HAR-14-2005 MON 04:50 PM FAX NO. P, 02 STATE OF FLORIDA OS APR Jp Py AGENCY POR HEALTH CARE ADMINISTRATION 4 fy STATE OF FLORIDA, AGENCY POR HEALTH CARY ADMINISTRATION, Petitioner, AHICA NO: 2004011169 s$ —~ = “ (OS - V0 LIFE CARE CENTERS OF AMERICA, INC. d/iva LIFE CARE CENTER AT WELLS CROSSING Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTIT CARE ADMINISTRATION (°ALICA”), by and through undersigned counsel, and files this Administrative Complaint against Life Care Centers of America, Inc. d/b/a Life Care Center at Wells Crossing (“Respondent”) pursuant to Sections 120,569 and 120,57, Florida Statutes (2003), and alleges: NATURE OF THE ACTION 1, This is an action to impose an administrative fine in the amount of $21,936 against Respondent, pursuant to Sections 408.034 and 408.040, Florida Statutes (2003); and Rules 59C-1.013 and $9C-£.021, Florida Administrative Code (2003). 2. Respondent failed to comply, for calendar year 2003, with the Medicaid condition upon its Certificate of Need (“CON”) (Exhibit “A”). Page L of 9 MAR-14-2005 MON 04:50 PM FAX NO. P. 03 3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes (2003), and Sections 408.031-408.45, !lorida Statutes (2003), the “Health Facility aad Services Development Act.” 4. Venue shall be determined, pursuant to Chapter 28-106.207, Florida Adiuiystrative Code (2003). PARTIES 5, Pursuant to Chapter 408, Florida Statutes, and Chapler 59C-1, Vlorida Adutinistrative Code, AUCA is the licensing and enforcing authority with regard to comniunity nursing hoaie laws and rules. 6, Respondent is a corporation authorized under the Jaws of Florida to do business and operates a Community Nursing Home located at 355 Crossing Boulevard, Orange Park, FL 32073. Respondent is the licensce on the Certificate of Need issued on November $, 1997, for the addition of nine nursing home beds to a 111 bed community nursing haine with the condition that a minimun of 61.2% of its 120 bed [acility’s total anuual paticat days shall be provided to Medicaid patients. fhe certificate number is CON #8809 and a copy is allached to this complaint as [exhibit “A.” COUNTI Respondent fated to mect the condition that a minimum of 61.2% of ifs 120-bed- facility’s total annual pationt days shall be provided to Medicaid patients. § 408.040, Ila. Stat. (2003) Fla. Admin. Code R. 59C-1,013 (2003) Hla. Admin. Code R. 59C-],021 (2003) 7, AHCA re-allegcs paragraphs 1-6 above. 8. Respondent filed an annual compliance report, which reflected that the facility did net coinply with the Medicaid condition for the calendar year 2003 (Lixhibit “B”). Page 2 of 9 “HAR- 14- 2005 HON 04:51 PM FAX NO. P, Additionally, the Florida Nursing flome Utilization by District and Subdistrict January 2003- December 2003 data indicates that the facility did not comply with the Medicaid condilion for the calendar year 2003 (Exhibit “C”), based on the findings below, to wil: a) Vhe Florida Nursing Home Utilization by District and Subdistrict January 2003 -December 2003 data indicates that the facility provided 51.44 percent of the total annual patient days for the 120 bed facility to Medicaid paticnts and the facitily report indicated that the facility provided 57.52 percent of the total annual patient days for the 120 bed facility to Medicaid patients. 9. Respondent failed to comply wilh the condition sct forth in its Certificate of Need, as required by Scctions 408.034 and 408.040, Florida Statutes (2003); and Rule 59C- 1.013, Morida Administrative Code (2003). 10. Compliance with the Medicaid condition upon which a Certificate of Need is based is required in pertinent part, as follows: § 408.040, Fla. Stat, (2003) Conditions and monitoring. (1)(a) The agency may issue a certificate of need predicated upon sfatements of intent expressed by an appheant in the appheation for a certificate of need. Any conditions imposed on a certificate of need bascd on such stalements of intent shall be stated on the face of the certificate of need. (b) The agency may coasider, in addition to the other criteria specified in s. 408.035, a statement of intent by the applicant that a specified percentage of the annual patient days at the facility will be utilized by patients cligible for care under Title XIX of the Social Sccurity Act. Any certificate: of need issued to a mirsing home in reliance upon an applicant's statements that a specified percentage of annual patient days will be unlized by residents cligible for care under Title XIX of the Social Security Act must include a statement that such certification is a condition of issuance of the certificate of need, The certificate-of-nced program shall notify the Medicaid program office and the Department of Elderly Affairs when it inposes conditions as authorized in this paragraph in an area in which a community diversion pilot project is implemented. (c) A certificateholdcr may apply to the agency for an modification of conditions imposed under paragraph (a) or paragraph (b). If the holder of a certificate of need demonstrates good cause why the certificate should be modified, ithe agency shall reissue the certificate of need with such modificalions as may be appropriate. The agency shall by rule define the factors constiluting good cause for modification. (A) Tf the holder of a certificate of nced fails to comply with a condition upon which the issuance of the ccrlificate was predicated, the agency may assess an administrative fine against the certificatcholder in an amount not to exceed $1,000 per failice por day. Tn assessing the penalty, the agency shall take into account as mitigation the relouve lack of scverily ofa particular failure. Pape 3 of 9 MAR-14-2005 MON 04:51 PM FAX NO. Fla. Admin, Code