:.. f ;·: 4r ,
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
j I ,u L , I.., •
/ ij·ICA
AG E L Y CLER
B.E.F., INC. d/b/a OAK BLUFFS HEALTH CENTER,
vs.
Petitioner,
PROVIDER NO.: 203823
ENGAGEMENT NO.: NH05-112C
RENDITION NO.: AHCA- /1 - 015.(, -5-MDA
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRA TION,
Respondent.
I
FINAL ORDER
THE PARTIES resolved all disputed issues and executed a settlement agreement, which
is attached and incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED.
-
DONE AND ORDERED this 2916 day of in Tallahassee, Leon County, Florida.
uqusl '2014,
ELIZ , SECRETARY
Agency for Health Care Administration
Page 1 of3
Filed September 2, 2014 3:39 PM Division of Administrative Hearings
ENGAGEMENT NO.: NH05-l 12C
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 BYLAW, 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:
R. Bruce McKibben Administrative Law Judge
Division of Administrative Hearings The DeSoto Building
1230 Apalachee Parkway
Tallahassee, Florida 32399-3060
David C. Jones
Assistant Secretary of B.E.F., Inc., d/b/a Oak Bluffs Health Center 420 Bay Avenue
Clearwater, Florida 33756
Email address: djones@tjmproperties.us
Debora E. Fridie, Assistant General Counsel Office of the General Counsel, MS #3
Zainab Day, Audit Administrator
Bureau of Medicaid Program Analysis, MS #21 Bureau of Finance & Accounting, MS #14
Page 2 of3
ENGAGEMENT NO.: NH05-112C
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order was furnished by United States Mail, interoffice mail, or email transmission to the above-referenced addressees this 2t:L2y of -2014.
RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3
Tallahassee, Florida 32308
Telephone No. (850)-412-3630
Fax No. (850)-921-0158
Page 3 of3
STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
B.E.F., INC. d/b/a OAK BLUFFS HEALTH CENTER,
Petitioner,
PROVIDER NO.: 203823
ENGAGEMENT NO.: NH05-112C
vs.
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
Respondent.
:/
SETTLEMENT AGREEMENT
The Respondent, Agency for Health Care Administration ("AHCA" or ''Agency"), and the Petitioner, B.E.F., Inc., d/b/a Oak Bluffs Health Center ("PROVIDER"), stipulate and agree as follows:
This Agreement is entered into between the parties to resolve disputed issues arising from audit engagement NH05-l 12C.
The PROVIDER is a Medicaid provider, Provider Number 203823, in the State of Florida operating a nursing home facility, which was audited by the Agency.
In audit engagement number NH05-112C, AHCA audited the PROVIDER'S cost
report for B.E.F., Inc., d/b/a Oak Bluffs Health Center, Provider Number 203823, covering the period ended September 30, 2003.
In its subsequent Audit Report, a copy of which is attached as Exhibit A, AHCA notified the PROVIDER that Medicaid reimbursement principles required adjustment of the costs stated in the cost report. The Agency further notified the PROVIDER of the adjustments AHCA was making to the cost report.
Page I of5
Oak Bluffs Health Center v. AHCA. NH05-l l 5C Settlement Agreement
In response to the Audit Report, the PROVIDER filed a timely petition for administrative hearing and identified specific adjustments that it appealed.
Subsequent to the filing of the petition for administrative hearing, AHCA and the PROVIDER exchanged documents and discussed the disputed adjustments. As a result of the aforementioned exchanges, the parties agree to accept all of the Agency's adjustments that were subject to these proceedings as set forth in the Audit Report, a copy of which is attached as Exhibit A and incorporated by reference herein, except for the following changes:
Adjustment 1 Interest Expense NRP is reduced to zero.
Adjustment 3 Interest Expense - Mortgage is reduced to zero.
In order to resolve this matter without further administrative proceedings, the PROVIDER and AHCA expressly agree to the adjustment resolutions, as set forth in paragraph 6 above, completely resolve and settle this case and this agreement constitutes the PROVIDER'S withdrawal of its petition for administrative hearing, with prejudice.
The PROVIDER and AHCA further agree that the Agency shall recalculate the per diem rates for the above-stated audit period and issue a notice of the recalculation. Where the PROVIDER was overpaid, the PROVIDER will reimburse the Agency the full amount of the overpayment within thirty (30) days of such notice. Where the PROVIDER was underpaid, AHCA will pay the PROVIDER the full amount of the underpayment within forty-five (45) days of such notice.
Payment shall be made to:
AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid Accounts Receivable-Mail Stop 14 2727 Mahan Drive, Building 2, Suite 200
Tallahassee, Florida 32308
Page 2 of 5
Oak Bluffs Health Center v. AHCA. NH05-l l 5C Settlement Agreement
Notices to the PROVIDER shall be made to:
Oak Bluffs Health Center 420 Bay Avenue
Clearwater, Florida 34616
Payment shall clearly indicate it is pursuant to a settlement agreement and shall reference the audit/engagement number and the Medicaid provider number.
PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute the PROVIDER'S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to the PROVIDER for any Medicaid claims.
