12-001560MPI Agency For Health Care Administration vs. New Life Assisted Living, Inc., D/B/A New Life Assisted Living Facility Status: Closed Recommended Order on Wednesday, November 14, 2012.

Summary: Petitioner demonstrated that Respondent failed to comply with the provisions of the Medicaid laws. This violation was Respondent's first offense. Respondent presented mitigating factors. Recommend fine and corrective action plan.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

AGENCY FOR HEALTH CARE )

ADMINISTRATION, )

)

Petitioner, )

)

vs. ) Case No. 12 - 1560 MPI

)

NEW LIFE ASSISTED LIVING, INC., )

d/b/a NEW LIFE ASSISTED LIVING )

FACILITY, )

)

Respondent. )

___________________________ _____)

RECOMMENDED ORDER

Pursuant to notice, a final hearing was held in this case

on July 30, 2012 , by video teleconferenc e with connecting sites

in West Palm Beach and Tallahassee, Florida, before Errol H.

Powell, an Administrative Law Judge of the Di vision of

Administrative Hearings.

APPEARANCES

For Petitioner: Jeffries H. Duvall , Esquire

Agency for Health Care Administration

Fort Knox Building III, Mail Station 3

2727 Mahan Drive

Ta llahassee, Florida 32308

For Re sponden t: J. Garry Rooney, Esquire

Rooney & Rooney, P.A.

Second Floor, Suite 20

2145 - 14th Avenue

Vero Beach , Florida 32960 - 4414

STATEMENT OF THE ISSU E

The issue for determination i s whether Respondent committed

the offense set forth in Petitioner's letter of agency action

dated March 9, 2012, and, if so, what action should be taken.

PRELIMINARY STATEMENT

By agency action letter dated March 9, 2012 , the Agency for

Health Care Administration, hereinafter AHCA, notified New Life

Assisted Living, Inc., d/b/a New Life Assisted Living Facility ,

hereinafter N ew Life , that , in accordance with section 409.913,

Florida Statutes, and Florida Administrative C ode Ru le 59G -

9. 070 , AHCA was imposing a fine against Ne w Life in the amount

of $7,000.00 for violating r ule 59G - 9.070(7)(e) , in that New

Life violated federal and state laws, including the failure to

maintain a current Health Assessment, Resident Service Plan, a nd

Certification of Medical Necessity for consumers E . H . , I . M . ,

J . S . , K . L . , M . B . , R . F . , and R . J. New Life challenged AHCA's

action and requested a hearing. On April 2 7, 2012 , this matter

was referred to the Division of Administrative Hearings.

At hearing , AHCA presented the testimony of two witness es ,

including the owner/ administrator of New Life, and entered ten

exhibit s (Petitioner's Exhibit s numbered 1 through 3, 4A, 4B,

4C, 4D , 4E, 4F, and 4G ) into evid ence. New Life presented no

witnesses and entere d one exhibit (Respondent's Exhibit numbered

1) into evidence. Additionally, the undersigned took Official

Recognition of chapter 409, Florida Statutes; Florida

Ad ministrative Code c hapter 59G ; Florida Medicaid Assistive Care

Services Coverage an d Limitat ions Handbook, July 2009; and

Florida Medicaid Provider General Handbook, January 2007 and

July 2008 .

A t ranscript of the hearing was ordered. At the request of

the parties, the time for filing post - hearing submissions was

set for more than ten days follo wing the filing of the

transcript . The t ranscript, consisting of one volume, was filed

on August 1 4, 2012. A n extension of time to file pos t - hearing

submissions was granted. The parties timely filed their post -

hearing submissions, which were considered in the preparation of

this Recommended Order.

FINDINGS OF FACT

1. At all times material hereto, New Life was issued

individual Medicaid provider number 140680900.

2 . A t all times material hereto, New Life was enrolled as

an assisted l iving facility .

3 . At all tim es material hereto, New Life had a valid

Medicaid Provider Agreement with AHCA (Agreement).

4. Under the Agreement, New Life was authorized to provide

assistive living services to Medicaid recipients.

