united states district court lexington division appalachian regional...

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY

LEXINGTON DIVISION

APPALACHIAN REGIONAL HEALTHCARE, INC. and ARH MARY BRECKINRIDGE HEALTH SERVICES, INC.

PLAINTIFFS, CIVIL ACTION NO.

COVENTRY HEALTH AND LIFE INSURANCE COMPANY

DEFENDANTS.

Serve: National Registered Agents, Inc. 400 West Market Street, Suite 1800 Louisville, KY 40202

COMMONWEALTH OF KENTUCKY, CABINET FOR HEALTH AND FAMILY SERVICES and AUDREY HAYNES, Not Individually But In Her Official Capacity As Secretary, Cabinet For Health And Family Services

Serve: Audrey Haynes, Secretary Office of the Secretary Cabinet for Health and Family

Services 275 E. Main Street, 5W-A Frankfort, Kentucky 40601

Serve: Jack Conway, Esq. Office of Attorney General Capitol Building, Suite 118 Frankfort, Kentucky 40601

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Case: 5:12-cv-00114-KSF Doc #: 1 Filed: 04/16/12 Page: 1 of 25 - Page ID#: 1

Courtesy Copy By Regular Mail: Christina Heavrin, Esq. Office of General Counsel Cabinet for Health and Family

Services 275 E. Main Street, 5W-A Frankfort, Kentucky 40601

COMPLAINT

Plaintiffs, Appalachian Regional Healthcare, Inc. and ARH Mary Breckinridge

Health Services, Inc., for their Complaint, state as follows:

Plaintiffs who are providers of health care services to Medicaid beneficiaries in

Eastern Kentucky bring this Complaint against Defendants to compel them to reimburse

Plaintiffs in a timely fashion as required by law; to obtain an injunction prohibiting Defendants

from reducing their Medicaid payments by ten percent or more in retaliation for Plaintiffs’

refusal to enter into managed care contract with unfavorable, illegal and oppressive terms; and to

obtain a declaration as to the rates Defendants must pay to Plaintiffs as out-of-network providers.

THE PARTIES.

1. Plaintiffs, Appalachian Regional Healthcare, Inc. and ARE Mary

Breckinridge Health Services, Inc. (collectively "ARII"), are not-for-profit, tax-exempt

Kentucky corporations with their principal places of business in the Commonwealth of

Kentucky. ARE operates eight acute care hospitals in southeastern Kentucky, in addition to

numerous physician practices, rural health clinics, diagnostic services, home health agencies and

other services. Accordingly, it is the predominant provider of health care services to an

economically challenged and medically needy region of the state.

2. Defendant Coventry Health and Life Insurance Company ("Coventry") is

a Delaware for-profit corporation with annual revenues of at least $1 billion (according to its

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website). Its principal place of business is in Maryland or some place other than the

Commonwealth of Kentucky.

3. Defendant, the Cabinet for Health and Family Services (the "Cabinet"), is

the administrative agency of the Commonwealth of Kentucky assigned responsibility for

administering the Kentucky Medical Assistance Program ("KMAP") pursuant to KRS 205.510

to 205.630. These statutes provide for the implementation of the federal Medicaid program in

Kentucky in accordance with the provisions of Title XIX of the Social Security Act and

applicable federal regulations. The Cabinet administers KMAP through its Department for

Medicaid Services as provided in KRS 145A.030(2).

4. Defendant, Audrey Haynes, is the Secretary of the Cabinet for Health

Services (the "Secretary") and is named in her official capacity. The Secretary has been joined

specifically because she has the responsibility to administer KMAP consistent with applicable

law and injunctive relief is sought herein, among other forms of relief. Except when necessary,

the Secretary will be referred to herein with the Cabinet as (the "Cabinet")

JURISDICTION AND VENUE.

5. This action is brought pursuant to 28 U.S.C. §§ 1331 (federal question),

28 U.S.C. § 1361 (actions to compel Defendants to comply with federal Medicaid laws), and

28 U.S.C. 1332 (diversity). The amount in controversy exceeds the sum of value of $75,000,

exclusive of interest and costs. The Court also has supplemental jurisdiction over the state

claims herein pursuant to 28 U.S.C. § 1367. Venue is proper in this District pursuant to 28

U.S.C. § 1391(c).

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BACKGROUND AND FACTS.

a. State Plan.

6. Title XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396v

("Medicaid Act"), provides for the establishment of the Medicaid program. The Medicaid

program is a cooperative federal-state program whereby the federal government provides

financial assistance to the states so they may furnish medical care to low-income individuals and

families in designated eligibility groups.

7. To qualify for federal financial participation, a state must submit to the

federal Centers for Medicare and Medicaid Services ("CMS") and secure its approval for a plan

for medical assistance. See 42 U.S.C. § 1396a (a) and (b); 42 C.F.R. Pt. 430, sub pt. B. KMAP

has been established according to such a plan that the Cabinet filed with CMS and that it updates

or modifies periodically (the "State Plan")

8. The State Plan submitted by the Cabinet must "provide such safeguards as

may be necessary to assure that ... care and services will be provided [ ] in a manner consistent

with ... the best interests of the recipients." 42 U.S.C. § 1396a(a)(19).

9. The Medicaid Act requires that beneficiaries be permitted to receive

healthcare services from participating providers of their choice, 42 U.S.C. §1396a(a)(23) (the

"freedom of choice" provision), and that the state pay those providers directly on a fee-for-

service basis according to state-established fee schedules. 42 U.S.C. § 1 396a(a)(30)(A).

b. The Waiver.

10. States may seek waivers from the requirements of that traditional fee-for-

service program and its freedom of choice provision, however, so that healthcare services may be

provided through managed care systems. In such systems managed care organizations

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("MCOs") sign contracts with the state to provide healthcare services to Medicaid beneficiaries

in return for capitated rates. The MCOs enroll Medicaid beneficiaries as "Members" in their

respective health plans, contract with providers to provide care to their Members, and pay those

providers for their services.