Either party is entitled to enforce this Agreement under the laws of the State of Florida; the Rules of the Medicaid Program; and all other applicable federal and state laws, rules, and regulations.
This settlement does not constitute an admission of wrongdoing or error by the parties with respect to this case or any other matter.
Each party shall bear their respective attorney's fees and costs, if any.
The signatories to this Agreement, acting in their respective representative capacities, are duly authorized to enter into this Agreement on behalf of the party represented.
The parties further agree that a facsimile or photocopy reproduction of this Agreement shall be sufficient for the parties to enforce the Agreement. The PROVIDER agrees, however, to forward a copy of this Agreement to AHCA with original signatures, and understands that a Final Order may not be issued until said original Agreement is received by AHCA.
Page 3 of 5
Oak Bluffs Health Center v. ARCA, NH05- l l 5C Settlement Agreement
This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida.
This Agreement constitutes the entire agreement between the PROVIDER and AHCA, including anyone acting for, associated with, or employed by them, respectively, concerning all matters and supersedes any prior discussions, agreements, or understandings: There are no promises, representations, or agreements between the PROVIDER and AHCA other than as set forth herein. No modifications or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties.
This is an Agreement of settlement and compromise, recognizing the parties may have different or incorrect understandings, information and contentions, as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information, and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof.
The PROVIDER expressly waives in this matter their right to any hearing pursuant to §§120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or rules of the Agency regarding these proceedings and any and all issues raised herein, other than enforcement of this Agreement. The PROVIDER further agrees the Agency shall issue a Final Order which adopts this Agreement.
This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it.
Page 4 of 5
Oak Bluffs Health Center v. AHCA. NH05-l l 5C Settlement Agreement
To the extent any provision of this Agreement is prohibited by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement.
This Agreement shall inure to the benefit of and be binding on each party's successors, assigns, heirs, administrators, representatives, and trustees.
B.E.F., INC., D/B/A
OAK BLUFFS HEALTH CENTER
AGENCY FOR HEALTH CARE ADMINISTRATION
2727 Mahan Drive, MS #3
Tallahassee, Florida 32308
BY:
JUSTINM.
Deputy Secretary, Medicaid
Date:
-" e_•/_J_1
-1---l.
, 2013
Date: --- 9.--/-10-1 , 2013
/
//
/
</ :_....-
- /
BY/4. ··.. - STUART . WILLIAMS
General Counsel
1 '
BY l(_(l (;r/\.,l_olu
D ORA E. FRIDIE
Assistant General Counsel
Date: frV5 v S: f- < g' , 2013
Page 5 of 5
'
--·-- · --• .ll'iff"t'
B.E.F.JNO.
D/B/A OAK BLUFFS aEALTH CENTER MEDIOAID EXAMINATION REPORT YEAR ENDED SEPTEMBER 30, 2003
B.E.F. INO.
D/B/A OAK BLUFFS HEALTH GENTER MEDIOAID EXAMINATION REPORT YEAR ENDED SEPTEMBER 30, 2003
TABLE OF CONTENTS.
Page
Independent Accountants' Report. 1 - 2
Scfi dul'es:
Schedule of Costs·············•............................................................................................_ 3
Schedule of Charges 4
Schedule of Statistics and Equity Capital. 5
Schedule of Allowable Medicaid Costs....................................................................................................................i................i 6
Schedule of Fair Rental Value System Data.................: ............................................· 7
Schedule of Direct .Patient Care"'...-·--·.........-...........---...-..............................··••"'I•--- ••••.••" .......■ - -------·-...-·· 8 - 11 .
Notes to Schedules.........................................................................................................· 12
Attachment A:
Adjustments ................................................................................................•..................·. .....13 - 18
CFRI JPIED PUBLIC ACCOUNTANTS & CONSlJL111NTS
Independent Accountan.ts' Report
Secretary
Agency for Health Care Administration:
We have examined the schedules and statis1ical data, as listed in the Table of Contents, which were derived from the Cost Report for Florida Medicaid Program Nursing Home Service Providers (the "Cost Report") of B.E.F. Inc. d/b/a Oak Bluffs Health Center, (the "Provider"), for the year ended Sep1ember 30, 2003. These schedules and statistical· data are the responsibility of the Provider's management. Our responsibility is to express an opinion on the schedules and statistical data based on our examination.
Except ·as discussed in the following paragraph, our examination was made in accordance with standards established by the American Institute of Certified Public Accountants and, accordingly, Included examining on a test basis: evidence supporting the accompanying schedules and statistical data and performing .such other procedures as we considered necessary in the circumstances. We believe that our examination provides a reasonable basis for our opinion. ·
The Provider Is reimbursed under the Fair Rental Value System ("FRVS"). Accordingly, property cost information for depreciation, Interest and rent included on the Schedul!3 of Costs, equity capital information on the Schedule of Statistics and Equity Capital, capital replacement and equity In capital assets Information on the Schedule of Fair Rental Value System Data and related per diem information on the Schedule of Allowable Medicaid Costs have not been subjected to examination procedures.