5 . The Florida Medicaid Assistive Care Serv ices Coverage

and Limit ations Handbook, effective July 2009 , hereinafter

Handbook, provides , among other things, requirements of Medicaid

home health services providers and sets forth pertinent Medicaid

policies and service requirements . The Handbook is p rovided to

each Medicaid provider upon enrollment into the Medicaid program

and is available online. Each provider is expected and presumed

to be familiar with the Handbook .

6 . The Handbook was incorporated by reference in to r ule

59G - 4.0 25 , Assistive Car e Services .

7 . No dispute exists that, at all times material hereto,

New Life was an assistive care services provider as defined by

the Handbook.

8 . The Handbook provides in pertinent part:

Recipients receiving Assistive Care Services

must have a complet e assessment at least

annually . . . or sooner if a significant

change in the recipient's condition occurs

. . . . An annual assessment must be

completed no more than one year plus fifteen

days after the last assessment. An

assessment triggered by a sig nificant change

must be completed no more than fifteen days

after the significant change.

The assessment for a resident of a ALF . . .

must be completed by a physician or other

licensed practitioner of the healing arts

(Physician Assistant, Advanced Regis tered

Nurse Practitioner, Registered Nurse) acting

within the scope of practice under state

law, physician assistant or advanced

registered practitioner.

* * *

Th e assessment for ALF [assisted living

facility] residents must be recorded on the

Resid ent Health Assessment for Assisted

Living Facilities, AHCA Form 1823.

* * *

Along with the annual assessment

requirement, all recipients receiving ACS

[Assistive Care S ervice s ] must have an

updated Certification of Medical Necessity

for Medicaid Assi stive Care Services, AHCA -

Med Serv Form 035, July 2009 , signed by a

physician or other licensed practitioner of

the healing arts (Physician Assistant,

Advanced Registered Nurse Practitioner,

Registered Nurse ) and the Resident Service

Plan for Assistive Car e Services, AHCA - Med

Serv Form 036 , July 2009, completed and

available in the recipient's case file at

the facility.

* * *

Every ACS recipient must have a service plan

completed by the ACS service provider. The

Resident Service Plan for Assistive Ca re

Services, AHCA - Med Serv Form 036, July 2009,

shall be us ed for each recipient receiving

ACS . The form must be included in the

recipient's case file at the facility. The

ALF , RTF [residential medical facility] and

AFCH [adult family care home] are

resp onsible for ensuring the service plan is

developed and implemented.

* * *

The Resident Service Plan for Assistive Care

Services (AHCA - Med Serv Form 036) must be

completed within 15 days after the initial

health assessment or annual assessment, be

in writing and based on information

contained in the health assessment. . . .

* * *

A new service plan is required on an annual

basis or sooner if a significant change in

the recipient's condition occurs. The new

service plan must be completed no more than

15 days after the annual assessment or an

assessment because of a significant change

in the recipient's condition.

* * *

In addition to records required by the

applicable licensure standards, ACS records

that must be kept include:

Copies of all eligibility documents;

Health Ass essment Forms, AHCA Form 1823

. . .;

Certification of Medical Necessity for

Medicaid Assistive Care Services, AHCA - Med

Serv Form 035;

The Resident Service Plan for Assistive Care

Services, AHCA - Med Serv Form 036; and

The Resident Service Log, AHCA - Med Serv Form

037.

This documentation must be maintained at the

facility, kept for at least five years, and

be made available to the Agency for Health

Care Administration monitoring or surveyor

staff or its designated repres entative, upon

request. . . .

* * *

ACS documentation may be in electronic

format. The original, signed . . .

documents must be kept in the recipient's

case file in the facility . . . for audit,

monitoring and quality assurance

purposes. . . .

Han dbook at P 2 - 7 through 2 - 11.

9 . AHCA's investigator performed a sit e visit at New Life

on December 8, 2011. The investigator reviewed case files of

residents for the service - period covering January 1, 2011,

through November 30, 2011 (service - p eriod) .

