Item P9
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
7f A OD - ON*'
Meeting Date: November 19. 2008
Division: Mayor Pro Tern DiGennaro
Bulk Item: Yes No -X- Staff Contact Person: Tamara Lundstrom
289-6000
AGENDA ITEM WORDING: Resolution by the Board of County Commissioners
expressing support for a 90 day extension for Key West Convalescent Center allowing
time for the center to come into compliance with ARCA and CMS standards, or to transfer the
facility to another company, or to relocate the patients to appropriate accommodations in a
manner which supports appropriate care for the many severely ill and elderly patients and allows
for visitation of family and friends.
ITEM BACKGROUND: In November 2008 a team of investigators from Florida's
Agency for Health Care Administration (ARCA), conducted an on-sight investigation of the Key
West Convalescent Center (KWCC). Based on the investigation, the Centers for Medicare and
Medicaid Services' (CMS) regional office in Atlanta issued a letter dated November 7"', 2008, to
Key West Convalescent Center. The letter informed the KWCC that as of November 11, 2008
they could no longer accept Medicare of Medicaid patients of be reimbursed for Medicare of
Medicaid patients and advised KWCC that all patients had to be removed by December 11,2008.
As a result, the center will have no choice bnt to close the facility and to relocate all the patients.
There are not enough available beds in the Florida Keys to accommodate all the patients,
many will have to be relocated from the Key West area out of the Florida Keys, which will
adversely impact the health ofthe patients and the ability of family and friends to visit their loved
ones.
This Resolution expresses the view of the BOCC that a 90 day extension would be in the
public interest of Keys residents who will be unable to locate a facility for their loved ones in the
Florida Keys.
PREVIOUS RELEVANT BOCC ACTION: NONE
CONTRACT/AGREEMENT CHANGES: NONE
STAFF RECOMMENDATIONS:
BUDGETED: Yes No
SOURCE OF FUNDS:
AMOUNT PER MONTH N?A
OMBlPurchasing _ Risk
TOTAL COST: -0-
COST TO COUNTY: -0-
REVENUE PRODUCING: Not applicable
APPROVED BY: County Atty X -NWC
Management
DOCUMENTATION: Included X
AGENDA ITEM #
r
..~
Not Required_
DISPosmON:
RESOLUTION NO.
- 2008
A RESOLUTION OF THE MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS EXPRESSING CONCERN ABOUT
THE POSSIBLE IMPACT ON MONROE COUNTY'S ELDERLY
POPULATION AND THEIR FAMILIES IF THE KEY WEST
CONVALESCENT CENTER IS REQUIRED TO CLOSE AND TO
TRANSFER PATIENTS AND REQUESTING A 90 DAY
EXTENSION TO COMB INTO COMPLIANCE WITH AHCA AND
CMS REGULATIONS OR LOCATE ANOTHER FIRM TO TAKE
OVER THE OPERATION OF THE CENTER, OR TRANSFER
PATIENTS TO ANOTHER FACILITY
WHEREAS, a team of investigators from Florida's Agency for Health Care
Administration (AHCA) conducted an on-sight investigation of the Key West
Convalescent Center (KWCC) and
WHEREAS, based on the AHCA investigation, the Centers for Medicare
and Medicaid Services' (CMS) regional office in Atlanta issued a letter dated
November 7th, 2008, to Key West Convalescent Center. The letter informed the
KWCC that as of November 11, 2008 they could no longer accept Medicare of
Medicaid patients of be reimbursed for Medicare of Medicaid patients and
advised KWCC that all patients had to be removed by December 11, 2008; and
WHEREAS, KWCC is presently in negotiations with that ftrm to step in
and take over the operation of the center; and
WHEREAS, the KWCC has requested a 90 day extension of time to
comply, however CMS has denied the extension; and
WHEREAS, as a result of the letter from CMS, KWCC will have no choice
but to close the facility and to relocate all the patients;
WHEREAS, because there are not enough available beds in the Florida
Keys to accommodate all the patients residing at KWCC, many will have to be
relocated from the Key West area out of the Florida Keys, which will adversely
impact the health of the patients and the ability of family and friends to visit
their loved ones; and
WHEREAS, allowing an extension of time for KWCC to comply with the
standards, would allow for KWCC to continue to move toward compliance,
transfer ownership to another party, and beneftt the patients and families of
current residents;
1
NOW THEREFORE BE IT RESOLVED BY THE BOARD OF COUNTY
COIlllIlllISSIONERS OF 1lII0NROE COUNTY, FLORIDA, THAT:
Finding or Fact:
1. KWCC houses and cares for many extremely ill and elderly patients.
2. The forced removal of those patients will adversely impact their health and
the ability of their families to visit with them and to monitor their heath and
welfare.
ACTIONS AUTHORIZED:
1. The Board of County Commissioners hereby requests the Florida's Agency
for Health Care Administration and Centers for Medicare and Medicaid Services'
to allow a ninety (90) day extension on its requirements, as stated in its letter
dated November 7th, 2008, and to allow for KWCC to come into compliance with
ARCA and CMS standards, to transfer the facility to another company, or to
relocate the patients to appropriate accommodations.
PASSED AND ADOPTED by the Board of County Co=issioners of Monroe
County, Florida, at a regular meeting of said board held on the 19th day of
November, 2008.
Mayor
Mayor Pro Tem
Co=issioner
Commissioner
Co=issioner
(Seal)
Attest: DANNY L. KOLHAGE, Clerk
By:
DEPUTY CLERK
BOARD OF COUNTY
COMMISSlONERS OF
MONROE COUNTY, FLORIDA
BY:
Mayor
MONROE COUNTY ATTORNEY
~OVEDASTO~
NATI~ W~SSEL'
ASSISTANT CO~TY ATTyRNEY
Data II -/ - ~
2
RANKING MEMBER:
COMMITTEE ON FOREIGN AFFAIRS
PLEASE RESPOND TO:
2160 RAYBURN HOUSE OFFICE BUILDiNG
WASHINGTON, DC 20515-0918
o (202} 225-3931
FAX: (202)225-5620
http;f/wwN.house,gov/ros-lehtinen
http://foreignaffairs_house.nov/mif\Qrity!repu bl i ca ns.htm
RECEIVED NOV 17 2009
Cltongte~~ of tlJe Wntteb ~tate~
J,)ouse of i\epresfntatibes
ILEANA ROS-LEHTINEN
18TH DISTRICT. FLORIDA
DISTRICT OFFICE:
8660 W. FLAGLER STREET, #131
MIAMI, Fl33144
(305) 220-3281
FAX.: (305)220-3291
o
November 17, 2008
o
o
MONROE COUNTY:
(305)304-7789
MIAMI BEACH AREAS'
{3051934-9441
Mr. Kerry N. Weems
Acting Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
Dear Mr. Weems:
II would like bring to your attention a matter of grave importance to my Congressional
district regarding the Key West Convalescent Center (KWCC) which has been operating in our
community for years providing families with essential and life-saving care for their loved ones.
Recently, I was informed of a critical situation involving KWCC and Florida's Agency for Health
Care Administration (AHCA) and the Centers for Medicare and Medicaid Services (CMS) by
constituents of my Congressional district. The possible shutdown of this facility and its impact
on the community's elderly population concerns me greatly.
.1 request that KWCC be l!iven at least an immediate 90 dav extension and
permission to transition to a new firm with time to l!et into compliance with CMS
rel!ulations.
It was relayed to me that on October 27th and for five additional days through to
November I sl, a large team from Florida's Agency for Health Care Administration (AHCA)
conducted an on-site investigation of the Key West Convalescent Center. Their evaluation, using
a new reporting methodology produced a staggering 175 pages (not the usual 30), which revealed
KWCC was not on par with AHCA standard operating procedures. It has been relayed to my
office that some AHCA employees actually communicated their apologies to K WCC after the
fact, of perhaps, over-zealousness. I wonld appreciate CMS ewe KWCC a chance to respond
to tbe AHCA state allegations: while simnltaneonslv workinl! on a buvont and transition
that meets CMS compliance. so as to avoid further uunecessarv disruntions to these elders
and their devoted familv and friends.
