229.22 230.75 9/1/2016 · 2016-07-21 · medicaid reimbursement per diem rates provider number: 0...
TRANSCRIPT
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 001135-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.22 230.75 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 001135073120150801201403142016112219
SURREY PLACE CARE CENTER
110 SE LEE AVE
LIVE OAK, FL 32060
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 001136-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.82 232.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 001136073120150801201403142016113124
SIGNATURE HEALTHCARE OF PALM BEACH
4405 LAKEWOOD ROAD
LAKE WORTH, FL 33461
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 001416-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.20 208.92 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 001416123120140101201406262015110645
FLORIDA BAPTIST RETIREMENT CENTER
1006 33RD ST
VERO BEACH, FL 32960
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 002400-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.53 261.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 002400083120140101201411192014133156
VILLAGE PLACE HEALTH AND REHAB CENTER
2370 HARBOR BLVD
PORT CHARLOTTE, FL 33952
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005219-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.54 235.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005219123120140701201404212015154724
OSCEOLA HEALTH CARE CENTER
4201 W NEW NOLTE ROAD
SAINT CLOUD, FL 34772
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005372-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.76 235.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005372063020140101201410122014133247
DEBARY HEALTH AND REHABILITATION CENTER
60 N HWY 17/92
DEBARY, FL 32713
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005374-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.09 235.86 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005374063020140101201410122014132004
FLAGLER HEALTH AND REHABILITATION CENTER
300 DR CARTER BOULEVARD
BUNNELL, FL 32110
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005379-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.72 238.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005379063020140101201410132014132230
LONGWOOD HEALTH AND REHABILITATION CENTER
1520 S GRANT ST
LONGWOOD, FL 32750
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005380-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.40 246.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005380063020140101201410132014150000
THE REHABILITATION CENTER OF WINTER PARK
1700 MONROE AVE
MAITLAND, FL 32751
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005381-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.54 247.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005381063020140101201410132014160002
BRYNWOOD HEALTH AND REHABILITATION CENTER
1656 SOUTH JEFFERSON STREET
MONTICELLO, FL 32344
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005383-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 235.39 237.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005383063020140101201410122014130233
CHIPOLA HEALTH AND REHABILITATION CENTER
4294 3RD AVENUE
MARIANNA, FL 32446
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005384-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.35 241.52 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005384063020140101201410122014131408
GLENCOVE HEALTH AND REHABILITATION CENTER
1027 E HWY 98
PANAMA CITY, FL 32401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005385-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.55 233.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005385063020140101201410112014161020
PANAMA CITY HEALTH AND REHABILITATION CENTER
924 W 13TH ST
PANAMA CITY, FL 32401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005386-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.18 235.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005386063020140101201410132014161243
RIVERCHASE HEALTH AND REHABILITATION CENTER
1017 STRONG RD
QUINCY, FL 32351
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005387-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.30 246.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005387063020140101201410132014155217
SUWANNEE HEALTH AND REHABILITATION CENTER
1620 HELVENSTON ST SE
LIVE OAK, FL 32064-3474
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005519-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.80 251.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005519063020140101201410112014160654
WAVE CREST HEALTH AND REHABILITATION CENTER
1415 S HICKORY ST
MELBOURNE, FL 32901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005543-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.03 241.55 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005543063020140101201410122014135403
SEASIDE HEALTH AND REHABILITATION CENTER
324 WILDER BLVD
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005547-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.69 232.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005547063020140101201410122014135946
PARKSIDE HEALTH AND REHABILITATION CENTER
451 S AMELIA AVE
DELAND, FL 32724
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005549-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.17 249.25 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005549063020140101201410122014124836
OAKS OF KISSIMMEE
320 N MITCHELL ST
KISSIMMEE, FL 34741
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005701-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.15 229.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005701123120140601201407062015132018
AVANTE AT OCALA
2021 SW 1ST AVE
OCALA, FL 34471
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005811-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.04 250.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005811123120140701201404132015134820
PALATKA HEALTH CARE CENTER
110 KAY LARKIN DR
PALATKA, FL 32177
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005814-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 263.75 264.77 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005814063020140101201410122014121820
BOYNTON HEALTH CARE CENTER
7900 VENTURE CENTER WAY
BOYNTON BEACH, FL 33437-7402
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005826-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.45 236.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005826063020140101201410122014123932
ACCENTIA HEALTH & REHAB. CENTER OF TAMPA
1818 E FLETCHER AVE
TAMPA, FL 33612-3770
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005849-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 272.49 274.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005849063020140101201410132014160617
GLEN OAKS HEALTH CARE CENTER
1100 N PINE ST
CLEARWATER, FL 33756-4104
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005850-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.15 232.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005850063020140101201410132014132816
HERITAGE PARK
37135 COLEMAN AVE
DADE CITY, FL 33525-4526
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005851-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.24 236.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 005851063020140101201410132014110207
LAKE EUSTIS CARE CENTER
411 W WOODWARD AVE
EUSTIS, FL 32726
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006339-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.31 244.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 006339063020140101201410132014112001
LAKE PLACID HEALTH AND REHABILITATION CENTER
125 TOMOKA BLVD S
LAKE PLACID, FL 33852-8123
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006340-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.46 235.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 006340063020140101201410132014110751
WINDSOR HEALTH AND REHABILITATION CENTER
602 E LAURA ST
STARKE, FL 32091
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006483-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.69 243.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 006483063020140101201410132014133428
SALERNO BAY HEALTH AND REHABILITATION CENTER
4801 SE COVE RD
STUART, FL 34997-1602
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006489-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.43 245.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 006489063020140101201410132014111430
ROYAL PALM BEACH HEALTH AND REHABILITATION CENTER
600 BUSINESS PARK WAY
ROYAL PALM BEACH, FL 33411-1747
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006767-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.25 253.04 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 006767063020140101201410122014132634
OAKBROOK HEALTH AND REHABILITATION CENTER
250 BROWARD AVE
LABELLE, FL 33935
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 008793-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.42 229.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Cardinal Resources, LLC
16 Norcross Street
Roswell, GA 30075
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 008793123120140101201407172015084321
WOODS OF MANATEE SPRINGS
5627 9TH ST E
BRADENTON, FL 34203
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 010082-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.93 225.34 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 010082063020140701201304272015113542
COURTYARD GARDENS REHABILITATION CENTER
17781 THELMA AVE
JUPITER, FL 33458
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 010453-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.76 249.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 010453123120140101201405282015093151
HEARTLAND HEALTH CARE & REHABILITATION CENTER
5401 SAWYER RD
SARASOTA, FL 34233
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 011997-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.42 243.36 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 011997123120140101201405282015094749
HEARTLAND HEALTH CARE AND REHABILITATION CENTER OF BOCA RATON
7225 BOCA DEL MAR DRIVE
BOCA RATON, FL 33433
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 011998-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.77 242.38 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Grace Healthcare, Inc
7201 Shallowford Rd, STE 200
Chattanooga, TN 37421
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 011998123120150101201504262016151432
GRACE REHABILITATION CENTER OF VERO BEACH
2180 10TH AVENUE
VERO BEACH, FL 32960
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 014169-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.02 250.34 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 014169123120140201201404252015154626
GULF SHORE REHAB & NURSING
6767 86TH AVE N
PINELLAS PARK, FL 33782
