STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, OS Case No. 2005002795 vs. LIFE CARE CENTERS OF AMERICA., d/b/a LIFE CARE CENTER OF CITRUS COUNTY, Respondent. / DMINISTRATIVE COMPLAINT ADMINISTRATIVE COME“ Petitioner, the Florida Agency For Health Care Administration (“AHCA”), through undersigned counsel, files this Administrative Complaint against the above named Respondent (‘Respondent’) pursuant to Sections 120.569 and 120.57, Florida Statutes (2004)', and alleges: NATURE OF THE ACTION BOE 1. This is an action to impose an administrative fine in the amount of $45,807 (the “Fine Amount’) against Respondent, per Sections 408.034 and 408.040, Florida Statutes and Florida Administrative Code Rules 59C-1.013 and 59C-1.021. 2. For the calendar year 2004 (the “Calendar Year”), Respondent failed to comply with the Medicaid condition upon its Certificate of Need (“CON”) (Exhibit “A”’). ‘A]] Statutes and rules hereinafter cited, unless otherwise noted, are to the 2004 version, controlling year in question. which is the Page 1 of 8 URISDICTION AND VENUE JURISDICTION AND Views 3. This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569 and 120.57, Florida Statutes, and also Sections 408.031-408.45, Florida’s “Health Facility and Services Development Act.” 4. Venue is determined by Florida Administrative Code Rule 28-106.207. PARTIES 5. Pursuant to Chapter 408, Florida Statutes, and Chapter 59C-1, Florida Administrative Code, AHCA is the licensing and enforcing authority with regard to community nursing home laws and rules. 6. Respondent is a corporation authorized under the laws of Florida to do business. Respondent operates a community nursing bome located at 3325 Jerwayne Lane, Lecanto, Florida 34461, and is the licensee on the CON issued on March 29, 1996, for the construction of an additional 9 community nursing beds to an existing 111 bed community nursing home with the condition that a minimum of 55% of its 120 bed facility’s total annual patient days shall be provided to Medicaid patients (the “Medicaid Condition”). The certificate number is CON #8090 and a copy is attached to this Complaint as Exhibit “A.” COUNT I (Respondent failed to meet Its Medicaid Condition) § 408.040, Fla. Stat. Fla. Admin. Code R. 59C-1.013 Fla. Admin. Code R. 59C-1.021 7. AHCA re-alleges paragraphs 1-6 above. 8. Respondent filed an annual compliance report, which reflected that the facility did not comply with the Medicaid condition for the Calendar Year (Exhibit “B”). the Florida Nursing Home Utilization by District and Subdistrict data for the Additionally, Page2 of 8 Calendar Year indicates that the facility did not comply with the Medicaid condition for said Calendar Year (Exhibit “C’”), based on the following findings: The Florida Nursing Home Utilization by District and Subdistrict January 2004-December 2004 data indicates that the facility provided 48.10 percent of the total annual patient days for its facility to Medicaid patients and the facility reports indicated that the facility provided 46.78 percent of the total annual patient days for its facility to Medicaid patients. 9. Respondent failed to comply with the condition set forth in its CON, as required by Sections 408.034 and 408.040, Florida Statutes; and Rule 59C-1.013, Florida Administrative Code which provide in part as follows: 408.040 Conditions and monitoring (1)(a) The agency may issue a certificate of need predicated upon statements of intent expressed by an applicant in the application for a certificate of need. Any conditions imposed on a certificate of need based on such statements of intent shall be stated on the face of the certificate of need. (b) The agency may consider, statement of intent by the applicant t facility will be utilized by patients eligi certificate of need issued to a nursing specified percentage of annual patient days in addition to the other criteria specified in s. 408.035, a hat a specified percentage of the annual patient days at the ‘ble for care under Title XIX