STATE OF FLORIDA 2015 AUG -Lt A II: I 0

AGENCY FOR HEALTH CARE ADMINISTRATION

FI-EVERGREEN WOODS, LLC d/b/a EVERGREEN WOODS,

vs.

Petitioner,

ENGAGEMENT NO. NH09-134C PROVIDER NO. 263893

RENDITION NO.: AHCA- \S -o '133 -S-MDA

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

                                                                              I

FINAL ORDER

THE PARTIES resolved all disputed issues and executed a Settlement Agreement. The parties are directed to comply with the terms of the attached settlement agreement. Based on the

foregoing, this file is CLOSED.

DONE and ORDERED on this the 3rd day of - fl UJ-U_S_f

, 2015, in

Tallahassee, Florida.

ELIZ

Agency for Health Care Administration

Filed August 13, 2015 2:43 PM Division of Adminis1trative Hearings

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A 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 BYLAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW 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.

Copies furnished to:

Ephraim Livingston Assistant General Counsel

Agency for Health Care Administration Office of the General Counsel (Electronic Mail)

Peter A. Lewis, Esquire

3023 N. Shannon Lakes Drive, Suite 101 Tallahassee, Florida 32309

. palewis@petelewislaw.com (Electronic Mail)

Zainab Day, Audit Administrator, Medicaid Program Finance Finance and Accounting

Health Quality Assurance (via email)

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to

the above named addressees by U.S. Mail, Laserfiche or electronic mail on this the f                

/J      ,2015.

Richard Shoop, Esquire Agency Clerk

State of Florida

Agency for Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, Florida 32308-5403

(850) 412-3689/FAX (850) 921-0158

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

FI-EVERGREEN WOODS, LLC d/b/a EVERGREEN WOODS,

Petitioner,

vs. ENGAGEMENT NO. NH09-134C

PROVIDER NO. 263893

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

Respondent.

                                                              I

SETTLEMENT AGREEMENT

Respondent, STATE OF FLORIDA, AGENCY FOR HEALTH CARE

ADMINISTRATION ("AHCA" or "the Agency"), and Petitioner, FI-EVERGREEN WOODS, LLC d/b/a EVERGREEN WOODS, ("PROVIDER"), by and through the undersigned, hereby stipulate and agree as follows:

1. This Agreement is entered into between the parties to resolve disputed issues arising from examination engagements NH09-l 34C.

2. The PROVIDER is a Medicaid provider in the State of Florida operating a nursing home facility that was examined by the Agency.

3. AHCA conducted an examination of the PROVIDER's cost report as follows: for examination engagement number NH09-134C, AHCA examined the PROVIDER's cost report covering the examination period ending on March 31, 2007.

4. In its subsequent Examination Report, AHCA notified the PROVIDER that Medicaid reimbursement principles required adjustment of the costs stated in the cost report. The

   
   

   Agency further notified the PROVIDER of the adjustments AHCA was making to the cost report. The Examination Report is attached hereto and incorporated herein as Exhibit A.

5. In response to AHCA's Examination Report, the PROVIDER filed a timely petition for administrative hearing, and identified specific adjustments that it appealed. The PROVIDER requested that the Agency hold the petition in abeyance in order to afford the parties an opportunity to resolve the disputed adjustments.

6. Subsequent to the petition for administrative hearing, AHCA and the PROVIDER exchanged documents and discussed the disputed adjustments. As a result of the aforementioned exchanges, the parties agree to accept all of the Agency's adjustments that were subject to these

   proceedings as set forth in the Examination Report, except for the following adjustments which the parties agree shall be changed or removed as set forth in the attached Exhibit B, which is hereby incorporated into this Settlement Agreement by reference.

7. In order to resolve this matter without further administrative proceedings, and to avoid incurring further costs, PROVIDER and AHCA expressly agree the adjustment resolutions, which are listed and incorporated by reference as Exhibit B above, completely resolve and settle this case and this agreement constitutes the PROVIDER'S withdrawal of their petition for administrative hearing, with prejudice.