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 015613-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.85 207.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Saber Healthcare Group, LLC
26691 Richmond Road
Bedford Heights, OH 44146
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 015613123120140101201405142015092143
ST. JAMES HEALTH AND REHABILITATION CENTER
239 CROOKED RIVER ROAD
CARRABELLE, FL 32322
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017221-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.06 232.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017221063020140101201410122014140646
BAYSIDE HEALTH AND REHABILITATION CENTER
4343 LANGLEY AVENUE
PENSACOLA, FL 32504
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017222-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.47 247.40 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017222063020140101201410132014134039
MARGATE HEALTH AND REHABILITATION CENTER
5951 COLONIAL DRIVE
MARGATE, FL 33063
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017223-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.40 239.34 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017223063020140101201410112014160148
ROSEWOOD HEALTHCARE AND REHABILITATION CENTER
3107 NORTH H STREET
PENSACOLA, FL 32501-1043
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017225-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.18 245.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017225063020140101201410122014142122
BAY BREEZE SENIOR LIVING AND REHABILITATION CENTER
3387 GULF BREEZE PARKWAY
GULF BREEZE, FL 32563
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017230-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.91 244.62 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017230063020140101201410132014105545
SILVERCREST HEALTH AND REHABILITATION CENTER
910 BROOKMEADE DRIVE
CRESTVIEW, FL 32539
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017236-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.55 246.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017236063020140101201410122014142356
SPECIALTY HEALTH AND REHABILITATION CENTER
6984 PINE FOREST ROAD
PENSACOLA, FL 32526
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017242-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.26 251.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 017242063020140101201410122014123221
GRAND BOULEVARD HEALTH & REHAB. CENTER
138 SANDESTIN LANE
MIRAMAR BEACH, FL 32550
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 018066-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.77 236.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
FiveStar Quality Care Inc
400 Centre Street
Newton, MA 02458
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 018066123120150101201503262016142110
THE PARK SUMMIT AT CORAL SPRINGS
8500 ROYAL PALM BLVD
CORAL SPRINGS, FL 33065
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 018777-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 262.69 272.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 018777123120140101201405212015102809
BAY VILLAGE OF SARASOTA
8400 VAMO ROAD
SARASOTA, FL 34231
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019085-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.16 209.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 019085073120150801201403142016133924
GOLFVIEW HEALTHCARE CENTER
3636 10TH AVE N
SAINT PETERSBURG, FL 33713
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019282-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 191.26 195.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 019282073120150801201403282016102245
SOUTHERN PINES HEALTHCARE CENTER
6140 CONGRESS ST
NEW PORT RICHEY, FL 34653
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019284-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.47 202.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 019284073120150801201403142016131649
SIGNATURE HEALTHCARE OF JACKSONVILLE
2061 HYDE PARK RD
JACKSONVILLE, FL 32210
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019287-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.86 202.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 019287073120150801201403142016132142
GOLFCREST HEALTHCARE CENTER
600 NORTH 17TH AVE
HOLLYWOOD, FL 33020
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 021261-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.39 216.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 021261063020140101201410122014134040
COASTAL HEALTH AND REHABILITATION CENTER
820 N CLYDE MORRIS BLVD
DAYTONA BEACH, FL 32117
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 022138-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 235.93 242.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 022138123120150901201404292016141227
CARLTON SHORES HEALTH AND REHAB CENTER
1350 S NOVA RD
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 022987-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.57 212.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
WW Healthcare Consultants, LLC
1978 8th Avenue NW
Hickory, NC 28603
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 022987123120140101201406302015115717
BLOUNTSTOWN HEALTH AND REHABILITATION CENTER
16690 SW CHIPOLA RD
BLOUNTSTOWN, FL 32424
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 022994-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.72 211.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 022994063020150701201411092015093211
THE HOME ASSOCIATION, INC.
1203 E 22ND AVE
TAMPA, FL 33605
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 023067-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 265.22 268.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 023067033120151001201404292015144210
OKEECHOBEE HEALTHCARE FACILITY
1646 HIGHWAY 441 N
OKEECHOBEE, FL 34972
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 024167-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.07 218.20 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 024167063020150701201411032015073045
KEY WEST HEALTH & REHABILITATION
5860 W JUNIOR COLLEGE RD
KEY WEST, FL 33040
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 026536-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.80 262.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 026536123120150101201504272016145017
WEST BROWARD REHABILITATION AND HEALTHCARE
7751 W BROWARD BLVD
PLANTATION, FL 33324
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 032049-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.59 249.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Florida Dept. of Veterans Affairs
11351 Ulmerton Road, Room 332-I
Largo, Fl 33778-1630
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 032049063020150701201411232015125519
CLYDE E. LASSEN STATE VETERANS' NURSING HOME
4650 STATE RD 16
SAINT AUGUSTINE, FL 32092
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 032482-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.31 246.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 032482083120140101201411192014165437
UNITY HEALTH AND REHAB CENTER
1404 NW 22ND STREET
MIAMI, FL 33142
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 032486-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.30 250.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 032486083120140101201410092014140735
LADY LAKE SPECIALTY CARE CENTER
630 GRIFFIN AVENUE
LADY LAKE, FL 32159
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 032551-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.96 257.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 032551083120140101201411202014165527
SUNSET LAKE HEALTH AND REHAB CENTER
832 SUNSET LAKE BOULEVARD
VENICE, FL 34292
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 032553-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.91 227.91 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 032553123120150901201404292016004102
LEXINGTON HEALTH & REHABILITATION CENTER
6300 46TH AVE N
SAINT PETERSBURG, FL 33709
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 033175-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.70 230.37 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 033175013120160201201504292016105106
SEVEN HILLS HEALTH & REHAB CENTER
3333 CAPITAL MEDICAL BLVD
TALLAHASSEE, FL 32308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 033717-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.47 242.46 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 033717063020150701201406012016153735
BENDERSON FAMILY SKILLED NURSING & REHAB CENTER
1959 N HONORE AVE
SARASOTA, FL 34235
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 034504-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.73 215.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Grace Healthcare, Inc
7201 Shallowford Rd, STE 200
Chattanooga, TN 37421
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 034504123120150101201504282016111947
GRACE HEALTHCARE OF LAKE WALES
730 N SCENIC HWY
LAKE WALES, FL 33853-3208
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 038640-00
Date: 6/30/2016
Fiscal Year End: 6/30/2012
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.00 234.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
NUVISTA LIVING AT WELLINGTON GREEN
10330 NUVISTA AVENUE
WELLINGTON, FL 33414
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 041324-00
Date: 6/30/2016
Fiscal Year End: 6/30/2012
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.23 231.47 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
NUVISTA LIVING AT HILLSBOROUGH LAKES
19091 N DALE MABRY HWY
LUTZ, FL 33548
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 041685-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.14 218.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 041685022820150901201407072015141215
UNIVERSITY CENTER WEST
545 WEST EUCLID AVENUE
DELAND, FL 32720
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 041686-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.82 225.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 041686013120160201201504202016112008
UNIVERSITY CENTER EAST
991 E NEW YORK AVE
DELAND, FL 32724
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043832-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 189.03 189.73 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043832123120150101201504252016110649
HERON POINTE HEALTH AND REHABILITATION
1445 HOWELL AVE
BROOKSVILLE, FL 34601-1502
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043833-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 193.83 196.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043833123120150101201504252016120205
HERITAGE HEALTHCARE CENTER AT TALLAHASSEE
3101 GINGER DR
TALLAHASSEE, FL 32308-4437
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043835-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.05 215.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043835123120150101201504252016112754