11. Both the waiver and the contracts between the MCOs and the state must be

approved by CMS and comply with certain statutory and regulatory requirements. 42 U.S.C.

§ 13 96b(m)(2)(A)(iii); 42 C.F.R. §438.86(b) & 438.6.

12. On June 13, 2011, the Cabinet submitted a request to CMS for a waiver

under Section 1915(b) of the Act that was approved by CMS and became effective November 1,

2011 (the "Waiver").

13. To gain CMS approval and to fulfill these statutory and regulatory

requirements, the Cabinet entered contracts with Coventry and two other insurance companies,

Kentucky Spirit Health Plan, Inc. ("Kentucky Spirit"), and WellCare Health Insurance of

Illinois, Inc. ("WeilCare") to act as MCOs and provide healthcare services to Kentucky

Medicaid beneficiaries that enrolled in each of their health plans.

c. Federal Prompt Pay Requirements.

14. CMS is supposed to approve implementation of a managed care system

and grant a waiver of the freedom-of-choice requirements only if the waiver request satisfies

certain conditions, including provisions ensuring that providers of healthcare services will be

paid on a timely basis. Section 1396n(b)(4) specifically states, as follows:

The Secretary ... may waive such requirement of Section 1396a of this title ... as may be necessary for a State ... to restrict the provider from (or through) whom an individual ... can obtain services (other than in emergency circumstances) to providers or practitioners who undertake to provide such services and who

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meet, accept and comply with the reimbursement, quality, and utilization standards under the state plan ... if such restriction does not discriminate among classes of providers on grounds unrelated to their demonstrated effectiveness and efficiency in providing those services and if providers under such restriction are paid on a timely basis in the same manner as health care practitioners must be paid under Section 1396a(a)(37)(A) of this title (emphasis added).

15. Section 1396u-2(f) entitled "Timeliness of Payment" also provides that in

contracting with its MCOs under a waiver, a state must ensure that payments to providers will be

made on a timely basis. That section states:

A contract ... with a Medicaid managed care organization shall provide that the organization shall make payment to health care providers for items and services which are subject to the contract and that are furnished to individuals eligible for medical assistance under the State Plan ... who are enrolled in the organization on a timely basis consistent with the claims payment procedures described in Section 1396a(a)(37)(A) of this title unless the health care provider and the organization agree to an alternate payment schedule....

16. Section 1396a(a)(37)(A) (the "Prompt Pay Provision") referenced in the

two aforesaid provisions requires, in turn, that a state Medicaid plan must provide for claims

payment procedures that

ensure that 90 per centum of claims for payment (for which no further written information or substantiation is required in order to make payment) made for services covered under the plan and furnished by health care practitioners through individual or group practices or through shared health facilities are paid within 30 days of the date of receipt of such claims and that 99 per centum of such claims are paid within 90 days of the date of such claims.

d. State Contractual Prompt Pay Requirements.

17. In keeping with these federal statutory provisions and to assure CMS that

all prompt pay duties would be fulfilled by the MCO, the Cabinet incorporated prompt pay

provisions into its contract with Coventry. The Cabinet also added provisions incorporating state

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prompt pay laws as well into the contract with Coventry Thus, Section 29.1 of the Cabinet’s

contract with Coventry provides, as follows:

In accordance with the Balanced Budget Act (BBA) Section 4708, the Contractor shall implement Claims payment procedures that ensure 90% of all Provider Claims for which no further written information or substantiation is required in order to make payment are paid or denied within thirty (30) days of the date of receipt of such Claims and that 99% of all Claims are processed within ninety (90) days of the date of receipt of such Claims. In addition, the Contractor shall comply with the Prompt-Pay statute, codified within KRS 304.17A-700-730, as may be amended, and KRS265.593, and KRS3O4.14-135 and 99-123, as may be amended.

The Contractor shall notify the requesting provider of any decision to deny a claim, or to authorize a service in an amount, direction, or scope that is less than requested. The notice to the provider need not be in writing.

Any conflict between the BBA and Commonwealth law will default to the BBA unless the Commonwealth requirements are stricter.

18. These same Prompt Pay requirements were also included in the Cabinet’s

emergency regulation, 907 KAR 17:005E, Section 56 1 , promulgated to implement the Waiver.

19. Therefore, KRS 304.17A-700 to 304.17A-730 and KRS 205.593, KRS

304.14-135 and KRS 304.99-123 also apply to Coventry as a managed care organization under

contract with the Cabinet to manage care, process health care claims and pay for services

provided to Kentucky Medicaid recipients covered under the Waiver and enrolled in Coventry’s

Medicaid managed care plan.

On February 15, 2012, the Cabinet filed with the State Legislative Research Commission a new version of ordinary regulation 907 KAR 17:005, which deleted subsection (1)(a) from Section 56, while still requiring compliance with 42 U.S.C. §1396a(a)(37), 42 C.F.R. 447.45, KRS 205.593, KRS 304.14-135 and KRS 304.17A-700-730.

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e. State Prompt Pay Laws.

20. These state Prompt Pay Statutes are also applicable to Coventry by virtue

of the fact that it is an insurer authorized by the Kentucky Department of Insurance to do

business in the Commonwealth of Kentucky. See KRS §304.17A-005 & 304.17A-700.

21. The Commonwealth’s Prompt Pay requirements are stricter than the BBA

requirements. KRS 304.17A-702 requires that Coventry reimburse its providers for a "clean

claim" or send written or electronic notice denying or contesting the claim within thirty calendar

days from the date the claim is received by Coventry or any entity that administers or processes

claims on Coventry’s behalf.