8. After issuance of the Final Order, PROVIDER and AHCA further agree that the Agency shall recalculate the per diem rates for the above-stated examination period and issue a notice of the recalculation. Where the PROVIDER was overpaid, the PROVIDER will reimburse the Agency the full amount of the overpayment within thirty (30) days of such notice. Where the PROVIDER was underpaid, AHCA will pay the PROVIDER the full amount of the underpayment within forty-five (45) days of such notice.

   
   

   
   

   Payment shall be made to:

   AGENCY FOR HEALTH CARE ADMINISTRATION

   Medicaid Accounts Receivable - MS #14 2727 Mahan Drive, Building 2, Suite 200

   Tallahassee, Florida 32308

   
   

   Notice to the PROVIDER shall be made to:

   
   

   Peter A. Lewis

   Law Offices of Peter A, Lewis, P.L. 3023 N. Shannon Lakes Drive, Suite 101 Tallahassee, Florida 32309

   
   

9. Payment shall clearly indicate it is pursuant to a settlement agreement and shall reference the audit/engagement number.

10. PROVIDER agrees that failure to pay any monies due and owing under the terms

    
    

    of this Agreement shall constitute PROVIDER's authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to the PROVIDER for any Medicaid claims.

11. The parties are entitled to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable law.

12. This settlement does not constitute an admission of wrongdoing or error by the parties with respect to this case or any other matter.

13. Each party shall bear their respective attorneys' fees and costs, if any.

    
    

14. The signatories to this Agreement, acting in their representative capacities, are duly authorized to enter into this Agreement on behalf of the party represented.

15. The parties further agree a facsimile or photocopy reproduction of this Agreement shall be sufficient for the parties to enforce the Agreement. The PROVIDER agrees, however, to forward a copy of this Agreement to AHCA with original signatures, and understands that a Final Order may not be issued until said original Agreement is received by AHCA.

    
    

16. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida.

17. This Agreement constitutes the entire agreement between PROVIDER and AHCA, including anyone acting for, associated with or employed by them, concerning all matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between PROVIDER and AHCA other than as set forth herein. No modifications or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties.

18. This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions, as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof.

19. Except with respect to any recalculation(s) described in Exhibit B, PROVIDER expressly waives in this matter their right to any hearing pursuant to sections§§120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or rules of the Agency regarding these proceedings and any and all issues raised herein, other than enforcement of this Agreement. The PROVIDER further agrees the Agency shall issue a Final Order, which adopts this Agreement.

20. This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it.

    
    

    
    

21. To the extent any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement.

22. This Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives and trustees.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK

FI-EVERGREEN WOODS, LLC d/b/a EVERGREEN WOODS

Printed Title of Providers' R resentative

Dated: Tuite 23

,2015

Legal Counsel for Provider

Dated:,/

/ , 2015

THE REMAINDER OF THIS PAGE IS INTENTIONALLY BLANK

Settlement Agreement Engagement No: NH09-134C Page 6 of7

FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

2727 Mahan Drive, Mail Stop #3

Tallahassee, Florida 32308-5403

Justin

Deputy Secretary, Medicaid

Dated: ----8--/, ,2015

Dated: 7/47ft ..S ,2015

tu rt F. Williams General Counsel

-----1 -

Dated:      l

/_z._l-(

, 2015

Ep7mri':"iTtfngston Assistant General Counsel

Dated: '7 , 2015

Settlement Agreement Engagement No: NH09-134C Page 7 of7

RICK SCOTT

GOVERNOR

A Divfflria,i of the Ag for Health:.Ca1'9 Adm:/11i,;!ration

Better Health Care for all Floridians ELIZABETH DUDEK

INTERIM SECRETARY

EVERGREEN WOODS

FI-,,EVERGREEN WOODS, .LLC 7045 EVERGREEN WOODS TRAIL SPRING HILL, FL 346.08

Provider No.: 26389j

January 30, 2011 Certified Mail Receipt No. 7008 1830 0000 6859 2968

Examination Period/Engagement No.: March 31, 2007/NH09-134C Dear Administrator:

We have completed the examination of your facility 1 s Medicaid cost report for the period specified above.. A copy of the examination report is attached for your information.

