Conclusions THIS CAUSE came before the State of Florida, Agency for Health Care Administration (“the Agency") for the issuance of a final order. 1. On June 28, 2013, Sebring Hospital Management Associates, LLC d/b/a Highlands Regional Medical Center (“Highlands Regional”) requested a formal administrative hearing to contest the preliminary denial of Certificate of Need (“CON”) Application No. 10182, which it submitted to establish a seven-bed comprehensive medical rehabilitation unit in District 6 (Highlands County). Filed May 15, 2014 4:07 PM Division of Administrative Hearings 2. The matter was referred to the Division of Administrative Hearings (“DOAH”) where it was assigned Case No. 13-2512 CON. 3. On June 28, 2013, Haines City HMA, LLC d/b/a Heart of Florida Regional Medical Center (“Heart of Florida”) requested a formal administrative hearing to contest the preliminary denial of CON Application No. 10180, which it submitted to establish a 14-bed comprehensive medical rehabilitation unit in District 6 (Polk County). 4. The matter was referred to DOAH where it was assigned Case No. 13-2513 CON. 5. On July 23, 2013, DOAH issued an Order of Consolidation. 6. On April 23, 2014, Highlands Regional filed a Notice of Voluntary Dismissal. 7. On April 23, 2014, Heart of Florida filed a Notice of Voluntary Dismissal. It is therefore ORDERED: 8. The denial of Highlands Regional’s CON Application No. 10182 is upheld. 9. The denial of Heart of Florida’s CON Application No. 10180 is upheld. ORDERED in Tallahassee, Florida, on this He day of thax , 2014. Elizabeth Dudek, Secretary Agency for Healjh Care Administration
Other Judicial Opinions 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 CERTIFY that a true and correct copy of this Final Order was served on the below- named persons by the method designated on this [Ema Loe , 2014. . Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 412-3630 John D. Newton, IT Lorraine M. Novak, Esquire Administrative Law Judge Office of the General Counsel Division of Administrative Hearings Agency for Health Care Administration (Electronic Mail) (Electronic Mail) James McLemore, Supervisor Corrine T. Porcher, Esquire Certificate of Need Unit Susan C. Smith, Esquire Agency for Health Care Administration Geoffrey D. Smith, Esquire (Electronic Mail) Sabrina B. Dieguez, Esquire Smith & Associates 3301 Thomasville Road, Suite 201 Tallahassee, Florida 32308 Corinne@smithlawtlh.com Susan@smithlawtlh.com Geoff@smithlawtlh.com Sabrina@smithlawtlh.com LL (Electronic Mail)
Conclusions THIS CAUSE came before the Agency for Health Care Administration (“the Agency") concerning the denial of Certificate of Need (“CON”) Application No. 10187 submitted by Naples HMA, LLC d/b/a Physicians Regional Medical Center-Collier to establish a 17-bed comprehensive medical rehabilitation unit in District 8, Collier County. 1. On June 7, 2013, the Agency published its decision denying CON Application 10187 submitted by Naples HMA, LLC d/b/a Physicians Regional Medical Center-Collier (“Physicians Regional”) to establish a 17-bed comprehensive medical rehabilitation unit in District 8, Collier County. 2. On June 7, 2013, the Agency published its decision denying CON Application 10188 submitted by Venice HMA, LLC d/b/a Venice Regional Medical Center (“Venice Regional”) to establish a 22-bed comprehensive medical rehabilitation unit in District 8, Sarasota County. 3. On June 28, 2013, Physicians Regional filed a petition for formal administrative hearing challenging the Agency’s denial of CON Application No. 10187. 4. On June 28, 2013, Venice Regional filed a petition for formal administrative hearing challenging the Agency’s denial of CON Application No. 10188. 5. The petitions for formal administrative hearing were referred to the Division of Administrative Hearings (‘DOAH”). 6. Pursuant to the order of the Administrative Law Judge, the above-named intervenors were permitted to intervene in their respective actions and the matters were consolidated. 7. On July 7, 2014, Physicians Regional filed a Notice of Voluntary Dismissal. 8. On July 7, 2014, Venice filed a Notice of Voluntary Dismissal. It is therefore ORDERED: 1. The denial of Physicians Regional’s CON Application No. 10187 is upheld. 2. The denial of Venice Regional’s CON Application No. 10188 is upheld. ORDERED in Tallahassee, Florida, on this esi day of ‘uly Quand l gud fy ElizaMeth Dudek, Secretary / Agency for Health Care Administration