Attachment A to this report includes adjustments which, in our opinion, should be recorded in order for.the data, as reported, in the accompanying schE)dules for the year ended September 30, 2003, to be presented in conformity with federal and state Medicaid reimbursement principles as described In Note 1. To quantify the effect of.the required adjustments, we have applied the adjustments as described in Attachment A to the amounts and statistical data, as reported, in tlie accompanying schedules. ·
In our opinion,·except for the effects of such adjustments as might have been determined to be necessary ha9 amounts and data described in the third paragraph above been examined, and for the effects of not recording adjustments as discussed In the pre dlng paragraph, the accompanying schedules and stc.1tistical data listed In the Table of Content present, in all material respects, the amounts and statistical data derived from the Gast Report of B.E.F. Inc. d/b/a Oak Bluffs Health Center, for the. year ended September 30, 2003, in conformity with federal and state Medicaid reimbursement principles as described in Note 1.
This report is intended solely for the information and use of the State of Florida's Agency for Health Care Administration and management of B.E.F. Inc. d/b/a Oak Bluffs Health Center, and is not intended to be and should not be used by anyone other than these specified ·parties. ·
Orlando, Flqrida
June 27, 2005
B.E.F.INO.
D/B/A OAK BLUFFS HEALTH GENTER SOHEDULE OF OOSTS
YEAR ENDED SEPTEMBER 30, 2003
As | Increase | As |
Reeorted | (Decrease} | Adjusted |
Cost Center Totals
Costs to be allocated:
Plant operation $ 75,700 $ $ 75,700
Housekeeping 110,707 1101707
Administration owner's admlnlstraliv compensation | 610,443 | (41_,867) | 468,676 |
510,443 | {41,867} | 468,676 | |
6961850 (411867} 6541983 Allowable ancillary cost centers: | |||
Physical therapy . | 60,471 | 80.471 | |
Speech therapy | 32,423 | 32,423 | |
Occupational therapy | 67,161 | 67,161 | |
Audlologlcal therapy | |||
Medlcal supplies | 16,008 | 16,008 | |
Other | |||
1861407 186,407
Patient care costs:
176,063 176,063
Nursing | 1,419,413 | 1,419,413 | |
Dietary Oxygen | 426,609 | 426,609 | |
Other | 104,543 104,643 | ||
1,950,565 | 11950,565 | ||
Laundry and linen costs | 38,036 | 381036 | |
Proparty costs: Depreciation (not exam'ined) | 45,661 | 45,661 | |
Interest on property (not examined) | 10,964 | 30,636 | 41,600 |
Rent on property (not examined) Insurance on property | 34,746 | (21,124) | 13,622 |
Taxes on property | 3,207 | 3,207 | |
Horne office property
94,578 1, 9,512 104,090
Nonallowable ancillary cost centers:
Radiology 7,146 7,146
Lab
Pharmacy 6,722 6,722
Other
12,868 12,868
Other nonreimbursal;>le cost centers:
Beauty and barber 6,615 6,615
Gift Shop Clinic Other
6,61'5 6,615
Total operating costs 2,975,575 {32,355) 2,943,220
Medicaid bad debts
Totaloosts $ 2,975,575 $ (32,355} $ 2,943,220
The accompanying notes are an 3 NHO5•1120
Integral part of this schedule. 20382-3
B.E.F.INO.
D/B/A OAK BLUFFS HEALTH CENTER
SCHEDULE OF CHARGES
YEAR ENDED S.EPTEMBER 30, 2003
As | Increase | As |
Reeorted | {Decrease} | Adjusted |
Usual and customary daily rate· $ 151.59 $ $ 151.59
Patient Charges:
Medicaid:
Ancillary cost centers: | |||
Physlcal therapy Speech therapy Occupational therapy | $ | $ | $ |
Audiological therapy Medical supplies | 16,499 | 15,499 | |
Other Room and board | 1,674,542 | 11574!542 | |
Totals | 1,590,041 | - | 1,590,041 |
Medicare:
Ancillary cost centers:
Physical therapy 209,698 209,598
Speech therapy 140,592 140,692
Occupational therapy 289,988 289,988
Audlologlcal therapy
Medical supplies 8,944 8,944
Other ·
Room and Board 351,135 351,135
Totals 1,000,257 1,000,257
Private and other; Ancillary cost centers:
Physical therapy 2,485 2,485
Speech therapy 75 75
Occupational therapy 1,472 1,472
Audiological therapy
Medical supplies 24,197 24,197
Other 1,898 1,898
Room and board 1,010,7f2 1,010,712
Totals 1,040,839 1,040,839
Total charges $ 31631,137 $ $ 3,631,137
The accompanying notes are an integral part of tb!s schedule.
4 NHO5•1120
20382-3
B.E.F. IN(l.