On Friday, November 7"' of this month, the Centers for Medicare and Medicaid Services'
(CMS) regional office in Atlanta issued a letter to KWCC informing them that they could no
longer accept Medicare or Medicaid patients, or be un-reimbursed as of November II, 2008. In
addition, they informed KWCC that all patients had to be removed by December 11,2008. As
you know, KWCC has located a firm to take over the center and bring them into compliance with
all AHCA and CMS regulations. I understand the firm has a history of reliability and experience,
and suc:cessfully conducted a similar transition in the Atlanta area. However, it has come to my
attention that CMS has summarily rejected this KWCC proposal leaving them 110 other choice but
to embark on an immediate move of all 80 patients.
PRINTED ON RECYCLED PAPER
The patients at KWCC are not only elderly, but in need of a stable environment. The
news of their relocation to facilities throughout Florida have not only scared them, but affected
their health. It was brought to my attention that many residents were put on anti-depressants as a
result. Many health-care professionals feel that some of the 80 elderly patients might die as a
result of the move. I am also concerned for the much-loved and respected staff, of nurses and
health care professionals, who are scurrying to find work in this unstable economy. I do not want
them or their charges disturbed until the agencies decide on a proper and considered course of
action. Moving this population is unusual due to the geography of this 127 mile string of islands.
The nearest receiving center is in Plantation Key and they can take only 10 of the 80 patients,
Homestead perhaps 10 more, leaving the rest to be more than 200 miles from home in Miami,
Hialeah, Fort Lauderdale and beyond.
I am ioinin!! the constituents of mv district.. alon!! with Florida State Renresentative
Ron Saunders, the Mavor and Commissioners of our nation's southernmost city of Kev
West.. and the Monroe County Mavor and Board of County Commissioners. in askin!! that
CMS !!rant KWCC an immediate 90 day extension so that the transition to a new firm can
take nlace. If the residents at KWCC are moved, not only will there be possible negative health
conseQuences, but their families will have to deal with the physical ordeal of relocations that
might stretch all the way to Jacksonville in some instances.
In conclusion, I would like to express my hope that CMS reconsider and grant a 90 day
extension to KWCC. I understand and support CMS' role in assuring that those in our
community are given the best-quality health-care and treatment. I also know that you can
appreciate the uniqueness of this situation and that any resolution must take into account the
health and well-being of the residents at KWCC and their families. I would appreciate your
consideration in this matter.
- e men
Member of Congress
IRL:gv
CC:
Ms. Sandra Pace
CMS, Atlanta Regional Office
Associate Regional Administrator
61 Forsyth Street, SW, Suite 4T20
Atlanta, GA 30303
Representative Ron Saunders
Florida House of Representatives
1402 The Capitol
402 South Monroe Street
Tallahassee, FL 32399
Key West Mayor & Commissioners
525 Angela Street 2nd Floor
Key West, FL 33040
Monroe County Mayor & Commissioners
1100 Simonton Street
Key West, FL 33040
Me - HQ/HEAOOUARTERS Fax:850-487.fj240
Nov 10 2008 12:05 P. 01
Privacy Statement: This fa-may include confidential andlor proprietary
information, and m-y be used only by the person or entity to which it is
addressed. If the reader of this fa- is not the intended recipient or his
or her authorized agent, the reader is hereby notified that any
disselnination, distribution or copying of this e-mail is prohibited. If
you h-ve received this in error, please reply to the sender and delete it
:iJrmediately.