Other Judicial Opinions , 2014. 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 CERTIFY that a true and correct of this Final Order rved on the below-named persons by the method designated on this 772 day of f , 2014. Richard J. Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 (850) 412-3630 James H. Peterson, III Administrative Law Judge Division of Administrative Hearings (Electronic Mail) Lorraine M. Novak, Esquire Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Karen A. Putnal, Esquire Robert A. Weiss, Esquire Moyle Law Firm, P.A. 118 N. Gadsden Street Tallahassee, Florida 32301 Kputnal@moylelaw.com Rweiss@moylelaw.com (Electronic Mail) R. Terry Rigsby, Esquire Brian A. Newman, Esquire Pennington, P.A. 215 South Monroe Street, Second Floor Tallahassee, Florida 32301 Trigsby@penningtonlaw.com Brian@penningtonlaw.com (Electronic Mail) 3 James McLemore, Supervisor Certificate of Need Unit Agency for Health Care Administration (Electronic Mail) Marisol Fitch Health Services & Facilities Consultant Certificate of Need Unit Agency for Health Care Administration (Electronic Mail) | Susan C. Smith, Esquire Corinne T. Porcher, Esquire Geoffrey D. Smith, Esquire Smith and Associates 3301 Thomasville Road, Suite 201 Tallahassee, FL 32308 Susan@smithlawtth.com Corinne@smithlawtlh.com Geoft@smithlawtlh.com (Electronic Mail) Sabrina B. Dieguez, Esquire Smith & Associates 1499 S. Harbor City Blvd., Suite 202 Melbourne, Florida 32091 Sabrina@smithlawth.com (Electronic Mail)
Findings Of Fact Cilla McCray, is a resident of Gadsden County. The parties have stipulated that on December 3, 1977, she was admitted to the Tallahassee Memorial Hospital in an emergency medical condition, and that the treatment performed by the hospital was of an emergency nature. The parties have further stipulated that the Tallahassee Memorial Hospital is a regional referral hospital within the meaning of Section 154.304(4) , Florida Statutes (1977). Cilla McCray was admitted to the Tallahassee Memorial Hospital on December 3, 1977, and was discharged on January 9, 1978. The total bill for her services amounted to $8,753.80. The Hospital submitted a bill to Gadsden County in the amount of $1,521.48 for the services. This latter amount is the maximum allowed to be billed in accordance with the Florida Health Care Responsibility Act. Gadsden County has refused to pay the bill, contending that the patient was not indigent. The patient has not paid the bill. Cilla McCray is married to Lawrence McCray. They have three children but only two of them reside at home. The oldest child is not supported by his parents. During the six months preceding the hospitalization of Cilla McCray her husband had average earnings of $80.00 per week as a logger. Mrs. McCray had earned a total of $732.60 for employment during the six months prior to her hospitalization. The McCray's thus had average monthly earnings during that period in excess of $450.00 per month.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is, RECOMMENDED: That a final order be entered rejecting the bill submitted by the Tallahassee Memorial Hospital for medical services performed for Cilla McCray. RECOMMENDED this 16th day of June, 1978, in Tallahassee, Florida. G. STEVEN PFEIFFER, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: John Shaw Curry, Esquire Post Office Box 706 Quincy, Florida 32351 John D. Buchanan, Jr., Esquire Post Office Drawer 1049 Tallahassee, Florida 32302 Chairman Board of County Commissioners Gadsden County Courthouse Quincy, Florida
The Issue The issue in this cause is whether the prerequisites of Section 154.314, Florida Statutes, have been met. That section governs withholding of funds due to the county under revenue sharing or tax-sharing in order to forward said funds to a regional referral hospital to compensate the hospital for services rendered to an out-of-county indigent patient. Specifically, the parties stipulated and agreed that all prerequisites had been met except whether Tallahassee Memorial Regional Medical Center exhausted its administrative and legal remedies, as provided in Chapter 120, prior to certifying to the Comptroller's Office the amount due from Suwannee County. Suwannee County presented the testimony of Frank C. Davis and had one exhibit admitted in evidence. The Department of Banking and Finance (Department) had one exhibit admitted into evidence. Tallahassee Memorial Regional Medical Center (TMRMC) had six exhibits admitted into evidence. The Department waived the filing of a proposed order. Suwannee County and TMRMC submitted proposed findings of fact and conclusions of law. All proposed findings of fact and conclusions of law have been considered. A ruling has been made on each proposed finding of act in the Appendix attached hereto and made a part of this Recommended Order.
