STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED"

Transcription

1 STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Villa Maria Nursing and Rehabilitation Center, Inc./CON # N.E. 125 th Street North Miami, Florida Authorized Representative: Mr. Gene Nelson Health Strategies, Inc. (850) Service District/Subdistrict District 11, Subdistrict 1 (Miami-Dade County) B. PUBLIC HEARING A public hearing was not held or requested on the proposed project which is to add 20 community nursing home beds to a skilled nursing facility (SNF) on the third floor of a 40-bed comprehensive medical rehabilitation (CMR) hospital (St. Catherine s West), with the latter being previously approved under CON #9722. The 20 community nursing beds are to be acquired through the delicensure of an equal number of community nursing home beds at St. Anne s Nursing Center. Letters of Support The Agency for Health Care Administration did not receive directly any letters of support for this project. However, in its application, Villa Maria Nursing and Rehabilitation Center, Inc. (Villa Maria and also Villa Maria West SNF) submits two letters of support from staff at St. Catherine s Rehabilitation Hospital. The applicant (Villa Maria) states that it is the license holder and operator of the 60-bed St. Catherine s Rehabilitation Hospital and also the 212-bed Villa Maria Nursing Center. The support letters from the latter facility are both signed with December 17, 2007 dates. One is from Miriam Feliz, MD, Medical Director at St. Catherine s Rehabilitation Hospital, in North Miami. This letter supports the establishment of a sub-acute inpatient rehabilitation unit within St.

2 Catherine s West Rehabilitation Hospital in the Hialeah Gardens area. It generally states a multi-disciplinary approach is needed to enhance medical care for those patients (at St. Catherine s West Rehabilitation Hospital under CON #9722). The other support letter is from Pedro Cardich, MD, Co-Medical Director at the same facility (St. Catherine s Rehabilitation Hospital). This letter supports the transfer of 20 skilled nursing beds to the new building, stating the transfer of 20 skilled nursing beds will enhance the services that the organization will be able to provide. No letters of opposition were received regarding this project. C. PROJECT SUMMARY Villa Maria Nursing and Rehabilitation Center, Inc. (CON #10008) (Villa Maria or Villa Maria West SNF) proposes to add 20 community nursing home beds to the third floor of a 40-bed comprehensive medical rehabilitation (CMR) hospital to be known as St. Catherine s West, through the delicensure of an equal number of community nursing home beds at St. Anne s Nursing Center, a SNF further toward the southern portion of Miami-Dade County, Florida. The CMR facility (St. Catherine s West) is still under construction, originally approved under CON #9722. The third floor SNF portion of St. Catherine s West is to be called Villa Maria West SNF. All these facilities are located in the Greater Miami area, District 11, Subdistrict 1, Miami-Dade County, with St. Catherine s West CMR and Villa Maria West SNF being co-located at 8850 N.W. 122 nd Street, Hialeah Gardens, Florida The project will not add any community skilled nursing home beds to the existing complement of such beds in the subdistrict. The project involves a combined total of 20,743 gross square feet (GSF) of new construction at a total construction cost of $6,653,092. The total cost of the project is $6,940,804. This includes building, project development, financing and start-up costs with land and equipment costs. The applicant proposes a single condition to the approval of the project. The condition is the following physical location of the facility: 8850 N.W. 122nd Street, Hialeah Gardens, Florida The sacrificing facility, 240-bed St. Anne s Nursing Center, is conditioned per CON #8158 to have a minimum of percent of total annual patient days provided to Medicaid patients. 2

3 D. REVIEW PROCEDURE The evaluation process is structured by the certificate of need review criteria found in Section , Florida Statutes. These criteria form the basis for the goals of the review process. The goals represent desirable outcomes to be attained by successful applicants who demonstrate an overall compliance with the criteria. Analysis of an applicant's capability to undertake the proposed project successfully is conducted by assessing the responses provided in the application, and independent information gathered by the reviewer. Applications are analyzed to identify strengths and weaknesses in each proposal. If more than one application is submitted for the same type of project in the same district (subdistrict), applications are comparatively reviewed to determine which applicant best meets the review criteria. Section 59C-1.010(2) (b), Florida Administrative Code, allows no application amendment information subsequent to the application being deemed complete. The burden of proof to entitlement of a certificate rests with the applicant. As such, the applicant is responsible for the representations in the application. This is attested to as part of the application in the Certification of the applicant. As part of the fact-finding, the consultant, Steve Love analyzed the application in its entirety with consultation from the financial analyst, Ryan Fitch, who evaluated the financial data, and the architect, Scott Waltz, who evaluated the architecturals and the schematic drawings as part of the application. E. CONFORMITY OF PROJECT WITH REVIEW CRITERIA The following indicate the level of conformity of the proposed project with the criteria and application content requirements found in Florida Statutes, sections , and ; applicable rules of the State of Florida, Chapter 59C-1 and 59C-2 and Florida Administrative Code. 3

4 1. Fixed Need Pool a. Does the project proposed respond to need as published by a fixed need pool? Or does the project proposed seek beds or services in excess of the fixed need pool? ss. 59C-1.008(2), Florida Administrative Code. The Florida Legislature extended a moratorium until July 1, 2011 on the issuance of CONs for increases in the number of community nursing home beds around the state. Due to the moratorium, a fixed need pool was not published by the Agency and the number of community nursing home beds will remain constant statewide. The moratorium will allow the expansion of alternative and more cost-efficient programs. This project, if approved, will not impact the moratorium concerning total community nursing home beds. b. If no Agency policy exists, the applicant will be responsible for demonstrating need through a needs assessment methodology, which must include, at a minimum, consideration of the following topics, except where they are inconsistent with the applicable statutory or rule criteria: Population demographics and dynamics; Availability, utilization and quality of like services in the district, subdistrict or both; Medical treatment trends; and Market conditions. Population demographics and dynamics: District 11, Subdistrict 1 (Miami-Dade) is comprised of 52 licensed community nursing home facilities. As of July 1, 2007, District 11, Subdistrict 1 had a total of 7,998 licensed and 420 CON approved community nursing home beds. For the most recent reporting period, July 2006-June 2007, the licensed beds within the district experienced an average occupancy rate of percent and percent for the subdistrict. The table below illustrates the annual utilization of the applicant s St. Anne s Nursing Center (the facility set to have 20 community nursing home beds delicensed and then transferred to the proposed site), the subdistrict and the district: 4

5 Annual Utilization Total for the Applicant s Sacrificing Facility, Subdistrict 1 and District 11 July 2006-June 2007 Patient Days Total Occup. Medicaid Days Medicaid Occup. Facility Bed Days St. Anne s Nursing Center, St. Anne s Residence, Inc. 87,600 85, % 51, % Subdistrict 1 2,917,722 2,668, % 1,747, % District 11 3,005,322 2,734, % 1,794, % Source: AHCA s publication of Florida Nursing Home Utilization by District and Subdistrict July 2006-June The above table shows that St. Anne s Nursing Center was highly utilized (above full capacity) for the period shown. St. Anne s Nursing Center is located approximately 23.6 miles from the proposed project location 1. The applicant anticipates a primarily elderly population in need of its services through this proposal. The applicant s primary service area (PSA) is within a seven-mile radius of the proposed site (8850 N.W. 122nd Street, Hialeah Gardens, Florida 33018). The applicant does not specify the zip codes that fall within its PSA; however, it names seven nursing homes within the PSA that will be within relative geographic proximity, at least within a seven-mile radius. It is noted here that due to the benefits listed below (largely co-location) the applicant does not foresee direct competition with any of the seven nursing homes it lists as within the seven-mile radius. These facilities are as follows: Fair Havens Center; Heartland Health Care Center - Miami Lakes; Hialeah Convalescent Home; Hialeah Shores Nursing & Rehab Center; Palmetto Rehabilitation & Health Center; Susanna Wesley Health Center and Waterford Rehab & Nursing Center. Below is a map with the project location and the nursing homes within a seven-mile radius of the project location. 1 Per MapQuest at 5

6 Microsoft MapPoint Legend #1. Proposed Villa Maria Nursing and Rehabilitation Center (Villa Maria West SNF) #2. Susanna Wesley Health Center #3. Palmetto Rehabilitation & Health Center #4. Hialeah Shores Nursing & Rehab Center #5. Hialeah Convalescent Home #6 Heartland Health Care Center - Miami Lakes #7. Waterford Rehab & Nursing Center #8. Fair Havens Center The utilization rates for these seven facilities ranged from a low of percent at Hialeah Shores Nursing & Rehabilitation Center to a high of percent at Fair Havens Center, with the latter having the highest total occupancy in the entire district. This was for the most recent reporting period (12 months ending June 30, 2007). Below is a table of the bed days, patient days, total occupancy and Medicaid occupancy rates of each facility. The applicant notes that it does not plan to seek 6