of the Social Security Act. Any home in reliance upon an applicant's statements that a will be utilized by residents eligible 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-need program shall notify the Medicaid program office and the Department of Elderly Affairs when it imposes conditions as authorized in this paragraph in an area in which a community diversion pilot project is implemented. (c) A certificate holder may apply to the agency for a 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, the agency shall reissue the certificate of need with such modifications as may be appropriate. The agency shall by rule define the factors constituting good cause for modification. (d) If the holder of a certific issuance of the certificate was pre the certificate holder in an amount not to excee: penalty, the agency shall take into account as mitigatio! particular failure. ate of need fails to comply with a condition upon which the dicated, the agency may assess an administrative fine against d $1,000 per failure per day. In assessing the n the relative lack of severity of a ROK 59C-1.013 Monitoring Procedures (4) Reporting Requirements Subsequent to holders of a certificate of need that was issued pre the certificate of need shall provide annual compliance reports to the agency. The reporting period shall be January 1 through December 31 of each year. The holder of a certificate of need who began operation after January 1 will report from the date operation began through December 31. The compliance report shall be submitted no later than April 1 of the subsequent year. (a) The compliance report will contain information necessary for an assessment of compliance with conditions on the certificate of need, utilizing measures, such as a percentage 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 measured; 5. The Licensure or Commencement of Services. All dicated upon conditions expressed on the face of Page3 of 8 person and position responsible for supplying the compliance report; 6. Any other information necessary for the agency to determine compliance with conditions; and 7. If applicable, the reason or reasons, with supporting data, why the certificate of need holder was unable to meet the conditions set forth on the face of the certificate of need. (b) A change in the licensee for a facility or service does not affect the obligation for that facility or service to continue to meet conditions imposed on a certificate of need and to provide annual condition compliance reports. (c) Conditions imposed on a certificate of need may bi 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 set forth in their certificate of need shall be fined as defined in Rule 59C-1.021, FAC. e modified consistent with Rule 59C- 10. The foregoing violation warrants imposition of the above-mentioned Fine Amount pursuant to Florida Administrative Code Rule 59C-1.021 which provides in part: 59C-1.021 Penalties. (1) General Provisions. The agency certificate of need for violation of paragraphs 408.040(2){a) and (b administrative fines for failure to comply with conditions placed on a specified under Rule 59C-1 .013, F.A.C shall initiate administrative proceedings for revocation of a ), F.S., or the assessment of certificate of need as * OK (3) Penalties for Failure to Comply 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 facilities or services and other pertinent data to assess compliance with certificate of need conditions. Providers who are not in compliance with certificate of need conditions shall 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 must be submitted 30 calendar days following the eighteenth month of operation or the first month where an 85 percent occupancy is achieved, whichever comes first. The schedule of fines is as follows: (a) Facilities failing to comply with any conditions set forth on the Certificate of Need will be assessed a fine, not to exceed $1,000 per failure per day. In assessing the penalty the agency shall take into account