AGENCY FOR HEALTH CARE ADMINISTRATION
Division of Health Quality Assurance
2727 MAHAN DRIVE BUILDING 1, ROOM 170 TALLAHASSEE, FL.32308
FAX (850)487-6240 PHONE (850) 922-2945
The Honorable Larcenia Bullard, Senator
The Honorable Ron Saunders, Representative
Subject:
\)iIne :
Rebecca Knapp, Assistant Deputy Secretary, HQA
Key West Convalescent Center
Nml,Il8
We haVI: been advised that the letter sent via e-mail to your respective offices on Friday could not be
opened properly. I am sending a printed copy herewith.
This Centers for Medicare and Medicaid letter to Key West Convalescent Center terminates their
Medicare and Medicaid participation effective midnight November 11,2008. Should you receive
calls from your constituents, please advise that residents in the facility will not be required to leave
immediately. The 3D-day period is used for orderly transfer and relocation.
lIe - HQ/HEROQURRTERS Fax:850-487-6240
Nov 10 200812:05 P.02
Department of Health & Human Services
Centers for Medicare & Medicaid Services
61 Forsyth St., Suite 4T20
Atlanta, Georgia 30303-8909
Referto: 5456.lnvoI.Term. 11.07,08
IMPORT ANT NOTICE - PLEASE READ CARHZULL Y
(Receipt of this Notice is Presumed to be November 7, 2008 - Date Notice Faxed)
Novemb<::r 7, 2008
Mr. Mark Hmater, Administrator
Key West Convalescent Center
5860 West Junior College Road
Key West, Florida 33040
Re: Involuntary Termination Notice
CMS Certification Number: 10-5456
Dear Mr. Hunter:
A facility must meet the pertinent provisions of Sections 1819 and 1919 of the Social Security Act
and be in substantial compliance with each of the requirements for long term care facilities, established by
the Secretary of Health and Human Services in 42 CFR section 483.1 et sea., in order to qualifY to
participate as a skilled nursing facility in the Medicare program and as a nursing facility in the Medicaid
program.
On November !, 2008, a recertification and life safety code survey was completed at Key West
Convalescent Center by the Florida Agency for Healthcare Administration to determine if your
facility was in compliance with the Federal requirements for nursir-g homes participating in the
Medicare and Medicaid programs. This survey found that yonr facility was not in substantial
compliance -vith the participation requirements, and that conditions in your facility
constituted immediate jeopardy to residents' health and safety and substandard quality of
care. A statement of the deficiencies (CMS-2567) was furnished to you by the Florida Agency
for Health Care Administration on November 6,2008.
All references to regulatory requirements contained in this letter are found in Title 42, Code of
Federal Regulations.
t1L- IX HatHt:AUUUAK I i=K-=> t"aX:tl~-LRlI-oL4U
NOV W LUUtl"IL:UO 1"""'" U:J
Remedie- Imposed:
Based upon the November i, 2008 survey, we have determined, in accordance with sections 1819(h) and
1919(h) of the Social Security Act aud the enforcement regulations at 42
Part 488, to impose the following remedies:
Discretionarv Termination
Your Medicare provider agreement will be terminated at midnight on November 11, 2008, in accordance
with 42 CFR 488.456(b) (i) (i) and 42 CFR 489.53. We are required to provide the general public with a notice of
impending termination and will publish a notice in yollr local newspaper prior to the effective date of the termination.
Medicm'e and Medicaid payments for services rendered to those residents admitted to Key West Convalescent Center before
November 11. 2008. will continue to be made for a 30-day period, in order to facilitate the orderly tyansferlrelocation of
resident.. The 30-day time interval tor payment is from November 11,2008 through December 11,2008.
Discretionarv Denial .ofPavment for New Admissi..ons (l)PNA)
Discretionary Denial of Payment for New Admissions is effective November 9, 2008.
Please note that any filing of Medicare or Medicaid claims for new admissions after the denial of payment for
new admissions (DPNA) is in effect could result in such claims being considered "false" claims under
applicable federal statutes and thus potentially subjecting the filing entity to a referral to the appropriate
authorities and possibly to the penalties prescribed under such statutes, An exception possibly applies where a
timely appeal of the controlling certification/fmding of non -compliance is filed (and remains pending) under
42 C,F.R. Part 498, and where your facility has made arrangements acceptable to your Medicare and
Medicaid fiscal intermediaries to submit the claim (or claims) with prominent flagging clearly indicating that
the claim(s) is/are being filed not for current payment, but "under protest" and for the sole purpose of
preserving a timely filing should the facility prevail on its administrative appeal under 42 C.F.R, Part 498.