7 Medicaid certification (CON #10008, page 14) for the 20-bed proposed facility because of a planned short average length of stay (ALOS) less than 30 days. Annual Utilization Total for Planned PSA Seven Mile Radius Seven Nursing Home Facilities District 11; Subdistrict 1, Miami-Dade County July 1, 2006 June 30, 2007 Commun. Nursing Home Bed Total Inventory Bed Days Pt. Days Occupancy 7 Medicaid Occupancy Fair Havens Center ,185 97, % 70.82% Heartland Hlth Care Center - Miami Lakes , % 52.27% Hialeah Convalescent Home ,740 95, % 74.09% Hialeah Shores Nursing & Rehab Center ,800 35, % 78.87% Palmetto Rehabilitation & Health Center 90 32,850 31, % 47.03% Susanna Wesley Health Center ,800 40, % 65.33% Waterford Rehab & Nursing Center ,110 74, % 76.36% Seven PSA Facilities 1, , , % 69.10% Subdistrict 1 8,232 2,917,722 2,668, % 65.49% District 11 8,472 3,005,322 2,734, % 65.62% Source: AHCA s publication of Florida Nursing Home Utilization by District and Subdistrict July 2006-June The seven facilities within the applicant s PSA had a total occupancy rate higher than the average for the subdistrict and the district. The utilization rates for District 11, Subdistrict 1 (Miami-Dade County) for all facilities ranged from a low of percent at Berkshire Manor to a high of percent at Fair Havens Center (as previously shown). This was for the most recent reporting period as stated above, with the lowest, highest and St. Anne s Nursing Center bed days, patient days, total occupancy, Medicaid days and Medicaid occupancy rates shown below. Annual Utilization Total for Select Facilities District 11; Subdistrict 1, Miami-Dade County July 1, 2006 June 30, 2007 Bed Days Pt. Days Total Occupancy Medicaid Days Medicaid Occupancy Berkshire Manor 89,425 42, % 38, % Fair Havens Center 98,185 97, % 69, % Saint Anne's Nursing Center 87,600 85, % 51, % Subdistrict 1 2,917,722 2,668, % 1,747, % District 11 3,005,322 2,734, % 1,794, % Source: AHCA s publication of Florida Nursing Home Utilization by District and Subdistrict July 2006-June The applicant states that the elderly are the most likely seekers of its proposed services. According to the applicant (CON #10008, page 16, Table 1 PSA Historic and Projected Population), 2007 Claritas population data is showing that by April 1, 2010, the 65 to 74 age range population will grow at a rate of 4.7 percent while the 75+ age range

8 population will grow at a 7.1 percent rate. The same source indicates the 15+ age range population will grow at a 2.4 percent age range. The applicant uses this data to support its contention that the elderly (age 65 to 74 and 75+ age range) population is growing faster than the adult population age 15 and over. Villa Maria states that there is a need for a post-acute step-down unit for residents discharged from the inpatient rehabilitation setting but not yet well enough to return home (CON #10008, page 10). The applicant cites the following advantages should the proposal be approved. These include: the co-location with the CMR facility; effecting seamless patient transfer; improved continuity of care; minimizing transfer errors involving medical records and decompression at St. Anne s Nursing Center resulting in large common areas and more private rooms, due to conversion (some semi-private to private rooms at St. Anne s Nursing Center). Availability, Utilization and Quality of Like Services: As previously stated, the seven facilities within the applicant s PSA, had a total occupancy rate higher than the average for the subdistrict and the district during the 12-month period ending June 30, Based on the total occupancy, the facility that could make the most compelling argument that it has substantial availability would be Hialeah Shores Nursing & Convalescent Center (81.7 percent total occupancy for the period). Hialeah Shores reported a percent Medicaid occupancy rate for the period. The applicant previously stated it does not plan to seek Medicaid certification; therefore, the one facility (Hialeah Shores) mostly likely to have availability is not likely to be impacted to a large extent by approval of the project, as Villa Maria West SNF does not anticipate having any Medicaid patient days. Utilization was discussed above in detail. Although the above charts and reference (reported 2007 Claritas data), indicate that the elderly population will grow faster than the general adult population demand for community nursing home beds in the PSA is in all but one case above the district and subdistrict averages. St. Anne s Nursing Center also has a very high total occupancy relative to the subdistrict and district. The utilization data indicates that within the PSA, the majority of facilities are highly utilized and accept patients covered under Medicaid. The applicant does not contest the quality of like services among any of the seven facilities in the PSA (CON #10008, page 17). 8

9 Medical Treatment Trends: As stated previously, this application is in coordination with already approved CON #9722 (a 40-bed comprehensive medical rehabilitation [CMR] hospital St. Catherine s West Rehabilitation Hospital). St. Catherine s West Rehabilitation Hospital is to be a specialty CMR hospital. The applicant states that St. Catherine s West will also be an Inpatient Rehabilitation Facility (IRF). As an IRF, the facility from which the applicant plans to draw most of its patients must provide a minimum of 75 percent of their patient volume to Medicare cases, with a diagnosis of any one of 13 conditions (CON #10008, page 18). This minimum 75 percent patient population with a diagnosis/condition within any one of 13 federally mandated and approved illnesses or injuries is in compliance with 42 CFR (2)(b). St. Catherine s West Rehabilitation Hospital must meet the minimum of 75 percent rule by federal fiscal year ending September 30, The applicant holds that the project is an alternative to the federally mandated downward pressure on inpatient rehabilitation utilization, relatively high total occupancies at the nursing homes within its PSA, an increasingly growing elderly population and the continued state legislated moratorium on nursing home bed additions statewide. The applicant provides no local, regional or national trending or emerging evidence to support a skilled nursing facility (post-acute step-down unit) being co-located with a CMR facility for residents discharged from the inpatient rehabilitation setting. Characteristically, comprehensive medical rehabilitation patients are discharged to community settings (most typically home and less frequently to an assisted living facility). The applicant does not demonstrate that the introduction of a skilled nursing facility in this scenario would be warranted. Market Conditions: The applicant indicates that current market conditions discourage, due to unprofitable or excessively costly expenditures, the development of sub-acute care units within acute care hospitals. The applicant contends that certain benefits will result if the project is approved. As previously stated, some of these benefits include the following: the colocation with the CMR facility effecting seamless patient transfer; improved continuity of care; minimizing transfer errors involving medical records and decompression at St. Anne s Nursing Center resulting in large common areas and more private rooms, due to conversion (some semi-private to private rooms at St. Anne s Nursing Center). According to the applicant, these market conditions are less likely and less realized in the current environment. The applicant states these more favorable 9

10 circumstances are becoming less and less common due to changes in federal reimbursement rates and the proposal will help bring these benefits to fruition. Villa Maria also indicates it is already addressing the needs generated by existing and future market conditions and that the project will further expand the accommodation of these market conditions. 2. Agency Rule Preferences Does the project respond to preferences stated in Agency rules? Please indicate how each applicable preference for the type of service proposed is met. Chapter 59C , Florida Administrative Code. Chapter 59C of the Florida Administrative Code does not contain preferences relative to community nursing home beds nor does the Agency for Health Care Administration publish specific preferences for these facilities. However, the rule does contain standards the Agency utilizes in assessing the applicants ability to provide quality care to the residents. a. Geographically Underserved Areas. In a competitive certificate of need review within the nursing home subdistrict as defined in 59C-2.200, Florida Administrative Code, the agency shall award a certificate of need if the applicant meets all applicable criteria for a geographically undeserved area as specified in subsection (18), Florida Statutes (Florida Statutes), and if the applicant meets the applicable statutory certificate of need review criteria specified in section , Florida Statutes, including bed need according to the relevant bed need formula contained in this rule. If the applicant is awarded a certificate of need based on the provisions of this paragraph, the applicant shall agree that the nursing facility will be located in a county without a nursing facility, or in the center of an area within the subdistrict of a radius of at least 20 miles which meets the definition of a geographically undeserved area. The center of the geographically undeserved area shall be the proposed nursing home location in the application. The applicant is the sole applicant and this is not a competitive CON review. 10

11 b. Proposed Services. Applicants proposing the establishment of Medicare-certified nursing facility beds to be licensed under Chapter 400, Florida Statutes, shall provide a detailed description of the services to be provided, staffing pattern, patient characteristics, expected average length of stay, ancillary services, patient assessment tools, admission policies, and discharge policies. The applicant plans for Villa Maria West SNF to be a Medicare but not Medicaid-certified nursing home. According to the applicant, the facility will provide all services necessary to satisfy federal IRF requirements and also Center for Medicaid Services (CMS) requirements, pursuant to CMS 13 (CON #10008, page 18). St. Catherine s Rehabilitation Hospital plans to serve a minimum of 75 percent of its patient volume (by September 30, 2009) to Medicare cases treated for any one or a combination of 13 listed diagnoses. A total of 11 services are noted in the application, with five ancillary services (CON #10008, page #35). This minimum 75 percent patient population with a diagnosis/condition within any one of 13 federally mandated and approved illnesses or injuries is in compliance with 42 CFR (2)(b). The applicant encloses a series of policies and procedures (CON #10008, Tab 4) and a detailed description of its quality improvement program. Some of these address such topics as assessment tools, admission and discharge (CON #10008, page #36). Below is a representation of the applicant s Schedule 6 New Inpatient Health Care Facilities/Staffing Pattern. 11

12 Villa Maria West SNF Staffing Patterns For Year 1 and Year 2 of Operation Year 1 FTEs Year 1 Ending 9/30/09 Year 2 FTEs Year 2 Ending 9/30/10 ADMINISTRATION Administrator Director of Nursing Assistant Administrator Financial Services Receptionist Medical Records Coordinator Other (Community Liaison): TOTAL PHYSICIANS Unit/Medical Director TOTAL NURSING RN LPN Nurse s Aides Other: Unit Secretaries Other: MDS Coordinator Other: Indirect Licensed Other: Nursing Supervisors TOTAL ANCILLARY Physical Therapist Speech Therapist Occupational Therapist TOTAL DIETARY Dietary Supervisor Cooks Dietary Aides TOTAL SOCIAL SERVICES Social Service Director Social Worker Pastoral Care Other: Admissions Clerk TOTAL HOUSEKEEPING Housekeeping Supervision Housekeepers TOTAL LAUNDRY Laundry Supervisor Laundry Aides TOTAL PLANT MAINTENANCE Maintenance Supervisor Maintenance Assistance Security TOTAL GRAND TOTAL Source: CON #10008, Financial Schedule 6 12