10 . AHCA's investigator found deficiencies in the case

files of seven residents at New Life : M . B . ; R . F . ; E . H . ; R . J . ;

I . M . ; K . L . ; and J . S. Additional document s , not contained in the

case files during the site visit, were provided subsequent to

the site vis it.

11 . Regarding Resident M . B . , the Health Assessment and the

Resident Service Plan were dated August 17, 2010 , which was

after the s ervice - p eriod; and the Certification of Medical

Necessity was dated March 28, 2012, which was not within the

s ervice - p eri od and after the site visit.

12 . The evidence demonstrates that the case file of

Resident M . B . lacked the Health Assessment, Resident Service

Plan, and Certification of Med ical Necessity for the service -

period.

13 . As to Resident R . F . , the Health Assessm ent was dated

January 1, 2011 , which was with in the service - period but not up -

to - date ; the Resident Service Plan was up - to - date; and the

Certification of Medi cal Necessity was dated March 1 , 2012,

which was not within the service - period and after the site

visit.

14 . The evidence demonstrates that the case file of

Resident R . F . lacked the Heal th Assessment and Certification of

Medical Necessity for the se rvice - period .

15 . Regarding Resident E . H . , the Health Assessment was

dated January 24, 2011, and was up - to - date ; the Resident Service

Plan was not provided ; and the Certification of Medical

Ne cessity was dated September 27, 2002 , with no more recent

Certificat ion of Medical Necessity .

16 . The evidence demonstrates t hat the case file of

Resident E . H . lacked the Resident Service Plan and Certification

of Medical Necessity for the se rvice - period .

17. As to Resident R . J . , the parties stipulated that the

Health Assessment was up - to - date; the Resident Service Pla n was

not provided ; and the Certification of M edic al Necessity was

dated February 29 , 2012, which was not within the service - period

and after the site visit.

18 . The evidence demonstrates t hat the case file of

Resident R . J . lacked the Resident Service Plan and Certification

of Medical Necessity for the s e rvice - period .

19. Regarding Resident I . M . , the Health Assessment and the

Re sident Service Plan were up - to - date ; and the Certification of

Medi cal Necessity was dated March 1 , 2012, which was not within

the service - plan and after the site visit.

2 0 . The evidence demonstrates t hat the case file of

Resident I . M . lacked the Certification of Medical Necessity for

the se rvice - period .

21. As to Resident K . L . , the Health Assessmen t was dated

March 1, 2012, which was not within the service - period and after

the s ite visit ; the Resident Service Plan was not provided ; and

the Certification of Medical Necessity was provided, but the

date as to the year was unintelligible e ven though the month and

day were intelligible, i.e., March 1 .

2 2. The evidence demonstrates t h at the case file of

Resident K . L . lacked the Health Assessment, Resident Service

Plan, and Certification of Medical Necessity for the serv ice -

period .

23. Regarding Resident J . S . , the Health Assessment was

dated August 22, 2009, which was not within the se rvice - period;

the Resident Service Pla n was not provided ; and the

Certification of M edical Necessity was dated February 29 , 2012,

which was not within the service - period and was after the site

visit.

24 . The evidence demonstrates t hat the case file of

Res ident J . S . lacked the Health Assessment, Resident Service

Plan, and Certification of Medical Necessity for the ser vice

period .

25. The Director and owner of New Life is Ethel Newton.

Ms. Newton has been the Director and owner for the past 13

years. S he was not familiar with the Health Assessment form ,

the Resident Service Plan form, or the Certification of Medical

Necessity form. Ms. Newton advised AHCA's investigator that she

was not familiar with the forms and admitted same at the

hearing.

26. Ms. N ewton historically depended upon the assistance

of the Dep artment of Children and Family Services (DCF) to

complete any required forms. She depended upon DCF until 2005

when DCF closed its local office which had been assisting her .

After DCF closed its l ocal office , Ms. Newton dep ended upon the

residents' case managers at New Horizons , an agency where the

residents' physicians are located , to complete any required

forms . Five of the seven residents had case managers at New

Horizons; J.S. and E.H. did not have case managers at New

Horizons. E.H. is no longer a resident at New Life.