the relative lack of severity of a particular failure. he agency within 45 calendar days after written (b) The assessed fine shall be paid to t notification of assessment by certified mail or within 30 calendar days after final agency action if der desires it may remit payment an administrative hearing has been requested. Ifa health care provi according to a payment schedule accepted by the agency. The health care provider must submit the schedule of payments to the agency within 30 calendar days after the date of receipt of the notification of assessment or 21 calendar days after final agency action. The final balance will be due no Jater than 6 months after the health care provider has been notified in writing by the agency of the amount of the assessed fine or 6 months after final agency action. 11. AHCA, in determining the penalty imposed, considered the degree of non- compliance and the relative lack of severity of a particular failure. WHEREFORE, AHCA demands the following relief (1) enter factual and legal findings as set forth in this Count, (2) impose the above-mentioned Fine Amount for the violation; and (3) impose such other relief as this tribunal may find appropriate. Page4 of 8 NOTICE RESPONDENT is hereby notified that it has a right to request 2 L hearing pursuant to Section 120.569, Florida Statutes. Specific options for: dininistrayre action are set out in the attached Election of Rights (one page) and explained in thenattached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration, and delivered to the Agency for Health Care Administration, 2727 Mahan Dr., Bldg. 3, MS #3, T. allahassee, Florida, 32308; Attention: Agency Clerk. RESPONDENT IS FURTHER NOTIFIED, IF THE REQUEST FOR HEARING IS NOT RECEIVED BY THE AGENCY FOR HEALTH CARE ADMINISTRATION WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THIS ADMINISTRATIVE COMPLAINT, 4 FINAL ORDER WILL BE ENTERED. Submitted this 18" day of April 2005. Tale, 8. aad Timothy B. Elidtt, Senior Attorney Fla. Bar No. 210536 Agency for Health Care Administration 2727 Mahan Drive, Bldg. 3, MS #3 Tallahassee, Florida 32308 Phone: (850) 922-5873 Fax: (850) 921-0158 or 413-9313 CERTIFICATE OF SERVICE LENSES I HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by US. Certified Mail, Return Receipt Requested (receipt # ) to Respondent, Attention: Administrator, at the address stated in the above paragraph 6, this 18 day of April 2005. “7. ~ / 2B. CL Timothy lliott, Senior Attorney Page5 of 8 EXPLANATION OF RIGHTS UNDER SEC. 120.569, FLORIDA STATUTES ; AD (To be used with the attached Election of Rights form) oy “a o In response to the allegations set forth in the Administrative Complaint igs r d. by th Agency for Health Care Administration (“AHCA” or “Agency”), Respondent must’maké-one of the following elections within twenty-one (21) days from the date of receipt of the Administrative Complaint and your Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date you receive the Administrative Complaint. Please make your election on the attached Election of Rights form and return it fully executed to the address listed on the form. ispute the allegations in the Administrative the right to be heard, Respondent should select 1 order will be entered finding you guilty of You will be OPTION. If Respondent does not d Complaint and Respondent elects to waive OPTION 1 on the election of rights form. A fina the violations charged and imposing the penalty sought in the Complaint. provided a copy of the final order. OPTION 2. If Respondent does not dispute any material fact alleged in the Administrative Complaint (Respondent admits all the material facts alleged in the Complaint.), Respondent may request an informal hearing pursuant to Section 120.57(2), Florida Statutes before the Agency. At the informal hearing, Respondent will be given an opportunity to present both written and oral evidence to reduce the penalty being imposed for the violations set out in the Complaint. For an informal hearing, Respondent