Examination adjustments result from the application of Medicaid reimbursement principles to costs as reported on the Medicaid cost report for the period specified. You have the right to request

a formal or informal hearing pursuant to Section 120.57, Florida Statutes. If a petition for a formal hearing is made, the petition must be made in compliancewij:h Section 28-106.201, Florida Administrative Cc:ide.. Please note that Section 28-106.201(2) specifies that the p tition shall.contain a concise discussion

of specific items in dispute. Additionally, you are hereby informed that if a request for a·hearing is made, the request or petition must be receive<i within twenty-one (21) days of your receipt of this.letter, and that failure to timely request a hearing shall be deemed a waiver of your right to a hearing.

Please address all petitions for a hearing and/or questions to

2727 'Mahan Drive, Mail Stop 211 Tallahassee, FL. 32308.

Since:r:ely,

ctk t:]) !}'-LAY}.

Lisa D. Milton

Administrator of Audit Services Medicaid Program Analysis (850) 412-4102

I It

EXHIBIT

Attachment(s):

2727 Mahan Drive, MS# 21

Tallah;;i,.see, Florida 32308

Visit AHCA onlina at AHCA.MyFlorida.com

EVERGREEN WOODS MEDICAID EXAMINATION REPORT

FOR THE YEAR ENDED MARCH 31, 2007

EVERGREEN WOODS

MEDICAID EXAMINATION REPORT

FOR THE YEAR ENDED MARCH 31. 2007

TABLE OF CONTENTS

Page

Independent Accountants' Report........................................................................................:. 1 • 2

Schedules:

Schedule of Costs. 3 - 4

Schedule of Charges. 5

Schedule of Statistics and Equity Capital................,. 6

Schedule of Allowable Medicaid Costs. 7

Schedule of Fair Rental Value System Data....,. 8

Schedule of Direct Patient Care 9 - 11

Notes to Schedules............................................................,. 12

Attachment A:

Adjustments 13 - 18

-

(J:TCTIJ"TI'[! P\"[;J I(

:"'1.Cf_Ul ' 1."i.. 1..,;;... ( tJN'-iUl IA'-!/:-,,

Independent Accountants' Report

Secretary

Agency for Health Care Administration:

We have examined the schedules and statistical data, as listed in the Table of Contents, which were derived from the Cost Report for Florida Medicaid Program Nursing Home Service Providers (the "Cost Report") of Evergreen Woods, (the "Provider"), for the year ended March

31. 2007. These schedules and statistical data are the responsibility of the Provider's management. Our responsibility is to express an opinion on the schedules and statistical data based on our examination.

Except as discussed in the following paragraph, our examination was made in accordance with standards established by the American Institute of Certified Public Accountants and, accordingly, included examining on a test basis, evidence supporting the accompanying schedules and statistical data and performing such other procedLJres as we considered necessary in the circumstances. We believe that our examination provides a reasonable basis for our opinion.

The Provider is reimbursed under the Fair Rental Value System ("FRVS"). Accordingly, property cost information for depreciation, interest and rent included on the Schedule of Costs, equity capital information on the Schedule of Statistics and Equity Capital. capital replacement and equity in capital assets information on the Schedule of Fair Rental Value System Data and related per diem information on the Schedule of Allowable Medicaid Costs have not been subjected to examination procedures.

Attachment A to this report includes adjustments which, in our opinion, should be recorded in order for the data, as reported, in the accompanying schedules for the year ended March 31, 2007. to be presented in conformity with federal and state Medicaid reimbursement principles as described in Note 1. To quantify the effect of the required adjustments, we have applied the adjustments as described in Attachment A to the amounts and statistical data, as reported, in the accompanying schedules.