Findings Of Fact TMRMC is a regional referral hospital located in Tallahassee, Leon County, Florida. From May 15, 1985, to July 2, 1985, TMRMC provided medical care to Doris M. Cherry. The total bill for these services was $68,182.75. On July 10, 1985, TMRMC wrote to Suwannee County and requested reimbursement in the amount of $3,827.83 for the treatment rendered to Doris M. Cherry. This amount represented the maximum reimbursement which can be sought under Section 154.306, Florida Statutes. Reimbursement is limited to payment for 12 days of services at the per diem reimbursement rate currently in effect for the regional referral hospital under the medical assistance program to the needy under Title XIX of the Social Security Act. On July 23, 1985, Suwannee County, through its county coordinator, Frank C. Davis, refused TMRMC's request for payment and disputed whether the patient was entitled to the benefits under Chapter 154, Part IV. The letter from Suwannee County did not advise TMRMC of its right to request a formal hearing pursuant to Chapter 120 and it did not provide a point of entry as required in Rule 28-5.111(1), Florida Administrative Code. On December 20, 1985, TMRMC wrote to Suwannee County requesting an administrative proceeding to determine the issues and liability of Suwannee County to TMRMC for the claimed services. TMRMC also filed a formal Request for Hearing. TMRMC requested that the matter be referred to the Division of Administrative Hearings for a hearing to be conducted according to Section 120.57(1), Florida Statutes. Suwannee County failed to take any action on TMRMC's Request for Hearing. In an abundance of caution, TMRMC again wrote to Suwannee County on January 17, 1986, pointing out that no response had been received to the Request for Hearing and again requesting a hearing. TMRMC attached a copy of the Request for Hearing to this letter. As evidenced by the return receipt, the Board of County Commissioners received this letter on January 22, 1986. Suwannee County neither granted nor denied TMRMC's Request for Hearing. Instead, Suwannee County chose to ignore the request. The February 4, 1986, meeting of the Suwannee County Board of Commissioners shows that the Board voted unanimously to wait before responding to the request. No response was ever made. Suwannee county did not give written notice to TMRMC of their decision to ignore the request for hearing. TMRMC took no judicial action by mandamus or certiorari to enforce its right to a hearing. Further, TMRMC did not petition the District Court of Appeal for review of this matter. After waiting several months for a response from Suwannee County, on August 13, 1986, TMRMC certified to the Division of Accounting and Auditing, Comptroller's Office, the sum of $3,827.83 to be withheld from revenue-sharing or tax- sharing funds allocated to Suwannee County. The Department of Banking and Finance sent Its Notice of Intent to Withhold Funds to the Board of County Commissioners of Suwannee County on August 29, 1986. It was only in response to this action by the Comptroller's Office, acting through the Department of Banking and Finance, that Suwannee County requested a formal hearing. By its Request for Formal Hearing, Suwannee County attempted to raise and litigate the eligibility of Doris M. Cherry to the benefits of Chapter 154, Part IV. However, it is undisputed that these disputed issues the fact cannot be litigated in this proceeding because this hearing is limited in scope to determine only, if the prerequisites of Section 154.314, Florida Statutes, have been satisfied. Tallahassee Memorial Regional Medical Center, et al., v. Lewis, 399 So.2d 106 (Fla. 1st DCA 1981).