27. Ms. Newton is willing to cooperate with AHCA and do

whatever it takes to have the required forms completed timely

and correctly .

28. The evidence does not demonstrate tha t Ms. Newton

intentionally failed to complete the required forms.

29 . None of the seven residents w ere harmed as a result of

the deficiencies in the documentation .

30 . No evidence was presented demonstrating that New Life

has any prior administrative san ction or penalty.

31. No evidence was presented demonstrating that New Life

has any prior violations .

CONCLUSIONS OF LAW

32 . The Division of Administrative Hearings has

jurisdiction over the subject matter of this proceeding and the

parties thereto pursu ant to sections 120.569 and 1 20.57(1),

Florida Statutes (2012 ).

33 . No dispute exists that AHCA is responsible for

administering the Medicaid program in Florida.

34 . AHCA is required to "operate a program to oversee the

activities of Florida Medicaid rec ipients, and providers and

their representatives, to ensure that fraudulent and abusive

behavior and neglect of recipients occur to the minimum extent

possible, and to recover overpayments and impose sanctions as

appropriate." § 409.9 13, Fla. Stat. (2009 ) . 1

35. Florida Administrative Code Rule 59G - 4.025 , titled

Assistive Care Services, provides:

(1) This rule applies to all assistive care

service providers enrolled in Medicaid under

Section 409.906, F.S., who pr ovide assistive

care services.

(2) All as sistive care service providers

enrolled in Medicaid program must be in

compliance with the Florida Medicaid

Assistive Care Services Coverage and

Limitations Handbook, July 2009 which is

incorporated by reference, and the Florida

Medicaid Provider Reimburse ment Handbook,

CMS - 1500, which is incorporated by reference

in Rule 59G - 4.001, F.A.C. Both handbooks

are available from the Medicaid fiscal

agent's Web Portal at http://mymedicaid -

florida.com . Click on Public Information

for Providers, then on Provider S upport, and

then on Provider Handbooks. Paper copies of

the handbooks may be obtained by calling the

Provider Contact Center at (800) 28 9 - 7799

and selecting Option 7.

(3) The following forms that are included

in the Florida Medicaid Assistive Care

Servi ces Coverage and Limitations Handbook

are incorporated by reference:

(a) Appendix B contains the Certification

of Medical Necessity for Medicaid Assistive

Care Services, AHCA - Med Serv Form 035, July

2009, one page. The form is available from

the Medicai d fiscal agent's Web Portal at

http://mymedicaid - florida.com . Click on

Public Information for Providers, then on

Provider Support, and then on Forms or by

phot ocopying it from the handbook.

(b) Appendix C contains the Resident

Service Plan for Assistive Care Services,

AHCA - Med Serv Form 036, July 2009, three

pages. The form is available from the

Medicaid fiscal agent's Web Portal at

http://mymedicaid - florida.com . Click on

Public Information for Providers, then on

Provider Support, and then on Forms or by

phot ocopying it from the handbook.

(c) Appendix D contains the Resident

Service Log for Medicaid Assistive Care

Services, AHCA - Med Serv Form 037, July 2009,

one page. The form is available from the

Medicaid fiscal agent's Web Portal at

http://mymedic aid - florida.com . Click on

Public Information for Providers, then on

Provider Support, and then on Forms or by

photocopying it from the handbook.

36 . Section 409.913 , Florida Statutes , provides in

pertinent part:

(1) For the purposes of this section, th e

term:

* * *

(c) "Fraud" means an intentional deception

or misrepresentation made by a person with

the knowledge that the deception results in

unauthorized benefit to herself or himself

or another person. The term includes any

act that constitute s fraud under applicable

federal or state law.

(d) "Medical necessity" or "medically

necessary" means any goods or services

necessary to palliate the effects of a

terminal condition, or to prevent, diagnose,

correct, cure, alleviate, or preclude

deterior ation of a condition that threatens

life, causes pain or suffering, or results

in illness or infirmity, which goods or

services are provided in accordance with

generally accepted standards of medical

practice. For purposes of determining

Medicaid reimburs ement, the agency is the

final arbiter of medical necessity.