22. The statute further provides that within these thirty calendar days,

Coventry shall (a) pay the total contracted reimbursement for the claim, (b) pay the portion of any

claim that is not in dispute and notify its providers, in writing or electronically, of the reasons the

remaining portion of the claim will not be paid or (c) notify its providers in writing or

electronically, of the reasons no part of the claim will be paid.

23. Coventry is further required to acknowledge receipt of original or

corrected claims within forty-eight hours, if submitted electronically, or within twenty calendar

days, for mail or non-electronic submissions. See KRS 304.17A-704(1). At the time Coventry

makes this required acknowledgement, it is also required to notify its providers if there is any

information missing from the billing instrument, or any errors in the billing instrument, or of any

other circumstances which preclude it from being a clean claim. Id.

24. Thus, Prompt Pay laws and policies and their importance to the public

welfare have been stressed many times to Coventry.

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E The Letter of Agreement.

25. ARH entered into what was designated as a "Binding Letter of

Agreement" ("LOA") with Coventry dated October 5, 2011. "Amendment #1" was added to the

LOA effective December 31, 2011.

26. Amendment #1 revised Section 16, Term of LOA to read, "This LOA shall

remain in force until the sooner of the execution of a Participation Agreement between the parties

or June 30, 2012. If a Participation Agreement is not executed by June 30, 2012, this LOA shall

continue for a period of time mutually agreed to in writing by the parties." Amendment #1 also

added ARH Mary Breckenridge Health Services, Inc. as a party to the LOA. A Participation

Agreement has not been subsequently agreed upon or executed between the parties.

27. Under the terms of the LOA, ARH agreed to provide Covered Services to

individuals who are enrolled as "Members" in a benefit plan issued by Coventry pursuant to its

contract with the Cabinet.

28. In return for AR}I providing services to these Members, Coventry agreed

in the LOA that it would pay ARI-I for its services at rates described in Exhibit A to the LOA.

29. Included in the LOA was a covenant by Coventry to "pay clean claims (as

defined in the Provider Manual) within 30 days of receipt (or 60 days if a claim for an organ

transplant)".

30. Included within the LOA is also the following provision:

Compliance With Law. Both Parties shall recognize and abide by all applicable Commonwealth and federal laws, regulations and guidelines. As such both Parties understand and agreed that LOA incorporates by reference all applicable federal and Commonwealth laws or regulations, and revisions of such laws or regulations shall automatically be incorporated into this LOA as they become effective.

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31. In entering into the LOA, ARH reasonably relied upon Coventry’s

agreement that it would abide by all applicable laws and regulations including all prompt pay

requirements.

g. Coventry Fails To Pay Promptly.

32. Since November 1, 2011, ARE has provided health care services to

Coventry Members and has submitted more than five thousand claims on properly completed

billing instruments to Coventry for payment.

33. Coventry has with great consistency and in the overwhelming number of

case failed to process and pay clean claims submitted by ARH within the time-frames or

according to any prompt pay provisions contained in applicable federal and state statutes,

regulations and agreed upon contractual provisions.

34. As of March 19, 2012, ARE had 3,932 clean claims with charges totaling

$11,840,035 under submission and awaiting for payment by Coventry. Thirty-four percent of

those claims (constituting forty-one percent of the total charges) have been submitted to Coventry

for payment for more than thirty days. Ten percent of the total claims have been submitted for

payment for more than ninety days.

h. Notice The LOA Is Terminated.

35. Coventry gave ARE thirty days notice first by telephone and then by

means of a letter dated March 29, 2012, that it was terminating the LOA, as amended, effective

May 4, 2012, but that it wanted to negotiate new terms for ARE to continue in Coventry’s

network including lower reimbursement rates.

36. On April 11, 2012, Coventry told ARE that it was no longer interested in

negotiating a new contract with ARE.

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i. Threatened Economic Duress.

37. In Section 29.2 of the MCO contract negotiated between Coventry and the

Cabinet, those two Defendants agreed that Coventry would reimburse out-of-network ("OON")

providers at 100 percent of the Cabinet’s current Medicaid fee schedule/rate before January 1,

2012. After January 1, 2012, however, Coventry and the Cabinet agreed that Coventry would

reimburse OON providers at only 90 percent of the Medicaid fee schedule/rate. Section 29.2

provides, in relevant part for OON providers, as follows:

Covered Services shall be reimbursed at 100 percent of the Medicaid fee schedule/rate until January 1, 2012 and after January 1, 2012, at 90% of the Medicaid fee schedule/rate.

38. This provision, that OON providers would be paid only 90 percent of

Medicaid rates after January 1, 2012, was then published by the Cabinet in Question and Answer

sheets sent to providers in August 2011. The Medicaid rates were already inadequate.

According to the Cabinet’s own calculations the Diagnosis Related Group ("DRG") rates the

Cabinet devised and have had in place since October 15, 2007, (with some minor revisions) pay

hospitals, on average, eighty to eighty-two percent of their Medicaid allowable costs for

inpatient, acute care services. By agreeing to this provision in Section 29.2 of their contract, the

Cabinet and Coventry were effectively conspiring to punish providers who did not sign contracts

with Coventry with payments for OON services that would be even more oppressive and

inadequate after January 1, 2012, than the Cabinet’s already grossly inadequate Medicaid rates.

39. Coventry has terminated the LOA so that it can reduce its payments to

ARH after May 4, 2012, to ninety percent of the Cabinet’s Medicaid rates, unless ART-I agrees to

enter into a new contract with terms more favorable to Coventry than under the LOA.

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j. An Unconstitutional Taking.

40. ARE-I hospitals must continue to treat many Coventry Members after

May 4, 2012, however, even in the absence of an express contract with Coventry due to the

Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. 1 395dd. Under

EMTALA, hospitals providing emergency room services must treat and stabilize all persons who

present themselves needing emergency services regardless of their ability to pay or whether they

have health insurance. In treating Coventry Members in its Emergency Rooms ("ERs") after

May 4, 2012, ARE will not be acting as a voluntary participant in Coventry’s and the Cabinet’s

Medicaid managed care arrangements. Rather ARE will be treating Coventry Members under

compulsion of law.