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Banking and Finance enter a final order determining that all prerequisites to Section 154.314, Florida Statutes, had been met and forward the amount certified to the Tallahassee Memorial Regional Medical Center from the revenue-sharing or tax-sharing funds due to Suwannee County. DONE AND ENTERED this 12th day of March, 1987, in Tallahassee, Florida. DIANE K. KIESLING Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 12th day of March, 1987. APPENDIX TO RECOMMENDED ORDER, CASE NO. 86-3901 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the proposed findings of fact submitted by the parties in this case. Specific Rulings on Proposed Findings of Fact Submitted by Petitioner Suwannee County Proposed findings of fact 1, 3, and 4 are rejected as unnecessary. Proposed finding of fact 11 is rejected as being unsupported by the competent, substantial evidence. Each of the following proposed findings of fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed findings of fact: 2(11); 5(1); 6(2); 7(3); 8(4); 9(5); 10(6); 12(9); and 13(10). Specific Rulings on Proposed Findings of Fact Submitted by Intervenor, TMC Proposed finding of fact 8 is rejected as being argumentative and conclusory. Each of the following proposed findings of fact are adopted in substance or as modified in the Recommended Order. The number in parentheses is the Finding of Fact which so adopts the proposed finding of fact: 1(3); 2(4); 3(4); 4(4); 5(5 and 6); 6(7); 7(8); 9(10); and 10(9). COPIES FURNISHED: Walter W. Wood, Esquire Office of the Comptroller The Capitol, Suite 1302 Tallahassee, Florida 32301 Jesse F. Suber, Esquire Post Office Box 1049 Tallahassee, Florida 32302 Ernest A. Sellers, Esquire James W. Prevatt, Jr., Esquire Post Office Box 8 Live Oak, Florida 32060 Honorable Gerald Lewis Comptroller, State of Florida The Capitol Tallahassee, Florida 32301
Findings Of Fact On July 31, 1987, DOA mailed a Request for Proposal, (RFP), to various Health Maintenance Organizations, (HMOs), soliciting proposals for the providing of HMO services in the Orlando service area. Petitioner, Cigna, and the various Intervenors herein, submitted proposals which were opened by DOA on August 28, 1987, with a contemplated date of award of September 14, 1987 and an effective date of contract on January 1, 1988. Section 2 of the RFP defined the general purposes of the procurement as being to meet benefit objectives of DOA and to provide high quality benefits and services to state employees. Specifically, the objectives of the RFP were: A proactive approach to cost containment, including an emphasis on aggressive claims management, utilization review, and superior statistical reporting. Quality medical care which encourages health promotion, disease prevention, early diagnosis and treatment. Stability in the financial structure of offered health plans. Professional, high quality service in all administrative areas including claims processing, enrollment, membership services, grievances, and communications. Competitive premium rates which take into account the demographics and, if appropriate, the claims experience of state employees. Other stated objectives included: Have each county or contiguous group of counties be considered one service area. Award no more than two contracts per service area; however, the awards will be based on the HMO's ability to respond to the needs of employees and on accessibility by employees. Have reciprocal agreements between locations, if an HMO has multiple service areas. Enter into a two year, non-experience rates contract. A provision will be included tying renewal action at each of the two renewals to the consumer price index, (CPI), for medical care services. In order to be considered as a "qualified" proposer, an organization had to be licensed by the Department of Insurance pursuant to Part II, Chapter 641, Florida Statutes. Section IX of the RFP listed five major criteria for evaluation of the proposals. They were: Premium Cost Extensiveness of service area - by county and/or contiguous counties. Plan Benefits as follows: Covered services Limitations and exclusions Co-payments, deductibles, and coinsurance features Range of providers including specialists and numbers of hospitals D. Out of service area coverage F. Grievance procedures Accessibility as follows: Reciprocal agreements Provider locations Number of primary care physicians and specialists, in relation to membership Completeness of proposals The first four of the above objectives were called for by the Legislative action providing for these procurements to be effective January 1, 1988. The fifth, completeness of proposals, was not identified by the Legislature but was added by DOA. The Department reviewed and evaluated all the proposals submitted by Petitioner and the various Intervenors. Each proposer was evaluated by three individual evaluators. Two separate sets of evaluations were performed; the second coming upon the direction of the Secretary who, after the first evaluation and