Determinations of medical necessity must be

made by a licensed physician employed by or

under contract with the agency and must be

based upon information available at the time

the goods or servic es are provided.

(e) "Overpayment" includes any amount that

is not authorized to be paid by the Medicaid

program whether paid as a result of

inaccurate or improper cost reporting,

improper claiming, unacceptable practices,

fraud, abuse, or mistake.

* * *

(2) The agency shall conduct, or cause to

be conducted by contract or otherwise,

reviews, investigations, analyses, audits,

or any combination thereof, to determine

possible fraud, abuse, overpayment, or

recipient neglect in the Medicaid program

a nd shall report the findings of any

overpayments i n audit reports as

appropriate. . . Medical necessity

determination requires that service be

consistent with symptoms or confirmed

diagnosis of illness or injury under

treatment and not in excess of the pat ient's

needs. . . .

* * *

(7) When presenting a claim for payment

under the Medicaid program, a provider has

an affirmative duty to supervise the

provision of, and be responsible for, goods

and services claimed to have been provided,

to supervise an d be responsible for

preparation and submission of the claim, and

to present a claim that is true and accurate

and that is for goods and services that:

(a) Have actually been furnished to the

recipient by the provider prior to

submitting the claim.

(b) Are Medicaid - covered goods or service s

that are medically necessary.

* * *

(e) Are provided in accord with applicable

provisions of all Medicaid rules,

regulations, handbooks, and policies and in

accordance with federal, state, and local

law.

(f) Are documented by records made at the

time the goods or services were provided,

demonstrating the medical necessity for the

goods or services rendered. Medicaid goods

or services are excessive or not medically

necessary unless both the medical basis and

the specific need for them are fully and

properly documented in the recipient's

medical record.

The agency shall deny payment or require

repayment for goods or services that are not

presented as req uired in this subsection.

* * *

(9) A Medicaid pro vider shall retain

medical, professional, financial, and

business records pertaining to services and

goods furnished to a Medicaid recipient and

billed to Medicaid for a period of 5 years

after the date of furnishing such services

or goods. The agency may investigate,

review, or analyze such records, which must

be made available during normal business

hours. . . The provider is responsible for

furnishing to the agency, and keeping the

agency informed of the location of, the

provider's Medicaid - related reco rds. The

authority of the agency to obtain Medicaid -

related records from a provider is neither

curtailed nor limited during a period of

litigation between the agency and the

provider.

* * *

(15) The agency shall seek a remedy

provided by law, includ ing, but not limited

to, any remedy provided in subsections (13)

and (16) and s. 812.035, if:

* * *

(e) The provider is not in compliance with

provisions of Medicaid provider publications

that have been adopted by reference as rules

in the Florida A dministrative Code; with

provisions of state or federal laws, rules,

or regulations; with provisions of the

provider agreement between the agency and

the provider; or with certifications found

on claim forms or on transmittal forms for

electronically submi tted claims that are

submitted by the provider or authorized

representative, as such provisions apply to

the Medicaid program;

* * *

A provider is subject to sanctions for

violations of this subsection as the result

of actions or inactions of the pro vider, or

actions or inactions of any principal,

officer, director, agent, managing employee,

or affiliated person of the provider, or any

partner or shareholder having an ownership

interest in the provider equal to 5 percent

or greater, in which the provi der

participated or acquiesced.

(16) The agency shall impose any of the

following sanctions or disincentives on a

provider or a person for any of the acts

described in subsection (15):

* * *

(c) Imposition of a fine of up to $ 5,000

for each viola tion. . . .

* * *

(i) Corrective - action plans that would

remain in effect for providers for up to 3

years and that would be monitored by the

agency every 6 months while in effect.

* * *

The Secretary of Health Care Administration

may make a de termination that imposition of

a sanction or disincentive is not in the

best interest of the Medicaid program, in

which case a sanction or disincentive shall

not be imposed.