D/B/A OAK BLUFFS HEALTH CENTER SGHEDULE OF STATISTl{lS AND EQUITY CAPITAL
YEAR ENDED SEPTEMBER 30, 2003
As
Reported
Increase
{Decrease)
As Adjusted
Statistics:
Number of beds
60 60
Patient days: · | |||
Medicaid | 10,647 | 10,647 | |
Medicare | 2,271 | 2,271 | |
PrJvate and other 6,866 6,866 · | |||
Total patient days | 19,784 | 19,784 | |
Percent Medicaid | 63,82% | 0.00% 63.82% | |
Facility square footage: | |||
Allowable anclllary cost centers: | |||
Physical th rapy | 114 | 6 | 120 |
Speech therapy | 114 | 6 | 120 |
Occupational therapy | 113 | 7 | 120 |
Audiological therapy | |||
Medical supplies 28 | 87 | 115 | |
Patient care 14,800 | 373 | 15,173 | |
Laundry and linen 714 | (479) | 235 | |
Radiology | |||
. '
I
I
;I
:i
Other
=qulty Capital (not examined}: Ending equity capital Average equity capita/ · Annual rate of return
Return on equity before apportionment
$ (708,694)
$
4.052%
$
$ $ (708,694)
$ =$=====-=
(2.701)% 1.351%
$ ..,.$,_========
{pe of ownership:
ate cost report accepted:
Private Non-Profit
May 10, 2004
1e aceompanyln&r notes are an
:agralpart of this schedule.
5 NH06-1l2C
20382-3
B.E.F. ING.
D/B/A OAK BLUFFS HEALTH GENTER
SCHEDULE OF ALLOWABLE MEDICAID COSTS | |||
YEAR ENDED SEPTEMBER 30, 2003 | |||
Total Costs: | Cost After | ||
Cost As | Allocations & | Allocatlons & | |
Reimbursement Class Adjusted | Aeeortionment | Aeeortlonment | |
Operating | $ 693,019 | $ (342,934) | $ 350,085 |
Patient Care | 2,126,628 | (1,071,811) | 1,054,817 |
Property (not examined) | 104,090 | (48,073) | 56,017 |
Nonrelmbursable 19,483 1,462,818 1,482,301 | |||
Totals (Page 3) | 2,943,220 | 2,943,220 | |
Return on Equity (not examined)
Non-Medicaid
Totals $ 21943,220 $ $ 2,943,220
Allowable Ml'ldlcald Costs:
As Reimbursement Class Reeorted | Increase As (Decrease} Adjusted | ||
Operating | $ 371,209 | $ (21,124) | $ 350,085 |
Patient care | 1,054,789 | 28 | 1,054,817 |
Property (not examined) Return on Equity (not examined) | 50,893 | .. 5,124 | 56,017 |
Totals | $' | 1,476,891 | $ {1s,912l $ 1,460,919 |
Allowable Medicaid Per Diem Costs:
R,elmbursement Clas.s
As Increase As Reported (Decrease} Adjusted
Opt?ratlng | $ 34.87 | $ (1.99) | $ 32.88 |
Patient care | $ 99.07 | 99.07 | |
Property (not applicable ff reimbursed under FRVS) (not examined) | $ 4.78 | 0.48 | 5.26 |
Return on Equity (not examined) |
Initial Medicaid per diem (Note 3) $ 138.72 $ ,1.s1i $ 137.21
The accompanying notes are an Integral part of tb1s schedule.
6 NHO5-1120
20382·3
B.E.F.INC.
D/B/A OAK BLUFFS HEALTH GENTER SOHEDULE OF FAIR RENTAL VALUE SYSTEM DATA
YEAR ENDED SEPTEMBER 30, 20D3
As | Increase | As |
Reported | (Decrease) | Adjusted |
Capital Additions and Improvements:
Acquisition costs:
10/01/2002 - 12/31/2002 $ $ $
01/01/2003 - 06/30/2003
07/01/2003 - 09/30/2003
Totals $ $ $
Original loan amount $ $ $
Retirements $ $ $
Capital Replacements (not examined}:
Acquisition costs
10/01/2002 - 09/30/2003 $ 38,095 $ $ 381095
Original loan amount $ $ $
Pass-through costs (Note 4):
-
Acquisition:
10/01/2002 09/30/2003
Depreciation $ $ .$
interest
Prior to 10/01/2002 Depreciation Interest
Totals $ $ $
Equity in Capital Assets (not examined):
Ending equity In capital assets $ {2,623,853} $ $ {2,523,853}
Average equity In capital assets $ $ $
Annual rate of retur.n 4.052% (2.701}% 1.351%
Return on equity In capital assets
before apportionment $ $ $
Return on equity in apltal assets
apportioned to Medicaid $ $ $
Mortgage Interest B9te:
10/15/2092 | 1.66% | Variable |
04/15/2003 | 1.85% | Variable |
The accompanying notes are an
Integral part of this schedule.
7 NH05-112G
20382-3
B.E.F.INO.