13 In the notes to Schedule 6, the applicant states contractual services for the following: a consulting medical director; housekeeping; non-corporate legal and accounting services. Chapter , Florida Statutes, currently requires a minimum licensed nursing staffing of 1.0 hours of direct care for each resident per day and a minimum certified nursing assistant staffing of 2.9 hours of direct care for each resident per day. The calculations below are based on the applicant s proposed staffing from Schedule 6 and projected occupancy from Schedule 5 of the application. Villa Maria West SNF Minimum Staffing Requirements FTE Nurses/Aides Minimum Requirement 1 st Year Ending 9/30/09 2 nd Year Ending 9/30/10 Nurses 1.0 hours of direct care per resident 1.28 hours 1.27 hours Aides 2.9 hours of direct care per resident 3.00 hours 3.02 hours Sources: Schedule 5 & 6 of CON #10008 As shown in the above table, the applicant s projected staffing patterns exceed the minimum requirements outlined in Section (3)(a), Florida Statutes. Licensed nursing staff must be at least one per 40 residents and a minimum of one nurse aide for each 20 residents. The applicant s projections are in compliance with these requirements. The applicant projects an average length of stay (ALOS) of 26.6 days (CON #10008, page 35). Villa Maria West SNF patients are anticipated to be Medicare-eligible, needing neither three hours of therapy per day, nor daily physician care. These patients are expected to need a relatively short stay in a sub-acute setting for recovery sufficient to return home, as opposed to long-term care or other institutional care. Patient diagnoses are not utterly unlike those stated in CMS 13 (CON #10008, page 18) though some are different than stated under CMS 13, such as automobile accident victims, tracheotomy residents who have been stabilized and others. 13

14 c. Quality of Care. In assessing the applicant s ability to provide quality of care pursuant to s (1)[c], Florida Statutes, the Agency shall evaluate the following facts and circumstances: 1. Whether the applicant has had a Chapter 400, Florida Statutes, nursing facility license denied, revoked, or suspended within the 36 months prior to the application. The applicant has never had a nursing facility license denied, revoked, or suspended. 2. Whether the applicant has had a nursing facility placed into receivership at any time during the period of ownership, management, or leasing of a nursing facility in the 36 months prior to the current application. The applicant has never had a nursing facility placed into receivership. 3. The extent to which the conditions identified within subparagraphs 1 and 2 threatened or resulted in direct, significant harm to the health, safety, or welfare of the nursing facility residents. This provision is not applicable. 4. The extent to which the conditions identified within subparagraph 3 were corrected within the time frames allowed by the appropriate state agency in each respective state and in a manner satisfactory to the agency. This provision is not applicable. (4) (f) Harmful Conditions. The Agency shall question the ability of the applicant to provide quality of care within any nursing facility when the conditions identified in subparagraph (e) 1 and (e) 2 result in the direct, significant harm to the health, safety, or welfare of a nursing facility resident, and were not corrected within the time frames allowed by the appropriate state agency in each respective state and in a manner satisfactory with the Agency. This provision is not applicable. 14

15 (5) Utilization Reports. Within 45 days after the end of each calendar quarter, facilities with nursing facility beds licensed under Chapter 400, Florida Statutes shall report to the Agency, or its designee, the total number of patient days, which occurred in each month of the quarter, and the number of such days that were Medicaid patient days. The applicant states it will provide the required utilization data to the Agency, as required. The applicant elects to respond to additional criteria - the Health Care Access Criteria, as stated in Chapter 59C-1.030(2). Below are the applicant s volunteered responses. (a) The need that the population served or to be served has for the health or hospice services proposed to be offered or changed, and the extent to which all residents of the district, and in particular low income persons, racial and ethnic minorities, women, handicapped persons, other underserved groups and the elderly are likely to have access to those services. In its discussion of need and the history of its management partner (Catholic Health Services [CHS], sponsored by the Archdiocese of Miami) the applicant explains its reasoning. The applicant states a need for a post-acute step-down unit for residents discharged from the inpatient rehabilitation setting but not yet well enough to return home. It also stresses the benefit of co-location of the CMR with the SNF and contends that this produces better health care outcomes: more seamless patient transfer; improved continuity of care; fewer transfer errors and reduced travel time in transit between facilities. Villa Maria states medical trends and conditions are favorable for its proposal. The applicant quotes what it calls the CHS charitable admissions policy, To fulfill the mission of Catholic Health Services, each facility will be able to provide charity care to those truly in need who have proven their eligibility, based on the facility s operational and clinical ability to provide such care. 15

16 (b) The extent to which that need will be met adequately under a proposed reduction, elimination or relocation of a service, under a proposed substantial change in admissions policies or practices, or by alternative arrangements, and the effect of the proposed change on the ability of members of medically underserved groups which have traditionally experienced difficulties in obtaining equal access to health services to obtain needed health care. The applicant states this in not applicable as it does not anticipate the proposal will impact any of these criteria. (c) The contribution of the proposed service in meeting the health needs of members of such medically underserved groups, particularly those needs identified in the applicable local health plan and State health plan as deserving of priority. The applicant affirms that local health plans are no longer a part of CON review and neither are state health plans. However, the applicant anticipates that 100 percent of Villa Maria West SNF patient days will be Medicare-sponsored (including Medicare HMO) [CON #10008, page #54]. The applicant previously stated it does not intend to seek Medicaid certification. There is no commitment to a given Medicaid, indigent care or charity percentage to be served; however, it is stated that Villa Maria West SNF will provide services regardless of payer source, or in some instances, in light of the absence of a payer source. (d) In determining the extent to which a proposed service will be accessible, the following will be considered: 1. The extent to which medically underserved individuals currently use the applicant s services, as a proportion of the medically underserved population in the applicant s proposed service area(s), and the extent to which medically underserved individuals are expected to use the proposed services, if approved; Per the applicant, CHS, the umbrella management partner, attributed 26.2 percent of its gross revenues to Medicaid recipients (in fiscal year 2006 this is reported to be $19,592,000). The applicant also references Section E.3.g. 16

17 2. The performance of the applicant in meeting any applicable Federal regulations requiring uncompensated care, extent to which medically underserved individuals currently use the applicant s services, as a proportion of the medically underserved population in the applicant s proposed service area(s), and the extent to which medically underserved individuals are expected to use the proposed services, if approved; Per the applicant, this is not applicable. 3. The extent to which Medicare/Medicaid and medically indigent patients are served by the applicant; and There is no commitment from the applicant to a given Medicaid, indigent care or charity percentage to be served; however, it is stated that Villa Maria West SNF will provide services regardless of payer source, or in some instances, in light of the absence of a payer source. Schedule 7A projects of the project s patient days will be Medicare and Medicare HMO. The applicant references Section E.3.g. 4. The extent to which the applicant offers a range of means by which a person will have access to its services. As with questions 1 and 3 immediately above, the applicant again references Section E.3.g. (e) In any case where it is determined that an approved project does not satisfy the criteria specified in paragraphs (a) through (d), the Agency may, if it approves the application, impose the condition that the applicant must take affirmative steps to meet those criteria. The applicant states this is not applicable. (f) In evaluating the accessibility of a proposed project, the accessibility of the current facility as a whole must be taken into consideration. If the proposed project is disapproved because it fails to meet the need and access criteria specified herein, the Agency will so state in its written findings. The applicant states this is not applicable. 17

18 (4)(d) Proposed Services, (e) Quality of Care, and (f) Harmful Conditions. The applicant references Section E.3.b for this response. (5) Utilization Reports. Within 45 days after the end of each calendar quarter, facilities with nursing facility beds licensed under Chapter 400, Florida Statutes shall report to the Agency, or its designee, the total number of patient days, which occurred in each month of the quarter, and the number of such days that were Medicaid patient days. The applicant agrees to provide timely utilization reports. 3. Statutory Review Criteria a. Is need for the project evidenced by the availability, quality of care, efficiency, accessibility and extent of utilization of existing health care facilities and health services in the applicant's service area? ss (2), (7), Florida Statutes. The applicant summaries again the high utilization among existing nursing home facilities within the seven-mile radius (14-mile diameter) of the PSA and that few acute care hospitals provide skilled nursing units, due to changes in and less advantageous federal Medicare reimbursements. The applicant anticipates 100 percent of patient days to be compensated through Medicare and the applicant has previously stated a relatively higher percentage of elderly patients are projected to be in the PSA (using reported 2007 Claritas data). The applicant does not contest the quality of care provided at existing facilities that might be alternatives to its proposal. Villa Maria states that its major impetus is enhanced or improved continuity of care and improved quality in postacute step-down care for residents who have been discharged from a colocated inpatient CMR facility (CON #9722) who are not yet medically ready to return home. The project calls for delicensure of 20 community nursing home beds from St. Anne s Nursing Center, where plans are to convert some semiprivate rooms to private and enlarge existing common areas, as a result of this proposal, if approved. 18

