STATE OF FLORIDA “Ae gy AGENCY FOR HEALTH CARE ADMINISTRATION OCT IY gs ‘ c GULF CARE, INC. d/b/a Dep: wAHCA GULF COAST VILLAGE CARE CEECOTTENT CLERK CENTER, Petitioner, LPS lee DOAH No.: 02-1906. © vs. AHCA No.: 2002028861 = STATE OF FLORIDA, AGENCY FOR aA. HEALTH CARE ADMINISTRATION, re Respondent. sof _/ Oo FINAL ORDER Having reviewed the Notice of Intent dated April 25, 2002, a copy of which is attached hereto as Exhibit “1”, and all other matters of record, the Agency for Health Care Administration (“Agency”) finds and concludes as follows: FINDINGS OF FACT 1. The Agency issued a Notice Of Intent To Deny stating its intent to deny the license renewal application of Petitioner, Gulf Care, Inc. d/b/a Gulf Coast Village Care Center (“Petitioner”), a skilled nursing facility. 2. The Agency stated the following reasons for the denial in the Notice Of Intent to Deny: e Pursuant to section 400.179(5)(d), Florida Statutes, (F.S.) you were required to provide an original 30 month Medicaid Lease Bond. ° Pursuant to section 400.111(3), F.S., you were requested to provide evidence of an escrow account in the amount of $5,000 pending appeal of the Centers for Medicare and Medicaid (CMS) or pay the Civil Money Penalty (CMP) to CMS as assessed by final order in CMP #200104LTC624. 3. Petitioner was advised of its right to request an administrative hearing, was given an explanation of rights, and was provided with an Election of Rights form. On April 30, 2002 the Agency received a request for a formal hearing pursuant to Sections 120.569 and 120.57(1), Florida Statutes. (A copy of the Petition for Forma! Hearing is attached hereto as Exhibit “2”.) 4. Section 400.179(5)(d), Florida Statutes, was subsequently amended by the 2002 Florida Legislature via House Bill 59-E. The new law now permits a skilled nursing facility to participate in a Medicaid lease fund program as an alternative to obtaining a Medicaid lease bond. Petitioner is participating in the Medicaid lease fund program. 5. Under Section 400.111(3), Florida Statutes, the Agency may deny a license renewal application if a facility has failed to pay any fines assessed by final order of the Centers for Medicare and Medicaid Services ("CMS"). CMP #200101LTC624 is not in final order status. 6. Based on all of the foregoing, the Agency rescinded its Notice of Intent to Deny Petitioner’s license renewal application pursuant to that certain letter dated June 3, 2002. (A copy of the rescission letter is attached hereto as Exhibit “3”.) 7. On June 6, 2002 Petitioner voluntarily dismissed its request for a formal hearing. (A copy of the voluntary dismissal is attached hereto as Exhibit “4”.) CONCLUSIONS OF LAW 1. The Agency has jurisdiction over Respondent pursuant to the provisions of Chapter 400, Part II, and Chapter 59A-4, Florida Administrative Code. 2. Due to the Legislature’s recent amendment to Section 400.179(5)(d), Florida Statutes, Petitioner is no longer in violation of Section 400.179(5)(d), Florida Statutes. 3. Section 400.111(3), Florida Statutes, is inapplicable in the present situation because CMP #200101LTC624 is not in final order status. 4. Based on the foregoing, this case is now moot. Based on all of the foregoing findings of fact and conclusions of law, it is ORDERED that: Petitioner’s renewal application for a skilled nursing facility license hereby is approved. DONE and ORDERED this (9 day of _Splinbe 2002 in Tallahassee, Leon County, Florida. Rhonda M. Agency for health Care Administra A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO 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 BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS — ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW OF 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: Lori C. Desnick Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive, M.S. #3 Tallahassee, Florida 32308 (via Interoffice Mail) James M. Barclay, Esquire Ruden, McClosky, Smith, Schuster & Russell, P.A. 215 South Monroe Street, Suite 815 aoa Tallahassee, Florida 32301 (via U.S. Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, M.S. #9 Tallahassee, Florida 32308 (via Interoffice Mail) Wendy Adams, Regulatory Consultant Agency for Health Care Administration 2727 Mahan Drive, M.S. #3 Tallahassee, Florida 32308 (via Interoffice Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) by U.S. Mail, or the method designated, on this dt day of Coton 2002. Chaxtowe 1 hedssoh SokLeland McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 ~LAHCA AGENCY FOR HEALI CARR AQMIIGTIA TK JES BUSH, GOVERNOR RHONDA M, MEGOWS, MO, FAAFP. SECRETARY April 25, 2002 _. CERTIFIED MAIL RETURN RECEIPT REQUESTED (#7000 0520 0024 8387 7108) Administrator Gulf Coast Village Care-Center 1333 Santa Barbara Boulevard Cape Coral, FL 33991 NOTICE OF {INTENT TO DENY #200202806 It is the decision of this Agency that the nursing home license renewal application for Gulf Coast Village Care Center is DENIED. * Pursuant to sectian 400.179(5 Xd), Florida Statutes (F.S.), you wers requested to provide an original 30 month Medicaid Lease Bond. « Pursuant to section 400.1113). F.S., you were requested f0 provide evidence of an escrow account in the amount of $5,000 pending appeal to the Centers for Medicare and Medicaid (CMS) or pay the Civil Money Penalty (CMP) to CMS as assessed by final order in CMP #200104LTC624. You were notified on April 4, 2002 to provide this required documentation. To date this infornation has not been received. EXPLANATION OF RIGHTS right to request an administrative hearing. In order to F Administrative Hearings under section 120.57(1), F.S.. t conform to the requirements in section 28-106.201, he material facts you dispute. Pursuant to section 120.569, F.S., you have the obtain a formal proceeding before the Division o your request for an administrative hearing mus! Florida Administrative Code (F.A.C), and must state ¢ SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS Molly McKinstry, Program Manager Long Term Care Unit cc: Agency Clerk, Mail Stop 3 FDAU, Mail Stop 47 Fort Myers Field Office K. Munn, LTC file Legal File, LTC Unit 2727 Mahan Drive » Mail Stop # 33 Kistt AHCA Online at www fdhe state fi us ‘Tallohassee, FL 32308 bv: epiet a. Of Yd = Ad 96T ZPZO-ZLL-ThG FILED STATE OF FLORIDA Pg AGENCY FOR HEALTH CARE ADMINISTRATION - X30 02 -», AHC DEPARTMENTS CLERK GULF COAST VILLAGE CARE CENTER, - . Petitioner, Case Number: AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. Gulf Coast’s Request for Hearing Gulf Coast Village Care Center, (hereafter, “Gulf Coast”), pursuant to 120.69, Florida Statutes (2000), requests a Formal Administrative Hearing to contest and dispute the Agency for Health Care Administration’s (hereafter, “AHCA”) intent to deny Gulf Coast’s nursing home license renewal application. In support of this Request for Hearing, Gulf Coast would show as follows: 1. Petitioner is Gulf Coast Village Care Center, 1333 Santa Barbara Boulevard, Cape Coral, Florida 33991. For purposes of this proceeding, its address is that of its undersigned counsel. TAL:36863:1 EXHIBIT __ 2. Gulf Coast holds a license from AHCA to operate skilled nursing home beds in its facility. It is entitled to relief under Section 120.169, Florida Statutes (2000). ~ Te meee es 3. The affected Agency is Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop # 33, Tallahassee, Florida 32308. Upon information and belief, AHCA’s notice of intent to deny Gulf Coast’s application is 200202806. 4. By letter dated April 25, 2002, AHCAnotified Gulf Coast that its nursing home license renewal application is denied. Exhibit A attached | hereto. 5. Gulf Coast’s interests will be substantially and adversely affected if its nursing home license renewal application is denied and if its nursing home license is not renewed. 6. This Request for Hearing is timely. 7. Disputed issues include the following: a. Whether Gulf Coast is required to provide a 30-month Medicaid lease bond. b. Whether Gulf Coast is required to provide evidence of an escrow account or pay a $5,000 civil money penalty assessed by CMS in matter 20014LTC624. TAL:36863:1 c. Other issues determined during discovery. 8. Disputed facts include the following: -~ a--Whether Gulf Coast has a lease requiring a Medicaid-bond. b. Whether Gulf Coast owes a $5,000 civil money penalty assessed by CMS in matter 20014LTC624. c. Other facts determined during discovery. 9. Ultimate facts include the following: a. Gulf Coast does not have a “lease” requiring a Medicaid bond. b. Gulf Coast does not owe a $5,000 civil money penalty in matter 20014LTC624. 10. Gulf Coast requests that its nursing home license renewal application be approved as submitted. 11. Gulf Coast has been required to retain counsel and will be required to incur costs in connection with these proceedings. Gulf Coast demands payment of attorneys fees and costs. WHEREFORE, Gulf Coast asks that this Request for Hearing be forwarded to the Division of Administrative Hearings, that an Administrative Law Judge to be assigned to conduct proceedings to determine that Gulf Coast does not have a “lease” requiring a 30-month TAL:36863:1 Medicaid bond, that Gulf Coast does not owe a $5,000 civil money penalty assessed by CMS in matter 20014LTC624 and that Gulf Coast’s Florida nursing home license renewal application proceed to approval, together with such other relief as may be appropriate. Respectfully submitted April.30, 