41. The Medicaid rates for emergency room services are set by the Cabinet in

accordance with 907 KAR 10:015. Laboratory services are reimbursed either at the Medicare-

established technical component rate for the service in accordance with 907 KAR 1:029 or, if no

Medicare rate exists for the particular service, the rate is determined by multiplying the hospital’s

current outpatient cost-to-charge ratio by its billed laboratory charges. Laboratory services

reimbursements are final and not settled to cost at any later date. Id. Section 5.

42. The Medicaid rates for all other emergency services are reimbursed

according to regulation on an interim basis at ninety-five percent of the hospital’s specific,

outpatient cost-to-charge ratio based on the hospital’s most recently filed cost report, and then

settled to ninety-five percent of actual costs at year end. 907 KAR 10:015, Section 2.

43. If Coventry reimburses ARE for ER services beginning May 4, 2012, at

ninety percent of the Medicaid rate established in 907 KAR 10:0 15 as it has contractually agreed

with the Cabinet to do, it will be paying, at best, ninety percent of ninety-five percent of ARE’s

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costs for ER services or, in essence, eighty-five percent of the costs necessarily incurred in

providing that care.

k. Non-ER Services.

44. Under its Waiver the Cabinet has required that the majority of the State’s

Medicaid enrollees obtain services only from the three MCO’s. These MCOs are supposed to

provide such services and meet reimbursement, quality and utilization standards which are

consistent with access, quality, and efficient and economic provision of covered care and services

as required by federal law.

45. Under federal law the Cabinet was required to assure CMS that in

implementing the Waiver it was in compliance with Section 1932(a)(3) of the Act and 42 CFR

438.52, which requires that if a state mandates that its Medicaid beneficiaries enroll in an MCO,

it must give those beneficiaries a choice of at least two managed care entities.

46. Pursuant to 42 U.S.C. 1396u-2(b)(5) each MCO was required to provide

adequate assurances to the State and CMS that the organization had and would maintain a

sufficient number, mix, and geographic distribution of providers of services. The implementing

regulation at 42 C.F.R. § 438.206(a) requires that the Cabinet ensure that all services covered

under the State Plan are available and accessible to enrollees of the MCOs. More specifically,

under 42 C.F.R. § 438.206(b), the Cabinet is required to ensure through its contracts that each

MCO maintains and monitors a network of appropriate providers that is supported by written

agreements and sufficient to provide adequate access to all services covered under the contract.

47. In its application for a 1915(b) Waiver relating to operation of its MCO

program, the Cabinet made assurances to CMS that it had complied with 42 CFR 438.206 & 207

as follows::

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It also certified, that it complied with provisions of 42 CFR 438.10, which states, in pertinent part:

a State may not enter into contracts with MCOs unless it has established intermediate sanctions that it may impose on an MCO that fails to comply with specified requirements.

However, in reality, the Cabinet has failed to scrutinize the MCOs compliance with the network

adequacy requirements and has not established effective, intermediate sanctions on MCOs that

fail to comply with federal requirements.

48. While the Cabinet also established standards for network adequacy

through its Emergency Regulations at 907 KAR 17:005 and under its MCO Contracts with the

MCOs, it has not enforced those standards.

49. According to 907 KAR 17:005, Section 14, an MCO must enroll providers

of sufficient types, numbers and specialties in its network to satisfy certain access and capacity

requirements. Specifically, 907 KAR 17:005, Section 15 sets forth network adequacy standards

for certain services as follows. Among other things, the MCO must establish a network with

sufficient numbers and types of providers to adequately furnish, for example:

(i) emergency services on a twenty-four hour, seven day per week basis;

(ii) urgent care services within forty eight hours of request;

(iii) behavioral health services requiring crisis stabilization within twenty four hours of the referral;

(iv) behavioral health urgent care services within forty eight hours of the referral;

(v) behavioral health service appointments following a discharge from an acute psychiatric hospital within fourteen days of discharge; and

(vi) any other behavioral health service within sixty days of the referral.

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50. Moreover, transport time to a hospital may not exceed sixty minutes from

an enrollee’s residence for a behavioral or physical rehabilitation service. The transport time for

hospital services cannot exceed thirty minutes in urban areas and sixty minutes in rural areas. If

the MCO cannot meet such requirements, it must submit to the Cabinet a corrective action plan

to remedy the deficiencies.

51. Pursuant to an emergency regulation, 907 KAR 17:005, the Cabinet

assigned every Medicaid beneficiary in the state to one of the three MCOs without making a

determination or taking into consideration whether the MCO had, in fact, an adequate network in

place.

52. Indeed, Kentucky Spirit did not have a contract with ARE on November 1,

2011, when the Waiver went into effect, or at any point in time since then. Kentucky Spirit has

never had an adequate network in Region 8 (Eastern Kentucky) that satisfies federal requirements

or the requirements in the MCO contract. Yet the Cabinet has continued to let Kentucky Spirit

operate in Region 8. To ARH’s knowledge, the Cabinet has not sanctioned Kentucky Spirit for

failing to comply with network adequacy requirements.

53. Given the Cabinet’s failure to police or correct inadequacies in Kentucky

Spirit’s network, there is no reason to believe that when Coventry’s network in Eastern Kentucky

becomes similarly inadequate after May 4, 2012, when the LOA is terminated, that the Cabinet

will not ignore the inadequacies with Coventry’s network just as it has ignored Kentucky Spirit’s

inadequacies. Indeed, the Cabinet’s failure to correct the inadequacies with Kentucky Spirit’s

network demonstrates that it is the Cabinet’s policy and practice to overlook or ignore

deficiencies in MCO networks. This policy and practice has emboldened Coventry to take the

actions complained about herein.