19 b. Does the applicant have a history of providing quality of care and has the applicant demonstrated the ability of providing quality care? ss (3) (12), Florida Statutes. The applicant's designation as a Gold Seal Program nursing facility pursuant to ss , when the applicant is requesting additional nursing home beds at that facility. ss (10), Florida Statutes. The applicant includes current accreditation documentation for the Villa Maria Nursing Center and St. Catherine s Rehabilitation Hospital from the Joint Commission on Accreditation of Healthcare Organizations [JCAHO] in Tab 1 of the application. The applicant expects Villa Maria West SNF to also have JCAHO accreditation. The applicant also claims licensure by the Agency, to be in good standing with the Medicare and Medicaid programs and that it has never had a license denied, revoked or suspended, or had a facility placed in receivership. CON #10008, Tab 4 includes numerous policies that relate to the operations of Villa Maria Nursing Center. The first is entitled an Organizational Performance Improvement Plan. The applicant states that a governing board requires the monitoring, assessing and evaluating of resident safety, resident care and opportunities for improvement. Committees that relate to such topics as resident safety meet monthly to review data, evaluate results and plan improvements. Among others, a Risk Management Surveillance Team is also mentioned. An overall Performance Improvement Committee oversees and coordinates the subcommittees. Agency records indicate two confirmed complaints at Villa Maria Nursing Center, as of the three-year period ending January 14, The confirmed complaints are as follows: dietary (one) and resident rights (one). St. Anne s Nursing Center, St. Anne s Residence, Inc., as of the three-year period ending January 14, 2008 has three confirmed complaints. The confirmed complaints are as follows: plan of care (one), lack of assessment (one) and call lights (one). Villa Maria Nursing Center does not enjoy the state Gold Seal. As of the on-line run date of January 23, 2008, it had an Agency overall inspection rating of one of a possible five stars. St. Anne s Nursing Center has a two star rating and had a conditional license from May 14, 2007 through August 28, 2007 or for 11.6 percent of the time from July 23, 2005 to January 23, Both facilities presently have standard licenses. 19

20 c. What resources, including health manpower, management personnel and funds for capital and operating expenditures, are available for project accomplishment and operation? ss (6), Florida Statutes. This review is for Villa Maria Nursing and Rehabilitation Center, Inc., (also known as Villa Maria West SNF) applying to transfer 20 skilled nursing beds to the third floor of a 40-bed comprehensive medical rehabilitation hospital (CMR) in District 11, Miami-Dade County, Florida. The CMR facility is currently under construction and was approved in CON #9722. The 20 skilled nursing beds will be transferred from St. Anne s Nursing Center, an affiliated facility. The financial impact of the project will include the project cost of $6,940,804 and incremental year two operating costs of $2,824,573. The applicant is a not-for-profit Florida corporation established under the sponsorship of the Archdiocese of Miami. The applicant is a member of the Obligated Group which includes several affiliated Catholic Health facilities. The audited financial statements of the applicant for the periods ending September 30, 2005 and 2006 were analyzed for the purpose of evaluating the applicant s ability to provide the capital and operational funding necessary to implement the project. Short-Term Position: The applicant s current ratio of 1.3 indicates current assets are slightly greater than current obligations; this is below average and a moderately weak but adequate position. The working capital (current assets less current liabilities) of $1.3 million is a measure of excess liquidity that could be used to fund capital projects. The ratio of cash flow to current liabilities of 0.3 is below average and a weak position. Overall the applicant has a moderately weak but adequate short-term position. (See Table below). Long-Term Position: The applicant s long-term debt to net asset ratio of 3.0 indicates the applicant is highly leveraged. This is a weak position and may impair the applicant s ability to acquire future long-term debt at reasonable rates. The most recent year had $386,333 in operating income, which resulted in an operating margin of 1.3 percent. Overall, the applicant has a weak long-term position. (See Table below). 20

21 VILLA MARIA NURSING AND REHABILITATION CENTER, INC. 9/30/2006 9/30/2005 Current Assets (CA) $6,237,367 $5,141,598 Cash and Current Investment $1,913,906 $1,588,698 Beneficial Interest in Net Assets of Foundation $624,403 $611,528 Total Assets (TA) $19,574,280 $18,275,357 Current Liabilities (CL) $4,964,614 $3,847,600 Total Liabilities (TL) $15,894,355 $15,061,727 Net Assets (NA) $3,679,925 $3,213,630 Total Revenues (TR) $28,740,232 $26,766,659 Interest Expense (Int) $690,590 $577,279 Excess of Revenues Over Expenses (ER) $386,333 $822,346 Cash Flow from Operations (CFO) $1,367,465 $2,333,881 Working Capital $1,272,753 $1,293,998 FINANCIAL RATIOS 9/30/2006 9/30/2005 Current Ratio (CA/CL) Cash Flow to Current Liabilities (CFO/CL) Long-Term Debt to Net Assets (TL-CL/NA) Times Interest Earned (ER +Int/Int) Net Assets to Total Assets (NA/TA) 18.8% 17.6% Operating Margin (ER/TR) 1.3% 3.1% Return on Assets (ER/TA) 2.0% 4.5% Operating Cash Flow to Assets (CFO/TA) 7.0% 12.8% Capital Requirements: Schedule 2 listed capital projects totaling $25.9 million which includes $14.4 million for the 40-bed CMR approved in CON #9722. Available Capital: The applicant provided a copy of a bond-offering dated October 18, 2007, in the amount of $48.6 million. The bonds are secured by the Obligated Group of which the applicant is a member. The purpose of the proceeds in the bond offering includes a description of this project. As discussed above, the applicant has working capital of $1.3 million and $386,333 in operating income. In addition, cash flow from operations was $1.4 million. Staffing: Schedule 6 indicates, by September 30, 2009 (the first year of the proposed project), the applicant forecasts 25.8 FTEs as follows: administrator, director of nursing and assistant administrator (

22 FTEs each); financial services director (0.16 FTEs); receptionist (0.35 FTEs); medical records coordinator (0.17 FTEs); community liaison (0.48 FTEs); registered nurses [RNs] (1.5 FTEs); licensed practical nurses [LPNs], (2.0 FTEs); nurse s aides (8.2 FTEs); other nursing staff (3.03 FTEs); physical therapists (2.0 FTEs); speech therapists (0.8 FTEs); occupational therapists (0.5 FTEs); dietary supervisor (0.59 FTEs); cooks (1.06 FTEs); dietary aides (1.59 FTEs); social worker (1.0 FTEs); pastoral care (0.33 FTEs); admissions clerk (.24 FTEs); maintenance supervisor (0.33 FTEs) and security (0.5 FTEs). This total FTE count for the proposed site increases to 26.2 for year two (ending September 30, 2010) a difference of 0.92 FTEs. The FTEs remain the same in all categories except for the following changes: LPNs (2.2 FTEs); nurses aides (8.8 FTEs) and dietary aides (1.7 FTEs). In the notes to Schedule 6, the applicant asserts the staffing mix and FTEs are based on the experienced of management on operating other SNFs. The following are provided contractually: housekeeping; non-corporate legal and accounting services and a consulting medical director. The applicant claims support from Catholic Health Services (CHS), under the sponsorship of the Archdiocese of Miami, in the recruitment, training, compensation and employee relations of staff. The applicant further claims to attract local and regional candidates for many of the needed planned positions at the site. In order to meet the needs of the Spanish-speaking Northwestern Miami-Dade community, it plans to employ a large number of a bi-lingual candidates (English/Spanish). However, no target percentage is offered. It asserts that in 2002, CHS received the third highest job satisfaction score (third of 733 eligible organizations). The applicant does not state the geographic spread of these 733 organizations, how many were in Miami-Dade County, etc. or whether they were in the same or a like industry. It is further stated CHS was recognized by HR Solutions as being a cut above the rest but gives no further detail about this recognition and does not include a copy in its application. Conclusion: The applicant has secured funding for this project through a tax-exempt bond issue. In addition, funding for working capital should be available as needed. d. What is the immediate and long-term financial feasibility of the proposal? ss (8), Florida Statutes. This project is dependent on the development and profitable operation of the 40-bed CMR approved in CON #9722. Although the 40-bed CMR project was approved in CON #9722, the financial portion of the review 22

23 raised questions about the projected profitability. In addition, that review was completed back in late Therefore, the Agency reviewed the projected operations of both the 40-bed CMR and the 20 skilled nursing unit. A comparison of the applicant s estimates to the control group values provides for an objective evaluation of financial feasibility, (the likelihood that the services can be provided under the parameters and conditions contained in Schedules 7 and 8), and efficiency, (the degree of economies achievable through the skill and management of the applicant). In general, projections that approximate the median are the most desirable, and balance the opposing forces of feasibility and efficiency. In other words, as estimates approach the highest in the group, it is more likely that the project is feasible, because fewer economies must be realized to achieve the desired outcome. Conversely, as estimates approach the lowest in the group, it is less likely that the project is feasible, because a much higher level of economies must be realized to achieve the desired outcome. These relationships hold true for a constant intensity of service through the relevant range of outcomes. As these relationships go beyond the relevant range of outcomes, revenues and expenses may, either go beyond what the market will tolerate, or may decrease to levels where activities are no longer sustainable. The 40-bed CMR unit will be compared to Peer Group 18 (CMR Hospital Group). This group contains CMR hospital data reported with a fiscal year ending Per diem rates are projected to increase by an average of 3.3 percent per year. Inflation adjustments were based on the new CMS Market Basket, third Quarter, CMR Revenue: Projected net revenue per adjusted patient day (NRAPD) of $1,094 in year one and $1,129 in year two is between the median and highest values of $882 and $1,259 in year one and $905 and $1,292 in year two. With NRAPD between the median and highest values, the facility is expected to consume health care resources in proportion to the services provided. (See Table below). Based on the above, projected CMR revenues appear reasonable. Skilled Nursing Revenue: The applicant indicates that the skilled nursing facility beds will be used as a step down unit from the CMR hospital. Based on this, the applicant is projecting that 100 percent of it patient days will come from Medicare and that these patients would fall into the rehab patient category. Therefore, the Agency compared projected net Medicare revenue to the Medicare rehab RUG III utilization rates for Miami-Dade County. Projected net Medicare revenue per 23

