20 | $ 1,448.48 120413[Bartow Memorial Hospital 4/1/2011] 3/31/2012] 7/1/2013] 6/30/2014] TotaliP $ (332,955.85) Total OP $ 527,667.74 [Total Lump Sum $194,711.89 AHCA 4/13/2017 t Medicaid Program Finance

Docket for Case No: 15-001435