recommendation of award, concluded the standards for evaluation had been too subjective and directed a second evaluation utilizing more objective standards. During this second evaluation process, after the actual evaluations had been done but before the recommendation was forwarded to the Secretary, several computer treatments of the raw scores were accomplished by Mr. Nye because of additional unidentified factors brought to his attention. The final computer run identified that Central Florida Physicians, not a party to this action, received the highest point total followed by Health Options, Pru-Care, and Petitioner, Cigna. Mr. Nye, who had designed and supervised the evaluation process, recommended to the Secretary that Central Florida Physicians, Health Options, and Pru-Care receive the award even though the guidelines called for only two recommendees. Central Florida Physicians was recognized to be in financial difficulties though it received the highest rating, and in order to provide two viable candidates in the event that provider should be disqualified, Health Options and Pru-Care were added. Central Florida Physicians was, in fact, subsequently disqualified due to financial insolvency. This left Health Options and Pru-Care as the two providers with the highest evaluations and the Secretary made the award to them. At the final count, Health Options received a point total of 64.635; Pru-Care, 57.415; and Cigna, 56.83, or a difference of .585 between Pru-Care and Cigna. According to Mr. Black, an administrator with the Department of Insurance and responsible for the licensing of HMOs and other health care facilities, as of January 12, 1988, Pru- Care was not licensed in Volusia or Lake Counties and department records show that Pru-Care has never been or requested to be licensed in those counties. Mr. Beckerink, the Director of Planning for Cigna of Florida, who oversaw Cigna's proposal for the Orlando area and who reviewed DOA's evaluation of the various proposals submitted, carefully examined the evaluation forms for both Cigna and Pru- Care and concentrated on scores relating to costs, benefits, accessibility, service area, and completeness. He noted that Pru-Care received 10 points for proposing service in Orange, Seminole, Osceola, Lake, and Volusia Counties though it is not licensed in the latter two, whereas Cigna received only 4 points for Orange and Seminole Counties. Cigna is licensed in all five counties and has hospitals and physicians in Seminole, Osceola, and Orange Counties. He contends Pru-Care received credit by the evaluators for five counties when it is licensed only in three, an unearned award of 4 points, and Cigna was awarded credit for only two counties when it is licensed in five, an improper denial of 6 points. According to Mr. Nye, the award to Pru-Care was based on its representation it would provide service in five counties. The Department of Insurance could not tell him, at the time, in which counties Pru-Care was licensed. As a result, he took the proposal, which indicated the five counties, at face value. Credit was given only for full counties to be served and Cigna's proposal indicated it would deliver service to two full counties and to only portions of three counties. The evidence indicates that Pru-Care's facilities are primarily in Orange and Seminole Counties with some service offered in the extreme northern portion of Osceola County, too far away for those individuals living in the southern portion of that county reasonably to take advantage of it. Mr. Nye indicates that driving time, which would be the problem here, is not a consideration in assessing accessibility, but merely a factor in quality of service. The department is not concerned with whether it is convenient for the employee to get to the service but merely whether the service will be offered to anyone residing in the county. For this reason, Pru-Care was awarded credit for Osceola county since it proposed to enroll any eligible employee living in the county whether service was convenient to that party or not, whereas Cigna, which limited it's enrollment in certain counties to those personnel living in only a part of the county, was not given any credit for those partially served counties. Mr. Nye admits that had he known Pru-Care was not fully licensed, he would have deferred to legal counsel, but would most likely not award points if a provider is not licensed in a county for which it proposes service. Mr. Breckerink identified additional areas in the evaluation wherein he believes errors were made, the correction of which would result in an adjustment of the award of points. For example, in evaluating plan benefits, the evaluator gave Pru- Care 20 points when only 10 points are available for award without a demonstration of additional services. For emergency room availability, Cigna was awarded 5 points when it should have received 10. In the area of co- payments, Cigna was awarded points and should have received 23. Concerning range of providers, Cigna's proposal lists seven hospitals