Golfcrest Nursing Home v. State, Agency for Health Care Admin., No. 94-4077

CourtCourt of Appeal of Florida (US)
Writing for the CourtSMITH
Citation662 So.2d 1330
Parties20 Fla. L. Weekly D2585 GOLFCREST NURSING HOME, Appellant, v. STATE of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION, Appellee.
Decision Date14 November 1995
Docket NumberNo. 94-4077

Page 1330

662 So.2d 1330
20 Fla. L. Weekly D2585
GOLFCREST NURSING HOME, Appellant,
v.
STATE of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION, Appellee.
No. 94-4077.
District Court of Appeal of Florida,
First District.
Nov. 14, 1995.

Page 1331

Alfred W. Clark, Tallahassee, for Appellant.

Karel Baarslag, Senior Attorney, Agency for Health Care Administration, Tallahassee, for Appellee.

SMITH, Senior Judge.

Golfcrest appeals an order of the State of Florida Agency for Health Care Administration ("AHCA") denying an interim Medicaid reimbursement rate increase. We reverse.

Golfcrest Nursing Home (Golfcrest) filed an application for interim rate increase based upon costs incurred to correct deficiencies noted during licensure surveys conducted by AHCA in 1990 and 1991. The AHCA denied the interim rate increase based upon its interpretation of the Florida Title XIX Long-Term Care Reimbursement Plan Medicaid (the Plan).

First, with respect to claimed capital costs, the AHCA interpreted the Plan to require utilization of the chronologically-most-recent cost report in calculating the threshold one (1%) per cent comparison formula for determining whether such capital costs warranted an interim rate increase. The most recent cost report was, in this case, different from the cost report from which the base rate was derived.

Second, with respect to patient costs, the AHCA interpreted the Plan to require the applicant to prove, as part of its prima facie case, that its claimed costs were consistent with what a reasonable and prudent buyer would pay. Because AHCA determined that Golfcrest failed to meet its burden of proof in this regard, the requested rate increase was denied.

Golfcrest is a properly licensed nursing home located in Broward County, Florida. Golfcrest participates in the Florida Medicaid Program and provides inpatient nursing home services to Medicaid-eligible persons. Pursuant to the program, Golfcrest is entitled to reimbursement in accordance with the Florida Title XIX Long-Term Care Reimbursement Plan (the "Plan"), which has been adopted and incorporated by reference in Rule 10C-7.0482, Florida Administrative Code. The Appellee, AHCA, is the state agency responsible for administration and implementation of the Florida Medicaid Program.

Page 1332

In May of 1990 and July of 1991, the Department of Health and Rehabilitative Services (now AHCA) conducted its annual licensure surveys at Golfcrest. During those surveys, AHCA identified several licensure deficiencies, which it ordered Golfcrest to correct. Failure to correct the deficiencies would have resulted in sanctions against Golfcrest's nursing home license, including administrative fines, a reduction in licensure rating, other civil penalties, and a reduction in Medicaid reimbursement.

Thereafter, Golfcrest incurred certain property costs and costs due to patient care and operating changes which it attributes to correction of the licensure deficiencies. Accordingly, by letter dated 6 January 1992, Golfcrest submitted to AHCA a request for an interim rate increase for patient care costs, operating costs, and property costs incurred or to be incurred to comply with existing state regulations and to correct identified licensure deficiencies. 1 After an exchange of correspondence, AHCA denied Golfcrest's interim rate request by letter dated 15 June 1992, as revised by letter dated 1 July 1992.

Golfcrest challenged the proposed agency action by filing its Petition for Formal Administrative Hearing on 28 February 1993. The matter was referred to the Division of Administrative Hearings, and a formal hearing was held on 22 February 1994. On 3 August 1994, the Hearing Officer entered her Recommended Order, recommending partial approval of the interim Medicaid reimbursement request.

In its final order, the AHCA adopted in substantial part the Hearing Officer's recommendations. First, it disapproved an interim rate increase related to property costs, on the ground that such costs did not meet the threshold test of equalling at least one (1%) percent of Golfcrest's total applicable reimbursement rate.

