Petitioner: AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent: THE HEALTH CENTER OF MERRITT ISLAND
Judges: R. BRUCE MCKIBBEN
Agency: Agency for Health Care Administration
Locations: Merritt Island, Florida
Filed: Aug. 28, 2007
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Thursday, November 1, 2007.
Latest Update: Dec. 22, 2024
STATE OF FLORIDA fh
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AGENCY FOR HEALTH CARE ADMINISTRATION Aug 29°
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STATE OF FLORIDA, AGENCY FOR “ARI Me
HEALTH CARE ADMINISTRATION,
Petitioner, Cage No. 2007006420
Va.
THE HEALTH CENTER OF MERRITT ISLAND, INC.
Respondent.
/
nee eel
ADMINISTRATIVE COMPLAINT
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 (2005)', and alleges:
NATURE OF THE ACTION
1. This is an.action to impose an administrative fine in ‘the amount of seven
thousand six hundred and ten dollars ($7,610) against Respondent, pursuant to Section
408.040, Florida Statutes, and Florida Administrative Code Rules 59C-1.013 and 59C-
1.021,
. 2. For the calendar year 2005, Respondent failed to comply witht te Medicaid
condition upon its Certificate of Need (“CON”), & copy of which is attached to this
complaint as Exhibit A.
‘Unless otherwise noted, all statutes and miles hereinafter cited are to the indicated year’s
version of the statute or rule because this is the controlling year in question.
1
EXHIBIT
JURISDICTION AND VENUE
3, This tribunal has jurisdiction over Respondent, pursuant to Sections 120.569
and 120.57, Florida Statutes, and also Sections 408.031- 408.045, 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 Statistes, and Chapter 59C-1, Florida
Administrative Code, AHCA is the licensing and epforcing 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 commimity nursing home located at 500 Crockett
Boulevard, Morritt Island, Florida 32953 and is the licensee on the CON issued on July 17,
1995, for the addition of 60 community skilled nursing beds to the existing 120-bed
Nursing Home, with the condition that a minimum of 47% of its 180-bed facility’s total
annual patient days shall be provided to Medicaid patients. The CON number is 7527; a
copy of the CON js attached to this complaint as Exhibit A.
COUNT I.
Respondent failed to meet its Medicaid condition
Section 408.040, Florida Statutes
Florida Administrative Code Rule 59C-1.013
Florida Administrative Code Rule 59C-1,02)
7. AFICA re-alleges paragraphs 1-6 above.
&. Respondent faiJed to comply with its Medicaid condition as reported to
the Agency in its Florida Nursing Home Utilization Report for the year 2005, 1 copy of
which is attached to this complaint as Exhibit B, and its facility report, a copy of which
js attached to this complaint as Exhibit C,
9, Respondent failed to comply with the condition set forth in its CON, as
required by Section 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 agenoy may issuo a certificate of need, or an exemption, predicated upon statements
of intent expressed by an applicant in the application for a cartificate of need. Any conditions
imposed on.a certificate of need or an exemption based on such statements of intent shall be stated on
the face of the certificate of need or in the exemption approval.
(b) The agency may consider, in addition fo 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 eligible for care under Title XIX of the Social Security Act. Any certificate of
need issued to a nursing home in reHlance upon an applicant's statements thet a specified percentage
of annual patient days will be utilized by residents eligible for care under Title XIX of the Social
Scourlty Act roust include a statement that such cortification ia a condition of issuance of the
certificate of need. The certificate-of-need program shall notify the Medicald program office and the
Department of Elderly Affairs when it imposes conditions ag authorized in this paragraph in an ares
in which a copumunity diversion pilot project is implemented,
(c) A certificate holder or an excmption holder may apply to the agency for a modification of
conditions imposod under paragraph (a) or paragraph (b), If the holder of a cextificate of need or’ an
exemption demonstrates good cause why the certificate or exemption should be modified, the agency
shall relsgue the certificate af need or exernption with such modifications as may be appropriate. The
agency shall by rule define the factors constituting good cause for modification,
(a) If the holder of a certificate of ueed or an exemption falls to comply with a condition
upon which tho issuance of the certificate or exemption was predicated, the agency may asaesa
an administrative fine against the certificate holder 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_account.as_mitigation, the depres of noncompliance,
penalties shall be deposited in the Public Medicaid Assistance Trust Fund,
aH
59C-1.013 Monitoring Procedures
(4) Reporting Requirements Subsequent to Licensure or Commencement of Services, All holders
of a certificate of need that was issued predicated upon conditions expressed on the face of the
certificate of need shall provide annual compliance reports to the agency, The reporting perlod shall
be January 1 through December 31 of each year, The holder of a certificate of nead who began
operation after January | will report from, the date operation began through December 31, The
compliance zeport shall ‘be submitted no later than April 1 of the subsequent yeor.