D/B/A OAK BLUFFS HEALTH GENTER SCHEDULE OF DIRECT PATIENT OARE YEAR ENDED SEPTEMBER 30, 2008
As Reeorted | Increase {Decrease} | As Adjusted | |||
RN Data | |||||
Productive $alarles | $ 176,632 | $ | (1,084) | $ | 174,448 |
Non-Productive Salaries | 4 702 | 1,084 5,786 | |||
Total Salaries | $ 180,234 | $ $ 180,234 | |||
FICA | $ 13,313 | $ | $ 13,313 | ||
Unemployment Insurance | 412 | 412 | |||
Health Insurance | 2,735 | 6,323 | 9,058 | ||
Workers Compensation | 10,384 | 10,384 | |||
Other Fringe Benefits 1,109 1 109
Total Benefits $ 27,953 $ 6,323 $ 34,276
prodUctf\le Hollrs 8,101 (50) 8,051
Non-Productive Hours 240 68 298.
Total Hours 8,341 8 8,349
LPN Data
Productive Salaries $ 176,426 $ (1,126) $ 175,300
Non-Productive Salaries 10,963 1126 12,089
Total Salaries $ 187,389 $ $ 167,389
FICA | $ 13,001 | $ 700 | $ 13,701 |
Unemployment Insurance | 637 | 637 | |
Health Insurance | 7,231 | 2,186 | 9,417 |
Workers Cqmpensation | 10,796 | 10,796 |
Other Fringe B r,efits 760 643 1 403
Total Benefits $ 32.425 $ 3,529 $ 35,954
Productive Hours 10,661 (899) 9,762
Non-Productive Hours 693 60 753
Total Hours 11,354 (839) 10,615
CNAOata
Productive Salaries | $ 617,873 | $ 10,767 | $ 528,630 |
Non-Productive Salaries | 49,300 | (10,767} | 38,543 |
Total Salaries $ 567,173 $ $ 567,173
...
FICA $ 42,948 $ (1,478} $ 41,470
Unemployment Insurance 2,821 (520) 2,301
Health Insurance 26,031 · 2,473 28,604
Workers Compensation 32,677 32,677
Other Fringe Benefits 4,151 4,151
Total Benefits $ 108,628 $ 475 $ ·109,103
Productive Hours 47,457 (448) 47,009
Non-Productive Hours 4284 (465} 31799
Total Hours 51,741. (93 50,808
The aecompan notes are an
integral part of tbJs schedule.
8 NH05·U20
20382-3
B.E.F.IN0.
DIB/A OAK BLUFFS HEALTH CENTER SCHEDULE OF DIRECT PATIENT CARE YEAR ENDED SEPTEMBER 30, 2003
Agenpy Data
RN LPN CNA
Total Agency Costs
61,445 61,445
As Reeorted | Increase (Decrease) | As Adjusted | |||
$ | 23,420 | $ | $ | 23,420 |
$ 84,865 $ $ . 84,865-
RN
LPN
CNA
Total Agency Hours
820 820
3 671 3,671
4,491 4,491
Pediatric Offset • RN Data
Productive Salaries Non-Productive Salaries | $ | $ | $ | |
Total Salaries | $ | $ | $ | |
Productive Hours Non-Productive Hours | ||||
Total Hours | ||||
Pediatric Offset • LPN Data
Productive Salaries
Non-Productive Salaries
Total Salaries
$ $ $
$ $ $
Productive Hours
Non-Productive Hours
Total Hours
Pediatric Offset • CNA Data
Productive Salaries Non-Productive Salaries
Total Salaries
$ $
$ $ $
Productive Hours
Non-Productive Hours
Total Hours
Pediatric Offset -Agency Data
RN LPN | $ | $ | $ | |
CNA. | ||||
Total Agency Costs | $ | $ | $ |
RN LPN CNA
Total Agency Hours
The accompanying notes are an
integral part of tbls schedule.
9 NH05-112G
20382-3
B.E.F. INC.
DIB/A OAK BLUFFS HEALTH GENTER SCHEDULE OF DIRECT PATIENT CARE YEAR ENDED SEPTEMBER. 30, 2003
·.,
As Increase As
Reported (Decrease) Adjusted
AIDS Offset'• RN Data | |||
Productive Salaries | $ | $ | $ |
Non-Productive Salaries |
|
|
|
Total Salaries | $ | $ | $ |
Productive Hours
Non-Productive Hours
Total Hours
AIDS Offset • LPN Data
Productive Salarfes $ $ $
Non-Productive Salaries
Total Salaries $ $ i
Productive Hours
Non-Productive Hours
Total Hours
AIDS Offset • CNA Data
Productive Salaries $ $ $
Non-Productive Salaries
Total Salaries ! $ $
Productive Hours
Non-Productive Hours
Total Hours
AIDS Offset -Agency Data
RN $ $ $
LPN
CNA
Total Agency Costs $ $
RN LPN CNA
Total Agency Hours
Data for All Departments
Total Salaries $ 1,356,292 $ $ 1,356,292
FICA $ 99,168 $ $ 99,168
Unemployment Insurance 5,502 5,502
Health Insurance 68,162 68,162
Workers Compensation 58,678 58,67B
Other Fringe Benefits 101158 10,158
Total Benefits $ 241,668 $ $ 241,668
The accompanying notes are an
Integral part of this schedule.
10 NH05·112C
20382·3
B.E.F.INO.
