All Children's Hospital v. Hospital Cost Containment Board

28 Fla. Supp. 2d 196
CourtState of Florida Division of Administrative Hearings
DecidedFebruary 17, 1988
DocketCase No. 87-4988H
StatusPublished

This text of 28 Fla. Supp. 2d 196 (All Children's Hospital v. Hospital Cost Containment Board) is published on Counsel Stack Legal Research, covering State of Florida Division of Administrative Hearings primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
All Children's Hospital v. Hospital Cost Containment Board, 28 Fla. Supp. 2d 196 (Fla. Super. Ct. 1988).

Opinion

OPINION OF THE COURT

WILLIAM C. SHERRILL, JR., Hearing Officer.

RECOMMENDED ORDER

The formal administrative hearing in this case was held before William C. Sherrill, Jr., in Tallahassee, Florida, on December 11, 1987.

The Petitioner presented exhibits A through R, except Q, which were admitted into evidence, and the testimony of Wanda N. Johnson, [197]*197Harold E. Fulmer, and Michael C. Poland. The Respondent presented exhibits 1, 4, and 5, which were admitted into evidence, and the testimony of William Summers and James Bracher. The parties filed a stipulation which is Hearing Officer’s Exhibit 1. There is a transcript. The parties filed proposed findings of fact and conclusions of law.

The record stayed open until 5:00 P.M., December 15, 1987, to allow the Respondent an opportunity to review Petitioner’s Exhibit R, and to determine if it needed to present additional evidence. T. 133. That time passed without a request to present additional evidence, and the record is now closed.

The issues involved in this case were well-stated in the prehearing stipulation. Chapter 87-92, Laws of Florida, authorized the Department of Health and Rehabilitative Services (HRS) to distribute $69.5 million from the Public Medical Assistance Trust Fund to hospitals meeting certain criteria. The distribution was to be based upon actual data from fiscal year 1986 as reported to the Hospital Cost Containment Board. Pursuant to subsection (5) of section 12, chapter 87-92, hospitals were allowed to correct fiscal year 1986 data, subject to verification by independent certified auditors. Based upon this corrected data, the Hospital Cost Containment Board was required to recalculate the distribution due and certify the revised amounts to HRS in October, 1987. The Petitioner in this case, All Children’s Hospital, reclassified certain amounts related to its regional perinatal intensive care center (RPICC) program. The Hospital Cost Containment Board denied the reclassification, and All Children’s Hospital requested a formal administrative hearing. At stake for All Children’s Hospital is an additional amount of distribution of $197,347.

References in this recommended order to Petitioner’s exhibits will only include the page number provided by the Petitioner in the booklet of such exhibits.

Findings of Fact

1. The Regional Perinatal Intensive Care Centers (RPICC) Program in Florida is a regionalized health care delivery system designed to deliver optimal medical care to high risk pregnant women and sick or low birth weight newborns. P. Ex. H., p. 24.

2. The RPICC program is a program for indigents. T. 101. Each patient must be individually qualified for the RPICC program as an indigent. T. 31. See P. Ex. P, pp. 261, 265, and 269.

3. All Children’s Hospital is a 113 bed hospital located in St. Petersburg, Florida, which specializes in services to children. Fifty-five [198]*198percent of the beds are intensive care beds qualified as intensive care beds by Social Security and Medicare definitions, and of these, 40 beds are neonatal nursery beds involved in the RPICC program. T. 16-17.

4. All Children’s Hospital has participated in the RPICC program since about 1981. T. 58.

5. Data from the Petitioner’s fiscal year 1986 is the year relevant to this case. Hearing Officer’s Ex. 1. Petitioner’s fiscal year runs from October 1st to September 30th.

6. The Petitioner provided RPICC services in its fiscal year 1986 pursuant to contracts with HRS. Hearing Officer’s Ex. 1; P. Exs. K and L. (References in this recommended order will be to the contract which is P. Ex. K, although the same provisions are present in P. Ex. L. T.27.)

7. RPICC patients served by the Petitioner during fiscal year 1986 were medically indigent. Hearing Officer’s Ex. 1.

8. All Children’s Hospital’s total charges for fiscal year 1986 RPICC patients were $1,562,390. Hearing Officer’s Ex. 1.

9. For fiscal year 1986, All Children’s Hospital received $1,034,115 of RPICC grant funds. Hearing Officer’s Ex. 1.

10. Thus, in fiscal year 1986, the Petitioner received only partial payment for RPICC sponsored patients’ charges. The difference was $528,275. Moreover, this partial payment did not cover its costs. T. 39, 22.

11. Hospitals that participate in the RPICC program usually lose money on the program. T. 101; P. Ex. I, p. 128.

12. Hospitals regulated by the Hospital Cost Containment Board must annually file a fiscal year report of their actual fiscal experience. T. 109. That report includes an unaudited report prepared in accordance with the Florida Hospital Uniform Reporting System (FHURS), certified by the hospital, and a report by a certified public accountant. T. 109-110.

13. For fiscal year 1986, the Petitioner originally reported to the Hospital Cost Containment Board $3,804,574 as “contractual adjustments-other” on line 11 of Worksheet C-2, FHURS account 5940. R. Ex. 4; P. Ex. B, p. 6; T. 55. This amount originally contained the difference between charges and payments related to RPICC patients, an amount that was $528,275. T. 55.

14. This manner of reporting was the same as had been used by All Children’s Hospital in each year since at least 1983. T. 59.

[199]*19915. Reporting the RPICC differential as “contractual adjustment-other” was also consistent with the manner in which some other hosiptals have reported and classified their RPICC charges and funds. T. 84, 91. It is unclear from the record whether all hospitals having RPICC programs report in this way.

16. There is no evidence that the RPICC program changed in any material way in fiscal year 1986 from prior years.

17. By letter dated September 18, 1987, the Petitioner filed a correction to its fiscal year 1986 report, making the following changes to the manner in which it accounted for the RPICC program:

a. Charges related to RPICC program patients in the total amount of $1,562,390 were reclassified under “charity uncompensated-other,” Worksheet C-2, line 13, FHURS account 5960. T. 56; P. Ex. B, p. 6; P. Ex. M, p. 254.

b. Funds received from the RPICC program in the total amount of $1,034,115 were reclassified under “restricted grants for indigent care,” Worksheet C-2, line 14. FHURS account 5970. T. 56, P. Ex. B, p. 6; P. Ex. M, p. 254.

c. The difference between RPICC charges and amounts received, a total amount of $528,275, which had originally been contained in the category “contractual adjustments-other” was subtracted from that account, Worksheet C-2, line 11. P. Ex. B, p. 6; T. 55-56.

18. Account 5940, “contractual adjustments-other,” of the FHURS manual, provides in part that:

These accounts must be used to report the differential (if any) between the amount, based on the hospital’s full established rates of contractual patients’ charges for hospital services which are rendered during the reporting period and are covered by the contract, and the amount received and to be received from third-party agencies in payment of such charges, including adjustments made at year end, based upon cost reports submitted.

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Bluebook (online)
28 Fla. Supp. 2d 196, Counsel Stack Legal Research, https://law.counselstack.com/opinion/all-childrens-hospital-v-hospital-cost-containment-board-fladivadminhrg-1988.