On this point, the parties agree that, if the cost of renovations which Golfcrest incurred to correct licensure deficiencies caused a change of 1% or more in Golfcrest's existing total per diem reimbursement rate, Golfcrest would be entitled to an interim per diem rate increase. The parties also agree that, at the time of submission and review of Golfcrest's interim rate request, Golfcrest's existing total per diem reimbursement rate was $71,2565. That was derived by dividing costs by the number of patient days from the applicable cost report period, which was, at that time, the July 31, 1990 Medicaid Cost Report. 2 During that cost report period, Golfcrest experienced 22,676 patient days.

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4 practice notes
  • Miles v. FLORIDA A AND M UNIVERSITY, No. 1D00-4961.
    • United States
    • Court of Appeal of Florida (US)
    • April 10, 2002
    ...... defer to the expertise of an agency in interpreting its rules."); Golfcrest Nursing Home v. State, Agency for Health Care Admin., 662 So.2d 1330, 1333 (Fla. 1st DCA 1995) ("An agency's interpretation of its own rules and regulations is entitled to great weight, and shall not be overturn......
  • Colonnade Medical Center, Inc. v. State, No. 4D02-1026.
    • United States
    • Court of Appeal of Florida (US)
    • April 23, 2003
    ...its own rules and regulations is entitled to considerable deference. See Golfcrest Nursing Home v. State, Agency for Health Care Admin., 662 So.2d 1330, 1333 (Fla. 1st DCA 1995). Here, additionally, the AHCA's interpretation of the statute is consistent with its plain meaning. Colonnade als......
  • ELLINGHAM v. FLORIDA DCF, No. 1D03-2971.
    • United States
    • Court of Appeal of Florida (US)
    • March 4, 2005
    ...that a particular benefit is allowed by the law." Id. at 498; see also Golfcrest Nursing Home v. State, Agency for Health Care Admin., 662 So.2d 1330 (Fla. 1st DCA 1995) (holding burden is initially on party seeking entitlement to benefit, and only when prima facie case is shown does burden......
  • GOLFVIEW NURSING HOME v. STATE, AHCA, No. 1D02-0027
    • United States
    • Court of Appeal of Florida (US)
    • November 25, 2003
    ...proceeding into two completely separate and independent proceedings. See Golfcrest Nursing Home v. Agency for Health Care Admin., 662 So.2d 1330, 1332 (Fla. 1st DCA 1995) (stating that the failure to correct the deficiencies discovered during an annual licensure survey "would have resulted ......
4 cases
  • Miles v. FLORIDA A AND M UNIVERSITY, No. 1D00-4961.
    • United States
    • Court of Appeal of Florida (US)
    • April 10, 2002
    ...... defer to the expertise of an agency in interpreting its rules."); Golfcrest Nursing Home v. State, Agency for Health Care Admin., 662 So.2d 1330, 1333 (Fla. 1st DCA 1995) ("An agency's interpretation of its own rules and regulations is entitled to great weight, and shall not be overturn......
  • Colonnade Medical Center, Inc. v. State, No. 4D02-1026.
    • United States
    • Court of Appeal of Florida (US)
    • April 23, 2003
    ...its own rules and regulations is entitled to considerable deference. See Golfcrest Nursing Home v. State, Agency for Health Care Admin., 662 So.2d 1330, 1333 (Fla. 1st DCA 1995). Here, additionally, the AHCA's interpretation of the statute is consistent with its plain meaning. Colonnade als......
  • ELLINGHAM v. FLORIDA DCF, No. 1D03-2971.
    • United States
    • Court of Appeal of Florida (US)
    • March 4, 2005
    ...that a particular benefit is allowed by the law." Id. at 498; see also Golfcrest Nursing Home v. State, Agency for Health Care Admin., 662 So.2d 1330 (Fla. 1st DCA 1995) (holding burden is initially on party seeking entitlement to benefit, and only when prima facie case is shown does burden......
  • GOLFVIEW NURSING HOME v. STATE, AHCA, No. 1D02-0027
    • United States
    • Court of Appeal of Florida (US)
    • November 25, 2003
    ...proceeding into two completely separate and independent proceedings. See Golfcrest Nursing Home v. Agency for Health Care Admin., 662 So.2d 1330, 1332 (Fla. 1st DCA 1995) (stating that the failure to correct the deficiencies discovered during an annual licensure survey "would have resulted ......

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