r @ ane STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, vs. Case No. 2005004331 LIFE CARE CENTERS OF AMERICA, INC, d/b/a LIFE CARE CENTER OF PORT SAINT LUCIE, Respondent. ADMINISTRATIVE COMPLAINT Petitioner, the Florida Agency For Health Care Administration ((AHCA”), through undersigned counsel, files this Administrative Complaint against the above named Respondent t to Sections 120.569 and 120.57, Florida Statutes (2004), and alleges: (“Respondent”) pursuan NATURE OF THE ACTION 1. This is an action to impose an administrative fine in the amount of $24,071 (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 “CON”) (Exhibit “A”. with the Medicaid condition upon its Certificate of Need ( rs version of the ‘Uniess otherwise noted, all Statutes and rules hereinafter cited are to the indicated yea statute or rule, because this is the controlling year in question. Page 1 of 8 Se ly with its 66% Medicaid condition for the Calendar reflected that the facility did not compl Year. Respondent’s annual report indicates that Respondent provided only 48% of its total annual patient days to Medicaid patients. Similarly, the Florida Nursing Home Utilization by District and Subdistrict data for the Calendar Year (Exhibit “C”) indicates that Respondent provided only 47.94% of its total annual patient days to Medicaid patients. 9. Thus, Respondent did not comply with its Medicaid condition as required by Sections 408.034 and 408.040, Florida Statutes and Rule 59C-1.013, Florida Administrative Code which provide in relevant part: 408.040 Conditions and monitoring (1)(a) The agency may issue a certificate of need, or an exemption, 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, of intent by the applicant that a specified perc’ utilized by patients eligible for care under Tit need issued to a nursing home in reliance upon a of annual patient days will be utilized by residents ¢ Security Act must include a statement that such certification is a certificate of need. The certificate-of-need program shall notify the Me Department of Elderly Affairs when it imposes conditions as authorize in which a community diversion pilot project is implemented. agency for a modification of (c) A certificateholder or an exemption holder may apply to the agraph (b). If the holder of a certificate of need conditions imposed under paragraph (a) or par 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 certificate of need fails to comply with a condition upon which the issuance of the certificate or exemption was predicated, the agency may assess an administrative fine against the certificateholder in an amount not to exceed $1,000 per failure per day. Failure to annually report compliance with any condition upon which the issuance of the certificate or exemption was predicated constitutes noncompliance. In assessing the penalty, the agency shall take into of a particular failure. Proceeds of account as mitigation the relative lack of severity such penalties shall be deposited in the Pub in addition to the other criteria specified in s. 408.035, a staternent entage of the annual patient days at the facility will be Je XIX of the Social Security Act. Any certificate of n applicant's statements that a specified percentage ligible for care under Title XIX of the Social condition of issuance of the dicaid program office and the d in this paragraph in an area lic Medical Assistance Trust Fund. ** OK 59C-1.013 Monitoring Procedures (4) Reporting Requirements Subsequent to Licensure or of a certificate of need that was issued predicated upon co: 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 Jamuary 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, Commencement of Services. All holders nditions expressed on the face of the Page3 of 8 that are consistent with the stated condition. The following information shall be provided in the holder’s annual compliance report: ]. The time period covered by the measures, 2. The measure for assessing compliance with each of the conditions jdentified 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 person and position responsible for supplying the compliance report; 6. Any other information for the agency to determine compliance with conditions; and 7. If applicable, the reason oT necessary 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 be modified consistent with Rule 59C- 1,019, F.A-C. eed Conditions. Health care providers found by the agency to be (5) Violation of Certificate of N in noncompliance with conditions set forth in their