(17) In determining the appropriate

administrative sanction to be applied, or

th e duration of any suspension or

termination, th e agency shall consider:

(a) The seriousness and extent of the

violation or violations.

(b) Any prior history of violations by the

provider relating to the delivery of health

care programs which resulted i n either a

criminal conviction or in administrat ive

sanction or penalty.

(c) Evidence of continued violation within

the provider's management control of

Medicaid statutes, rules, regulations, or

policies after written notification to the

provider of impr oper practice or ins tance of

violation.

(d) The effect, if any, on the quality of

medical care provided to Medicaid recipients

as a result of t he acts of the provider.

(e) Any action by a licensing agency

respecting the provider in any state in

which t he provider o perates or has operated.

(f) The apparent impact on access by

recipients to Medicaid services if the

provider is suspended or terminated, in th e

best judgment of the agency.

The agency shall document the basis for all

sanctioning actions an d recommendations.

3 7 . The parties agree that the ultimate burden of proof is

on AHCA to e stablish by a preponderance of the evidence that New

Life committed the violations . Southpointe Pharmacy v. Dep't of

HRS , 596 So. 2d 106, 109 (Fla. 1st DCA 1992); S. Medical Serv . ,

Inc. v. A g. For Health Care Admin. , 653 So. 2d 440, 441 (Fla. 3d

DCA 1995).

38. The evidence demonstrates that New Life failed to have

in the files of Resident M . B . , Resident K.L. , and Resident J.S.

a Health Assessment, Resident Service Plan, and Certification of

Medical Necessity for the service - period as required by the

Handbook.

39. The evidence demonstrates that New Life failed to have

in Resident R . F . 's file a Health Assessment and Certification of

Medical Necessity for the service - period as required by the

Handbook.

40. The evidence demonstrates that New Life failed to have

in its file of Resident E . H . and Resident R.J. a Resident

Service Plan and Certification of Medical Necessity for the

service - period as required by the Handbook .

41. The evidence demonstrates that New Life failed to have

in Resident I.M.'s file a Certification of Medical Necessity for

the service - period as required by the Handbook.

42. Hence, the evidence demonstrates that New Life failed

to comply with the Med icaid laws.

43 . Florida Administrative Code Rule 59G - 9.070 provides in

pertinent part:

(1) PURPOSE: This rule provides notice of

administrative sanctions imposed upon a

provider, entity, or person for each

violation of any Medicaid - related law.

* * *

(3) DEFINITIONS:

* * *

(d) A "corrective action plan" is an

activity to address the specific areas of

non - compliance determined by the Agency, to

reduce the risk of future non - compliance.

* * *

(f) "Fine" is a monetary sanction. The

amou nt of a fine shall be as set forth

within this rule.

* * *

(h) "Offense" means the occurrence of one

or more violations as set forth in a final

audit report. For purposes of the

progressive nature of sanctions under this

rule, offenses are characte rized as "first",

"second", "third", or "subsequent" offenses;

subsequent offenses are any occu rrences

after a third offense.

(i) "Patient Record" means the patient's

medical record, including all documentation

maintained by the provider, entity, or

pers on to document furnishing, ordering, or

authorizing goods or services, and includes

the documentation in multiple files if the

practitioner maintains separate files for

different types of documentation.

(j) "Patient Record Request" means a

request by the Agency for Medicaid - related

documentation or information. Such requests

are not limited to Agency audits to

determine overpayments or violations and are

not limited to enrolled Medicaid providers.

Each requesting document constitutes a

single Patient Re cord Request.

* * *

(n) "Sanction" shall be any monetary or

non - monetary disincentive imposed pursuant

to this rule; a monetary sanction may be

referred to as a "fine."

* * *

(q) "Violation" means any omission or act

performed by a provider, entity, or person

that is contrary to Medicaid laws, the laws

that govern the provider's profession, or

the Medicaid provider agreement.