24 adjusted patient day (NRAPD) of $394 in year one and $406 in year two approximate the median Medicare RUG III rehab category rates. (See Tables below). Skilled nursing facility revenue appears reasonable. MEDICARE RUG III REHAB CATEGORIES (Urban ) Values Adjusted for Inflation Projected $ $ Highest $ $ $ Median $ $ $ Lowest $ $ $ CMR Expenses: Anticipated costs per adjusted patient day (CAPD) of $976 in year one and $961 in year two is between the control group median and highest values of $812 and $1,137 in year one and $833 and $1,167 in year two. With CAPD falling between the median and lowest values, costs appear reasonable. (See Table below). Skilled Nursing Staffing: Section (3)(a)(2), Florida Statutes, specifies a minimum certified nursing assistant staffing of 2.9 hours of direct care per resident per day and a minimum licensed nursing staffing of 1.0 hour of direct resident care per resident day. Based on the information provided in Schedule 6, the applicant s projected certified and licensed nursing staffing exceeds the minimum level required in year two. Profitability: The skilled nursing facility operations are projected to add an incremental operating loss in year two of $428,972. As discussed above, this project is dependent on the profitable operations of the CMR facility. The year two operating profit for the CMR hospital (without the skilled nursing facility) of $1.95 million computes to an operating margin per patient day of $167 which is between the peer group median and highest vales of $108 and $251. The overall profitability of the CMR facility appears reasonable and appears sufficient to absorb the operating loss of the skilled nursing facility. 24

25 40-bed CMR ONLY REVIEW FOR USE IN CON #10008 Sep-10 YEAR 2 VALUES ADJUSTED 2006 DATA Peer Group 18 YEAR 2 ACTIVITY FOR INFLATION ACTIVITY PER DAY Highest Median Lowest ROUTINE SERVICES 30,218,508 2,587 1, INPATIENT AMBULATORY INPATIENT SURGERY INPATIENT ANCILLARY SERVICES 7,039, , OUTPATIENT SERVICES TOTAL PATIENT SERVICES REV. 37,258,390 3,190 3,553 1, OTHER OPERATING REVENUE TOTAL REVENUE 37,258,390 3,190 3,554 1, DEDUCTIONS FROM REVENUE 24,076,813 2, NET REVENUES 13,181,577 1,129 1, EXPENSES ROUTINE 3,750, ANCILLARY 3,519, AMBULATORY TOTAL PATIENT CARE COST 7,270, ADMIN. AND OVERHEAD 2,142, PROPERTY 1,815, TOTAL OVERHEAD EXPENSE 3,958, OTHER OPERATING EXPENSE TOTAL EXPENSES 11,228, , OPERATING INCOME 1,953, % PATIENT DAYS 11,680 ADJUSTED PATIENT DAYS 11,680 TOTAL BED DAYS AVAILABLE 14,600 VALUES NOT ADJUSTED ADJ. FACTOR FOR INFLATION TOTAL NUMBER OF BEDS 40 Highest Median Lowest PERCENT OCCUPANCY 80.00% 91.6% 58.5% 35.4% PAYER TYPE PATIENT DAYS % TOTAL SELF PAY % MEDICAID % 7.8% 2.6% 0.1% MEDICAID HMO 0 0.0% MEDICARE 8, % 82.1% 72.9% 38.0% MEDICARE HMO 2, % INSURANCE % HMO/PPO 0 0.0% 33.8% 16.1% 5.8% OTHER 0 0.0% TOTAL 11, % 25

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Helen Homes of South Dade, LLC d/b/a Homestead Manor A Palace Community/CON #10214

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED (813) 675-2341

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED (813) 675-2341 STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION: 1. Applicant/CON Action No. Greenbriar NH, L.L.C./CON #10215 4042 Park Oaks Boulevard, Suite 300 Tampa, Florida

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number University Plaza Rehabilitation and Nursing Center, Inc./ CON #10057 1800 NE 168

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Palm Court NH, LLC, d/b/a Wilton Manors Health and Rehabilitation Center/CON #10056

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2014

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2014 DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2014 CON REVIEW HR-RC-0514-006 THE MISSISSIPPI METHODIST HOSPITAL AND REHABILITATION CENTER, INC. D/B/A METHODIST REHABILITATION CENTER RENOVATION

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number SF Palm Beach, LLC/CON #10176 2 North Palafox Street Pensacola, Florida 32502

More information

MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT DECEMBER 2015

MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT DECEMBER 2015 MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT DECEMBER 2015 CON REVIEW HR-RC-1015-022 RENOVATION OF 6 th FLOOR, PATIENT AND NURSING AREA LOCATION: JACKSON,

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Plaza North, Inc. (CON #10417) 3023 N. Shannon Lakes Drive Tallahassee, Florida

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Fort Walton Beach Medical Center, Inc./CON #10093 1000 Mar-Walt Drive Fort Walton

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2013

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2013 DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2013 CON REVIEW MISSISSIPPI METHODIST HOSPITAL AND REHABILITATION CENTER, INC. d/b/a METHODIST OUTPATIENT REHABILITATION CONSTRUCTION OF CONSOLIDATED

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2011

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2011 DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2011 CON REVIEW: HG-RLS-1210-039 PATIENTS CHOICE MEDICAL CENTER LEASE/RELOCATION OF TEN CHEMICAL DEPENDENCY BEDS AND OFFERING OF ACUTE ADULT

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Manatee Memorial Hospital LP d/b/a Lakewood Ranch Medical Center/CON #10221 1424

More information

MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT JUNE 2016 STAFF ANALYSIS

MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT JUNE 2016 STAFF ANALYSIS MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT JUNE 2016 CON REVIEW HG-RB-0416-009 JACKSON HMA, LLC, D/B/A MERIT HEALTH CENTRAL EXPANSION OF PSYCHIATRIC BEDS

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2004

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2004 DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT AUGUST 2004 CON REVIEW INDEPENDENT HEALTHCARE MANAGEMENT, INC. DBA LACKEY MEMORIAL HOSPITAL CONSTRUCTION OF A REPLACEMENT HOSPITAL CAPITAL EXPENDITURE:

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Halifax Hospital Medical Center d/b/a Halifax Health Medical Center/CON #10101

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT JUNE 2003 STAFF ANALYSIS

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT JUNE 2003 STAFF ANALYSIS DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT JUNE 2003 THE NICHOLS CENTER CONSTRUCTION OF A 60-BED NURSING HOME REPLACEMENT FACILITY CAPITAL EXPENDITURE: $1,820,000 LOCATION: SUMRALL, MISSISSIPPI

More information

PREPARING FOR THE RETURN OF NURSING HOME CON PROCEEDINGS

PREPARING FOR THE RETURN OF NURSING HOME CON PROCEEDINGS Geoffrey D. Smith PREPARING FOR THE RETURN OF NURSING HOME CON PROCEEDINGS It s now old news that the Florida Legislature has lifted the 13-year moratorium on the Certificate of Need program for new nursing

More information

MISSISSIPPI DEPARTMENT OF HEALTH Division of Health Planning and Resource Development May 2007. Staff Analysis

MISSISSIPPI DEPARTMENT OF HEALTH Division of Health Planning and Resource Development May 2007. Staff Analysis MISSISSIPPI DEPARTMENT OF HEALTH Division of Health Planning and Resource Development May 2007 CON Review: HG-RC-0407-007 Southwest Mississippi Regional Medical Center Capital Expenditure: $8,597,238 Location:

More information

STATE HEALTH PLAN FOR FACILITIES AND SERVICES: ACUTE CARE HOSPITAL SERVICES. COMAR 10.24.10 Effective January 26, 2009

STATE HEALTH PLAN FOR FACILITIES AND SERVICES: ACUTE CARE HOSPITAL SERVICES. COMAR 10.24.10 Effective January 26, 2009 Marilyn Moon, Ph.D. CHAIR Rex W. Cowdry, M.D. EXECUTIVE DIRECTOR MARYLAND HEALTH CARE COMMISSION 4160 PATTERSON AVENUE BALTIMORE, MARYLAND 21215 TELEPHONE: 410-764-3460 FAX: 410-358-1236 STATE HEALTH PLAN

More information

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 A bill to be entitled An act relating to recovery care services; amending s. 395.001, F.S.; providing legislative intent regarding recovery

More information

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals United States Government Accountability Office Report to Congressional Requesters June 2015 MEDICARE PART B DRUGS Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

More information

SB 1241. Introduced by Senator Barto AN ACT

SB 1241. Introduced by Senator Barto AN ACT REFERENCE TITLE: AHCCCS; contractors; providers State of Arizona Senate Fifty-second Legislature First Regular Session SB Introduced by Senator Barto AN ACT AMENDING SECTION -, ARIZONA REVISED STATUTES;

More information

A Primer on Ratio Analysis and the CAH Financial Indicators Report

A Primer on Ratio Analysis and the CAH Financial Indicators Report A Primer on Ratio Analysis and the CAH Financial Indicators Report CAH Financial Indicators Report Team North Carolina Rural Health Research and Policy Analysis Center Cecil G. Sheps Center for Health

More information

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH CERTIFICATE OF NEED (CON) REVIEW STANDARDS FOR NURSING HOME AND HOSPITAL LONG-TERM-CARE UNIT (HLTCU) BEDS