R. 59C-1.013 (2003) Monitoring Procedures abe (4) Reporting Requirements Subsequent lo Licensure or Commencement of Services. All holders of a cerlifiente of iced that was issucd predicated upon conditions expressed on the [ace of the certificate of need shall provide annual comptiance reports to the agency. The reporting period shall be January 1 through December 31 of each year. The holder of a certificate of nced who began operation aller January 1 will report from the date operation began through December 31. ‘lhe compliance report shal) be submitted no later than April 1 of the subscquent year. (a) The compliance report will contain information necessary for an asscssinent of compliance with conditions on the certificate of need, utilizing measures, such as a perecatage of patient days, that are consistent with the stated condition. ‘the following information shall be provided in the holder’s annual compliance report: 1. The time period covered by the measures; 2. The measure for assessing compliance with each of the conditions identified and described on the face of the certificate of need; 3. The way in which the conditions were evaluated by applying the measures; 4. ‘The data sources used to generate information about the conditions that were vocasured; 5, The person and position responsible for supplying the compliance report; 6. Any other information nee y for the agency lo determine compliance with conditions; and 7. Ff applicable, the reason or reasons, with supporting data, why the certificate of need hofder was unable to meel the conditions sct forth on the face of the certificate of ued. (b) A change in the licensee for a facility or service does not affect the obligation for that fucilily or service to continue lo meet conditions imposed on a certificate of nced and to provide annual condition compliance reports. (c) Conditions imposed on a certificate of need may be iodified consistent with Rule 59C-1.019, F.A.C. (5) Violation of Certificate of Need Conditions. Health care providers found by the agency to be in noncompliance with conditions sel forth in their certificate of need shall be fined as defined in Rule 59C- 1.021, FLAC. HW. The forevoing violation warrants a fine of $21,936, to wil: ¥la. Admin. Code R. 59C-1.021 (2003) Penalties (1) General Provisions. ‘The agency shall initiate administrative proceedings for revocation of a certificate of need for violation of paragraphs 408.040(2)(a) and (b), I.S., or the assessment of administrative fines for fatlure to comply with conditions placed ona ceitificate of need as specified under Rale $9C-1.013, F.A.C AEE (3) Penalties for Failuce (o Conuply with Certificate of Need Conditions. The agency shall review the annual compliance report submitted by the health care providers who are licensed and operate the facilitics or services and other pertinent data fo assess comphance with ceitifieate of aced conditions. Providers who ure not in compliance with certificate of need conditions shill be fined. For community nursing homes or hospital-based skilled nursing units certified as such by Medicare, the first compliance report on the status of conditions nnist be submitted 30 calendar days following the cighteenth month of operahon or the first month where an 85 percent occupancy is achicved, whichever comes first. The schedule of fines is as follows: (a) Facilities failing to comply with any Page 4 of 9 05 MAR-14-2005 MON 04:51 PM FAX NO, P. conditions set forth on the Certificate of Need will be assessed a fine, not to exceed $1,000 per foture per day, In assessing the penalty the agency shall take into account the relative lack of severity of a particular failure. (b) The assessed fine shall be paid to the agency willtin 45 catendar days after written notification of assessment by certified mail or within 30 calendar days aller Jinal agency action if an administrative hearing has been requested. Ifa health care provider desires it may remit payment according to a payment schedule accepted by the agensy. The health care provider must submit the schedule of payments to the apency within 30 calendar days aller the date of receipt of the notification of assessment or 21 calendar days after final agency action. The final balance will be duc no later than 6 months afier the health care provider has been notified in writing by the agency of the amount of the assessed line or 6 months aller final agency action. 12. AUCA, in delenuining the penalty imposed, considered the degree of non- complinuee and the rctative lack of severily of a particular failure. WIEKBREFORE, ALICA demands the following relic: lL. Enter factual and legal findings as set forth in the allegations of this count; 2. finpose a line in the amount of $21,936 for the referenced violation; and 3. Impose such other relief as this (cibumal may find appropriate. NOTICE Respondent, Life Care Center at Wells Crossing, is notified that il has a right to request an administealive heaving pursuant to Scction 120.569, Florida Statutes. Specific options for adrainistralive action are set out in the attached Election of Rights (one page) and explained in the atiachicd Lxplanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Adininistration, and delivered to the Agency for Health Care Administration, 2727 Mahan Dr., Bldg. 3, MS #3, Tallahassee, Florida, 32308; Attention: Agency Cleck. RESPONDENT IS FURTIVER NOTIFIED, IF TOE REQUEST FOR HEARING IS NOT RECEIVED BY ‘THK AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE Q1) DAYS OF RECEIPT OF TRIS ADMINISTRATIVE COMPLAINT, A FINAL ORDER WILL BE ENTERED. Pape $ of 9 MAR-14-2005 MON 04:52 PH FAX NO, P. 07 gh. Submitted on this_{f ~ day of _ Lc CoA 2005,