(a) The complisnce report will contain information necessary for an assessment of compliance
with conditions on the oertificate of necd, 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, Tha thme perlod coveted by the measures; 2. The measure for
assessing compliance with each of the conditons 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 gencrate information about the conditions that’ were measured; 5. The
person end position responsible for supplying the compliance teport; 6. Any other information
necessary for the agency to determine compliance with conditions; and 7. If applicable, the Teagan, oF
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. . a -
(b) A change in the licensee for 2 facility or service does not affect the obligation for that facility
on service to continue to mest conditions imposed on a cortificate of need and to provide annual
-¢ondition compliance reports, .
(c) Conditions imposed on a certificate of need way be modified consistent with Rule 59C-
1.015, F.A.C.
(5) Violation of Certificate of Need Conditions. Health care providers found by the agenoy to be
in noncompliance with conditions set forth in thelr certificate of need shall be fined as defined in
Rule 59C-1.021, F.A.C. ,
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 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 assesament of
administrative fines for failure to comply with conditions placed on a certificate of need as specified
under Rule 59-1013, FA.C
WOOK
(3) Penalties for Failure to Comply with Certificuto of Need Conditions. Tho agency shall review
the annual compliance report submitted by the health care providers wha are licensed and operate the
facilities ot 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
cotamunity 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 tho
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
asgeased a fine, not to exceed $1,000 per failure per day. In aggessing the penalty the agency shall
toke into account the degree of noncomiplimec,”
(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
admitistrative hearing has been requested, If a health care provider desires it may remit payment
according to 0 payment schedule accepted by the agency, The health care provider must submit the
schedule of payments te the agency within 30 calendar days after the date of receipt of the
notification of assessment or 2) calendar days afier final agency action. The final balance will be duc
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
noncompliance,
CLAIM FOR RELIBE
WHEREFORE, tho State of Florida, Agency for Health Care Administration,
respectfully requests that the Court order the following relief against Respondent:
(A) Make factual and legal findings in favor of the Agency on Count J;
(B) Recommend an administrative fine against Respondent in the amount of seven
thousand six hundred and ten dollars ($1,000) for Count I, pursuant to Section 408.040, Florida
Statutes;
(C) Assess attorney's fees and costs; and
(D) Grant all other general and equitable relief allowed by law.
Respondent is notified that it has a right to request au administrative hearing
pursuant to § 120.569, Fla. Stat. (2006), Specific options for administrative action are set.
outin the attached Election of Rights form, All requests for hearing shall be made to the
attention of Richard Shoop, Agency Clerk, Agency for Wealth Care Administration, 2727
Mahan Drive, MS #3, Tallahassee, Florida 32308, ,
if you want to hire au attorney, you have the right to be represented by an
attorney in this matter.
RESPONDENT JS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST A HEARING —
WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF
THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE
AGENCY.
r B . Moore, Esq.
Florida Bar # 0768715
Agency for Health Care Administration
2727 Mahan Drive, MS #3
Tallahassee, Florida 32308
(850) 922-5873
CERTIFICATE OF SERVICE
LHEREBY CERTIFY thiat a true copy hereof has been sent by U.S. Certified Mail,
Retum Receipt No. 7004 2890 0000 5527 1206 to Owner The Health Center of Merritt Island,
500 Crockett Boulevatd, Meritt Island, Florida’3295afon this ['3* Gay of fuly, 2007.
Moore, Esquire
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THE HEALTH CENTER OF MERRITT ISLAND Up Se
CERTIFICATE OF NEED #7527
ASSESSMENT OF COMPLIANCE BO
‘The time period covered by the measures;
please see attached typed summary chart (Exhibit A) for jhe time perlad covered. (Column A)
The measure for assessing compliance of the conditions identified and described;
The measure for assessing compliance of fhe condition identified Is percent Medicaid of fofal
patient days, The formula is as follaws:
Medicald Tofal Days
% Medicaid of Total Patient Days teewererencnannneon
Total Patient Days
Corresponds fo Summary Chart .