BAY BREEZE HEALTH AND REHABILITATION CENTER
1026 ALBEE FARM RD
VENICE, FL 34285-6213
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043838-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.10 209.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043838123120150101201504252016113106
HERITAGE HEALTHCARE AND REHABILITATION CENTER
777 9TH ST N
NAPLES, FL 34102
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043839-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 189.98 185.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043839123120150101201504252016125023
KEYSTONE REHABILITATION AND HEALTH CENTER
1120 W DONEGAN AVE
KISSIMMEE, FL 34741-2247
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043841-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.56 202.55 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043841123120140101201411102015115120
OAKBRIDGE HEALTHCARE CENTER
3110 OAKBRIDGE BLVD E
LAKELAND, FL 33803-5987
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043843-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.79 207.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043843123120150101201504252016140336
OAKTREE HEALTHCARE
650 REED CANAL RD
SOUTH DAYTONA, FL 32119-3230
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043846-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.49 196.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043846123120150101201504252016135749
RIO PINAR HEALTH CARE
7950 LAKE UNDERHILL ROAD
ORLANDO, FL 32822
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043847-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.83 204.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043847123120140101201411102015105030
THE PALMS REHABILITATION AND HEALTHCARE CENTER
5405 BABCOCK ST NE
PALM BAY, FL 32905
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043848-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.15 200.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043848123120150101201504252016105837
CORAL TRACE HEALTH CARE
216 SANTA BARBARA BLVD
CAPE CORAL, FL 33991-2031
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043850-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.57 211.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043850123120140101201411102015123747
THE PARKS HEALTHCARE AND REHABILITATION CENTER
9311 S ORANGE BLOSSOM TRL
ORLANDO, FL 32837-8301
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043851-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.73 216.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043851123120140101201411102015124123
CORAL BAY HEALTHCARE AND REHABILITATION
2939 S HAVERHILL RD
WEST PALM BCH, FL 33415-8118
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043853-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.85 203.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043853123120140101201411182015112227
PLANTATION BAY REHABILITATION CENTER
4641 OLD CANOE CREEK ROAD
SAINT CLOUD, FL 34769
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043854-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 188.62 187.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043854123120150101201504252016144350
COLONIAL LAKES HEALTH CARE
15204 W COLONIAL DR
WINTER GARDEN, FL 34787-6042
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043856-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.16 225.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043856123120140101201411102015114858
CENTRAL PARK HEALTHCARE AND REHABILITATION CENTER
702 S KINGS AVE
BRANDON, FL 33511-5925
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043857-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.72 224.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043857123120150101201504252016144626
BENEVA LAKES HEALTHCARE AND REHABILITATION CENTER
741 SOUTH BENEVA ROAD
SARASOTA, FL 34232
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043859-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.22 212.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043859123120150101201504252016105110
BRADENTON HEALTH CARE
6305 CORTEZ RD W
BRADENTON, FL 34210-2604
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043860-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 193.11 199.30 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043860123120150101201504252016105442
BRANDON HEALTH AND REHABILITATION CENTER
1465 OAKFIELD DR
BRANDON, FL 33511-4854
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043861-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.31 206.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043861123120150101201504252016112038
FORT PIERCE HEALTH CARE
611 S 13TH ST
FORT PIERCE, FL 34950-4054
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043862-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.13 209.23 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043862123120150101201504252016143220
HABANA HEALTH CARE CENTER
2916 HABANA WAY
TAMPA, FL 33614
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043863-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.37 224.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043863123120150101201504252016144846
THE HEALTH AND REHABILITATION CENTRE AT DOLPHINS VIEW
1820 SHORE DR S
SOUTH PASADENA, FL 33707
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043864-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.65 207.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043864123120150101201504252016132333
GRAND OAKS HEALTH AND REHABILITATION CENTER
3001 PALM COAST PARKWAY SE
PALM COAST, FL 32137
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043865-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 186.47 188.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043865123120150101201504252016135142
HARTS HARBOR HEALTH CARE CENTER
11565 HARTS RD
JACKSONVILLE, FL 32218-3777
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043866-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.21 202.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043866123120150101201504252016111755
FLETCHER HEALTH AND REHABILITATION CENTER
518 W FLETCHER AVE
TAMPA, FL 33612-3419
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043867-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.73 201.89 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043867123120150101201504252016125649
WEDGEWOOD HEALTHCARE CENTER
1010 CARPENTERS WAY
LAKELAND, FL 33809-3926
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043868-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.33 209.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043868123120150101201504252016110425
DELTONA HEALTH CARE
1851 ELKCAM BLVD
DELTONA, FL 32725-3922
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043871-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.80 212.84 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043871123120150101201504252016125419
LAKE MARY HEALTH AND REHABILITATION CENTER
710 NORTH SUN DRIVE
LAKE MARY, FL 32746
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043872-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.23 197.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043872123120140101201411102015083940
COUNTRYSIDE REHAB AND HEALTHCARE CENTER
3825 COUNTRYSIDE BLVD N
PALM HARBOR, FL 34684-4928
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043873-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.30 217.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043873123120140101201411102015094623
HARBOR BEACH NURSING AND REHABILITATION CENTER
1615 MIAMI RD
FT LAUDERDALE, FL 33316-2933
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043874-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 193.05 188.22 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043874123120150101201504252016112525
HEALTH CENTER AT BRENTWOOD
2333 N BRENTWOOD CIR
LECANTO, FL 34461-8536
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043875-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.08 194.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043875123120150101201504252016131949
GOVERNOR'S CREEK HEALTH AND REHABILITATION
803 OAK ST
GREEN COVE SPRINGS, FL 32043
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043876-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.73 195.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043876123120140101201411172015134947
LARGO HEALTH AND REHABILITATION CENTER
9035 BRYAN DAIRY RD
LARGO, FL 33777-1104
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043877-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.24 208.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043877123120150101201504252016111041
MAGNOLIA HEALTH AND REHABILITATION CENTER
1507 S TUTTLE AVE
SARASOTA, FL 34239-2608
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043878-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 192.84 193.09 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043878123120140101201411102015105846
MARSHALL HEALTH AND REHABILITATION CENTER
207 MARSHALL DR
PERRY, FL 32347-1835
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 043880-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.55 202.52 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 043880123120150101201504252016131242
NORTH FLORIDA REHABILITATION AND SPECIALTY CARE
6700 NW 10TH PLACE
GAINESVILLE, FL 32605
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 044886-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 192.74 190.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 044886123120140101201403272015150542
CRESTVIEW REHABILITATION CENTER
1849 FIRST AVENUE EAST
CRESTVIEW, FL 32539
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 044888-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.95 209.19 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 044888123120140101201403272015152945
FORT WALTON REHABILITATION CENTER
1 LBJ SR DRIVE
FORT WALTON BEACH, FL 32548
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 044889-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.49 195.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 044889123120140101201403272015153338
RIVER VALLEY REHABILITATION CENTER
17884 NE CROZIER ST
BLOUNTSTOWN, FL 32424
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 044975-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 257.59 247.52 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lyric Healthcare Holdings III, Inc
1423 Clarkview Road
Suite 500
Baltimore, MD 21090
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 044975073120140801201310222015115206
PLANTATION KEY NURSING CENTER
48 HIGH POINT ROAD
TAVERNIER, FL 33070
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 046017-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 259.79 262.33 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Professional Care I, Inc.