D/B/A OAK BLUFFS HEALTH GENTER SOHEDULE OF DIREGT PATIENT OARE YEAR ENDED SEPTEMBER 30, 2003
Patient Days Data
As
Reported·
Increase (Decrease)
As
Adjusted
Medicaid Patient Days | 10,647 |
| 10,647 |
Total Patient Days | 19,784 |
| 19,784 |
The accompanying notes are an Integral part of this schedule.
11 NH05-ll2C
20382-3
B.E.F.JNC.
D/B/A OAK BLUFFS HEALTH GENTER NOTES TO SCHEDULES
YEAR ENDED SEPTEMBER 30, 2003
Note 1 - Basis of Presentation
. The. Schedules listed in the Table of Contents, which were derived from the Cost Report for· Florida Medicaid Program Nursing Home Service Providers (the "Cost Report") for the applicable period, have been prepared In conformity with federal and state Medicaid reimbursement principles, as specified in the State of Florida Medicaid Program and as defined by applicable cost and reimbursement principles, policies and regulations according to Medicare principles of reimbursement as interpreted by the Provider Reimbursement Manual (CMS Pub. 15-1), Florida Title XIX Long-Term Care Reimbursement Plan and the policies and procedures manuals for Nursing Home Services of. the .Agency.for Health. Care Admlnistration.olthe .State of FlorJda.
The balances in the . "As Reported" columns of the schedules are the assertions and responsibility of the management of nursing home. The balances in the "As Adjusted" columns are the result of applying the adjustments reflected in the "lncrease/(Decrease)" columns to th balances In the "As Reported'' columns. ·
Note 2 Allocations and Apportionment
Schedules ·G, G-1 and H of the Cost Report allocate allowable administration, plant operation and housekeeping costs to allowable and nonallowable·ancillary, patient care, laundry and linen
. and nonreimbursable cost centers based on predetermined statistical bases, such a_s square footage or total costs, as explained in the Cost Report. These schedules then apportion allowable costs after allocations to the Medicaid program based o·n other statistical bases, such as patient days or ancillary charges, as explained in the Cost Report. The net effect of such allocations and apportionment on each reimbursement class is presented In the Schedule of Allowable Medicaid Costs.
Note 3 - Initial Medicaid Per Diem
Medicaid per diem costs for property and return on equity have been calculated under the provisions of the Florida Title XIX Long-Term Care Reimbursement Plan, excluding fair rental value provisions. The effect, if any, of the fair rental value system, will be detennined during the rate setting process, and where applicable, prospective rates will be calculated by applying Inflation factors, incentives, low utilization penalties and reimbursement ceilings.
..,
Note 4 - Caplt,al Replacement Pass-through Costs
Capital replacement pass-through costs in the form of depreciation and Interest are presented without regard to the n!Jmber of years remaining, if any, to full fair rental value system phase-in. Accordingly, _pass-through reimbursement will be calculated based on amounts equal to or l_ess than fifty percent of the costs presented herein as capital replacement pass-thr(?ugh costs. Once full fair rental .:value system phase-in has occurred, no capital replacement costs are allowed to be passed-through.
12 NH05-1120
20382-3
B.E.F.INO.
D/B/A OAK BLUFFS HEALTH CENTER ATTACHMENT A - ADJUSTMENTS YEAR ENDED SEPTEMBER 30, 2003
Classlfication A,dJustments to Costs (Page 3) | Account Number | Comment | Increase {Decrease} |
Administration: | |||
1. Interest Expense • Non-Related | ·730907 | To reclassify interest expense to the proper, | |
Party | cost center. (Sections 200 and 2302.8, CMS Pub 15-1) | $ (30,636) | |
2. General and Professional Llablllty | 730810 | To adjust to amount supported by provider. (Section 2304, CMS Pub 15-1) | (11,231) |
(41,867) | |||
Property Costs: | |||
3. Interest Expense - Mortgage | 930320 | To reclassify Interest expense to the proper | |
cost center. (Septions 200 and 2302.8, CMS | |||
Pub 16-1} | 30,636 | ||
4. Insurance on Property | 93091'0 | To disallow costs related to the ACLF. | |
(Section 2304, CMS Pub. 15-1) | (21,124) | ||
9,512 | |||
Net Adjustment to Costs | $ (32,355) |
Adjustments Affecting S_chedule Direct Patient Care {Pages 8 11}
B Pmdy,tive Sala[les:
Productive Salaries To reclassify orientation salaries from productive to non-productive. (Florida Title XIX
Long-Term Care Reimbursement Plan "
Section V.B.) $ {1,084}
RN NQn-Prnductive Salaries:
Non-productive Salaries To reclassify orientation salaries from productive to non-productive. (Florida Title XIX
Long-Term Care Reimbursement Plan "
Section V.B.) $ 1,084
RN Health Insurance:
Health Insurance To adjust health insurance to amounts supported by the Provider. (Florida Title XIX Long-Term Care Reimbursement Plan -
Section V.B.) $ 6,323
NHO5-1120
13 20382·8
B.E.F.JNC..
D/B/A OAK BLUFFS HEALTH GENTER ATTACHMENT A· ADJUSTMENTS YEAR ENDED SEPTEMBER 30, 2003
Classification
Account
Number Comment
Increase (Decrease)
. .
