K.M. v. Dept. of Health

237 So. 3d 1084
CourtDistrict Court of Appeal of Florida
DecidedDecember 27, 2017
Docket16-0023
StatusPublished

This text of 237 So. 3d 1084 (K.M. v. Dept. of Health) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
K.M. v. Dept. of Health, 237 So. 3d 1084 (Fla. Ct. App. 2017).

Opinion

Third District Court of Appeal State of Florida

Opinion filed December 27, 2017. Not final until disposition of timely filed motion for rehearing.

________________

No. 3D16-23 Lower Tribunal No. 15-6009RP ________________

K.M., Appellant,

vs.

Florida Department of Health, Appellee.

An Appeal from State of Florida, Division of Administrative Hearings.

Moyle Law Firm, P.A., and Karen A. Putnal, Jon C. Moyle, and Robert A. Weiss, (Tallahassee), for appellant.

Jay Patrick Reynolds, Chief Litigation Counsel (Prosecution Services Unit), and Nichole C. Geary, General Counsel (Tallahassee), for appellee.

Before LAGOA, EMAS, and LOGUE, JJ.

LAGOA, J. Appellant, K.M., seeks reversal of a final administrative order dismissing

K.M.’s petition for a formal administrative hearing. Because K.M. would not be

“substantially affected” by the Department of Health’s repeal of Rule 64C-4.003 of

the Florida Administrative Code, we find that the administrative law judge did not

err in determining that the Division of Administrative Hearings lacked jurisdiction

to rule on the merits of K.M’s petition. K.M. does not have standing under section

120.56(1)(a), Florida Statutes (2015), to assert her challenge to the Department of

Health’s proposed repeal. Accordingly, we affirm the order dismissing the petition

for lack of jurisdiction. This opinion does not address the merits of K.M.’s case.

I. FACTUAL AND PROCEDURAL HISTORY

On July 29, 2015, the Department of Health (“DOH”), filed a Notice of

Proposed Rule for the purpose of repealing Rule 64C-4.003 of the Florida

Administrative Code (the “Rule”). The DOH summarized the Rule as one that

required pediatric cardiac facilities approved by Children’s Medical Services

(“CMS”) to comply with the CMS Pediatric Cardiac Facilities Standards mandated

by the Rule and to submit a number of forms that were adopted by the Rule. The

Rule, titled “Diagnostic and Treatment Facilities or Services -- Specific,” provides:

(1) CMS Pediatric Cardiac Facilities. CMS Headquarters approves pediatric cardiac facilities for the CMS Network on a statewide basis upon consideration of the recommendation of the Cardiac Subcommittee of the CMS Network Advisory Council. CMS approved pediatric cardiac facilities must comply with the CMS Pediatric Cardiac Facilities Standards, October 2012 . . . . CMS

2 approved pediatric cardiac facilities must collect and submit quality assurance data annually [using the prescribed forms] . . . .

(2) CMS Cardiac Regional and Satellite Clinics. CMS Headquarters approves regional and satellite cardiac clinics for the CMS Network on a statewide basis upon consideration of the recommendation of the Cardiac Subcommittee of the CMS Network Advisory Council. CMS regional and satellite clinics must comply with the CMS Cardiac Regional and Satellite Clinic Standards, October 2012. . . .

(3) The standards and forms are incorporated herein by reference and are available from CMS Headquarters, 4052 Bald Cypress Way, Bin A06, Tallahassee, FL 32399-1707.

Fla. Admin. Code R. 64C-4.003 (2015) (emphasis added). The DOH sought to

repeal the Rule because, according to the DOH, the Rule’s regulation of pediatric

care facilities exceeded the DOH’s statutory authority.

Florida’s CMS program provides financial assistance for medically

necessary services—similar to the benefits available under Medicaid—to children

with special health care needs who meet the program’s eligibility requirements.

The DOH reimburses health care providers for services rendered through the CMS

network, a statewide managed system of care in which providers may participate

under contract with the program. In order to receive reimbursement under the

CMS program, providers and facilities must be credentialed by the DOH.

K.M., a CMS beneficiary, suffers from a serious heart condition requiring

pediatric cardiac services. K.M. has received such services from participating

CMS providers, including CMS-approved pediatric cardiac facilities that currently

3 must comply with the Rule. K.M. will likely require future pediatric cardiac care

from CMS-approved providers, including facilities currently regulated by the Rule.

On October 22, 2015, K.M. filed a Petition for Determination of Invalidity

of Proposed Rule (the “Petition”)1 with the Division of Administrative Hearings

pursuant to section 120.56(2), Florida Statutes (2015). K.M. alleged that the

DOH’s proposed repeal of the Rule was an invalid exercise of delegated legislative

authority under Florida’s Administrative Procedure Act and would reduce the

quality of care available within the CMS program.

The final hearing was held on November 20, 2015. K.M. called two

pediatric cardiologists—Louis B. St. Petery, Jr. (“Dr. St. Petery”) and Ira H.

Gessner (“Dr. Gessner”)—to testify. Dr. St. Petery testified regarding K.M.’s

medical condition, diagnosis, prognosis, and treatment, including K.M.’s need for

additional cardiac surgery and diagnostic services. Although not offered by K.M.

to support K.M.’s standing argument, Dr. St. Petery concluded his testimony with

his opinion that the quality of care provided at CMS clinics was related to the

Rule’s volume requirements for procedures performed in regional and satellite

clinics.

1The Petition was filed by petitioners W.D., C.V., K.E., and K.M., all of whom are CMS beneficiaries requiring pediatric cardiac services from CMS-approved providers. Only K.M., however, seeks review of the final administrative order dismissing the Petition for lack of jurisdiction.

4 Dr. Gessner, who currently serves on the CMS Cardiac Technical Advisory

Panel and was a statewide consultant to the CMS program for pediatric cardiology

services for over thirty-eight years, was identified by K.M. as the witness who

would testify, for standing purposes, regarding the injury K.M. would suffer from

repeal of the Rule. Dr. Gessner testified that the Rule’s reporting requirement was

“meaningful” with respect to assuring quality in programs certified by the CMS

pediatric cardiac services program. Dr. Gessner also testified that if the Rule were

repealed, there was a “risk of changes in programs developing and continuing in a

way that is not consistent with the current standards [and] would allow

circumstances to exist within a given program that raise the potential for

deterioration of aspects of a program . . . as to make it risky for patients to be cared

for within that program.” Dr. Gessner further testified: “Now, this is—of course

we don’t expect people to behave badly simply because there are no standards.

But we know that it is possible for a program to have individuals leave, be

recruited to other institutions, or otherwise be without a particular component.”

Following the testimony, the administrative law judge (the “ALJ”) found

that K.M. failed to prove the proposed deregulation of CMS-approved pediatric

cardiac facilities would, in fact, have a real or immediate effect on the quality of

care available through the CMS network. As such, the ALJ concluded that K.M.

5 lacked standing to challenge the Rule’s repeal and dismissed K.M.’s Petition for

lack of jurisdiction. This appeal followed.

II. STANDARD OF REVIEW

In an appeal from a final administrative order, we review the ALJ’s findings

of fact to determine whether they are supported by competent, substantial

evidence.

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