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH CERTIFICATE OF NEED (CON) REVIEW STANDARDS FOR NURSING HOME AND HOSPITAL LONG-TERM-CARE UNIT (HLTCU) BEDS MICHIGAN DEPARTMENT OF COMMUNITY HEALTH CERTIFICATE OF NEED (CON) REVIEW STANDARDS FOR NURSING HOME AND HOSPITAL LONG-TERM-CARE UNIT (HLTCU) BEDS (By authority conferred on the CON Commission by Section

More information

BOARD MEETING: December 1-2, 2009. Original: $0 FACILITY NAME: OSF Holy Family Medical Center TYPE OF PROJECT: Non-Substantive

BOARD MEETING: December 1-2, 2009. Original: $0 FACILITY NAME: OSF Holy Family Medical Center TYPE OF PROJECT: Non-Substantive DOCKET NO: A-8 BOARD MEETING: December 1-2, 2009 PROJECT NO: 09-049 PROJECT COST: Original: $0 FACILITY NAME: TYPE OF PROJECT: Non-Substantive CITY: Monmouth Current: HSA: II PROJECT DESCRIPTION: The State

More information

HOUSE OF REPRESENTATIVES

HOUSE OF REPRESENTATIVES HOUSE OF REPRESENTATIVES HB 2010 2013-2014; health; welfare; budget reconciliation. Sponsor: Representative Pratt DPA X Caucus and COW House Engrossed OVERVIEW HB 2010 includes provisions to health and

More information

NOTICE OF PROPOSED AGENCY ACTION. MassHealth: Payment for Chronic Disease and Rehabilitation Hospital Services effective October 1, 2014

NOTICE OF PROPOSED AGENCY ACTION. MassHealth: Payment for Chronic Disease and Rehabilitation Hospital Services effective October 1, 2014 NOTICE OF PROPOSED AGENCY ACTION SUBJECT: AGENCY: MassHealth: Payment for Chronic Disease and Rehabilitation Hospital Services effective October 1, 2014 Massachusetts Executive Office of Health and Human

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Florida Medical Systems, LLC/CON #10368 899 N. W. 4 th Street Miami, Florida 33128

More information

May 18, 2015. The Honorable Rick Scott Office of the Governor 400 S. Monroe St. Tallahassee, FL 32399. Dear Governor Scott,

May 18, 2015. The Honorable Rick Scott Office of the Governor 400 S. Monroe St. Tallahassee, FL 32399. Dear Governor Scott, May 1, 01 The Honorable Rick Scott Office of the Governor 00 S. Monroe St. Tallahassee, FL Dear Governor Scott, We appreciate the opportunity to respond to your May 1, 01 data request. As you may know,

More information

4. Program Regulations

4. Program Regulations Table of Contents iv 437.401: Introduction... 4-1 437.402: Definitions... 4-1 437.403: Eligible Members... 4-2 437.404: Provider Eligibility... 4-3 437.405: Out-of-State Hospice Services... 4-3 437.406:

More information

HOSPITAL CHARITY CARE: THE CURRENT STATE OF ILLINOIS LAW

HOSPITAL CHARITY CARE: THE CURRENT STATE OF ILLINOIS LAW HOSPITAL CHARITY CARE: THE CURRENT STATE OF ILLINOIS LAW Caroline Chapman January 2013 2 How do uninsured individuals currently pay for and access care? Self-pay CCHS County Care Free/Low Cost Care at

More information

Facilities contract with Medicare to furnish

Facilities contract with Medicare to furnish Facilities contract with Medicare to furnish acute inpatient care and agree to accept predetermined acute Inpatient Prospective Payment System (IPPS) rates as payment in full. The inpatient hospital benefit

More information

HEALTH & SAFETY CODE SUBTITLE F. POWERS AND DUTIES OF HOSPITALS CHAPTER 311. POWERS AND DUTIES OF HOSPITALS

HEALTH & SAFETY CODE SUBTITLE F. POWERS AND DUTIES OF HOSPITALS CHAPTER 311. POWERS AND DUTIES OF HOSPITALS HEALTH & SAFETY CODE SUBTITLE F. POWERS AND DUTIES OF HOSPITALS CHAPTER 311. POWERS AND DUTIES OF HOSPITALS SUBCHAPTER C. HOSPITAL DATA REPORTING AND COLLECTION SYSTEM Sec. 311.031. DEFINITIONS. In this

More information

Attachment C. AGREEMENT between the County Department of. Social Services, (referred to in this Agreement as "the Social Services

Attachment C. AGREEMENT between the County Department of. Social Services, (referred to in this Agreement as the Social Services Attachment C AGREEMENT BETWEEN A SOCIAL SERVICES DISTRICT AND AN ASSISTED LIVING PROGRAM AGREEMENT between the County Department of Social Services, (referred to in this Agreement as "the Social Services

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2012 STAFF ANALYSIS

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2012 STAFF ANALYSIS DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2012 CON REVIEW NH-CRF-1211-023 HINDS COUNTY NURSING & REHABILITATION CENTER, LLC CONSTRUCTION/RELOCATION AND REPLACEMENT OF 119 NURSING HOME

More information

MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT NOVEMBER 2011 STAFF ANALYSIS

MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT NOVEMBER 2011 STAFF ANALYSIS MISSISSIPPI STATE DEPARTMENT OF HEALTH DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT NOVEMBER 2011 CON REVIEW: IMAGING CENTER AT BRIDGEPOINT, LLC, TUPELO OFFERING OF POSITRON EMISSION TOMOGRAPHY

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT (THURMAN) APRIL 2004 STAFF ANALYSIS

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT (THURMAN) APRIL 2004 STAFF ANALYSIS DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT (THURMAN) APRIL 2004 NORTH MISSISSIPPI MEDICAL CENTER TEM FOR RADIOLOGY CAPITAL EXPENDITURE: $9,250,000 LOCATION: TUPELO, MISSISSIPPI STAFF ANALYSIS

More information

Westchester Medical Center. 2012 Operating Budget

Westchester Medical Center. 2012 Operating Budget Westchester Medical Center 2012 Operating Budget December 7, 2011 WESTCHESTER COUNTY HEALTH CARE CORPORATION Overview Westchester Medical Center s (WMC) 2012 Operating Budget reflects significant reductions

More information

Health Care Finance 101

Health Care Finance 101 Alaska Health Care Commission Health Care Finance 101 Ken Tonjes CFO PeaceHealth Ketchikan Medical Center June 20, 2013 Basics: Glossary of Terms Common Financial Terminology Gross Charges (Revenue) Total

More information

National Stroke Association s Guide to Choosing Stroke Rehabilitation Services

National Stroke Association s Guide to Choosing Stroke Rehabilitation Services National Stroke Association s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you: Re-learn basic skills

More information

8.2000: HOSPITAL PROVIDER FEE COLLECTION AND DISBURSEMENT

8.2000: HOSPITAL PROVIDER FEE COLLECTION AND DISBURSEMENT DEPARTMENT OF HEALTH CARE POLICY AND FINANCING MEDICAL ASSISTANCE SECTION 8.2000 [Editor s Notes follow the text of the rules at the end of this CCR Document.] 8.2000: HOSPITAL PROVIDER FEE COLLECTION

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2013

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2013 DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2013 CON REVIEW: KEMPER CAH, INC. D/B/A JOHN C. STENNIS MEMORIAL HOSPITAL ESTABLISHMENT OF MOBILE MAGNETIC RESONANCE IMAGING (MRI) SERVICES

More information

Improving Transitions Between Emergency Departments and Long Term Care

Improving Transitions Between Emergency Departments and Long Term Care Improving Transitions Between Emergency Departments and Long Term Care Mary T. Knapp RN, MSN/GNP, NHA, FAAN The Health Care Improvement Foundation January 21, 2014 Purpose of Presentation Provide and overview

More information

This declaration provides for the additional changes to current reimbursement policies.

This declaration provides for the additional changes to current reimbursement policies. Diagnosis Related Groups Part 1: APR-DRG Reimbursement Implementation Senate Bill 853 (Statutes of 2010) added Section 14105.28 to the California Welfare and Institutions Code (W&I Code), which directed

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Published: July 2014 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

HEALTHCARE FINANCE: AN INTRODUCTION TO ACCOUNTING AND FINANCIAL MANAGEMENT. Online Appendix B Operating Indicator Ratios

HEALTHCARE FINANCE: AN INTRODUCTION TO ACCOUNTING AND FINANCIAL MANAGEMENT. Online Appendix B Operating Indicator Ratios HEALTHCARE FINANCE: AN INTRODUCTION TO ACCOUNTING AND FINANCIAL MANAGEMENT Online Appendix B Operating Indicator Ratios INTRODUCTION In Chapter 17, we indicated that ratio analysis is a technique commonly

More information

Government Programs Policy No. GP - 6 Title:

Government Programs Policy No. GP - 6 Title: I. SCOPE: Government Programs Policy No. GP - 6 Page: 1 of 12 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2) any other

More information

September 4, 2012. Submitted Electronically

September 4, 2012. Submitted Electronically September 4, 2012 Ms. Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1589-P P.O. Box 8016 Baltimore, MD 21244-8016

More information

FINANCIAL HEALTH WITHIN THE REHAB UNIT

FINANCIAL HEALTH WITHIN THE REHAB UNIT FINANCIAL HEALTH WITHIN THE REHAB UNIT 2013 UDSMR Annual Conference August 8, 2013 Presented by: Donna Cameron Chris Scotten Donna.cameron@navigant.com Chris.scotten@navigant.com 317.341.3389 317.217.5395

More information

Ascension Health Alliance

Ascension Health Alliance and Results of Operations The following information should be read with Ascension Health Alliance s audited consolidated financial statements and related notes to the consolidated financial statements.