In our opinion, except for the effects of such adjustments as might have been determined to be necessary had amounts and data described in the third paragraph above been examined. and for the effects of not recording adjustments as discussed in the preceding paragraph, the accompanying schedules and statistical data listed in the Table of Contents present, in all material respects, the amounts and statistical da derived from the Cost Report of Evergreen

Woods, for the year ended March 31, 2007. in conformity with federal and state Medicaid reimbursement principles as described in Note 1.

This report is ifltended solely for the information and use of the State of Florida's Agency for Health Care Administration and management of Evergreen Woods. and is not intended to be and should not be used by anyone other than these specified parties.

Orlando, Florida June 4, 2010

SCHEDULE OF COSTS

FOR THE YEAR ENDED MARCH 31, 2007

The accompanying notes are an

tntegral pan or this scnettuie.

3 NH09·134C

263893

SCHEDULE OF COSTS

FOR THE YEAR ENDED MARCH 31, .2007

The accompanying notes are an Integral part of this schedule.

4 NH09-134C

263893

1G/L0 39\;;:'d SW\;;:'IllIM QI\;;:'8IG3W

SCHEDULE OF CHAllGES

FOR THE YEAR ENDED MARCH 31, 2007

Total Charges $ 13,918,682        $       147,785         $ 14,066,467              

The accompanying notes are a.n 5 NH09-134C

integral part of this scliedule. Z63893

SCHEDULE OF STATISTICS AND EllUITY CAPITAL

FOR THE YEAR ENDED MAR.CH 31, 2007

A!'.

Reported

lncmase

(Decrease)

Statistics:

Number of beds 120 120

Total patient days

Percent Medicaid

Facility square footage;

Allowable ancillary c;ost centers:

40,369 40,369

53.78% 0,00% 53.78%

SCHEDULE OF ALLOWABLE MEDICAID COSTS

FOR THE YEAR ENDED MARCH 31, 2007

Total Costs:

Allocatione & Cost After Co5tAs Apportionment Allocations &

Reimbursement Class Ad1usted {Note 21 Aeeortionment

Allowable Medicaid Costs:

Increase

As (Decrease) As

Rtc!imbursemont Class Reported         {Note 11    Adjusted

Totals $    4,072,517    $ {98,187)      $     3,974,330

The accompanying notes are an integral part of this schedule.

7 NH09-134C

263893

SCHEDULE OF FAIR RENTAL VALUE SYSTEM DATA

FOR THE YEAR ENDED MARCH 31, 2007

Capital Additions and Improvements;

Acquisition costs:

01/01/2007 . 03/31/2007                                                                                          

Totals $ 3,132 $ $ 3,132

Original loan amount $ $ $

Retirements $ $ $

Capital Replacements: (not examined)

Acquisition c:osls:

04/01/2006 • 03/31/2007 $ 13.084 $ $ 13,084

Mortgage Interest Rate:

No mortgage

The aecompanytng notes are an

Integral part of this sehndule.

8 NH09•l34C

263893

SOllEDULE OF DIRECT PATIENT CARE .

FOR THE YEAR ENDED MARCH 31, 2007

R

LPN Data

CNA Data

The accompanying notes are an

lnteg-ral part of this schedule.

9 NH0&-134C

263893

FOR THE YEAR ENDED MARCH 31, 2007

Productive Hours

Non-Productive Hours

Total Hours

Productive Hours

Non-Productive Hours

Total Hours

Pediatric Offset • CNA

r

Productive Salaries $ $ $ Non-Productive Salaries

Total Salaries $ $

Productive Hours

Non-Productive Hours

Total Hours

Pediatric Offset - Agency

RN hours LPN hours CNA hours

Total Agency Hours

The accompanying notes are an

integral part of this schedole.