Civil Monetarv Penal-. (CMP)
As a result of your facility's noncompliance as evidenced by the fmdings of the November 1,2008 survey, and
in accordance with -eetions 1919 (h) and 1919 (h) of the Social Security Act and the enforcement
regulations specified at 42 CFR Part 488, we are imposing a CMP in the amount of $7,050.00 per day,
effective September 17, 2008 through November II, 2008, which is the effective date of the
involuntary termination remedy described above. CMS will issue a separate written notice
specifying the total amount of the CMP remedy, as well as instructions for submitting payment, We
considered factors identified at 42 CFR 488.438 (t) in setting the amount of the CMP being imposed for
each day of noncompliance.
If a hearing is requested, the CMP will not be collected until after it has stopped accruing and a
final administrative decision upholdiug its imposition has been made.
2
IVI\... II< HUlHt:TIUUUTIK 1 t:K;:' r-ax:o:>u-ao (-o;,:av
I'JOV IV LUUO .IL:UtJ 1-'. va
If you would like to waive your right to a hearing, you must do so in writing -vithin 60 calendar
days from the date of receipt of this notice. If you waive your right to a hearing in accordance with the
requirements specified at 42 CFR 488.436, the amount of the CMP will be reduced by thirty-five percent
(35%). In accordance with 42 CFR 488.436, if the facility does not waive its right to a hearir-g, the civil
monetary penalty - r-ot reduced by 35 percent.
You must submit your waiver request directly to the Regional Office by mail or fax to:
Ms. Bridget Winters
LTC Certification & Enforcement Branch Centers for Medicare & Medicaid
Services Sam Numa Atlanta Federal Center
61 Forsyth St., Suite-TIO
Atlanta, Georgia 30303-8909
PH: 404-562-7456
FAX: 404-562-7540
Plan.of Correction t-POC) a. ndlor AUe--ation of Compliance
A credible allegation of compliance and/or pac for the deficiencies must be submitted to this office ten (10)
calendar days after the facility receives it Form CMS-2567L. Please also submit a copy to the State Survey
Agency.
Loss of NurseAide Traininl! PrOl!ram (NAooTCEP)
Please note that Federal law, as specified in the Social Security Act at sections 1819 (f)(2)(B) and 1919
(f)(2)(B), prohibit approval of nurse aide training and competency evaluation programs offered by or in your
facility which within the previous two years has operated under a section 1819 (b)(4)(c)(ii)(ll) or section 1919
(b)(4)(ii) waiver; has been subj cot to an extended or partial extended survey; or has been assessed a civil
money penalty of not less than $5,000; or, has been subject to denial of payment, the appointment of a
t-mporary manager, termination or, in the case of an emergency, has been closed and/or had its residents
transfemld to other facilities. As a result of the exter-ded survey this provision is applicable to your
facility and you will receive further notification from the State.
Su.b.standard Ou.alit- of Care (S-OC!
Your facility's noncompliance with 42 C.F.R. 483.13 and 42 C.F.R. 483.25 has been determined to constitnte
Substandard Quality of Care. Sections 1818(g)(5XC) and 1919 (g)(5)(C) of the Social Security Act, as well as
implementing regulations at 488.325(h), require that the attending physician of each resident as well as
the State Board responsible for licensing the facility's administrator be notified of the SQC. In order to satisfy
these notification requirements, you are required to provide the State Survey Agency, within 10 working
days of receipt of their November 6, 2008 letter to you, with the name and address of the attending physician
for each resident found to have received substandard quality of care. Please note that, in accordance with
488.325(g), your failure to provide this information in a timely fashion will result in termination of
participation or the imposition of alternative remedies.