More information

STATEMENT OF ESTIMATED REGULATORY COSTS FEBRUARY 2014 PROPOSED CHANGES TO CHAPTER 58A-5, FLORIDA ADMINISTRATIVE CODE

STATEMENT OF ESTIMATED REGULATORY COSTS FEBRUARY 2014 PROPOSED CHANGES TO CHAPTER 58A-5, FLORIDA ADMINISTRATIVE CODE STATEMENT OF ESTIMATED REGULATORY COSTS FEBRUARY 2014 PROPOSED CHANGES TO CHAPTER 58A-5, FLORIDA ADMINISTRATIVE CODE Executive Summary The Department of Elder Affairs, (Department) in consultation with

More information

NURSE & ALLIED STAFFING CLINICAL TRIALS SERVICES EDUCATION & RETAINED SEARCH

NURSE & ALLIED STAFFING CLINICAL TRIALS SERVICES EDUCATION & RETAINED SEARCH NURSE & ALLIED STAFFING CLINICAL TRIALS SERVICES EDUCATION & RETAINED SEARCH May 2008 This presentation contains forward-looking statements. Statements that are predictive in nature, that depend upon or

More information

PACE Program Development Considerations: Responding to the Unique Needs of Seniors and their Families

PACE Program Development Considerations: Responding to the Unique Needs of Seniors and their Families Responding to the Unique Needs of Seniors and their Families PACE Program Development Considerations: Program Start-up and Development Costs To provide a general understanding of the start-up requirements

More information

907 KAR 9:010. Reimbursement for Level I and II[Payments for ] psychiatric residential RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.

907 KAR 9:010. Reimbursement for Level I and II[Payments for ] psychiatric residential RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B. 1 1 1 1 1 1 1 0 1 CABINET FOR HEALTH AND FAMILY SERVICES Department for Medicaid Services Division of Healthcare Facilities Management (Amended After Comments) 0 KAR :0. Reimbursement for Level I and II[Payments

More information

907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies.

907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. 907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),

More information

09 LC 33 3003S(SCS) A BILL TO BE ENTITLED AN ACT

09 LC 33 3003S(SCS) A BILL TO BE ENTITLED AN ACT Senate Bill 156 By: Senators Staton of the 18th, Adelman of the 42nd, Thomas of the 54th, Goggans of the 7th, Golden of the 8th and others AS PASSED SENATE A BILL TO BE ENTITLED AN ACT 1 2 3 4 5 6 7 To

More information

APPLICATION FOR THE CONVERSION FROM STATE LICENSED ONLY TO MEDICARE (TITLE 18 SNF) OR MEDICARE /MEDICAID (TITLE 18 SNF/TITLE 19 NF) PARTICIPATION

APPLICATION FOR THE CONVERSION FROM STATE LICENSED ONLY TO MEDICARE (TITLE 18 SNF) OR MEDICARE /MEDICAID (TITLE 18 SNF/TITLE 19 NF) PARTICIPATION APPLICATION FOR THE CONVERSION FROM STATE LICENSED ONLY TO MEDICARE (TITLE 18 SNF) OR MEDICARE /MEDICAID (TITLE 18 SNF/TITLE 19 NF) PARTICIPATION TO: FROM: Applicant Program Director-Provider Services

More information

Center for Medicare and Medicaid Innovation

Center for Medicare and Medicaid Innovation Center for Medicare and Medicaid Innovation Summary: Establishes within the Centers for Medicare and Medicaid Services (CMS) a Center for Medicare & Medicaid Innovation (CMI). The purpose of the Center

More information

Florida Senate - 2016 SB 1080

Florida Senate - 2016 SB 1080 By Senator Legg 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 A bill to be entitled An act relating to emergency air medical service; amending s. 20.435, F.S.;

More information

211 CMR: DIVISION OF INSURANCE 211 CMR 52.00: MANAGED CARE CONSUMER PROTECTIONS AND ACCREDITATION OF CARRIERS

211 CMR: DIVISION OF INSURANCE 211 CMR 52.00: MANAGED CARE CONSUMER PROTECTIONS AND ACCREDITATION OF CARRIERS 211 CMR: DIVISION OF INSURANCE 211 CMR 52.00: MANAGED CARE CONSUMER PROTECTIONS AND ACCREDITATION OF CARRIERS Section 52.01: Authority 52.02: Applicability 52.03: Definitions 52.04: Accreditation of Carriers

More information

COPLEY HOSPITAL, INC. FY 2013 BUDGET NARRATIVE

COPLEY HOSPITAL, INC. FY 2013 BUDGET NARRATIVE FY 2013 BUDGET NARRATIVE Overview of Copley Hospital Financial Goals and Objectives Budget Assumptions Other Disclosures OVERVIEW OF COPLEY HOSPITAL Copley Hospital is the critical access-designated community

More information

Florida Senate - 2015 SB 1280

Florida Senate - 2015 SB 1280 By Senator Soto 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 A bill to be entitled An act relating to emergency air medical service; creating s. 401.2515, F.S.; defining

More information

BEFORE THE DEPARTMENT OF JUSTICE FOR THE STATE OF MONTANA

BEFORE THE DEPARTMENT OF JUSTICE FOR THE STATE OF MONTANA BEFORE THE DEPARTMENT OF JUSTICE FOR THE STATE OF MONTANA In the Matter of the Certificate ) PRELIMINARY of Public Advantage Issued to ) FINDINGS CONCERNING Benefis Healthcare, Great Falls, ) COMPLIANCE

More information

Hospital Rehab Management

Hospital Rehab Management Why Heritage Healthcare as Your Rehab Delivery Partner? Hospitals are seeking collaborative partner relationships to better position them for the current environment, as well as tomorrow s increasing challenges.

More information

LSC Redbook Analysis of the Executive Budget Proposal Board of Nursing

LSC Redbook Analysis of the Executive Budget Proposal Board of Nursing LSC Redbook Analysis of the Executive Budget Proposal Board of Nursing Deauna Hale, Budget Analyst Legislative Service Commission February 2009 READER'S GUIDE The Legislative Service Commission prepares

More information

DEPT: Behavioral Health Division UNIT NO. 6300 FUND: General 0077. Budget Summary

DEPT: Behavioral Health Division UNIT NO. 6300 FUND: General 0077. Budget Summary 2 Budget Summary Category 2014 Budget 2014 Actual 2015 Budget 2016 Budget 2016/2015 Variance Expenditures 1 Personnel Costs $71,051,105 $68,846,318 $63,170,918 $61,866,902 ($1,304,016) Operation Costs

More information

Medical Education and Research Cost (MERC) Grant Application Fiscal Year 2013 Clinical Training

Medical Education and Research Cost (MERC) Grant Application Fiscal Year 2013 Clinical Training Date: September 2, 2014 To: From: Subject: Sponsoring Institutions Diane Reger 651/201-3566 Medical Education and Research Cost (MERC) Grant Application Fiscal Year 2013 Clinical Training The Minnesota

More information

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2005 STAFF ANALYSIS

DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2005 STAFF ANALYSIS DIVISION OF HEALTH PLANNING AND RESOURCE DEVELOPMENT FEBRUARY 2005 CON REVIEW ESTABLISHMENT OF MOBILE POSITRON EMISSION TOMOGRAPHY (PET) SERVICES CAPITAL EXPENDITURE: $16,541.32 LOCATION: GRENADA, MISSISSIPPI

More information

Arizona Administrative Code Title 9, Ch. 11 Department of Health Services Health Care Institution Facility Data

Arizona Administrative Code Title 9, Ch. 11 Department of Health Services Health Care Institution Facility Data TITLE 9. HEALTH SERVICES CHAPTER 11. DEPARTMENT OF HEALTH SERVICES HEALTH CARE INSTITUTION FACILITY DATA Editor s Note: The headings for Articles 3, 4, and 5 were amended or created as part of a Notice

More information

DEPARTMENT OF COMMUNITY HEALTH HEALTH POLICY AND REGULATION ADMINISTRATION CERTIFICATE OF NEED

DEPARTMENT OF COMMUNITY HEALTH HEALTH POLICY AND REGULATION ADMINISTRATION CERTIFICATE OF NEED DEPARTMENT OF COMMUNITY HEALTH HEALTH POLICY AND REGULATION ADMINISTRATION CERTIFICATE OF NEED (By authority conferred on the department of public health by sections 2226, 2233, and 22255 of 1978 PA 368,

More information

HOUSE BILL No. 2087. By Committee on Insurance 1-26. AN ACT enacting the Kansas professional employer organization licensing

HOUSE BILL No. 2087. By Committee on Insurance 1-26. AN ACT enacting the Kansas professional employer organization licensing Session of 00 HOUSE BILL No. 0 By Committee on Insurance - 0 0 AN ACT enacting the Kansas professional employer organization licensing act. Be it enacted by the Legislature of the State of Kansas: Section.