2002. James M. Barclay idtida Bar Number 1141/8 Ruden McClosky Smith Russell, PA 215 South Monroe Street, Suite 815 Tallahassee, Florida 32301 850-412-2000 Fax 850-224-2032 . Attorneys for Gulf Coast Village Care Center uster & CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was furnished by hand delivery to Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, MS-3, Tallahassee, Florida 32308 on April 30, 2002. TAL:36863:1 2viet STATE CF PLORIOA AQENGY FOR HEALTH CARE ADMINISTRA NOM RHONDA M. MEDOWS, MO, FAAFP, SECRETARY April 25, 2002 _. CERTIFIED MAIL RETURN RECEIPT REQUESTED (#7000 0520 0024 8387 7108) 4B BUSH, GOVERNOR Administrator Gulf Coast Village Care-Center 1333 Santa Barbara Boulevard Cape Coral, FL 33991 NOTICE OF INTENT TO DENY ___(#200202806 Itis the decision of this Agency that the nursing home license renewal application for Gulf Coast Village Care Center is DENTED. Pursuant to section 400.179(5)(d), Florida Statutes (F.S.), you were requested to provide an original 30 month Medicaid Lease Bond. Pursuant to section 400.11 1(3), F.S., you were requested to provide evidence of an escrow account in the amount of $5,000 pending appeal to the Centers for Medicare and Medicaid (CMS) or pay the Civil Money Penalty (CMP) to CMS as assessed by final order in CMP #200104LTC624. You were notified on April 4, 2002 to provide this required documentation. To date this information has not been received. EXPLANATION OF RIGHTS Pursuant to section 120.969, F.S. you have the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under section 120.57(1), F.S.. your request for an administrative hearing must conform to the requirements in section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS Liou Molly McKinstry, Pro, Long Term Care Unit ce: Agency Clerk, Mail Stop 3 FDAU, Mail Stop 47 Fort Myers Field Office K, Munn, LTC file Legal File, LTC Unit Mistt AHCA Online at 2727 Mahan Drive « Mail Stop & 33 wwwfdhc.state fl us ‘Tallohassce, FL 32308 EXHIBIT "A" ca. Of dy fad 96T HVTHUA LSe03 29 = SrzZa-ZL4-trG { STATE OF FLORIOA ~IAHCA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RHONDA M. MEDOWS, MD, FAAFP, SECRETARY June 3, 2002 Administrator Gulf Coast Village Care Center 1333 Santa Barbara Boulevard Cape Coral, Florida 33991 RE: Rescinding of Notice of Intent To Deny (#200202806) Dear Administrator; Our office sent you a certified letter with a Notice of Intent to Deny your facility’s annual license. renewal dated April 25, 2002 because we had not received as requested a Medicaid Lease Bond or proof that the $5,000 assessed in CMP #200104LTC624 was paid or placed in an escrow account. With the passing of Senate Bill 1276 into law on May 3, 2002 your facility is now exempted from the requirement to obtain a Medicaid Lease Bond. The Centers for Medicare and Medicaid Services (CMS) informed us that CMP #200104LTC624 is not in Final Order status so section 400.111 (3), Florida Statutes, is not applicable on this date. The Notice of Intent to Deny the renewal license is rescinded and the license will be issued to your facility for the May 1, 2002 through April 30, 2003 renewal period. If you have any questions, please contact Kathy Munn of my staff at (850) 488-5861. i/o fo Molly McKinstry Unit Manager Long Term Care Bureau of Health Facility Regulation ce: Wendy Adams, Legal MS-3 Lori Desnick, Legal MS-3 K. Munn, LTC Unit File fees 5s Visit AHCA Online at EXHIBIT www. fdhe. state fl.us 18 2727 Mahan Drive « Mail Stop # 33 Tallahassee, FL 32308 RECE} VED GENERAL COUNSEL STATE OF FLORIDA JUN 102 DIVISION OF ADMINISTRATIVE HEARINGS 002 Agency for Health GULF COAST VILLAGE CARE CENTER, Care Administration Petitioner, v. Case Number: 02-1906 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / Gulf Coast’s Voiuntary Dismissai of Request for Hearing Gulf Coast Village Care Center dismisses its request for hearing to contest and dispute the Agency for Health Care Administration’s (hereafter, “AHCA”) intent to deny Gulf Coast’s nursing home license renewal application. All parties hereto are called upon to take notice hereof. Respectfully submitted June 6, 2002. ‘James M. Barclay » ‘ Florida Bar Number | 14183. . Ruden McClosky Smith Schuster & Russell, PA 215 South Monroe Street, Suite 815 Tallahassee, Florida 32301 850-412-2000 Fax 850-224-2032 Attorneys for Gulf Coast Village Care Center EXHIBIT TAL:37056:1 j 3 4 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was furnished by facsimile 850-921-0158 and by regular US mail to Lori C. Desnick, Senior Attorney, Agency for Health Care Administration, 2727 Mahan Drive, MS-3, Tallahassee, Florida 32308 on June 6, 2002. a “ el t. Voter Ln, a : { James M. Barclay TAL:37056:1

Docket for Case No: 02-001906