should select OPT’ ION 2 on the Election of Rights form. OPTION 3. If the Respondent disputes the allegations set forth in the Administrative Complaint (you do not admit them) you may request a formal hearing pursuant to Section 120.57(1), Florida Statutes. To obtain a formal hearing, Respondent should select OPTION 3 on the Election of Rights form. obtain a formal proceeding before the Division of Administrative Hearings under request for an administrative hearing must conform to Jorida Administrative Code (F.A.C), and must state In order to Section 120.57(1), F.S., Respondent’s the requirements in Section 28-106.201, F the material facts disputed. IF YOU SELECT OPT. 3, CAREFULLY READ THE FOLLOWING PARAGRAPH: In order to preserve the right to a hearing, Respondent’s Election of Rights in this matter must be RECEIVED by AHCA within 21 days from the date Respondent receives the Administrative Complaint. If the election form with Respondent’s selected option is not received by AHCA within 21 days from the date of Respondent’s receipt of the Administrative Complaint, a final order will be issued finding the deficiencies and/or violations charged and imposing the penalty sought in the Complaint. Page6 of 8 EXHIBIT “A” EXHIBIT “B” - EXHIBIT “C” (All are copies.) EXHIBITS — Respondent’s CON #8090 Requiring that a Minimum of 55% of its 120 Bed Facility’s Total Annual Patient Days Be Provided to Medicaid Patients. Respondent’s Annual Compliance Report for Year 2004. — Florida Nursing Home Utilization Report for Year 2004 Page8 of 8 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CERTIFICATE OF NEED Under the provisions of the “Health Facility and Services Development Act” (Sections 408.031-.045, Florida Statutes (Supp 1992), AND Chapter 59C-1, Florida Administrative Code), the Agency for Health Care Administration certifies the need for this project. ’ QS:€ Hd 8- INF SO *Condition Modified (2/26/99) NUMBER: 8090 APPLICANT: Life Care Centers of America, Inc. PROJECT COST: $54,735 3570 Keith Street Northwest ISSUE DATE: March 29, 1996 Cleveland, Tennessee 37320-3480 TERMINATION DATE: March 28, 1997 REVISED TERMINATION DATE: COUNTY: — Citrus DISTRICT: 3 SUBDISTRICT: PROJECT DESCRIPTION: Add nine skilled nursing home beds to an existing 111-bed facility, Life Care Center of Citrus County, involving $10,000 in construction costs with no additional gross square footage. CONDITIONS: A minimum of 55%* of the 120-bed facility’s total annual patient days shall be provided to Medicaid patients effective January 1, 1999. The project will consist of 41,194 GSF of space. \ har FORM 1793, APRIL 1993 - We «Ws LIGIHXA © EXHIBIT “B” A. BRUCE McKIBBEN ATTORNEY AT LAW ont Drive, Suite 214 © Tallahassee, Fl 32308 * 850.942.8585 * 850.942.8524 (Fax) * romlow@eorthlink.net March 22, 2005 1435 €. Piedm Mr. James B. McLemore, Health Services Consultant Agency For Health Care Administration 2727 Mahan Drive * Mail Stop #28 Tallahassee, FL 32308 Re: CON No. 8090 Life Care Center of Citrus County (Lecanto) Condition compliance for calendar year 2004 Dear James: Please accept this letter and attachment as the formal report by Life Care Center: of Citrus County (located in Lecanto, FL) concerning its CON Condition Compliance for* calendar year 2004. I have been authorized by the owner and licensee of the facility to act as its authorized representative for purposes of filing this report. Per Rule 59C-1.013(4)(a), Florida Administrative Code: The time period covered by this report is January — December, 2004. The measure for assessing compliance with the Medicaid condition is to determine total patient days for the year and divide by the number of Medicaid patient days for the year. The data used was the facility’s internal census tracking information generated on a monthly basis. The compliance report is being submitted by the undersigned under the authority of the facility administrator and licensee of the facility. Requirement for 55% Medicaid Patient Days The facility experienced