10 NH09-1S4G

263893

FOR THE YEAR ENDED MARGH 31, 2007

AIDS Offset • RN

Productive Salaries

Non-Productive Salaries

Total Salarlgs

Productive Hours Non-Productive Hours

Total Hours

AIDS Offset • LPN

Productive Salaries . $ $ $

Non-Productive Salaries

Total Sal.!lries $ $ J

Productive Hours Non-Productive Hours

Total Hours

AIDS Offset • CNA

Productive Salaries $ $ $

Non-Productive Salaries

Total Salaries $ $ $

Productive Hours

Non-Productive Hours

Total Hours

AIDS Offset • Agency Data

RN costs $ $ $

LPN costs CNA costs

Total Agency Costs $ $ $

RN hours LPN hours CNA hours

Total Agency Hours

Data for AU Departments

The accompanying notes are an

integral part of this scb11dule.

11 NH09-134C

263893

EVERGREEN WOODS NOTES TO SCHEDULES

FOR THE YEAR ENDED MARCH 31, 2007

Note 1 - Basis of Presentation

The Schedules listed in the Table of Contents, which were derived from the Cost Report for Florida Medicaid Program Nursing Home Service Provlders (the "Cost Report") for the applicable period have been prepared in conformity with federal and state Medicaid reimbursement principles, as specified in the State of Florida Medicaid Program and as defined by applicable cost and reimbursement principles, policies and regulations according to Medicare principles of reimbursement as interpreted by the Provider Reimbursement Manual (CMS Pub. 15-1), Florida Title XIX Long-Term Care Reimbursement Plan and the policies and procedures manuals for Nur5ing Home Services of the Agency for Health Care Administration of the State of Florida.

. The balances in the "As Reported" columns of the schedules are the assertions and responsibility of the management of nursing home. The balances in the "As Adjusted" columns are the result of applying the adjustments reflected in the "lncrease/(Decrease)" columns to the

balances in the "As Reported" columns.

Note 2 - Allocatlons and Apportionment

Schedules G, G-1 and H of the Cost Report allocate allowable administration, plant operation and housekeeping costs to allowable and nonallowable ancillary, patient care, laundry and linen and nonreimbursable cost centers based on predetermined statistical bases, such as square footage or total costs, as explained in the Cost Report. These schedules then apportion allowable costs after allocations to the Medicaid program based on other statistical bases, such as patient days or ancillary charges, as explained in the Cost Report. The net effect of such allocations and apportionment on each reimbursement class is presented in the Schedule of Allowable Medicaid Costs.

Note 3 - Initial Medicaid Per Diem

Medicaid per diem costs for property and return on equity have been calculated under the provisions of the Florida Title XIX Long-Term Care Reimbursement Plan, excluding fair rental value provisions. The effect, if any, of the fair rental value system, will be determined during the rate setting process, and where applicable, prospective rates will be calculated by applying inflation factors, incentives, low utilization penalties and reimbursement ceilings.

Note 4 - Capital Replacement Pass-through Costs

Capital replacement pass-through costs in the form of depreciation and interest are presented without regard to the number of years remaining, if any, to full fair rental value system phase-in. Accordingly, pass-through reimbursement will be calculated based on amounts equal to or less

than fifty percent of the costs presented herein as capital replacement pass-through costs. Once full fair rental value system phase-in has occurred, no capital replacement costs are

allowed to be passed-through.

12 NH09-134C

263893

ATI'AOHMENT A · ADJUSTMENTS

FOR THE YEAR ENDED MARCH 31, 2007

Classification

Adjustments to Costs {pages 3 - 4}

Plant OperatiQn

Account

Number Comment

Increase (Decrease)

1. Workers' compensation

710450

To adjust workers' compensation based on $

(246)

ATl'ACBMENT A - ADJUSTMENTS

FOR THE YEAR ENDED MARCH 31, 2007

NHD9-134C

                     Clas:ilfication                       

Account

      Number                 Comment                                  

Increase (Decrease)

Adjustments to Costs {concluded}

Adju:.tments affecting Ending Equity Capital (page 6)

No adjustments

Ad)ustments affectiQa Charges (page 5)

Medicaid:

1. Medical supplies

   
   

2. IV therapy

606100

611100

To reclassify charges to the proper cost center. $

(Section 2302.8, CMS Pub. 15-1)

To reclassify charges to the proper cost center.