More information

Ch. 1130 HOSPICE SERVICES 55 CHAPTER 1130. HOSPICE SERVICES GENERAL PROVISIONS RECIPIENT ELIGIBILITY AND DURATION OF COVERAGE

Ch. 1130 HOSPICE SERVICES 55 CHAPTER 1130. HOSPICE SERVICES GENERAL PROVISIONS RECIPIENT ELIGIBILITY AND DURATION OF COVERAGE Ch. 1130 HOSPICE SERVICES 55 CHAPTER 1130. HOSPICE SERVICES Sec. 1130.1. Statutory basis. 1130.2. Policy. 1130.3. Definitions. GENERAL PROVISIONS RECIPIENT ELIGIBILITY AND DURATION OF COVERAGE 1130.21.

More information

Chapter. Funding for Treatment of Hearing Impairments

Chapter. Funding for Treatment of Hearing Impairments . Chapter Funding for Treatment of Hearing Impairments Chapter 5 Funding for Treatment of Hearing Impairments Hearing services and devices are paid for directly by hearing impaired people or by private

More information

Provider Based Status Attestation Statement. Main provider s Medicare Provider Number: Main provider s name: Main provider s address:

Provider Based Status Attestation Statement. Main provider s Medicare Provider Number: Main provider s name: Main provider s address: 1 SAMPLE ATTESTATION FORMAT The following is an example of an acceptable format for an attestation of provider based compliance. CMS recommends that you place the initial page of the attestation on the

More information

Biennial Nurse Employer Survey: Capturing Florida Nurse Demand

Biennial Nurse Employer Survey: Capturing Florida Nurse Demand Biennial Nurse Employer Survey: Capturing Florida Nurse Demand Mary Lou Brunell, MSN, RN Executive Director Visit us at: www.flcenterfornursing.org 1 Florida Statute 464.0195 Established in 2001, the FCN

More information

Subacute Inpatient MH - Adult

Subacute Inpatient MH - Adult Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis

More information

Coverage Basics. Your Guide to Understanding Medicare and Medicaid

Coverage Basics. Your Guide to Understanding Medicare and Medicaid Coverage Basics Your Guide to Understanding Medicare and Medicaid Understanding your Medicare or Medicaid coverage can be one of the most challenging and sometimes confusing aspects of planning your stay

More information

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number 4-2 CON LLC/CON #10271 10800 Biscayne Boulevard, Suite 600 Miami, Florida 33161

More information

APPENDIX 1. Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines

APPENDIX 1. Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines APPENDIX 1 Medicaid Emergency Psychiatric Demonstration Application Proposal Guidelines INTRODUCTION Section 2707 of the Affordable Care Act authorizes a 3-year Medicaid Emergency Psychiatric Demonstration

More information

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates.

HOSPICE SERVICES. This document is subject to change. Please check our web site for updates. HOSPICE SERVICES This document is subject to change. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota

More information

PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY APPLICATION FORM ARKANSAS HEALTH SERVICES PERMIT COMMISSION

PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY APPLICATION FORM ARKANSAS HEALTH SERVICES PERMIT COMMISSION PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY APPLICATION FORM ARKANSAS HEALTH SERVICES PERMIT COMMISSION ARKANSAS HEALTH SERVICES PERMIT AGENCY 5800 WEST 10TH STREET, SUITE 805 LITTLE ROCK, ARKANSAS 72204

More information

CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission Form and Instructions

CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission Form and Instructions CSHCN Services Program Prior Authorization Request for Inpatient Rehabilitation Admission Form and Instructions General Information Ensure the most recent version of the Prior Authorization Request for

More information

THE ROLE OF LONG TERM ACUTE CARE HOSPITALS IN THE ACUTE CARE CONTINUUM. Wednesday, June 02, 2010

THE ROLE OF LONG TERM ACUTE CARE HOSPITALS IN THE ACUTE CARE CONTINUUM. Wednesday, June 02, 2010 THE ROLE OF LONG TERM ACUTE CARE HOSPITALS IN THE ACUTE CARE CONTINUUM Wednesday, June 02, 2010 As A Provider Of Continuing Nursing Education, Triumph Healthcare Is Required By Texas Nurses Association

More information

Palliative Care Billing, Coding and Reimbursement

Palliative Care Billing, Coding and Reimbursement Palliative Care Billing, Coding and Reimbursement Anne Monroe, MHA Physician Practice Manager Hospice of the Bluegrass and Palliative Care Center of the Bluegrass Kentucky 1 Objectives Review coding and

More information

12 & 12, INC. FY 15 ANNUAL MANAGEMENT REPORT

12 & 12, INC. FY 15 ANNUAL MANAGEMENT REPORT 12 & 12, INC. FY 15 ANNUAL MANAGEMENT REPORT 12 & 12 Inc. is a comprehensive addiction recovery treatment center serving individuals and their families who are affected by alcoholism and other drug addictions.

More information

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013

Essential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Published: March 2015 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s

More information

Florida s Oral Anticancer Treatment Access Law: What Clinicians Need to Know

Florida s Oral Anticancer Treatment Access Law: What Clinicians Need to Know Outdated coverage policies in Florida USED TO limit cancer patients access to lifesaving drugs! Traditionally, IV chemotherapy treatments are covered under a health plan s medical benefit where the patient

More information

OFFICIAL. This attachment describes methods used to determine rates of payment for acute outpatient hospital services.

OFFICIAL. This attachment describes methods used to determine rates of payment for acute outpatient hospital services. Attachment 4.19-8 (1) Page 1 I. Introduction A. Overview This attachment describes methods used to determine rates of payment for acute outpatient hospital services. I. For dates of service beginning December

More information

REHABILITATION UNIT CRITERIA WORK SHEET

REHABILITATION UNIT CRITERIA WORK SHEET DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0986 REHABILITATION UNIT CRITERIA WORK SHEET RELATED MEDICARE PROVIDER NUMBER ROOM NUMBERS IN

More information

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems

PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs

More information

Critical Access Hospital Finance Operations and Reimbursement

Critical Access Hospital Finance Operations and Reimbursement Critical Access Hospital Finance Operations and Reimbursement Ralph J. Llewellyn, CHFP Health Care Services rllewellyn@eidebailly.com (701) 239-8594 Introduction No other industry operates in the same

More information

Details for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY. Wednesday, December 30, 2009

Details for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY. Wednesday, December 30, 2009 Details for: CMS PROPOSES DEFINITION OF MEANINGFUL USE OF CERTIFIED ELECTRONIC HEALTH RECORDS (EHR) TECHNOLOGY Return to List For Immediate Release: Contact: Wednesday, December 30, 2009 CMS Office of

More information

THE 2009 ANNUAL AMBULATORY SURGICAL TREATMENT CENTER QUESTIONNAIRE. 24-29 Definitions

THE 2009 ANNUAL AMBULATORY SURGICAL TREATMENT CENTER QUESTIONNAIRE. 24-29 Definitions THE 2009 ANNUAL AMBULATORY SURGICAL TREATMENT CENTER QUESTIONNAIRE Page Number P1-P2 Preface 3 22 Questionnaire Form 23 Charity Care Worksheet 24-29 Definitions PREFACE TO THE 2009 ANNUAL AMBULATORY SURGICAL

More information

Title 19, Part 3, Chapter 14: Managed Care Plan Network Adequacy. Requirements for Health Carriers and Participating Providers

Title 19, Part 3, Chapter 14: Managed Care Plan Network Adequacy. Requirements for Health Carriers and Participating Providers Title 19, Part 3, Chapter 14: Managed Care Plan Network Adequacy Table of Contents Rule 14.01. Rule 14.02. Rule 14.03. Rule 14.04. Rule 14.05. Rule 14.06. Rule 14.07. Rule 14.08. Rule 14.09. Rule 14.10.

More information

Report on the Repurposing of the Woodside Juvenile Rehabilitation Center

Report on the Repurposing of the Woodside Juvenile Rehabilitation Center Report to The Vermont Legislature Report on the Repurposing of the Woodside Juvenile Rehabilitation Center In Accordance with Act 146 Sec. C 10: Woodside Juvenile Rehabilitation Center Submitted to: Submitted

More information

Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016

Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016 Southwestern Vermont Medical Center Operating Budget Fiscal Year 2016 Southwestern Vermont Medical Center s (hereafter SVMC or Medical Center ) Operating Budget for Fiscal Year (hereafter FY ) 2016 has

More information

2014 LeadingAge Ohio / OHCA Salary and Benefits Survey Glossary

2014 LeadingAge Ohio / OHCA Salary and Benefits Survey Glossary Position Descriptions SKILLED NURSING FACILITY Direct Care Nursing Medical Director- Oversees care and quality, as well as the workings of the interdisciplinary team. An involved and informed medical director

More information

CHAPTER 2014-254. Committee Substitute for Committee Substitute for House Bill No. 1445

CHAPTER 2014-254. Committee Substitute for Committee Substitute for House Bill No. 1445 CHAPTER 2014-254 Committee Substitute for Committee Substitute for House Bill No. 1445 An act relating to the Citrus County Hospital Board, Citrus County; amending chapter 2011-256, Laws of Florida; authorizing

More information

THE EFFECTS OF ELIMINATING THE PERSONAL PTA SUPERVISION REQUIREMENT ON THE FINANCIAL CAPS FOR MEDICARE THERAPY SERVICES

THE EFFECTS OF ELIMINATING THE PERSONAL PTA SUPERVISION REQUIREMENT ON THE FINANCIAL CAPS FOR MEDICARE THERAPY SERVICES REPORT TO CONGRESS STANDARDS FOR SUPERVISION OF PHYSICAL THERAPIST ASSISTANTS (PTAs) AND THE EFFECTS OF ELIMINATING THE PERSONAL PTA SUPERVISION REQUIREMENT ON THE FINANCIAL CAPS FOR MEDICARE THERAPY SERVICES

More information