10850 SW 113th Place
Miami, FL 33176
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 046017123120140701201404202015080945
HOMESTEAD MANOR A PALACE COMMUNITY
1330 NW 1ST AVE
HOMESTEAD, FL 33030
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 046128-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.19 251.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 046128022920160301201504272016134457
VICTORIA NURSING AND REHABILITATION CENTER, INC.
955 NW 3RD ST
MIAMI, FL 33128
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 046233-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 263.49 205.01 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 046233013120150201201408192015111150
CROSSBREEZE CARE CENTER
1755 18TH ST
SARASOTA, FL 34234
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 046758-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 264.64 267.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Stacey Enterprises, Inc
421 Garrard Street
Covington, KY 41011
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 046758022820150301201404232015155227
RIVERSIDE CARE CENTER
899 NW 4TH STREET
MIAMI, FL 33128
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 047787-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.14 216.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 047787123120150101201504252016144134
RENAISSANCE HEALTH AND REHABILITATION
5065 WALLIS ROAD
WEST PALM BEACH, FL 33415
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 047788-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.11 217.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 047788123120140101201411102015124421
WOOD LAKE NURSING AND REHABILITATION CENTER
6414 13TH RD S
GREENACRES, FL 33415-1401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 047795-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.27 193.86 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 047795123120150101201504252016143712
HILLCREST HEALTH CARE AND REHABILITATION CENTER
4200 WASHINGTON ST
HOLLYWOOD, FL 33021-7353
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 048441-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.24 230.09 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 048441093020151001201402252016100607
HEALTH CENTRAL PARK
411 NORTH DILLARD STREET
WINTER GARDEN, FL 34787
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 048611-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.54 210.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 048611123120140101201403272015153558
OCALA OAKS REHABILITATION CENTER
3930 E SILVER SPRINGS BLVD
OCALA, FL 34470-5006
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 048807-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 267.53 264.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 048807022820151201201309282015165447
RIVIERA HEALTH RESORT
6901 YUMURI STREET
CORAL GABLES, FL 33146
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 054789-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.50 204.85 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Adirhu Associates, LLC
12221 W Dixie Hwy
Miami, FL 33161
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 054789123120150101201504282016164511
SOUTH DADE NURSING AND REHABILITATION CENTER
17475 S DIXIE HWY
MIAMI, FL 33157
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 054790-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.32 215.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Adirhu Associates, LLC
12221 W Dixie Hwy
Miami, FL 33161
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 054790123120140101201407282015090524
GOLDEN GLADES NURSING AND REHABILITATION CENTER
220 SIERRA DRIVE
MIAMI, FL 33179
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059369-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 259.32 264.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059369123120140701201404042015133215
CALUSA HARBOUR
2525 FIRST ST
FORT MYERS, FL 33901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059400-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.12 255.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059400123120140701201404042015140021
STRATFORD COURT OF PALM HARBOR
45 KATHERINE BLVD
PALM HARBOR, FL 34684
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059404-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 257.75 266.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059404123120150101201503282016171440
GARDENS OF PORT ST. LUCIE
1699 SE LYNGATE DRIVE
PORT SAINT LUCIE, FL 34952
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059783-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 191.23 189.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059783123120140701201406082015110054
SUMMER BROOK HEALTH CARE CENTER
5377 MONCRIEF ROAD
JACKSONVILLE, FL 32209
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059852-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 183.10 187.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059852123120150101201504252016131532
SHOAL CREEK REHABILITATION CENTER
500 HOSPITAL DRIVE
CRESTVIEW, FL 32539
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059855-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.97 200.75 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059855123120150101201504252016111530
ENGLEWOOD HEALTHCARE & REHABILITATION CENTER
1111 DRURY LN
ENGLEWOOD, FL 34224-4545
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059866-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.55 203.38 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059866123120150101201504252016130957
ISLAND HEALTH AND REHABILITATION CENTER
125 ALMA BLVD
MERRITT IS, FL 32953-4345
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059869-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.26 206.33 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059869123120150101201504252016140100
ROSEWOOD HEALTH AND REHABILITATION CENTER
3920 ROSEWOOD WAY
ORLANDO, FL 32808
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059873-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.20 204.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059873123120140101201411102015093437
EVANS HEALTH CARE
3735 EVANS AVE
FORT MYERS, FL 33901-9302
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059874-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 182.87 187.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059874123120150101201504252016112259
SEA BREEZE HEALTH CARE
1937 JENKS AVE
PANAMA CITY, FL 32405-4510
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 059877-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.43 197.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 059877123120150101201504252016143007
SPRING HILL HEALTH AND REHABILITATION CENTER
12170 CORTEZ BLVD
BROOKSVILLE, FL 34613-5578
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 060972-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 195.63 198.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 060972123120150101201504252016111307
EMERALD SHORES HEALTH AND REHABILITATION
626 N TYNDALL PKWY
CALLAWAY, FL 32404-6132
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 060993-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 192.91 195.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 060993123120150101201504252016110134
UNIVERSITY HILLS HEALTH AND REHABILITATION
10040 HILLVIEW ROAD
PENSACOLA, FL 32514
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 061095-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.72 196.55 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 061095123120140101201411102015103810
HERITAGE PARK REHABILITATION AND HEALTHCARE
2826 CLEVELAND AVE
FORT MYERS, FL 33901-6001
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 061101-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.40 200.04 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 061101123120140101201411102015091042
DESTIN HEALTHCARE AND REHABILITATION CENTER
195 MATTIE M KELLY BLVD
DESTIN, FL 32541-2811
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 061102-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.61 191.47 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 061102123120150101201504252016103613
SAN JOSE HEALTH AND REHABILITATION CENTER
9355 SAN JOSE BLVD
JACKSONVILLE, FL 32257
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 061107-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.41 205.74 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 061107123120150101201504252016135422
SEAVIEW NURSING AND REHABILITATION CENTER
2401 NE 2ND STREET
POMPANO BEACH, FL 33062
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 061109-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.25 195.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 061109123120150101201504252016143442
VISTA MANOR
1550 JESS PARRISH CT
TITUSVILLE, FL 32796-2147
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 061140-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.38 201.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 061140123120150101201504252016140740
LAKESIDE OAKS CARE CENTER
1061 VIRGINIA ST
DUNEDIN, FL 34698
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 072048-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.55 245.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 072048123120140701201307202015085027
SOUTH CAMPUS REHABILITATION & NURSING CENTER
715 E DIXIE AVE
LEESBURG, FL 34748
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 072054-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 266.83 267.91 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 072054123120140701201404132015163854
REHABILITATION CENTER OF ST. PETE
435 42ND AVE S
SAINT PETERSBURG, FL 33705
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 072320-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.41 243.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 072320123120150901201404292016013718
