STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS FLORIDA PREFERRED CARE DEVELOPMENT CENTERS I d/b/a SANDY PARK DEVELOPMENT CENTER, Petitioner, 4 — vs. en ° Ba AK ° eh ae ~ % STATE OF FLORIDA, AGENCY FOR HEALTH CARE ER Bw ADMINISTRATION, Pe = Respondent. FINAL ORDER THIS CAUSE is before me for issuance of a Final Order. In a letter dated July 23, 2002, Sandy Park Development Center (Petitioner) was informed that the State of Florida, Agency for Health Care Administration (Agency), Office of Medicaid Cost Reimbursement had denied Petitioner’s interim rate request. On August 14, 2002, the Petitioner petitioned for and was granted a formal administrative hearing. In a letter dated December 4, 2002, W. Rydell Samuel, Administrator, Medicaid Cost Reimbursement, notified the Petitioner that their interim rate request has been granted effective April 1, 2002. Therefore, the matter is moot and no other action affecting the Petitioner under the above-styled case number is pending. Based on the foregoing, the request for a hearing is dismissed and the file is CLOSED. DONE and ORDERED on Seber /_, 2003, in Tallahassee, Florida. Rhonda M. Medows, MD, Secretary Agency for Health Care Administration 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 BY LAW, 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: L. William Porter Il Assistant General Counsel Agency for Health Care Administration (Interoffice Mail) Theodore E. Mack, Esquire Powell & Mack 803 N. Calhoun Street Tallahassce, Florida 32303 (U.S. Mail) Ella Jane P. Davis Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 W. Rydell Samuel, Administrator, Medicaid Cost Reimbursement James Estes, Medicaid Cost Reimbursement CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing has the above-named addressees by U.S. Mail on been furnished to Lbaucey 48, 2003. ” AB ( Lealand McCharen, Esquir Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 oer al Ms. Leslie Steiner Page Two December 4, 2002 The settlernont of this interim rate shalt be based upon the FYE 12/31/02 cost report. Please provide a detailed breakdown, along with the completed Schedule CM, “interim Rate Settlement” supporting the total interim rate costs. This settlement will be further subject to a desk audit, or an on-site audit. You have the right to request a formal! or informal hearing pursuant to Section 120.57, Florida Statues (F.S.). Please be advised that the procedural rules as adopted by the Agency are found in Chapter 28-106, Florida Administrative Code (F.A.C.). Any petition filed is required to be in compliance with Rule 28- 106.111, F.A.C., and accordingly, this office must receive your petition requesting a hearing within twenty-one (21) days of your receipt of this lettcr. Failure to request a hearing within twenty-one (2)) days shall be deemed a waiver of your right to challenge any findings in a Section 120.57, F.S. hearing, Please address al! requests for an informal hearing or petitions for a formal hearing to: Mr. James L. Estes Regulatory Analyst Supervisor Medicaid Cost Reimbursement 2727 Ndahan Drive, Mail Stop 21 Tallabassce, Florida 32308 Any additional documented information that you might submit to us during this twenty-one day period will be considered, If satisfactory resolution is made during the twenty-one day period, you may withdraw your request for a heering. Please cal] Karen G. Barron or myself at (850) 488-9350, if you have questions or need additional information, Sincerely, huh W. Rydell Samuel, ‘Adiministrator Medicaid Cost Reimbursement WRS: /kgb Enclosure CC: Susan Dickerson, Departnent of Children & Families, Bill Wendt, Department of Children & Families INTE-128F Recerved Tims Dec. 3 rrr FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION JEB BUSH, GOVERNOR RHONDA M. MEDOWS, MO, FAAFP, SECRETARY July 23, 2002 CERTIFIED MAIL RETURN RECEIPT REQUESTED 7000 0600 0024 9208 2017 Mr, Guy Farmer, CPA Mitchell & Company, CPAs 2851 Remington Green Circle, Ste D Tallahassee, FL 32308 Dear Mr. Farmer: 24:6 WW 6! 