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54. Yet many Coventry Members in Eastern Kentucky will still have to go to

ARI-1 facilities for both ER and non-ER services or go without needed health care. In the case of

ER patients or with patients with pre-authorizations from Coventry, ARE will continue to treat

many of those patients but the reimbursement rates Coventry proposes to force on ARH, based

on Section 29.2 of Coventry’s MCO contract with the Cabinet, are inadequate, unreasonable and

in violation of law.

1. The Cabinet’s Rates Are Inadequate.

55. Under Kentucky law the Cabinet is also supposed to reimburse hospitals

for "hospital care . . . [on] bases which relate the amount of the payment to the cost of providing

services or supplies." KRS 205.560(2).

56. The Cabinet has failed, however, since October 15, 2007, to reimburse

ARE for inpatient, acute care services on any basis which relates the amount of the payment to

the cost of providing services or supplies. Instead, in designing its present diagnosis related

group ("DRG") methodology effective October 15, 2007, the Cabinet first designed a

methodology similar to the DRG methodology employed by CMS for Medicare reimbursements.

After the Cabinet modeled what that methodology would pay, it then arbitrarily applied a "budget

neutrality factor" to its DRG methodology to reduce expected payments by approximately twenty

percent. The Cabinet’s "budget neutrality adjustment" basically perpetuates all the inadequacies

and inequities of the Cabinet’s previous methodologies.

57. The inadequacies of the Cabinet’s Medicaid rates and its rate setting

methodologies have been a source of constant litigation between the Cabinet and hospital

providers since the federal district court directed in Memorial Hospital v. Childers, 896 F. Supp.

1427 (W.D. Ky. 1995), that individual inequities should be addressed through the Cabinet’s

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administrative appeal process. Despite subsequent numerous findings of inadequacy by

administrative hearing officers, in state court decisions, and recognized through numerous

settlements, the Cabinet’s current inpatient DRG rates continue to be grossly inadequate. Most

recently the Cabinet entered into a $185 million "Global Settlement" paying "rate enhancements"

to virtually every Kentucky hospital to settle hospital rate appeals for the July 1, 2004 through

October 14, 2007 rate periods. The Cabinet has never addressed, however, the fundamental

problems with its Medicaid rates that necessitated the Global Settlement.

58. AR}I has had rate appeals pending with the Cabinet concerning the

inadequacy of the Medicaid DRG rates paid by the Cabinet since October 15, 2007, through the

present time. Those rates only cover approximately 75 percent of the costs that ARH must incur

in treating Medicaid patients. Although dispute resolution meetings were conducted almost two

years ago for those appeals, dispute resolution decisions have never been rendered as required by

907 KAR 1:671, Section 8. Those Medicaid rates are already grossly inadequate. A 10 percent

reduction in those rates by Coventry beginning May 4, 2012, would reduce ARH’s cost coverage

below 67 percent of its costs for inpatient, acute care services. Those rates that are already so

low as to be confiscatory will have become more confiscatory.

59. The Cabinet is required to pay Coventry capitated rates that are certified to

be actuarially sound and appropriate for the populations to be covered and the services furnished

under the contract. See 42 C.F.R. §438.6(c).

60. The Cabinet’s Data Book that it provided with its Request For Proposals

("E.FP") giving "background information to enable interested MCOs to prepare their bids to

DMS" is not actuarially sound. While it purports to present "a summary of historical costs" it

does not present. the "costs" providers incur in providing care to Kentucky Medicaid

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beneficiaries. Rather the Data Book summarized historical payments made to providers by the

Cabinet, which in the case of inpatient hospital services, by the Cabinet’s own admission,2 cover

only eighty to eighty-two percent of hospital costs.

61. ART-I has a Provider Agreement with the Cabinet and continues to be a

Medicaid provider in good standing. As such, the Cabinet continues to be jointly and severally

liable with Coventry to ARH for medical services rendered to Kentucky Medicaid beneficiaries

assigned to Coventry for services.

COUNT I (Breach of Contract)

62. ARH realleges Paragraphs 1 through 61 as if fully set forth herein.

63. ART-I has provided health care services to Coventry Members in

accordance with the terms of the LOA and has submitted clean claims and otherwise performed

as necessary to receive reimbursement under the terms of the LOA.

64. Coventry has consistently failed to timely acknowledge receipt of original

or corrected claims as required by KRS 304.17A-704; or to timely notify ARH of information

missing from claims submitted or billing errors that Coventry contends precludes claims from

being clean claims.

65. Coventry has consistently failed or refused to pay ARH’s claims on a

prompt and timely basis as required by the terms of the LOA or any applicable statute, regulation

2 The Cabinet has been applying what it refers to as a "parity adjustment" of 80.5 to 82.5 percent to some types of hospital rates set by means other than the DRG methodology to reduce those other rates so they are on par (or in "parity") with the DRG rates. This is nothing less than a tacit admission that the Cabinet is, on average, paying 80.5 to 82.5 percent of Medicaid allowable costs with its budget driven DRG methodology.

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or in accordance with its contract with the Cabinet and has instead wrongfully delayed, denied or

otherwise reduced or withheld payments owed to ARH.

66. Coventry, through its breach of its obligations described above, has

materially breached the LOA and has caused monetary damages to ARH.

67. ARE is entitled to recover damages from Defendants including interest at

the statutory rates in an amount as shall be established according to proof at trial.

COUNT II (Declaratory and Injunctive Judgment)

68. ARI-I realleges Paragraphs 1 through 67 as if fully set forth herein.

69. An actionable and justiciable controversy and dispute now exists between

ARE and Defendants.

70. ARE contends that because Coventry has entered into an MCO contract

with the Cabinet and accepts Medicaid capitated payments that it has an obligation to conform to

the Prompt Pay provisions in both federal and state law as well as in the MCO contract and the

terms of the LOA. Coventry has not acted in conformity with such requirements causing great

harm and to the detriment of ARE.