a total of 42,014 total patient days in calendar year 2004. number equates to a total of almost forty-seven percent (46.78%) of all patient days. See attached census tracking logs. Note there were 151 bed hold days during the year, indicating additional beds being held for Medicaid resident. Also, as in most facilities now, there was a very large Medicare population, many of whom were Medicaid residents whose care was being paid by another payor source. (These residents were, nonetheless, Medicaid eligible residents.) Based upon the foregoing, it appears Life Care Center of Citrus is not in strict compliance but is in substantial compliance with its CON Condition. Please let me know if anything further is required in order to satisfy the reporting requirements for calendar year 2004. ote one further mitigating factor: One facility in the immediate area (Crystal River Health and Rehabilitative Center) has a 150-bed license. However, its census is rarely over 100 residents. The existence of such a facility in the competing market makes it extremely difficult for other facilities to attract residents from the available Medicaid resident pool. Rather, the facility with low census is more aggressive and is an easy resource for all groups seeking to place residents as quickly as possible. Please also n Thank you again for your assistance and attention to this matter. If you have any questions, please do not hesitate to contact me directly. Sincerely, ae Mv — f- R. Bruce McKibben, Jr. Enclosure cc: Executive Director of Life Care Center of Citrus County @3/22/2005 12:04 3527467022 Life Care Center of Citrus County CENSUS SUMMARY DECEMBER 2004 Hospice Medicare Private Medicaid ae Tota ne a 0 Efe cnael cee LCC CITRUS CO Ctr n for New Month Total Bed Holds al eee ae a a Me Big) oe ae Ge ce a a Ti eo ee oe eo 18 peas {10 | si] 0 fi 1918 iva Pe NUCH ae = : 22 Bo 23,4 cea ae 25k 26 a 27 sah BRT cd etl il 28 acl 29h 30 3115 Total A Wing 35 Total C Wing 57 Total Alzheimers Un 20 TOTAL Rae “a Ate: Hospice Medicare Private Medicaid Average Census 108.33 Quality Mix 52.00% Patient Days for Last 7 days Hospice 7 Medicare 220 Private 79 Medicaid 357 Insurance 0 Total S 6 YTD AVG Census 114.1 83/22/2605 12:84 35274676822 Lec CITRUS CO Life Care Center of Citrus County Ctrl n for New Month CENSUS SUMMARY NOVEMBER 2004 Total Bed Holds Hospice Medicare Private Medicaid Insurance Total ee WG Wes il ae 10 cD a 15 (i Om eer is IEE il ams ae BE iif a 7 Ce ee 19 fT Serie Lot arm a 114i 218 ma ae ie 2 =_— a he i i a Foes NSrpidinta 27 28 2g 30 31 —— ae J yl cn |__o_ | 1 am eee aa ae 53 Ce ad a Pek jt daagl Total A Wing 35 Total C Wing 56 Total Alzheimers Un 19 TOTAL “FF 449 REVISED 12/01 PAGE 12 Total Days to Date Hospice : 2 Medicare Private Medicaid Average Census 413.83 Quality Mix 41.00% Patient Days for Last 7 days Hospice 41 Medicare 308 Private 73 Medicaid 377 Insurance 7 Total &Y, YTD AVG Census 114.66 83/22/2085 12:84 3527467822 Lec CITRUS CO PAGE 11 Life Care Center of Citrus County Ctrin for New Month CENSUS SUMMARY OCTOBER 2004 Total Bed Holds Total Days to Date Hospice : Medicare Private : : Medicaid = ‘ 08 Ze afer] insurance | Total Average Census 114.3 Quality Mix 52.00% al Patient Days for eee 118, B Rat Last 7 days — 1 Hospice 0 Medicare Private Medicaid insurance Total YTD AVG Census 114.7 Total A Wing 36 Total C Wing 60 Tota! Alzheimers Un 18 TOTAL ie ahha @3/22/ 2885 Life Care Ce CENSUS SU 12:04 3527467822 Loc CITRUS CO PAGE 14 nter of Citrus County Ctrl n for New Month MMARY SEPTEMBER 2004 Total Bed Holds _ Total Days to Date AE Hospice Medicare 5 Private Medicaid aaiat | 114.78 A) UR. Ai il eet 1 cee a 8 | 49 | 14 | Average Census 9 foe. oye Meelcde 116.41 10|_ ; 49 | 14 | 11 (Re i Mame Us eae: Quality Mix ! P14 [54 53.00% so | 13 | 55 [| 1 Patient Days for mT Use, Meds eboets car ssi : Last 7 days Psi | 13 | 55 Hospice 0 ceca a a Medicare 319 18] 0d _—_ Private at 19 feet we eee cae Medicaid 381 ro | 47_| Insurance Oren Seas Total f areal tT Reks nS YTO AVG