THE CLUB HEALTH AND REHAB CENTER AT THE VILLAGES
16529 SE 86TH BELLE MEADE CIRCLE
THE VILLAGES, FL 32162-5885
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 073324-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.12 210.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 073324123120140701201306042015162154
BRADEN RIVER REHABILITATION CENTER, LLC
2010 MANATEE AVE E
BRADENTON, FL 34208-1560
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080062-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.65 200.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080062022920160301201504202016115421
THE GROVES CENTER
512 S 11TH ST
LAKE WALES, FL 33853-4901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080068-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.47 210.25 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080068022820150901201404192015121501
LAKELAND HILLS CENTER
610 E BELLA VISTA DR
LAKELAND, FL 33805
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080079-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.69 213.95 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080079022820150901201404192015115418
TARPON BAYOU CENTER
515 CHESAPEAKE DR
TARPON SPRINGS, FL 34689
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080374-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.42 193.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080374123120150101201504252016151239
CONSULATE HEALTH CARE OF BAYONET POINT
8132 HUDSON AVENUE
HUDSON, FL 34667-8571
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080377-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.03 198.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080377123120140101201411112015102108
CONSULATE HEALTH CARE OF BRANDON
701 VICTORIA ST
BRANDON, FL 33510-4100
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080384-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.28 214.82 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080384123120150101201504252016151636
CONSULATE HEALTH CARE OF JACKSONVILLE
4101 SOUTHPOINT DRIVE EAST
JACKSONVILLE , FL 32216
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080387-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 202.67 199.54 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080387123120140101201411172015145719
CONSULATE HEALTH CARE OF KISSIMMEE
2511 JOHN YOUNG PARKWAY NORTH
KISSIMMEE, FL 34741
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080391-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.09 193.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080391123120140101201411112015084851
CONSULATE HEALTH CARE OF LAKELAND
5245 N SOCRUM LOOP RD
LAKELAND, FL 33809
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080393-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.31 200.19 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080393123120140101201411112015102456
CONSULATE HEALTH CARE OF LAKE PARKER
2020 W LAKE PARKER DR
LAKELAND, FL 33805-5005
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080394-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.26 208.75 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080394123120140101201411112015102840
CONSULATE HEALTH CARE OF MELBOURNE
3033 SARNO RD
MELBOURNE, FL 32934
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080397-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 191.85 191.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080397123120140101201411112015101340
CONSULATE HEALTH CARE OF NEW PORT RICHEY
8417 OLD COUNTY RD 54
NEW PORT RICHEY, FL 34653
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080400-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.45 195.89 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080400123120140101201411172015135946
CONSULATE HEALTH CARE OF NORTH FT. MYERS
991 PONDELLA RD
NORTH FORT MYERS, FL 33903
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080402-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 199.13 196.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080402123120150101201504252016151901
CONSULATE HEALTH CARE OF ORANGE PARK
1215 KINGSLEY AVE
ORANGE PARK, FL 32073
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080405-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.16 206.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080405123120140101201411172015151107
CONSULATE HEALTH CARE OF PENSACOLA
235 WEST AIRPORT BLVD
PENSACOLA , FL 32505
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080406-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.02 197.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080406123120140101201411112015111105
CONSULATE HEALTH CARE OF SAFETY HARBOR
1410 DR MARTIN LUTHER KING JR ST N
SAFETY HARBOR, FL 34695-3303
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080409-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.13 202.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080409123120140101201411112015111750
CONSULATE HEALTH CARE OF ST. PETERSBURG
9393 PARK BLVD
SEMINOLE, FL 33777-4140
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080413-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.32 226.02 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080413123120140101201411112015111430
CONSULATE HEALTH CARE OF SARASOTA
4783 FRUITVILLE ROAD
SARASOTA, FL 34232
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080416-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.09 206.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080416123120140101201411112015110720
CONSULATE HEALTH CARE OF PORT CHARLOTTE
18480 COCHRAN BLVD
PORT CHARLOTTE, FL 33948
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080428-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.09 209.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080428123120150101201504252016145419
CONSULATE HEALTH CARE OF TALLAHASSEE
1650 PHILLIPS RD
TALLAHASSEE , FL 32308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080430-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.93 200.17 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080430123120140101201411182015110915
CONSULATE HEALTH CARE OF VERO BEACH
1310 37TH ST
VERO BEACH, FL 32960-4860
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080431-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.42 203.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080431123120140101201411172015142921
CONSULATE HEALTH CARE AT WEST ALTAMONTE
1099 WEST TOWN PARKWAY
ALTAMONTE SPRINGS, FL 32714
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080432-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.52 216.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080432123120140101201411172015140607
CONSULATE HEALTH CARE OF WEST PALM BEACH
1626 DAVIS RD
WEST PALM BCH, FL 33406-5640
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080434-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 202.02 196.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080434123120140101201407302015130228
CONSULATE HEALTH CARE OF WINTER HAVEN
2701 LAKE ALFRED RD
WINTER HAVEN, FL 33881
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 080436-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.90 219.43 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Consulate Management Company
800 Concourse Parkway South
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 080436123120140101201411112015101729
FRANCO NURSING AND REHABILITATION CENTER
800 NW 95TH STREET
MIAMI , FL 33150
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 082204-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 273.26 240.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 082204022820150301201409212015135240
UNIVERSITY PLAZA REHABILITATION & NURSING CENTER
724 NW 19TH ST
MIAMI, FL 33136
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 085643-00
Date: 6/30/2016
Fiscal Year End: 10/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 268.87 274.13 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 085643103120141024201308282015170540
SARASOTA POINT REHABILITATION CENTER
2600 COURTLAND STREET
SARASOTA, FL 34237
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 086990-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 235.71 252.32 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brooks Health System
3599 University Blvd, South
Jacksonville, FL 32216
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 086990123120140709201307282015142207
BARTRAM CROSSING
6209 BROOKS BARTRAM DRIVE
BUIDLING 100
JACKSONVILLE, FL 32258
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 088049-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 275.48 221.04 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 088049013120150501201408132015095740
CROSS GARDENS CARE CENTER
190 NE 191ST STREET
MIAMI , FL 33179
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 088601-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 254.94 258.89 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Vanguard Healthcare, LLC
6 Cadillac Drive
Suite 310
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 088601123120140802201307302015155955
WHITEHALL BOCA RATON
7300 DEL PRADO CIRCLE SOUTH
BOCA RATON, FL 33433
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 089220-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.18 254.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 089220013120150201201406262015092749
KRYSTAL BAY NURSING AND REHABILITATION
16650 W DIXIE HWY
NORTH MIAMI BEACH, FL 33160
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 092678-00
Date: 6/30/2016
Fiscal Year End: 1/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.94 227.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 092678013120140801201302032015130820
OSPREY POINT NURSING CENTER
1104 NORTH MAIN STREET