* * *

(7) SANCTIONS: In addition to the

recoupment of the overpayment, if any, the

Agency will impose sanction s as outlined in

this subsection. Except when the Secretary

of the Agency determines not to impose a

sanction, pursuant to Section

409.913(16)(j), F.S., sanctions shall be

imposed as follows:

* * *

(e) For failure to comply with the

provisions of t he Medicaid laws: For a first

offense, $ 1,000 fine per claim found to be

in violation. For a second offense, $ 2,500

fine per claim found to be in violation.

For a third or subsequent offense, $ 5,000

fine per claim found to be in violation.

[Section 409.913(15)(e), F.S.] . . . .

44 . AHCA suggests the sanction of a fine in the amount of

$1,000.00 for each Resident for which a violation was found ,

totaling $7,000.00 .

45. Under the particular circumstances of the instant

case, AHCA's suggested sanctio n is too harsh. For several

years, New Life's owner and administrator, Ms. Newton , has

depended upon other agencies to know what forms were required to

be complete and to complete the required forms . Her dependency

upon the other agencies , regarding the required forms , was to

the extent that, if forms were not completed, she did not

consider the forms as being required. Additionally, New Life

has had no prior violations under Ms. Newton's 13 - year ownership

and administration . Further, Ms. Newton is will ing to do

whatever she needs to do to comply with the Medicaid laws and to

comply with AHCA's directives. Moreover, no harm to the

Residents occurred.

46. A corrective action plan would be more appropriate for

the particular ci rcumstances of the instant case and beneficial

to New Life and the Medicaid program.

47. Further, AHCA's Secretary has the authority not to

impose the sanction provided in r ule 59G - 9.070 (7)(e).

48. A more appropriate sanction under the particular

circumstances of the instant case is a fine in the amount of

$250.00 per Resident, totaling $1,750.00.

RECOMMENDATION

Based on the foregoing Finding s of Fact and Conclusions of

Law, it is

RECOMMENDED that the Agency for Health Care Administration

enter a final order :

1. Finding that New Life Assisted Living, Inc., d/b/a New

Life Assisted Living Facility, violated Florida Administrative

Code Rule 59G - 9.070(7)(e) by failing to have in the case files

of Resident M.B., Resident K.L., and Resident J.S. a Health

Assessment, Resident Service Pl an, and Certification of Medi cal

Necessity for the service - period covering January 1, 2011,

through November 30, 2011; by failing to have in the case file

of Res ident R.F. a Health Assessment and Certification of

Medical Necessity for the service - period co vering January 1,

2011 , through November 30, 2011; by failing to have in the case

file of Resident E.H. and Resident R.J. a Resident Service Plan

and Certification of Medical Necessity for the service - period

covering January 1, 2011, through November 30, 2 011; and by

failing to have in Resident I.M.'s case file a Certification of

Medical Necessity for the service - period covering January 1,

2011, through November 30, 2011 ;

2. Requiring New Life Assisted Living, Inc., d/b/a New

Life Assisted Living Facility to enter into a corrective action

plan; and

3. Imposing a fine against New Life Assisted Living, Inc.,

d/b/a New Life Assist ed Living Facility in the amount of

$1,750.00.

DONE AND ENTERED this 14th day of November , 2012 , in

Tallahassee, Leon County, Flo rida.

S

ERROL H. POWELL

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Div ision of Administrative Hearings

this 14th day of November , 2012 .

ENDNOTE

1 / Unless otherwise provided, all citati ons t o Florida Statutes

are 2009. Section 409.913 was last amended in 2009.

COPIES FURNISHED:

Jeffries H. Duvall, Esquire

Agency for H ealth Care Administration

Fort Knox Building III, Mail Station 3

2727 Mahan Drive

Tallahassee, Florida 32308

J. Garry Rooney, Esquire

Rooney & Rooney, P.A.

Second Floor, Suite 20

2145 - 14th Avenue

Vero Beach, Florida 32960 - 4414

Elizabeth Dudek, Secret ary

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 - 5403

Stuart F. Williams , General Counsel

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 - 5403

R ichard J. S hoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308 - 5403

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this rec ommended order. Any exceptions

to this recommended order should be filed with the agency that

will issue the final order in this case.