Census biclaico es Total A Wing Total C Wing Total Alzheimers Un TOTAL 93/22/2885 12:84 3527467022 Life Care Center of Citrus County CENSUS SUMMARY AUGUST 2004 HOS Oe Medicare Private Medicaid oat ce or ee ee ess , ea ji | ss pose —s a 21 -— See See Te eats Total A Wing Total C Wing Total Alzheimers Un TOTAL : we gin aD ESB Soka gs | 48 ola aa Lec CITRUS CO Ctr n for New Month Total Bed Holds Insurance Total a 8 | 2 — PAGE 893 Total Days to Date Hospice Medicare = Private Medicaid | Insurance Total 604 Average Census 115.8 Quality Mix 55.00% Patient Days for Last 7 days Hospice 5 Medicare Private Medicaid tnsurance Total § YTD AVG Census 115 83/22/2885 12:84 3527467022 Lec CITRUS CO PAGE 68 Life Care Center of Citrus County Ctd n for New Month CENSUS SUMMARY JULY 2004 Total Days to Date Hospice Medicare cei me. 1° < Egceimce| Private Medicaid ce es r 40 Insurance Hi ar MUA este st a on aes Average Census . _r 440.04 B52 Be) Quality Mix 54.00% OF Patient Days for Last 7 days | Hospice Medicare 346 Private 92 Medicaid 372 Insurance Total s eae ft si 2a Gad a ee 7. an 21 LL 22 YTD AVG Census 114.89 a agin tag Beuaal ae] & iE eh (ar as eorae| ae ce ee tae =. eRe ors | Total A Wing 37 Total C Wing 60 Total Alzheimers Un 20 TOTAL ge ATE — ee AS EE EE EE 3527467822 12:84 Lec CITRUS CO @3/22/ 2885 Life Care Center of Citrus County Ctrl n for New Month CENSUS SUMMARY JUNE 2004 Total Hospice Medicare Private Medicaid insurance Total ee sec ne me | a Rawk ta Recs i a == ‘ aa oUnta ty are EC a dire Tae One. ee Bed Holds Bee ee ue aie ; 16 | 45 50 ee TT Sas UO Wares sca poi |e re ‘BE 2a 22 eee i 25 27 are aL — <== GN ai 28 roi ee ee Cia a ro | o_| Le Gane ae ae wae Total A Wing Total C Wing Total Alzheimers Un TOTAL PAGE @7 Total Days to Date Hospice Medicare Private Medicaid Insurance Total : Average Census 412.1 Quality Mix 53.00% Patient Days for Last 7 days Hospice Medicare Private Medicaid Insurance Total YTD AVG Census 115.7 83/22/2685 12:84 3527467822 LCC CITRUS CO PAGE 66 Life Care Center of Citrus County Ctri n for New Month CENSUS SUMMARY MAY 2004 Total ee Medicare Private Medicaid Insurance Total Bed Holds Total Days to Dat cl AIRG. BCS ce ae a alee Rie Hospice a Prvale ee at cee ee eLis Private ame 13 51 Medicaid ii Te Oe Vice. eal eRe Pei o Insurance 6 ii Total 5 Average Census — nd Ct nT Fee Id 116.33 40. s 41 Quality Mix 0 56.00% aes | 14 | 51 44% | |S Patient Days for eS RT SSS TERRE] 2st cays a So | ewok Et P20 EEE score ox = a Private 105 "i ee 8 OR medicais 356 Insurance 7 Total 789 YTD AVG Census 116.43 on Gorrie ae a ones 30) Total A Wing Total C Wing Total Alzheimers Un. TOTAL 4 63/22/2885 12:04 3527467822 LCG CITRUS CO PAGE @5 Life Care Center of Citrus County Ctrl n for New Month CENSUS SUMMARY APRIL 2004 otal Bed Holds _—— Total Days to Date Bias era we : BS ORY Hospice = BI a | 0 | Medicare a ee P24 RR Private | i aro Medicaid te We ana el eh a 116 (ER insurance See ace ts Total =f Average Census 116.64 Quality Mix 56.00% Patient Days for p 1} 60 ei = ; SE Last 7 days a 7 aS ae Hl eo" Be Ee a a ie Medicare f 1 | 50 116 Private ct Meee oa eee i Re RE © Medicaid a 7 _) Insurance ac Te WS Ma TH 16 [neta] Total I = — = 50 P 4 fe tao | 1 ae 9 tive Bs. rage) YTD AVG Census 13 Cho a See = Be AE Te a Bi ! i ae 116.4 28! 20fi Ee Batt sof 1 31 fie Ao. E Total A Wing 35 Total C Wing 60 Total Alzheimers Un 20 TOTAL sa 03/22/2685 12:64 3527467822 LCC CITRUS CO Life Care Center of Citrus County Ctrl n for New Month CENSUS SUMMARY MARCH 2004 Total Medicaid Insurance Total Bed Holds Hospice Medicare Private Sal scan ,, atin atin i Rea aaa hea ly Sr : te and A WL. tt | lt 12 54 Poe rT aE esi a a ae al cn — EA 3 2 OS. 1... ell Bl aie E | i aa 2o| 1 | p13 | 64 [2 et = 21 Tae Be Bh. na asa ees an 2314 sa bss ee 24,4 om aS 258 A ea a are se = 26| _ 1 a7_ | 13 | 53 27 aa al Piste A ee re nlgOO mSpCace _ 30 =_——e 52 a Total A Wing Total C Wing Totat Alzheimers Un TOTAL i PAGE 44 Total Days to Date Hospice Medicare Private Medicaid Insurance Total Average Census 418.17 Quality Mix 53.00% Patient Days for . Last 7 days Hospice 7 Medicare 341 Private 91 Medicaid 370 Insurance 14 Total YTD AVG Census 116.4 03/22/2885 12:84 3527467022 Lec CITRUS CO Lite Care Center of Citrus County Ctrl n for New Month CENSUS SUMMARY FEBRUARY 2004 Total Bed Holds 7 ‘a0 a E 13( oa — ee EAL. ramet ee 120 an ot cee ne) aaa. fo Be ans Sai | 320. 