Adlustments Affecting Schedule Direct Patient Care (Pages 8 -11) continued
RN Productive Hours:
Productive Hours To reclassify orientation hours from productive to non-productive. (Florida Title XIX Long Term Care Reimbursement Plan - Section V.B.)
(50}
RN Non-Productive Hours:
· Non-productive Hours
Non-productive Hours
LPN Productive Salaries:
To adjust hours to amounts supported by provider• (Florida Title XIX Long-Term Care Reimbursement Plan - Section V.B.)
To reclassify orientation hours from productive to non-productive. (Florida Title XIX Long Term Care Reimbursement Plan - Section V.B.}
8
50
58
Productive Salaries To reclassify orientation salaries from productive to non-productive. (Florida Title XIX Lon.g-Term Care Reimbursement Plan· -
Section V.B.) $ (1,126)
LPN Non-Productive Salaries:
Productive Salaries To reclasslfy orientation salaries from
productive to non-producUve. (Florida Title XIX Long-Term Care Reimbursement !='Ian -
Section V.B.) $ 1,126
LPN FICA:
FICA To adjust FICA to amounts supported by the Provider. (Florida Title XIX Long-Term Care
Reimbursement Plan - Section V.B.) $ 700
LPN Health Insurance:
.
Health Insurance To adjust health insurance to amounts supported by the Provider. (Florida Title XlX .
Long-Term Care Reimbursement Plan
Section V.B.) $ 2,·186
NB05-1120
14 20382·3
B.E.F.INO.
DfBIA OAK BLUFFS HEALTH OENTER ATTACHMENT A·ADJUSTMENTS YEAR ENDED SEPTEMBER 30, 2003
Classification
Account
Number Comment
Increase (Decreasel_
AdJustments Affecting Schedule Direct Patient Care {Pages 8 • 11) continued
LPN Qther Fringe Benefits:
Other fringe benefits
LPN Productive Hours:
Productive Hours
To adjust other fringe benefits to amounts supported by the Provider. (Florida Title XIX Long-Tern, Care· Reimbursement Plan -
Section V.B.) _$ 6_4_3_
To adjust hours to amounts supported by
provider• (Florlda Titre· XIX Long-Term Care
Productive Hours
LPN Non-Productive Hours:
Non-productive Hours
Non-productive Hours
CNA Productive Salaries;
Reimbursement Plan - Section V.B.)
To reclasslfy orientation hours from productive to non-productive. {Florida Title XIX Long Term Care Reimbursement Plan - Section V.B.)
To adjust hours to amounts supported by provider. (Florida Title XIX Long-Term Care Reimbursement Plan• Section V.B.)
To reclassify orientation hours from productive to non-productive. (Florida Tltle XIX Long• Term Care Reimbursement Plan - Section V.B.)
(8_31)
(68)
(899)
(8)
68
60
Productive Salarles
Productive Salaries
To adjust salaries to amounts supported by
provider• (Florida Title XIX Long-Term Care Reimbursement Plan- Section V.B.) $ 15,665
To reclassify orientation salaries from productive to non-productiv.e. (Florida Title XIX Long-Term Care Reimbursement Plan -
Section V.B.) {4,908)
$ 10,757
NH05-112C
15 . .20382-3
B.E.F.INO.
D/B/A OAK BLUFFS HEALTH CENTER ATTAOBME T A·ADJUSTMENTS YEAR ENDED SEPTEMBER 30, 2003
Classification
Account
Number Comment
Increase
(Decrease)
Adlustments Affecting Schedule Direct Patient Care {Pages 8 -11) continued
CNA Non-Productive Salaries:
Non-productive Salaries
Non-productive Salaries
To adjust salaries to amounts. supported by provider . (Florida· Title XIX Long-Term Care Reimbursement Plan• Section V.B.) .
To reclassify orientation salaries from productive to non-productive. (Florida Title XIX Long-Term Care Reimbursement Plan •· Section V.B.}
$ (15,665)
4,908
$ (10,757)
CNAFICA:
FICA To adjust FICA to amounts supported by the Provider. (Florida Title XIX Long-Term Care
Reimbursement Plan - Section V.B.) $ {1.478)
CNA Unemployment Insurance:
Unemployment Insurance To adjust unemployment insurance to amounts supported by the Provider. (Florida Title XIX Long-Term Care Reimbursement Plan -
Section V.B.) $ {520}
CNA Health Jnsuran_ce:
-
Health Insurance To adjust health Insurance to amounts supported by the Provider. (Florida Title XIX Long-Term Care Reimbursement Plan
Section V.8.) $ 2,473
CNA Productive !::!gur§;
Productive Hours To reclassify orientation hours from productive to non-productive. (Florida Title XIX Long- Term Care Reimbursement Plan - Section
V.B.) {448}
NB05-112C
16 20382·3
.
'
.. ,,. .•{•.'! ... ,·_ ·· --'---' :.:,::=/:·.: ·:.-"-·,_·'_.·'--'--·•-'"'•.'--'--··· ·· "'...: ' '; •"--.c'' ":.;..''--'-' ·-·--•:<..;, "' · --· -· -. :-.•,',
B.E.F.INC.