yet the evaluation form only reflects six, resulting in a shortage of 10 points. As to turnaround time, Cigna indicated it would accomplish payment in 60 days whereas Pru-Care indicated it would in "an average" of two weeks. As a result, Mr. Breckerink, who points out Cigna's actual time is 30 days and it therefore should have been given 30 points, contends there is no opportunity for a valid comparison here since Pru-Care's answer is not responsive to the RFP's call for" an "expected" time. His point is well taken. With regard to accessibility, Mr. Breckerink states that Cigna got only 20 points for its two allowed counties but should have received 30 points since it has hospitals in three counties in the service area. DOA's rationale on this point is identical to that on the issue of full counties served. He also alleges that Cigna was shortchanged by at least 2 points on the number of counties in which specialty providers are represented and by at least 1 point on the number of providers. Mr. Nye admits Pru-Care should have received 5 points instead of 10 for benefits. This would reduce its' raw score in this area from 258 to 253 points. Nye contends, however, that the points awarded Pru-Care for its' turnaround time were correct. He does not consider the question to be a bad one since it was asked equally of all providers and each responded as it saw fit realizing that its response might become a part of a contractual obligation. This reasoning is specious at best and does not address the real question of the fairness and appropriateness of the question asked. Further, Mr. Nye also admitted that under certain circumstances, if Pru-Care were to lose credit for those two counties in which it was not shown to be licensed, the change could result in a difference sufficient to reverse the relative standings of Pru-Care and Cigna. Mr. Breckerink alleges, and Mr. Nye admits that multiple computer runs were made utilizing the raw scores developed by the evaluators before the recommendation as to award was forwarded to the Secretary. On the first run for the second evaluation, Cigna was in second place with a point total of 71.1 and Pru-Care was third with 65.86 points. On the second run, which Nye contends was done to make the computer run consistent with what had been said at the pre-bid conference and in the RFP, Cigna dropped from second place to third with 58. 2 points and Pru-Care went from third to fourth with 57.195 points. In the third run, which ultimately formed the basis for the award, the positions of Cigna and Pru-Care reversed with Cigna dropping to 56.83 points and Pru-Care rising to 57.415. Central Florida Physicians remained in first and Health Options in second. When Central Florida Physicians dropped out due to insolvency, Health Options became number one and the other two each went up one place in the standings without changing relative positions. According to Mr. Breckerink when the mistakes were identified and changes made in the raw scores, Cigna got a total of 23 more points but Pru-Care still got 16 more points than it should have. He contends that if the mistakes were accurately corrected, if Cigna were to get all the points it should and Pru- Care lose all it should not legitimately have, Cigna would come out higher in the overall ranking than Pru-Care. However, he admits there are factors involved about which he does not know which may affect the standings. What is clear is that while Mr. Breckerink could not clearly follow the evaluation procedure, neither can others charged with evaluating it. What is more, notwithstanding the direction given in the objectives of the procurement that only two providers be awarded contracts, the department continuously has been unable to abide by this guideline. In its September 11, 1987 recommendation after the first evaluation sequence, Mr. Nye recommended, for the Orlando service area, awards to Central Florida Physicians, Cigna, and Pru-Care for a part of the service area and an additional award to Health Options and Florida Health Care for other counties in the service area. When the Secretary directed the objective second evaluation, no change was made to the number of providers to be recommended (two), but again, on October 6, 1987, Mr. Nye recommended three providers, Central Florida Physicians, Health Options, and Cigna. No evidence was presented as to why this recommendation was not implemented, but it is seen that on October 26, 1987, Mr. Nye submitted his third set of recommendations to the Secretary, this time recommending only Central Florida Physicians, and Health Options. Being still unable to finalize the process, on October 30, 1987, Mr. Nye submitted his fourth set of recommendations to the Secretary recommending, for the most part, three providers, but specifically recommending Pru-Care for award in Lake and Volusia Counties, where it was arguably not even licensed. No justification or explanation for this vacillation was forthcoming from the Department and the exercise appears to have been clearly capricious.