71. ARE desires a judicial determination of the parties’ respective rights and

obligations in connection with the applicable Prompt Pay provisions of federal and state statutes,

regulations and contractual provisions entered between Coventry, the Cabinet and ARE

72. ARE also desires preliminary and permanent injunctive relief causing

Defendants to immediately comply with all applicable Prompt Pay laws and contractual

provisions and to prevent Defendants from disregarding and breaching those laws and provisions

in the future.

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COUNT III (Bad Faith)


74. Every contract imposes on each party a duty of good faith and fair dealing

which embraces the mutual duty not to do anything to injure or destroy the right of the other

party to receive the benefits of the agreement.

75. To the extent Coventry retained any discretion to determine the manner

and format in which claims were to be submitted and whether claims submitted were "clean

claims", it has abused that discretion with the result that the right of ARE to receive the expected

and bargained for benefit of the LOA is being injured and destroyed.

76. While Coventry has been arbitrarily and unreasonably refusing or failing

to pay ARH’s claims promptly or otherwise delaying payment through pretextual means,

Coventry has continued to collect its monthly capitated payments from KMAP, amassing for

itself millions of dollars.

77. Coventry’s actions complained about herein have been taken to build up or

supplement its own working capital and increase its own profits even while causing serious harm

and detriment to ARE and ARE’s ability to provide needed health care services to Eastern

Kentucky residents. By its actions Coventry has acted in bad faith breaching its duty of good

faith and fair dealing owed to ARE.

78. As a result ARE has and will continue to suffer substantial damages in an

amount to be proven at trial.

COUNT IV (Third Party Beneficiaries)

79. ARE realleges Paragraphs 1 through 78 as if fully set forth herein.

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80. Coventry entered into an MCO contract with the Cabinet in which it

obligated itself to promptly pay for medical services provided to Coventry Members.

81. ARH is an intended third-party beneficiary of the MCO contract with the

Cabinet, including the Prompt Pay Provisions of Section 29.1.

82. The breach of Section 29.1 by Coventry of the MCO Contract has resulted

in economic loss to ARE and has impaired ARH’s ability to provide health care to Medicaid

beneficiaries.

83. The Cabinet has not imposed intermediate sanctions or taken adequate

efforts to enforce its Prompt Pay Provisions and has breached its own Prompt Pay duties.

84. As a direct and proximate result of Defendants’ breaches, ARH has

sustained damages in amounts to be determined at trial.

flfll fMT V

(Unconstitutional Taking)

85. ARE realleges Paragraphs 1 through 84 as if fully set forth herein.

86. After the LOA terminates on May 4, 2012, ARE will no longer be a

voluntary participant in Coventry’s Medicaid managed care plan. ARE will still have to

continue providing ER services under compulsion of law.

87. The Cabinet and Coventry have conspired to effect an unconstitutional

taking of property by contracting together that Coventry will only pay 90 percent of the Cabinet’s

Medicaid rates to OONs.

88. Through its policies and practices that are in violation of federal and state

law and its refusal to enforce federal and state requirements, the Cabinet is assisting Coventry in

violating ARE’s rights.

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89. A declaration is needed that once ARH becomes an OON provider with

Coventry, Coventry and the Cabinet are jointly and severally liable for ER services provided by

ARH and must reimburse ART-I for ER services provided Coventry Members at the Cabinet’s

standard Medicaid rates.

COUNT VI (Declaratory Judgment/Unjust Enrichment)


91. After May 4, 2012, there will be no agreement between ART-I and

Coventry as to the reimbursement rate for medical services provided to Coventry Members

outside the ER.

92. Under those circumstances Coventry stands in the place of any other

purchaser of medical services and must pay AR}I for the reasonable value of its services.

93. A declaration is requested that once ARH becomes an OON provider,

Coventry and the Cabinet are jointly and severally liable for non-ER services provided by ART-I

and must reimburse ART-I for non-ER services at ARH’s normal charges for those services.

COUNT VII (Breach By Cabinet)

94. ART-I realleges Paragraphs 1 through 93 as if fully set forth herein.

95. The Cabinet is responsible, both statutorily and by contract, for

reimbursing ARE for medical services provided to Kentucky Medicaid beneficiaries.

96. Although the Cabinet has tried to assign or delegate that duty to Coventry,

the Cabinet remains responsible for reimbursing ARE for medical services provided Kentucky

Medicaid beneficiaries and for any violations of Prompt Pay laws or violations of any other laws

by Coventry acting as the Cabinet’s agent.

22 of 24


97. ARH has not waived any of its rights against the Cabinet under its

Provider Agreements with the Cabinet.

98. Since Coventry has not reimbursed ARE promptly and in the amounts

ARH is entitled to receive, then ARH is entitled to recover for those damages from the Cabinet in

such amounts as are determined at trial.

WHEREFORE, Plaintiffs pray for the following relief:

A. That the Court enter a declaration that Defendants are required to comply

with applicable federal, state and contractual Prompt Pay provisions;

B. That the Court grant ARE preliminary and permanent injunctive relief

directing that Defendants comply with all applicable federal, state and contractual Prompt Pay

laws and provisions;

C. That the Court award ARE such damages as may be established at trial for

Defendant’s breaches of their contractual and statutory duties;

D. That the Court award ARE interest at the statutory rates of twelve (12%),

eighteen (18%) and twenty-one (21%) percent as provided in KRS 304.17A-730 for Defendants’

delays in making payments;

E. That the Court enter a declaration that ARE is entitled to be reimbursed at

lull, standard Medicaid rates for ER services provided Coventry Members as an OON provider

after May 4, 2012; and that it is entitled to be reimbursed for non-ER services at ARE’s normal

charges or the reasonable value of those services;

F. That the Court enter a judgment awarding ARE its reasonable attorneys’

fees, costs and expenses incurred herein; and

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G. That the Court enter judgment awarding ARH all further legal, equitable

and other relief to which it may appear to be entitled.