BUSHNELL, FL 33513-5045
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 092681-00
Date: 6/30/2016
Fiscal Year End: 1/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.37 234.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CMC II, LLC
800 Concourse Parkway South
Suite 200
Maitland, FL 32751
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 092681013120140801201302032015125337
BAYA POINTE NURSING AND REHABILITATION CENTER
587 SE ERMINE AVE
LAKE CITY, FL 32025
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 094353-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 264.50 267.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 094353063020140115201312292014121958
HAWTHORNE HEALTH AND REHAB OF SARASOTA
5381 DESOTO ROAD
SARASOTA, FL 34235
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 096150-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.91 226.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Acts, Inc
375 Morris Road
West Point, PA 19486
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 096150123120140101201405262015144932
WILLOWBROOKE COURT AT AZALEA TRACE
10100 HILLVIEW DR
PENSACOLA, FL 32514
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098577-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.91 244.94 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098577093020150701201402262016133807
PALM GARDEN OF AVENTURA
21251 E DIXIE HIGHWAY
NORTH MIAMI BEACH, FL 33180
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098580-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.62 241.74 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098580093020150701201402262016134910
PALM GARDEN OF CLEARWATER
3480 MCMULLEN BOOTH RD
CLEARWATER, FL 33761
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098581-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.17 231.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098581093020150501201402262016140307
PALM GARDEN OF GAINESVILLE
227 SW 62ND BLVD
GAINESVILLE, FL 32607
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098582-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.10 243.23 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098582093020150501201402262016133359
PALM GARDEN OF JACKSONVILLE
5725 SPRING PARK ROAD
JACKSONVILLE, FL 32216
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098583-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.64 242.45 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098583093020150601201402262016153700
PALM GARDEN OF LARGO
10500 STARKEY RD
LARGO, FL 33777
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098584-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.10 225.82 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098584093020150501201402262016141329
PALM GARDEN OF OCALA
2700 SW 34TH ST
OCALA, FL 34474
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098586-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.91 220.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098586093020150701201402262016142543
PALM GARDEN OF ORLANDO
654 N ECONLOCKHATCHEE TRAIL
ORLANDO, FL 32825-6402
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098587-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.92 241.55 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098587093020150501201402262016143859
PALM GARDEN OF PINELLAS
200 16TH AVE SE
LARGO, FL 33771
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098588-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.50 233.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098588093020150501201402262016145000
PALM GARDEN OF PORT SAINT LUCIE
1751 SE HILLMOOR DRIVE
PORT SAINT LUCIE, FL 34952
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098589-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.16 238.38 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098589093020150701201402262016154312
PALM GARDEN OF SUN CITY
3850 UPPER CREEK DR
SUN CITY CENTER, FL 33573
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098590-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.72 243.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098590093020150701201402262016154436
PALM GARDEN OF TAMPA
3612 E 138TH AVE
TAMPA, FL 33613
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098591-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.12 225.04 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098591093020150501201402262016151615
PALM GARDEN OF VERO BEACH
1755 37TH STREET
VERO BEACH, FL 32960
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098592-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.33 223.17 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098592093020150601201402262016145248
PALM GARDEN OF WEST PALM BEACH
300 EXECUTIVE CENTER DRIVE
WEST PALM BEACH, FL 33401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098593-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.37 245.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Palm Garden Healthcare Holdings, LLC
2033 Main Street
Suite 300
Sarasota, FL 34237
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098593093020150901201402262016131819
PALM GARDEN OF WINTER HAVEN
1120 CYPRESS GARDENS BLVD
WINTER HAVEN, FL 33884
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 098972-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.16 245.36 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 098972123120150701201503302016180318
COMMUNITY HEALTH AND REHABILITATION CENTER
3611 TRANSMITTER ROAD
PANAMA CITY, FL 32404-9799
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 099366-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 235.62 205.29 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 099366073120150801201403142016135436
GULFPORT REHABILITATION CENTER
1430 PASADENA AVE S
SOUTH PASADENA, FL 33707
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 100487-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.65 205.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SMJ Enterprises, LLC
480 Fentress Blvd. Suite H
Daytona Beach, FL 32114
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 100487022820151201201301082016104721
THE TERRACE OF KISSIMMEE
221 PARK PLACE BLVD
KISSIMMEE, FL 34741
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 100509-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.82 233.62 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 100509063020141201201310202014130627
ARCADIA HEALTH & REHABILITATION CENTER
10095 HILLVIEW ROAD
PENSACOLA, FL 32514
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 101391-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.30 204.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
TJM Properties
5801 Ulmerton Road
Suite 200
Clearwater, FL 33760
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 101391123120140117201408312015140423
THE OAKS OF CLEARWATER
420 BAY AVE
CLEARWATER, FL 33756
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 101959-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.57 211.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Traditions Management of Florida, LLC
24641 US Highway 19 North
Clearwater, FL 33763
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 101959123120140101201405192015070854
CARRINGTON PLACE OF ST. PETE
10501 ROOSEVELT BLVD N
SAINT PETERSBURG, FL 33716
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 101961-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.65 214.42 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Traditions Management of Florida, LLC
24641 US Highway 19 North
Clearwater, FL 33763
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 101961123120140101201405182015151718
TRINITY REGIONAL REHAB CENTER
2144 WELBILT BLVD
TRINITY, FL 34655
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 101963-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.54 216.36 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Traditions Management of Florida, LLC
24641 US Highway 19 North
Clearwater, FL 33763
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 101963123120140101201405182015144038
EAGLE LAKE REHAB & CARE CENTER
1100 66TH ST N
ST PETERSBURG, FL 33710-6224
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102419-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.45 203.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SMJ Enterprises, LLC
480 Fentress Blvd. Suite H
Daytona Beach, FL 32114
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102419022820151201201301072016113346
THE TERRACE OF ST. CLOUD
3855 OLD CANOE CREEK ROAD
SAINT CLOUD, FL 34769
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102586-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 271.60 279.36 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102586073120141230201312142015150952
THE CROSSROADS
206 W ORANGE ST
DAVENPORT, FL 33837
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102592-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 298.89 308.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102592073120141230201301052016102508
THE CROSSINGS
4445 PINE FOREST DR
LAKE WORTH, FL 33463-4676
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102787-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 293.57 299.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102787073120141230201301122016134425
CROSS POINTE CARE CENTER
440 PHIPPEN WAITERS ROAD
DANIA BEACH, FL 33004
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102791-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 254.72 257.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102791073120141230201312032015124037
CROSS TERRACE REHABILITATION CENTER
1351 SAN CHRISTOPHER DR
DUNEDIN, FL 34698
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102832-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 264.34 269.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102832073120141230201301052016104334