Recommendation In view of the foregoing, it is, therefore: RECOMMENDED that the Department of Administration issue a Final Order rejecting all proposals submitted for the Orlando service area and readvertise for new proposals if deemed appropriate. RECOMMENDED this 19th day of April, 1988 at Tallahassee, Florida. ARNOLD H. POLLOCK, Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 19th day of April, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 87-5525BID The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. By Petitioner Cigna: 1 - 5. Accepted and incorporated herein. First sentence not a Finding of Fact. Second sentence accepted except for conclusion as to legal license status of Pru-Care. Rejected as a restatement of testimony and not a Finding of Fact. First three sentences rejected as restatements of testimony. Balance accepted with the assumption that "those counties" indicates Lake and Volusia counties. First and second sentences rejected as restatements of testimony. Third sentence accepted. Accepted and incorporated herein. First and second sentences rejected as restatements of testimony. Third sentence accepted as a possibility and, not a fact. First sentence accepted and incorporated herein. Second sentence rejected. Accepted. Accepted. Accepted and incorporated herein. Accepted except for use of word "awarded" in last sentence. Award is a function of the Secretary. A better word would be "recommended". Accepted. Reject Accepted. Rejected. Accepted except for word "significantly". First sentence accepted. Second sentence rejected as not being a proper Finding of Fact. For Respondent, DHRS: 1 - 14. Accepted and incorporated as appropriate. 15 - 16. Accepted. 17 - 19. Accepted. First, second, and fourth sentences accepted. Third sentence rejected as not supported by the evidence. Accepted. Accepted. Accepted except for the last three sub-paragraphs which are not supported by the evidence. Absent. 25 - 26. Accepted except for last sub-paragraph which is rejected as a conclusion. 27. Absent. 28 - 29. Accepted. 30. Accepted. 31 - 37. Absent. 38. Accepted. For Intervenor, Pru-Care: 1 & 2. 3. Rejected as a restatement of testimony and not a Finding of Fact. Accepted. 4 - 5. Accepted. 6 - 7. Rejected as not being a Finding of Fact. 8 - 10. Accepted. 11. Accepted. 12. Rejected as not being a Finding of Fact. 13 - 14. Accepted. 15. Rejected as not being a Finding of Fact except for 16 - 17. last sentence which is accepted. Accepted. 18. Accepted. For Intervenor, Health Options: 1 - 3. Accepted and incorporated herein. 4 - 10. Accepted and incorporated herein. 11. Accepted except for the seventh sentence which is rejected. 12 - 13. Accepted. 14. Rejected as contra to the weight of the evidence. 15 - 16. Accepted. COPIES FURNISHED: David Yon, Esquire 315 South Calhoun Street Suite 800 Tallahassee, Florida 32301 Augustus D. Aikens, Jr., Esquire General Counsel Department of Administration 435 Carlton Bldg. Tallahassee, Florida 32399 John Buchanan, Esquire 118 South Monroe Street Tallahassee, Florida 32301 Jann Johnson, Esquire Post Office Box 391 Tallahassee, Florida 32302 J. Stanley Chapman, Esquire Ervin, Varn, Jacobs, Odom, & Kitchen Post Office Drawer 1170 Tallahassee, Florida 32302 Larry Carnes, Esquire 515 East Park Avenue Tallahassee, Florida 32301 Adis Vila, Secretary Department of Administration 435 Carlton Building Tallahassee, Florida 32399-1550