HL, l5< HUlHtoALJUUAK I t:K'=> r-ax:tlOU-4l:l (-<:lL4U
l'lOV 'I U LUUtl U:Utl 1-". UO
Appea) .m. "l!hts
If you disagree with our determination that Key West Convalescent Center was not in substantial
compliance with Medicare federal participation requirements at 42 C.F.R Part 483 as documented
during the November I, 2008 survey previously mentioned in this notice. you or your legal
representative may request a hearing before an administrative law judge of the Department of Health
and Human Services, Departmental Appeals Board. Procedures govert-ing this process are set out in
section 498.40, e-st se--<:-.q. You may appeal the certificettionslfmdings of rtoncompliaxace which led to the
enforcement actions, but you cannot appeal the choice of enforcement remedies 42 C.F.R, 488.408(g).
Procedures govering t!:tis process are set out in 42 C.F,P, Part 498, gubpart D.
A written re<juest for a hearing must be filed no later than sixty (60) calendar days from the date
of receipt ofihis letter. Such a request should be directed to:
Oliver Ports, Chief, Civil Remedies Division
Departmental Appeals Board, MS 6132
330 Independence Avenue, S.W.
Cohen Building, Room G-644
Washington, DC 20201
Please send o. copy of your hearing request to the attention of Phyllis King at the address belowartd
to the State Survey Agency:
Phyllis King
LTC Enforcement Branch
Centers for Medicare & Medicaid Services
Sam Nunn Atlanta Federal Center
61 Forsyth St., Suite 4T20
Atlanta, Georgia 30303-8909
FAX: (404)-562-7540
A request for a hearing should identify the specific issues, and the fmdings of fact and conclusion of law
with which you disagree. It should also specify the basis for contettding that the findings and
conclusions are incorrect. You may be represented by counsel at a hearing at your own expense.
Aoolicat..ion for Readmission Followinfl I......voluntarv Termination:
Under the Medicare regulation at 42 C.F.R..- 489.57(a) when a provider agreement i- terminated by
CMS, a new agreement will not be accepteduntil it has been detelmined that the reason for the
tennination of the agreement has been removed and there is a reasonable assurance that it will not recur.
Once terminated, therefore, you must demonstrate through a reasonable assurance period that you can
maintain substantial compliance for at least 180 consecutive days. Substantial eomplimaee with the
applicable participation requirements at 42 C.ER Part 483 will be verified by surveys conducted at the
beginning and end of this period. Additionally, before readmission to the Medicarerrogram, you must
demonstrate your ability to comply' with all p.ertinent requirements of Title XVlll 0 the Social Security
Act (including your financial ability to provide services required for Medicare participation). You
must also establish that you have fialfilled, or made satisfactory arrangements to fulfill, all of the statutory
and regulatory responsibilities of your previous provider agreement (including resolution of all
outstanding fmanciaI obligations due the Medicare program). 42 C.F.R. ~ 489.57(b).
4
HL: IS< HUlH~UUUAK I t:K:; t-ax:tlOlJ-4tSI-o~4U
NOV lU ~UUtll~:U\ r. UO
Assuming substantial compliance with partic{patio- requirements is doc,u, me-ted -at, the, beginning
and end of the reasonable assurance period, and assun)ing all orner tecteral requirements are met,
Medicare certification and reimbursement will begin following the conclusion of the reasonable
assurance period in accordance with the terms of 42 C.P.R. ~ 489.13.
If you have any questions regarding this matter. please contact Stephanie Davis at (404)-562-7471 or
Phyllis King at (404) 562-7456. Ir-formationcan also he fuxed to (404)-562-7450.
Sincerely,
Sandra M. Pace
Associate Regional Administrator
Division of Survey and Certification
State Survey Agency State
Medicaid Agency Fiscal
Intermediary Stephanie M.
Davis Tina Holloway
Howard Lewis
AmrAll
Mark Halter
NOTE TO THE FISCAL INTERMEDIARY
This lette:r replaces the CMS-2007, Provider Tie-In Notice