(Section 2302.8, CMS Pub. 15-1)

(206)

2,986

2,780

NH09-134C

Facility Square Footage:

34. Medical supplies Patient care Beauty and barber

To adjust the statistical basis for cost alloc.ition based on audited data. (Sections 2102.3 and 2304, CMS Pub, 15-1)

129

{138)

9

Net Adjustment to Square Footage                    

Adiustments affacting Direct Patient Care Information (pages 9 -11}

RN - Fringe Benefits:

NH09·134C

16 263893

A'rl'ACHMENT A - ADJUSTMENTS

FOR THE YEAR ENDED MARGH 31, 2007

                     Cla$Sification                       

Account

      Number                                      Comment                                   

Increase

(Decrease)

Adjustments aff2cting Direct Patient Care Information (concluded}

NH09-134C

17 263893

ATTACHMENT A· ADJUSTMENTS

FOR THE YEAR ENDED MARCH 31, 2007

The following adjustments reported in the Schedule of Fair R@nlal Value System Data are in .iccordance with the fair rental value system provisions of the Florida Title XIX Long-Term Care Reimbursement Plan and, where appropriate, the applicable sections of Chapters 100, Depreciation, and 2300, Adequate Cost Data and Cost Finding, of the Provider Reimbursement Manual (CMS Pub. 15-1). The Provider has been furnished with schedules developed during the course of the audit which detail allowable components of the fair rental value system.

Fair Rental Value System Data

Increase

{0'1CfVHlil}

Classification

Capital Additions and Improvements:

1. Acquisition costs $

   
   

2. Retirements $

   
   

   Capital Replacements: (not examined)

   
   

3. Acquisition costs $

   
   

4. Pass-through costs $

   
   

   Equity in Capital Assets: (not examined)

   
   

5. Ending equity $

   
   

6. Average equity $

7. Return on equity bBfore apportiontnent $ 18

6. Return on equity apportioned to Medicaid $ 8

18 NH09-I34C

263893

SW IllIM GI 8IG3W 9t,Tz;E9EP05

May 19, 2015

Zainab Day

Acting Administrator of Audit Services Agency for Health Care Administration 2727 Mahan Drive, MS #21

Tallahassee, FL 32308

RE: Evergreen Woods

Examination Period: F/Y/E March 31, 2007 Engagement No.: NH09-134C

EXHIBIT

j

8

Revisions to Attachment A: Adjustments

r.,. }    Evergreen Woods Health 7045 Evetgteen Woods Ttail

            _an_d_R_e_h_a_h_m_·t_an_·_on_C_e_n_t_er                  

s_pn_'ng_H_i_n,_FL_3_4_608

A NOT FOR PROFIT FACILITY Phone: (352) 596-8371

May 22, 2015

Zainab Day Audit Services

Agency for Health Care Administration 2727 Mahan Drive MS #21

Tallahassee, FL 32308

RE: Evergreen Woods

Audit Period/Engagement No.: March 31, 2007/NH09-134C/263893 Dear Ms. Day:

Per agreement between Errol Williams and me, we would like to propose that the Medicaid Examination Report for the above provider be revised based on the Exhibit B attachment. The settlement stipulation can be prepared with those agreed upon changes.

Please let me know if you have any questions about the above. Thank You,

e,,\Lv

Julie C. Kleiser

Director of Reimbursement Kane Financial Services, LLC

A Member of a Not Far Profit Organization

Docket for Case No: 13-002270

Orders for Case No: 13-002270