Column A = Time Petiod Covered
Column B = Medicaid Total Days
Column C = Total Patient Days
Column D = % Medicaid of Total Patient Days
AL41%= 24,482
57,121
Conditioned to be at minimum of 47% Medicaid of Total Patient Days
Actual percentage of Medicald Days to Total Patient Days is 41.41%, which Is less than the
required 47%. The referenced CON is therefore In not in compliance with the measure In the
sitictest sense, but we belleve the project Is in technical compliance with the spirit and Intent of
the condition, Please see response to Question Nine.
The way In which the condiilons were evaluated by applying the measures;
If the percent Medicaid of Total Patient Days fs equal fo or grecter than the measute for
assessing compliance of the condition (see Question 2 for method), then compliance has been
_ met, Please see altached Exhibit A.
Data was taken from a computer generated sheet (Exhibit B) which are altached hereto, and
placed on the aftached summaty chart. Two lIne items, with headings Medicaid SNF and
Medicaid NF, were totaled together and are found on the separate summary chart (Exhibit A}
under the tifle MEDICAID PATIENT DAYS, per month, The data found under the chart title TOTAL
PATIENT DAYS (Exhibit A) can be found under the heading TOTAL DAYS on a monthly basis.
The actual data sources used to generate the Information an the conditions that were
measured,
Please see the attached computer generated data fables (Exhibit B). Rows lilled Medicaid SNF,
Medicald NF and TOTAL DAYS have been summarized on a chart by month, and follow the
majhod stated in Questlon 2 fa report compliance.
The source of the data for the measure;
The Health Genter of Merritt Island, Inc., lessee and/er management entity of the referenced
CON, internal report’ entitled "Census Summary of Patient Days” prepared by the factlily
bookkeeper on a monthly basis as part of a financial report which is patient specific. Data -
recorded Is beised on revenue as paitents are approved by payor source. Some revenue may
be retroactive, :
The reasonableness of the measures and the confidence in tha measures;
The measure is both reasonable and one which allows confidence in assessing compliance
with the assigned condition, As can be seen from Question twa (2), the measure Is a
stralghiforward ratio of Medicaid Tatal Days qo Total Patient Days. We are confident that this is a
reasonable way to evaluate Percent Medicaid of Total Patient Days.
Checks and balances are that payment ts received-on the jurnaround documents and clalm
forms. Dafa is done on a case by case basis. Hospital Cost Containment Reports are prepared
off these reports. The report used also matches our Medicaid and Medicare reports. Therefore,
we feel the data is reasonable dnd accurate and one in which the confidence level Is
extremely high. ;
The person and position responsible for defining the measures dnd supplying the compliance
report;
Steven A. Strawn, Director for The Health Center of Mettift Island, Inc., and the Authorized
Representative for the referenced license and Cettificate of Need holder,
Any other Information necessary to determine compliance with conditions; and, None
It applicable, the recison of reasons, with supporting data, why the certificate of néed holder
was undble to mest the conditions set forth on the face of the certificate of need.
“The Héalth Center of Menttt Island- does-not-diseriminate..cgainstpatlents on any grounds
Including and not limited to payor source. The center warks closely with the area hospitals and
physicians to accommodate all referrals they may have. Because of our high census we
frequently do not have bed availabllity for patients regardless of payor source. However, we
do work with area discharges planneis to assist hem when they have patients to place
regardless of our vacancies.