certificate 0: Rule 59C-1.021, FAC. f need shall be fined as defined in arrants imposition of the above-mentioned Fine 10. The foregoing violation w Amount pursuant to Florida Administrative Code Rule 59C-1.021 which provides in part: 59C-1.021 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), F.S., or the assessment of administrative fines for failure to comply with conditions placed on a certificate of need as specified under Rule 59C-1.013, F.A.C * (3) Penalties for Failure to Comply with Certificate of Need Conditions. The agency shall review who are licensed and operate the the annual compliance report submitted by the health care providers 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 eccupancy 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 re lative lack of severity of a particular failure. (b) The assessed fine shall be paid to the agency within 45 calendar days after written notification of assessment by certified mail or within 30 calendar days after final agency action if an administrative hearing has been requested. If a health care provider desires it may remit payment 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 later than 6 months after the health care provider has been notifie d 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. Page4 of 8 WHEREFORE, AHCA demands the following relief (1) enter factual and legal ose the above-mentioned Fine Amount for the findings as set forth in this Count; (2) imp violation; and (3) impose such other relief as this tribunal may find appropriate. NOTICE RESPONDENT is hereby notified that it has a right to request an administrative 120,569, Florida Statutes. Specific options for administrative ed Election of Rights (one page) and explained in the attached 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, Tallahassee, 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, A FINAL ORDER WILL BE ENTERED. hearing pursuant to Section action are set out in the attach cated on the below Certificate of Service. Tk Gatey. Bp. LW Timothy B- tt, 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 Submitted as of the date indi CERTIFICATE OF SERVICE ] HEREBY CERTIFY that a copy of the original Administrative Complaint, Explanation of Rights form, and Election of Rights forms have been sent by U.S. Certified Mail, Return Receipt Requested (receipt # 7004 1160 0003 3739 7715) to Respondent, Attention: Administrator, at the address stated in the above paragraph 6, this 15" day of June , [nil 8 Colt Timothy B-Ethott, Senior Attorney Page5 of 8 1 a AARNERARNI: Ao Poe ee rm EXPLANATION OF RIGHTS 0, > Er UNDER SEC. 120.569, FLORIDA STATUTES WH 2 9 (To be used with the attached Election of Rights form) pe A, bs I a ., « 9 the Administrative Complaint, jssied by)the “Agency”), Respondent miust.make’ ope from the date of receipt of the his matter must be received by he Administrative Complaint. fully executed to the allegations set forth in Care Administration (“AHCA” or of the following elections within twenty-one (21) days Administrative Complaint and your Election of Rights in t AHCA within twenty-one (21) days from the date you receive t Please make your election on the attached Election of Rights form and return it to the address listed on the form. In response Agency for Health If Respondent does not dispute the allegations in the Administrative Complaint and Respondent elects to waive the right to be heard, Respondent should select OPTION 1 on the election of rights form. A final order will be entered finding you guilty of the violations charged and imposing the penalty sought in the Complaint. You will be provided a copy of the final order. OPTION 1. If Respondent does not dispute any material fact alleged in the Administrative dent admits all the material facts alleged in the Complaint.), Respondent may aring pursuant to Section 120.57(2), Florida Statutes before the Agency. At Respondent will be given an opportunity to present both written and oral e penalty being imposed for the violations set out in the Complaint. For an PTION 2 on the Blection of Rights form. 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. In order to obtain a formal Section 120.57(1), F.S., Re the requirements in Section the material facts disputed. OPTION 2. Complaint (Respon request an informal he the informal hearing, evidence to reduce th informal hearing, Respondent should select O OPTION 3. proceeding before the Division of Administrative Hearings under spondent’s request for an administrative hearing must conform to 28-106.201, Florida Administrative Code (F.A.C), and must state LLY READ THE FOLLOWING PARAGRAPH: IF YOU SELECT OPT. 3 CAREFU. 