833 £0 Sandy Park Development #0280003-00, additional information dated June 24, 2002, Received June 24, 2002; Need for an additional Certified Behavioral Analyst, additional Direct Care Staffing, and Additional Nursing and Supervisory Staff . This office has reviewed the additional documentation regarding the above reference interim rate request, submitted to our office on October 3, 2001, with additional information received June 24, 2002. Based on our review, this interim rate request does not meet the following provisions of the Florida Title XIX ICF/MR/DD Reimbursement Plan (the Plan) (copy enclosed): Section IV.G.2: “Request for interim rate changes reflecting increased costs occurring as a result of resident care or administration changes...shall be considered only if such changes were made to comply with existing state or federal rules, laws, or standards...” and Section TV.G.3: “In the event that new state or federal laws, rules, regulations, requirements, licensure and certification or new interpretations of existing laws, rules, regulations, or licensure and certification requirements require all affected providers t o make changes that result...” You are hereby notified that the interim rate request, in this instance is denied. You have the right to request a formal or informal hearing pursuant to Section 120.57, Florida Statues. Ifa petition for formal hearing is made, ‘he petition must be made in compliance with Rule Section 28-5.201, Florida Administrative Code. Please note that Rule Section 28-5(2) specifies that the petition 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 received 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. 2727 Mahan Drive * Mail Ste> #21 Visit AHCA online at Tallahassee, FL 32308 www Jdhe.state fl.us OMAGH PAew OdU eee tay FLORGA AGENCY FOR HEALTH CARE ADMINISTRATION JGB BUSH, GOVERNOR RHONDA M, MEOOWS, MD, FAAFP, SECRETARY December 4, 2002 CERTIFIED MAIL RETURN RECEIPT REQUESTED 7000 0600 0024 9208 1652 Ms, Leslie Steiner, Director Sandy Park Development Center 2975 Garden Strect North Fort Myers, FL 33917 Dear Ms Steiner: Sandy Park Development Center ~ 0280003-00, Nced for an additlonal Certified Behavior Analyst, Direct Care Staffing, and Additional Nursing and Supervisory Staff We have completed the revicw of the documentation submitted regarding the ebove reference interim rate request. Basec! on our review aud the approval from the Florida Deparnnent of Children and Families, an interim rate is being granted effactive 04/01/02. The granted interim rate is to cover the increased cost for an additional Certified Behavior Analyst, Direct Care Staffing and additional Nursing and Supervisory Staff, The following rate is being estatilished retroactive to 04/01/02. It is listed on the enclosed Medicaid Reimbursement Per Diem Ratc fonn and rate calculation worksheets, effective date 04/01/02: LOc7 Unaudited Prospective 04/01/02 Total Rate FYE 12/33/00 Intern Rate Rate Aprs02 Operating 47.156 0.0000 47.156 Resident Care 122,177 10,7800 132.957 Property 18.563 0.0000 18,563 ROE __ 1.650 0.0000 1.650 Totals 189.546 10.7800 200,326 Interim rates are subject to cost sertlement for the period in which the interim rates are in effect. The Florida Title XIX I1CF/MR-DD Reimbursement Plan for Not Publicly Owned and Not Publicly Operated, Section 1V.G.5. states, “Overpayment as a result of the difference between the approved budgeted jnteriin rate and actual costs of the budgeted items shall be rcfunded to AHCA. Underpayment as a result of the costs shall be refunded to the provider.” Viyit AHCA ontlive at waw dire state fl us 2727 Mahan Drive » Mall Stop #21 Tallakassac, Fl, 32308 5 ed Tit Nee, 4 ar Rece@yed tee . a Mr. Guy Farmer July 23, 2002 _ Page 2 Please address all requests for an informal hearing or petitions for a formal hearing to: Mr. James L. Estes Regulatory Analyst Supervisor Medicaid Cost Reimbursement 2727 Mahan Drive, Mail Stop 21 Tallahassee, FL 32308 Please call Karen G. Barron or myself at (850) 488-9350, if you have questions or need additional information. Sincerely, W. Rydell Samuel, Administrator Medicaid Cost Reimbursement WRS:/kgb | Enclosure CC: Susan Dickerson, Department of Children & Families, Bill Wendt, Department of Children & Families ~ INTE-128R.doc

Docket for Case No: 02-003852