Please note that according to the latest Florida Nursing Home Utilization by Disitict and
Subdistrict, July 2004 to June 2005, p.101, the occupancy rate in District/Subdistrict 7/1 was
92.28%, and our center occupancy rate was 72.15%. Based on Ilcensecl community beds of
2,629 and the average census of 72.28%, an average of 2,424 beds were occupied on any
given day. Consequently, that means that 203 beds were also unoccupied in (Brevard Caunty}
the Subdistrict during the same period of time on any given day. Thus, for calendar year 2005,
access fo nursing home beds did not appear to be an Issue In this Subeisirict,
Ag the cgency states In Its publication eniltled Florida Nursing Hame Bed Need Projections by
District and Subdistrict, 10/07/05, “The Legisiature finds that the continued growih in the
Medlacid budget for nursing home care hag consiralned the ability of the state to meet the
needs of its elderly residents through the use of less restrictive and less insittutlonal methods of
long-term care. It Is therefore the Intent of the Leglstature to limit the Increase In Medicald
nursing home expenditures in order to provide funds to Invest in long-term care that Is
cornmunity-based and provides supportive services In o manner that is both more cast-
atfective and more In keeping with the Wshes of the elderly residents of this state."(p.3, AHCA
FL Nursing Home Utilization, July 2004 ~ June 2005),
Lastly, this facility fs located in ¢ County which Is part of the Siute of Florida, Department of Elder
Affairs, Long-Term Care Community Diversion Program. “The objective is to provide frail elderly
with safe, appropriate community based care altematives In lleu of nursing home placement af
a cost less than Medicaid nursing home care.” (Department of Elder Affairs website) The CARES
unit at the Department of Elderly Affair determines the Individuals that meet the criterla to
receive services. This program by fis very nature, fs designed to reduce the number of
admissions and therefore, patlent days that nursing centers might have previously provided.
Please see alfached documentation about the Long-Term Care Community Diversion Program
In summary, patient admissions are based on need and not payor source. Given that fact and
the clear Legislative directive to reduce reliance on nursing homes dnd support community
based services, it would seem the current state of census utilzation would seer encouraging
fo the agency, Furthermore, the Inabllity ta serve Medicaid patients In the nursing home setting
due to lack of demand allows Madicald budget dollars to be Used in a fashion more in concert
with current Legislative direction. 0
If the agency requires any addtional Information or support as to why the center has not met
Its condition, please do not hesitate to contact The Health Center of Merttt Island, Inc. os we
woue be glad to provide any backup ovallable to document our operations and compliance
efforts.
January
February
March
April
May
June
July
August
September
October
November
December
TOTAL
THE HEALTH CENTER OF MERRITT ISLAND
FISCAL YEAR 12/37/05
% OF
MEDICAID TOTAL MEDICAID
PATIENTDAYS PATIENT DAYS PATIENT DAYS
2,104 5,020 41.85
1,898 4,710 40.30
2,104 5,208 40,34
2,009 5,110 30.32
2,189 5,249 44,70
2,115 4,721 44.80
2,028 4,764 42,46
2,005 4,876 44.13
1,874 4,909 38.17
2,034 4,749 42,77
2,027 4,830 41.97
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Docket for Case No: 07-003939
Issue Date |
Proceedings |
Dec. 03, 2007 |
Final Order filed.
|
Nov. 01, 2007 |
Order Closing File. CASE CLOSED.
|
Oct. 30, 2007 |
Motion to Remand Case to the Agency for Health Care Administration filed.
|
Sep. 17, 2007 |
Order of Pre-hearing Instructions.
|
Sep. 17, 2007 |
Notice of Hearing (hearing set for January 4, 2008; 9:00 a.m.; Merritt Island, FL).
|
Sep. 05, 2007 |
Joint Response to Initial Order filed.
|
Aug. 29, 2007 |
Initial Order.
|
Aug. 28, 2007 |
Petition for Evidentiary Hearing filed.
|
Aug. 28, 2007 |
Order of Dismissal without Prejudice Pursuant to Section 120.569(2)(c), Florida Statutes, to Allow for Amendment and Resubmission of Petition filed.
|
Aug. 28, 2007 |
Letter to M. Bittman from R. Shoop regarding receipt of Petition for Hearing filed.
|
Aug. 28, 2007 |
Modification of Condition on Certificate of Need filed.
|
Aug. 28, 2007 |
Administrative Complaint filed.
|
Aug. 28, 2007 |
Amended Request for Evidentiary Hearing filed.
|
Aug. 28, 2007 |
Notice (of Agency referral) filed.
|