VERIFICATION

I, Jerry W. Haynes, President and CEO of Appalachian Regional Healthcare, Inc.

hereby verify under penalty for perjury that the factual allegations forth herein are true and

correct to the best of my knowledge, informti5ifand belief Pis l3thyf April 2012.

Appalachian Regional Healthcare, Inc.

Respectfully submitted,

Stephen R. Price, Sr. Carole D. Christian John W. Woodard, Jr. Christopher A. Melton WYATT, TARRANT & COMBS, LLP 500 West Jefferson Street, Suite 2800 Louisville, Kentucky 40202-2898 502.589.5235

Counsel for Appalachian Regional Healthcare, Inc. and ARH Mary Breckinridge Health Services, Inc.

60151094.2

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G. That the Court enter judgment awarding ARE all further legal, equitable

and other relief to which it may appear to be entitled.

VERIFICATION

I, Jerry W. Haynes, President and CEO of Appalachian Regional Healthcare, Inc.

hereby verify under penalty for perjury that the factual allegations set forth herein are true and

correct to the best of my knowledge, information and belief this 16th day of April 2012.

Jerry W. Haynes, President and CEO Appalachian Regional Healthcare, Inc.

Respectfully submitted,

s/John W. Woodard, Jr. Stephen R. Price, Sr. Carole D. Christian John W. Woodard, Jr. Christopher A. Melton WYATT, TARRANT & COMBS, LLP 500 West Jefferson Street, Suite 2800 Louisville, Kentucky 40202-2898 502.589.5235

Counsel for Appalachian Regional Healthcare, Inc. and ARH Mary Breckinridge Health Services, Inc.

60151094.2

24 of 24


JS 44 (Rev. 09/11) CIVIL COVER SHEETThe JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as providedby local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiatingthe civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.)

I. (a) PLAINTIFFS DEFENDANTS

(b) County of Residence of First Listed Plaintiff County of Residence of First Listed Defendant(EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY)

NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE TRACT OF LAND INVOLVED.

(c) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known)

II. BASIS OF JURISDICTION (Place an “X” in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X” in One Box for Plaintiff)(For Diversity Cases Only) and One Box for Defendant)

’ 1 U.S. Government ’ 3 Federal Question PTF DEF PTF DEFPlaintiff (U.S. Government Not a Party) Citizen of This State ’ 1 ’ 1 Incorporated or Principal Place ’ 4 ’ 4

of Business In This State

’ 2 U.S. Government ’ 4 Diversity Citizen of Another State ’ 2 ’ 2 Incorporated and Principal Place ’ 5 ’ 5Defendant (Indicate Citizenship of Parties in Item III) of Business In Another State

Citizen or Subject of a ’ 3 ’ 3 Foreign Nation ’ 6 ’ 6 Foreign Country

IV. NATURE OF SUIT (Place an “X” in One Box Only)CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES

’ 110 Insurance PERSONAL INJURY PERSONAL INJURY ’ 625 Drug Related Seizure ’ 422 Appeal 28 USC 158 ’ 375 False Claims Act’ 120 Marine ’ 310 Airplane ’ 365 Personal Injury - of Property 21 USC 881 ’ 423 Withdrawal ’ 400 State Reapportionment’ 130 Miller Act ’ 315 Airplane Product Product Liability ’ 690 Other 28 USC 157 ’ 410 Antitrust’ 140 Negotiable Instrument Liability ’ 367 Health Care/ ’ 430 Banks and Banking’ 150 Recovery of Overpayment ’ 320 Assault, Libel & Pharmaceutical PROPERTY RIGHTS ’ 450 Commerce

& Enforcement of Judgment Slander Personal Injury ’ 820 Copyrights ’ 460 Deportation’ 151 Medicare Act ’ 330 Federal Employers’ Product Liability ’ 830 Patent ’ 470 Racketeer Influenced and’ 152 Recovery of Defaulted Liability ’ 368 Asbestos Personal ’ 840 Trademark Corrupt Organizations

Student Loans ’ 340 Marine Injury Product ’ 480 Consumer Credit (Excl. Veterans) ’ 345 Marine Product Liability LABOR SOCIAL SECURITY ’ 490 Cable/Sat TV

’ 153 Recovery of Overpayment Liability PERSONAL PROPERTY ’ 710 Fair Labor Standards ’ 861 HIA (1395ff) ’ 850 Securities/Commodities/ of Veteran’s Benefits ’ 350 Motor Vehicle ’ 370 Other Fraud Act ’ 862 Black Lung (923) Exchange

’ 160 Stockholders’ Suits ’ 355 Motor Vehicle ’ 371 Truth in Lending ’ 720 Labor/Mgmt. Relations ’ 863 DIWC/DIWW (405(g)) ’ 890 Other Statutory Actions’ 190 Other Contract Product Liability ’ 380 Other Personal ’ 740 Railway Labor Act ’ 864 SSID Title XVI ’ 891 Agricultural Acts’ 195 Contract Product Liability ’ 360 Other Personal Property Damage ’ 751 Family and Medical ’ 865 RSI (405(g)) ’ 893 Environmental Matters’ 196 Franchise Injury ’ 385 Property Damage Leave Act ’ 895 Freedom of Information

’ 362 Personal Injury - Product Liability ’ 790 Other Labor Litigation Act Med. Malpractice ’ 791 Empl. Ret. Inc. ’ 896 Arbitration

REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS Security Act FEDERAL TAX SUITS ’ 899 Administrative Procedure’ 210 Land Condemnation ’ 440 Other Civil Rights ’ 510 Motions to Vacate ’ 870 Taxes (U.S. Plaintiff Act/Review or Appeal of ’ 220 Foreclosure ’ 441 Voting Sentence or Defendant) Agency Decision’ 230 Rent Lease & Ejectment ’ 442 Employment Habeas Corpus: ’ 871 IRS—Third Party ’ 950 Constitutionality of’ 240 Torts to Land ’ 443 Housing/ ’ 530 General 26 USC 7609 State Statutes’ 245 Tort Product Liability Accommodations ’ 535 Death Penalty IMMIGRATION’ 290 All Other Real Property ’ 445 Amer. w/Disabilities - ’ 540 Mandamus & Other ’ 462 Naturalization Application

Employment ’ 550 Civil Rights ’ 463 Habeas Corpus -’ 446 Amer. w/Disabilities - ’ 555 Prison Condition Alien Detainee

Other ’ 560 Civil Detainee - (Prisoner Petition)’ 448 Education Conditions of ’ 465 Other Immigration

Confinement Actions

V. ORIGINTransferred fromanother district(specify)

(Place an “X” in One Box Only)’ 1 Original

Proceeding’ 2 Removed from

State Court’ 3 Remanded from

Appellate Court’ 4 Reinstated or

Reopened’ 5 ’ 6 Multidistrict

Litigation

VI. CAUSE OF ACTIONCite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity): Brief description of cause:

VII. REQUESTED IN COMPLAINT:

’ CHECK IF THIS IS A CLASS ACTIONUNDER F.R.C.P. 23

DEMAND $ CHECK YES only if demanded in complaint:JURY DEMAND: ’ Yes ’ No

VIII. RELATED CASE(S) IF ANY (See instructions): JUDGE DOCKET NUMBER

DATE SIGNATURE OF ATTORNEY OF RECORD

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE

Case: 5:12-cv-00114-KSF Doc #: 1-1 Filed: 04/16/12 Page: 1 of 2 - Page ID#: 26

JS 44 Reverse (Rev. 09/11)

INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44

Authority For Civil Cover Sheet

The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as requiredby law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for theuse of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civilcomplaint filed. The attorney filing a case should complete the form as follows:

I. (a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use onlythe full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, givingboth name and title.

(b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at thetime of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnationcases, the county of residence of the “defendant” is the location of the tract of land involved.)

(c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, notingin this section “(see attachment)”.

II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires that jurisdictions be shown in pleadings. Place an “X” in oneof the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below.

United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here.

United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an “X” in this box.

Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to theConstitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box1 or 2 should be marked.

Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship ofthe different parties must be checked. (See Section III below; federal question actions take precedence over diversity cases.)

III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this sectionfor each principal party.

IV. Nature of Suit. Place an “X” in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, issufficient to enable the deputy clerk or the statistical clerks in the Administrative Office to determine the nature of suit. If the cause fits more than one nature ofsuit, select the most definitive.

V. Origin. Place an “X” in one of the seven boxes.Original Proceedings. (1) Cases which originate in the United States district courts.

Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petitionfor removal is granted, check this box.

Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date.

Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date.

Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrictlitigation transfers.

Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When thisbox is checked, do not check (5) above.

Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judge’s decision.

VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutesunless diversity. Example: U.S. Civil Statute: 47 USC 553

Brief Description: Unauthorized reception of cable service

VII. Requested in Complaint. Class Action. Place an “X” in this box if you are filing a class action under Rule 23, F.R.Cv.P.Demand. In this space enter the dollar amount (in thousands of dollars) being demanded or indicate other demand such as a preliminary injunction.

Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded.

VIII. Related Cases. This section of the JS 44 is used to reference related pending cases if any. If there are related pending cases, insert the docket numbersand the corresponding judge names for such cases.

Date and Attorney Signature. Date and sign the civil cover sheet.


U.S. District Court Eastern District of Kentucky DCN Site Page 1 of 1

u.s. District Court Eastern District of Kentucky

Civil Case Assignment

Case number 5:12-CV-114

Assigned: Senior Judge Karl S. Forester Judge Code: 4310

Assigned on 04/16/2012


AO 440 (Rev. 12/09) Summons in a Civil Action

UNITED STATES DISTRICT COURTfor the

__________ District of __________

)))))))

Plaintiff

v. Civil Action No.

Defendant

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address)

A lawsuit has been filed against you.

Within 21 days after service of this summons on you (not counting the day you received it) — or 60 days if youare the United States or a United States agency, or an officer or employee of the United States described in Fed. R. Civ.P. 12 (a)(2) or (3) — you must serve on the plaintiff an answer to the attached complaint or a motion under Rule 12 ofthe Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiff’s attorney,whose name and address are:

If you fail to respond, judgment by default will be entered against you for the relief demanded in the complaint. You also must file your answer or motion with the court.

CLERK OF COURT

Date:Signature of Clerk or Deputy Clerk


AO 440 (Rev. 12/09) Summons in a Civil Action (Page 2)

Civil Action No.

PROOF OF SERVICE

(This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (l))

This summons for (name of individual and title, if any)

was received by me on (date) .

’ I personally served the summons on the individual at (place)

on (date) ; or

’ I left the summons at the individual’s residence or usual place of abode with (name)

, a person of suitable age and discretion who resides there,

on (date) , and mailed a copy to the individual’s last known address; or

’ I served the summons on (name of individual) , who is

designated by law to accept service of process on behalf of (name of organization)

on (date) ; or

’ I returned the summons unexecuted because ; or

’ Other (specify):

.

My fees are $ for travel and $ for services, for a total of $ .

I declare under penalty of perjury that this information is true.

Date:Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:




__________ District of __________

)))))))

Plaintiff

v. Civil Action No.

Defendant






CLERK OF COURT




Civil Action No.

PROOF OF SERVICE





on (date) ; or






on (date) ; or



.





Server’s address





__________ District of __________

)))))))

Plaintiff

v. Civil Action No.

Defendant






CLERK OF COURT




Civil Action No.

PROOF OF SERVICE





on (date) ; or






on (date) ; or



.





Server’s address



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