D/B/A OAK BLUFFS HEALTH CENTER ATTACHMENT A· ADJUSTMENTS YEAR ENDED BEPTEMJJER 30, 2003
Account
Classlflcatlon Number Comment
Increase
{Decrease)
Adjustments Affecting Schedule Direct Patient Care (Pages 8 -11) concluded
CNA Non-Productive Hours:
Non-productive Hours
Non-productive Hours
To· adjust hours to amounts supported by provider . (Florida Trtle XIX Long-Term Care Reimbursement Plan - Section V.B.)
To reclassify orientation hours from productive to non-productive. (Florida Title XIX Long Tenn Care Reimbursement Plan . Section V.B.)
(933)
448
(485)
Adjustments Affecting Statistics {Page 5)
Square Footage:
Physical Therapy
Speech Therapy
Occupational Therapy
Medical Supplies
Patient Care Costs
Laundry and Llnl:ln Costs
To adjust the statistical basis for cost'allocation based on audited data. (Section 2304, CMS Pub 15-1)
To adjust the statistical basis for cost allocation based on audited data. (Section 2304, CMS Pub 15-1)
To adjust the statistical basis for cost allocation based on audited data. (Section 2304, CMS Pub 15-1)
To adjust the statistical basis for cost allocation based on· audited data. (Section 2304, CMS Pub 15-1}
To adjust the statistical basis for cost allocation based on audited data. (Section 2304; CMS Pub 15-1)
To adjust the statistical basis for cost allocation based on audited data. (Section 2304, CMS Pub 15-1)
6
6
7
87
373
(479)
Net Adjustment to Square Footage
NH05-1120
17 20982-3
B.E.F. INO.
D/B/A OAK BLUFFS HEALTH CENTER ATTACHMENT A· ADJUSTMENTS YEAR ENDED SEPTEMBER 30,2003
The fofowlng adjustments reported In the Schedule of Fair Rental Value System Data are In accordance with the fair rental value system provisions of the Florida Tille XIX Long Term Care Reimbursement Plan and, where appropriate; the applicable sections of Chapters 100, Depreciation, and 2300, Adequate Cost Data and Cost Finding, of the Provider Reimbursement Manual (CMS Pub 15 1). The Provider has been furnished with schedules developed during the course of the audit which detail allowable components of the fair rental value system.
Fair Rental Value System Data .
Classlficatr on
Increase
(Decrease)
Capital Additions and Improvements:
Acquisition Costs
Retirements
. Capital Replacements:
Acquisition Costs
Pass-through costs Equity In Caeltal Assets:.
Ending equity
. 6. Average equity
Return on equity before apportionment
Return on equity apportioned to Medicaid
$
$
$
$
$
$
$
$
18 NH05·1120
20382·3
"'-::·
·: ' '.-
r·.
SENDER: COMPLETE THIS SECTION
Complete Items 1; 2., lll19,3. Also complete
I Item 4 If Restrtoted Delivery Is deslMd.,
1 ■ Print your name and address on the reverse
1 ■ so that we can return the card to you.
1
Attach this card to the back of the-mallplece,
, or on the front lf'space permits.
: 1, Article Addressed to:
I
Oak Bluffs Health Center 420 Bay Avenue
: Clearwater, Florida
D. Isdelivery address different fromItem 1? □ Yee
lf YES, enter dellveiy addre&a below: □ No
□
Service lype
0□Certlfkld Mall Express·Mall . .
Insured Man □C.O.D. ·
□Registered □Return Receipt for Merohandh
Restrlcted Delivery? (Extra Fee) □ Yee
1 153D ccx::p4acp l;>
1 2. Artlcle Number · · ·
! (11amferfroin Mtvlc:elsbeO /Xi) cQj
l PS Form 3811, February 2004 Domestic Return e'c pt··
I •
| Issue Date | Proceedings |
|---|---|
| Sep. 02, 2014 | Agency Final Order filed. |
| Sep. 07, 2006 | Order Closing File. CASE CLOSED. |
| Jul. 27, 2006 | Order Granting Continuance (parties to advise status by August 25, 2006). |
| Jul. 26, 2006 | Notice of Appearance (filed by W. Melvin, Jr.). |
| Jul. 26, 2006 | Joint Motion to Continue filed. |
| Jul. 20, 2006 | Notice of Transfer. |
| Jun. 06, 2006 | Order of Pre-hearing Instructions. |
| Jun. 06, 2006 | Notice of Hearing (hearing set for August 1, 2006; 9:00 a.m.; Tallahassee, FL). |
| May 26, 2006 | Joint Response to Initial Order filed. |
| May 18, 2006 | Initial Order. |
| May 17, 2006 | Notice of Audit Adjustments filed. |
| May 17, 2006 | Petition for Administrative Hearing filed. |
| May 17, 2006 | Notice (of Agency referral) filed. |
| Issue Date | Document | Summary |
|---|---|---|
| Sep. 02, 2014 | Agency Final Order |