18 x ll 90 1 if 20. fie =e fi!!! 22 eeee fel feces ewtestceectoaeoa Lil 24{ 0 | ce a 2 aR Ia Laren 2,1 | 27 a —_s ST a 28 eae | iz] 65 29 fy alec Eee Ee 30 = —_ a 31/4 ao A a SL ee Total A Wing 35 Total C Wing 58 Total Alzheimers Un 20 TOTAL a AIS PAGE @3 Total Days to Date Hospice Medicar Private Medicaid ® Insurance : Total Average Census 116.21 Quality Mix 50.00% Patient Days for Last 7 days Hospice 4 Medicare 309 Private 87 Medicaid 394 Insurance 9 Total ae YTD AVG Census 116.52 93/22/2885 12:84 3527467022 Lec CITRUS co PAGE &2 Life Care Center of Citrus County Ctr n for New Month CENSUS SUMMARY JANUARY 2004 Total Hospice Medicare Private — Medicaid Insurance Total Bed Holds _ Total Days to Date a Gres uae eae ee ene : er aia Hospice a as Medicare STeserd Private a Medicaid aa eal WE a z row ee] insurance - == ‘ Total Average Census Rees a ea me RTS 168 A SAL EL Ml Rue: oe 58 0 a 52.00% Wbiecitlc MT MASTS JING li ais ee 7 eps ahaa cary) “amon : ; Last 7 days Hospice 0 Medicare 289 Private 412 Medicaid 404 Insurance 7 Total BH YTD AVG Census 116.84 16 si bar bet ona Fea el i : =e Total A Wing 36 Total C Wing 58 Total Alzheimers Un 20 TOTAL ada A TT fr el Send Foul Fel ammnaenad et — — — — eee ~ DISTRICT 3 NURSING HOME UTILIZATION (January 2004 - December 2004 Data) BED DAYS QUARTERLY TOTALS 01/04-12/04 ANNUAL TOTALS JANUARY 2004 - DECEMBER 2004 EXHIBIT «Cc JAN- APR- 6-MO. JUL- Shel.| MAR JUN TOTAL SEP OCT- 6-MO. DEC TOTAL Licensed Beds Comm. BED PATIENT TOTAL M'CALD M'CAID DAYS DAYS OCCUP DAYS OCCUP 1D. Name of Facility Total Subdistrict 3 Putnam County 718 Crestwood Nursing Center 65 65 0 5915 5915 5 1830) 5980 5980 23790 22668 95.28% 16692 73.64%! 51 Lakewood Nursing Center 92 92 0 8372 8372 si 4 8464 8464 31586 = 93.80% 27005 = 85.50% 999 Palatka Health Care Center 180 180 0) 16380 1638028 60; 16560 16560 60148 = 91.30% 46201 76.81% 0130667 Marion County 1243 Life Care Center of Ocala 120 120 O| 10920 = 10920 43920 42485 96.73% 14028 33.02%! 1044 Marion House Health Care Center 120 120 0} 10920 10920 43920 39481 89.89% 25209 = 63.85% 600 New Horizon Rehabilitation Center 159 159 O| 14469 14469 58194 54749 94.08% = 29364 53.63% 858 Oakhurst Rehabilitation and Nursing Center 180 180 O} 16380 = 16380 65880 63636 96.59% 29983 47.12% 543 Oakwood Nursing Center, Inc. 133 133 Ol 12103 = 12103 48678 34750 71.39% 29256 84.19% 725 Ocala Health & Rehabilitation Center 180 180 0} 16380 16380 65880 62678 95.14% 46520 74.22%! 938 Palm Garden of Ocala 180 180 0} 16380 163808 65880 64196 97.44% 37474 58.37% 968 Surrey Place Health and Rehabilitation Center 120 120 0} 10920 10920 43920 41200 93.81% 25828 62.69% 1043 TimberRidge Nursing & Rehabilitation Center 180 180 0; 16380 16380 65886 62629 = 95.07% 25262 40.34% pT CITE Subdistrict 5 Citrus County 944 Arbor Trail Rehab & Skilled Nursing Center 116 116 QO} 10556 42456 40792 96.08% 25981 63.69%! 538 Avante at Inverness 104 104 0! 9464 : 38064 36421 95.68% 21027 57.73% 1123 Citrus Health and Rehab Center , lll lll 0} 10101 40626 39195 96.48% 22523 57. 46% 703 ~~ Crystal River Health & Rehabilitation Center 150 150 0} 13650 54900 40090 73.02% 26076 65.04% 830 Cypress Cove Care Center 120 120 0} 10920 43920 41785 95.14% 25744 61.61% 853 Health Center at Brentwood 120 120 Qo} 10920 43920 42047 95.74% 22227 52.86% 1130 Life Care Center of Citrus County 120 120 0} 10920 43920 40865 93.04% 19655 48. 10% 1004 Surrey Place Convalescent Center - Lecanto 120 120 QO} 10920 43920 41221 93.85% 25691 62.33% 1268 — Woodland Terrace of Citrus County (Lic. 5/10/01) 120 120 0) 10920 38% 35% 43920 42771 97.38% 25469 59.55% Rates 63 AHCA 4/08/05

Docket for Case No: 05-002452