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 plaint, a final order will be issued finding the deficiencies and/or Administrative Com violations charged and imposing the penalty sought in the Complaint. Page6of 8 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINI fg srration & Lys hf + of Port Saint Lucie Case No. 2005004331 7 bey Aan ° ; . 9 ite RE: Life Care Cente’ TS FOR ADMINISTRATIVE HEARING; ELECTION OF RIGH CT ONLY 1 OF THE 3 OPTIONS PLEASE SELE form is attached) (An Explanation of Rights OPTION_ONE_@) 9 Responden e allegations of fact contained in the Administrative Complaint and waives to object or to be heard. Respondent rder will be issued that adopts the understands that by waiving Respon Administrative Complaint and imposes the sanctions sought. 2) co Respondent does not dispute and Respondent admits the allegations of fact in OPTION TWO { ) the Administrative Complaint, but Respond afforded an informal proceeding, pursuant ermitted to submit oral and/or to Section 120.5 written evidence tot OPTION THREE (3) c Respondent and Respondent requests a formal hearing, pursua Administrative Law Judge appointe: f Administrative Hearings (“DOAH”). If Respondent chooses OPTION (3), in order to obtain a formal proceeding before the DOAH under Section 120.57(1), Florida Statutes, Respondent’s request for a 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. If you select Option 3, mediation may be available in this case pursuant to Section 120.573, Florida Statutes, if the Agency agrees to it. In order to preserve Respondent’s right to a hearing, Respondent’s Election of Rights in this matter must be received by AHCA within twenty-one (21) days from the date Respondent receives the Administrative Complaint. If the election of rights form with Respondent’s selected option is not received by AHCA within twenty-one (21) days from the date of the 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. has elected either OPTION (2) or THREE (3) above and if Respondent is interested _in ttlerent of this matter with the Agency, please also mark and check this block. 0 Mediation under Section 120.573 Florida Statutes, is not available in this matter. SEND NO PAYMENT NOW -- REGARDLESS OF THE OPTION SELECTED, PLEASE WAIT UNTIL RESPONDENT RECEIVES A COPY OF A FINAL ORDER FOR INSTRUCTIONS ON PAYMENT OF ANY FINES. (Please sign and fill in your cu t does not dispute th Respondent’s right dent’s rights, a final o he Agency in mitigation of the penalty imposed. { fact contained in the Complaint (1), Florida Statutes, before an If Respondent discussing a S€ rrent address.) Respondent (Licensee) _ Address: License. No. and facility type: Phone No. PLEASE RETURN YOUR COMPLETED FORM TO: Agency for Health Care Administration, Office of the General Counsel, Attention: Agency Clerk, 2721 Mahan Drive, Building 3, Mail Stop #3, Tallahassee, Florida 32308. Telephone Number: 850- 921-8177; FAX 350-922-5873; TDD 4-800-955-8771. Page7 of 8 Cf e S EXHIBITS (AHCA v. Life Care Center of Port Saint Lucie, Case No 2908604841),- — Respondent’s CON # 8975 containing the condition to provide a minimum of EXHIBIT “A” 66% of its total annual days for the 123 bed facility to Medicaid patients. EXHIBIT “B” - Respondent’s Annual Compliance Report, Calendar Year EXHIBIT “C” -F lorida Nursing Home Utilization Report for the Calendar Year (All are copies.) Pages of 8 an Gi ne 3 TTT TL 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 4992), AND Chapter 59C-1, Florida Administrative Code), the Agency for Health Care Administration certifies the need for this project. ae on TTA EP PEELE DOLE PEED PEPE TILL L LTE a y Ta TF ve NUMBER: 8975 APPLICANT: Life Care Centers of America, Inc. PROJECT COST:_ $251,645 3570 Keith Street, N.W. ISSUE DATE:_May 19, 1998 Cleveland, Tennessee 37320-3480 “May 19,1998 TERMINATION DATE:__November 18,1999 REVISED TERMINATION DATE: COUNTY: St. Lucie DISTRICT: SUBDISTRICT: 5 PROJECT DESCRIPTION: Add five community nursing home beds to CON #7555 (approved for 118 skilled nursing beds). This project involves no new construction or renovation. CONDITIONS: 4) A minimum of 66.0 percent of the 123 bed facility’s total annual patient days shall be provided to Medicaid patients; 2) A 20 bed Alzheimer’s unit shall b rovided; and 3) A 20 bed subacute unit shall be provided. FORM 1793, APRIL 1893 Dawe =e

Docket for Case No: 05-002329