CROSS LANDINGS HEALTH AND REHABILITATION CENTER
1780 N JEFFERSON ST
MONTICELLO, FL 32344
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 102833-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.13 267.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 102833073120141230201301052016113234
CROSSWINDS HEALTH AND REHABILITATION CENTER
13455 W US HWY 90
GREENVILLE, FL 32331
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 103165-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.58 214.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
TLC Management
1800 North Wabash Ave
Suite 300
Marion, IN 46952
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 103165063020150701201410282015073332
ASTORIA HEALTH & REHABILITATION CENTER
701 OVERLOOK DR SE
WINTER HAVEN, FL 33884-1671
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 103177-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 278.15 280.89 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 103177063020141231201307022015101609
DESOTO HEALTH AND REHAB
475 NURSING HOME DR
ARCADIA, FL 34266
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 103425-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 202.06 204.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 103425123120150101201503282016130617
COMMUNITY CONVALESCENT CENTER
2202 W OAK AVE
PLANT CITY, FL 33563
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 103475-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.78 252.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 103475083120141205201302042015163007
WESTWOOD NURSING & REHABILITATION CENTER
1001 MAR-WALT DRIVE
FORT WALTON BEACH, FL 32547
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 103852-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.28 232.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Preferred Care Inc.
5500 W. Plano Parkway
Plano, TX 75093
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 103852123120140301201403292016174338
OCOEE HEALTH CARE CENTER
1556 MAGUIRE RD
OCOEE, FL 34761
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 103858-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.30 255.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 103858022820150301201409282015152438
NORTH CAMPUS REHABILITATION AND NURSING CENTER
700 N PALMETTO ST
LEESBURG, FL 34748
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 104875-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.32 247.95 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Trillium Healthcare Consulting, LLC
5265 Office Park Boulevard
Suite 101
Bradenton , FL 34203
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 104875093020140401201403182015154529
REHABILITATION CENTER AT PARK PLACE
1717 W AVERY ST
PENSACOLA, FL 32501
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 108507-00
Date: 6/30/2016
Fiscal Year End: 4/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.52 227.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
THE TERRACE OF JACKSONVILLE
10680 OLD ST AUGUSTINE RD
JACKSONVILLE, FL 32257
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 110482-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.61 241.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 110482123120150101201504292016020133
VIERA HEALTH & REHABILITATION CENTER
8050 SPYGLASS HILL RD
VIERA, FL 32940
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 111543-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.29 237.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
St. Vincent Health System
1 Shircliff Way
Jacksonville, FL 32204
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 111543063020150701201404152016114514
ST. CATHERINE LABOURE MANOR, INC.
1750 STOCKTON ST
JACKSONVILLE, FL 32204
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122229-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 222.86 220.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
HARBOUR HEALTH CENTER
23013 WESTCHESTER BLVD
PORT CHARLOTTE, FL 33980
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122232-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.96 220.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211885123120140101201407272015202310
PLAZA WEST
912 AMERICAN EAGLE BLVD
SUN CITY CENTER, FL 33573
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122236-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 222.96 220.18 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122236123120150101201505242016142149
SEMINOLE PAVILION REHABILITATION & NURSING SERVICES
10800 TEMPLE TERRACE
SEMINOLE, FL 33772
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122239-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 222.03 222.73 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122239123120150101201506082016142942
FREEDOM SQUARE REHABILITATION & NURSING SERVICES
10801 JOHNSON BLVD
SEMINOLE, FL 33772
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122242-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 223.86 231.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122242123120150101201505242016143421
CYPRESS VILLAGE
4600 MIDDLETON PARK CIR E
JACKSONVILLE, FL 32224
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122243-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.89 206.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
LAKE HARRIS HEALTH CENTER
701 LAKE PORT BLVD
LEESBURG, FL 34748
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122248-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.57 247.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SYLVAN HEALTH CENTER
2770 REGENCY OAKS BLVD
CLEARWATER, FL 33759
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122250-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.58 234.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122250123120150101201506132016140136
THE NURSING CENTER AT FREEDOM VILLAGE
6410 21ST AVE W
BRADENTON, FL 34209
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122340-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.19 236.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122340123120140701201404152015131742
CITRUS HILLS HEALTH & REHABILITATION CENTER
124 W NORVELL BRYANT HWY
HERNANDO, FL 34442
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122341-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.52 237.50 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122341123120140701201408192015132021
WOODLAND GROVE HEALTH & REHABILITATION CENTER
4325 SOUTHPOINT BOULEVARD
JACKSONVILLE, FL 32216
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122342-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.71 236.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122342123120140701201404302015111729
THE GARDENS HEALTH & REHABILITATION CENTER
1704 HUNTINGTON VILLAGE CIRCLE
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122343-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.59 233.67 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122343123120140701201404152015150926
ISLE HEALTH & REHABILITATION CENTER
1125 FLEMING PLANTATION BLVD
ORANGE PARK, FL 32003
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122344-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.10 235.74 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122344123120140701201404142015142115
RIVERWOOD HEALTH & REHABILITATION CENTER
808 S COLLEY RD
STARKE, FL 32091
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122346-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.35 227.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122346123120140701201404152015143657
TERRACE HEALTH & REHABILITATION CENTER
7207 SW 24TH AVE
GAINESVILLE, FL 32607
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 122347-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.94 231.94 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 122347123120140701201404152015090317
VILLA HEALTH & REHABILITATION CENTER
120 CHIPOLA AVE
DELAND, FL 32720
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 128848-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.64 210.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 128848022920160301201504202016114016
BAY CENTER
1336 ST ANDREWS BLVD
PANAMA CITY, FL 32405
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 129312-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.71 207.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
THE PAVILION FOR HEALTH CARE
ONE PAVILION PLACE
PENNEY FARMS, FL 32079
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 130817-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.99 246.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 130817022820150901201404282016180908
OAK VIEW REHABILITATION CENTER
833 KINGSLEY AVE
ORANGE PARK, FL 32073
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 132045-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.11 214.45 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
NORTH DADE NURSING AND REHABILITATION CENTER
1255 NE 135TH STREET
NORTH MIAMI, FL 33161
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 132449-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.67 220.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
FOUNTAIN MANOR HEALTH & REHABILITATION CENTER
390 NE 135TH ST
NORTH MIAMI, FL 33161-3967
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 133196-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.02 198.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 133196013120150801201404192015120305
EMERALD COAST CENTER
114 THIRD STREET SE
FORT WALTON BEACH, FL 32548
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 133348-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.63 220.27 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 133348013120160201201504202016105350
EGRET COVE CENTER
550 62ND ST S
SAINT PETERSBURG, FL 33707
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 134463-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.63 255.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
FT LAUDERDALE HEALTH AND REHABILITATION CENTER
2000 EAST COMMERCIAL BLVD
FORT LAUDERDALE, FL 33308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 135581-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.69 239.46 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 135581063020150101201501222016183648
THE MANOR AT BLUE WATER BAY
1500 NORTH WHITE POINT ROAD
NICEVILLE , FL 32578
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 135647-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.74 243.17 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
X Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 135647063020150101201501222016171715
LAKE BENNETT HEALTH AND REHABILITATION
1091 KELTON AVE
OCOEE, FL 34761
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 140643-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.76 216.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212911022820150901201407072015134635
CLEARWATER CENTER
1270 TURNER ST
CLEARWATER, FL 33756
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 140648-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.52 200.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 140648022920160301201504202016113213
BARTOW CENTER
2055 E GEORGIA ST
BARTOW, FL 33830
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 141466-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.59 204.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
LANIER TERRACE
12740 LANIER ROAD
JACKSONVILLE, FL 32226-1704
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 143762-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.96 226.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 143762022920160301201504202016114624
BOCA CIEGA CENTER
1414 59TH ST S
GULFPORT, FL 33707
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 146222-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 261.53 257.37 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
THE FLORIDEAN NURSING AND REHABILITATION CENTER
47 NW 32ND PLACE
MIAMI, FL 33125
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 147672-00
Date: 6/30/2016
Fiscal Year End: 4/30/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.91 239.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
BAY VUE NURSING AND REHABILITATION CENTER
105 15TH ST E
BRADENTON, FL 34208
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 147958-00
Date: 6/30/2016
Fiscal Year End: 5/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 261.11 258.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
EXCEL CARE CENTER
2811 CAMPUS HILL DR
TAMPA, FL 33612
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 148040-00
Date: 6/30/2016
Fiscal Year End: 6/30/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.06 225.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
THE TERRACE AT HOBE SOUND
9555 SE FEDERAL HWY
HOBE SOUND, FL 33455
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 153181-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 254.01 251.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
GLADES WEST REHABILITATION AND NURSING CENTER
15955 BASS CREEK ROAD
PEMBROKE PINES, FL 33027
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 155062-00
Date: 6/30/2016
Fiscal Year End: 9/30/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 277.56 274.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
PINES NURSING HOME
301 NE 141 STREET
MIAMI, FL 33161
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 156586-00
Date: 6/30/2016
Fiscal Year End: 10/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 222.71 220.55 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
NORTHBROOK HEALTH AND REHABILITATION CENTER
575 LAMAR AVE
BROOKSVILLE, FL 34601
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 158851-00
Date: 6/30/2016
Fiscal Year End: 7/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.73 232.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
THE VILLAGES REHABILITATION AND NURSING CENTER
900 HIGHWAY 466
LADY LAKE, FL 32159
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162218-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.08 251.82 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE BAYONET POINT
7210 BEACON WOODS DR
HUDSON, FL 34667-1974
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162219-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.55 257.91 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE CHARLOTTE HARBOR
4000 KINGS HWY
PORT CHARLOTTE, FL 33980
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162220-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.92 260.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE COCONUT CREEK
4125 WEST SAMPLE RD
COCONUT CREEK, FL 33073
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162221-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.28 249.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE DAYTONA
550 NATIONAL HEALTHCARE DRIVE
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162222-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 253.97 253.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE IMPERIAL
900 IMPERIAL GOLF COURSE BLVD
NAPLES, FL 34110
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162224-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.98 245.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE LAKE CITY
560 SW MCFARLANE AVE
LAKE CITY, FL 32025
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162225-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.56 251.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE MERRITT ISLAND
500 CROCKETT BLVD
MERRITT ISLAND, FL 32953
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162226-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 285.82 288.54 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS SENIOR LIVING NORTH NAPLES
10949 PARNU STREET
NAPLES, FL 34109
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162228-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 256.71 256.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE PARKWAY
800 SE CENTRAL PKWY
STUART, FL 34994
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162230-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.84 247.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE PENSACOLA
8475 UNIVERSITY PARKWAY
PENSACOLA, FL 32514
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162231-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.43 250.52 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE PLANT CITY
701 N WILDER RD
PLANT CITY, FL 33566-7547
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 162232-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.46 248.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
SOLARIS HEALTHCARE WINDERMERE
4875 CASON COVE DRIVE
ORLANDO, FL 32811
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 163903-00
Date: 6/30/2016
Fiscal Year End: 12/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 256.88 258.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
X Interim Prospective
X Total Interim Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
X Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID:
FORT MYERS REHABILITATION AND NURSING CENTER
7173 CYPRESS DRIVE SW
FORT MYERS, FL 33907-2994
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200107-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.03 242.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Bon Secours Health System, Inc
1505 Marriottsville Road
Marriottsville, MD 21104-1399
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200107083120150901201401152016160058
BON SECOURS MARIA MANOR NURSING CARE CENTER
10300 4TH ST N
SAINT PETERSBURG, FL 33716
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200409-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.18 213.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200409033120150401201409152015090727
WESTMINSTER OAKS
4449 MEANDERING WAY
TALLAHASSEE, FL 32308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200506-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.63 252.23 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200506063020150701201411202015171049
MIAMI JEWISH HEALTH SYSTEMS
5200 NE 2ND AVENUE
MIAMI, FL 33137
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200735-00
Date: 6/30/2016
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.11 231.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200735123120130101201304302014092150
CROSS CARE CENTER
5888 BLANDING BLVD
JACKSONVILLE, FL 32244
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200859-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 257.20 260.32 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
River Garden Holding Company
11401 Old St. Augustine Road
Jacksonville, FL 32258
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200859123120140101201404082015133239
RIVER GARDEN HEBREW HOME FOR THE AGED
11401 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32258-1402
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200913-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.85 237.20 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200913123120150101201504152016095352
AVANTE VILLA AT JACKSONVILLE BEACH INC
1504 SEABREEZE AVE
JACKSONVILLE BEACH, FL 32250
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 200956-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 250.97 252.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lyric Healthcare Holdings III, Inc
1423 Clarkview Road
Suite 500
Baltimore, MD 21090
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 200956083120140901201304252015110653
COMPREHENSIVE HEALTHCARE OF CLEARWATER
2055 PALMETTO ST
CLEARWATER, FL 33765
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 201006-00
Date: 6/30/2016
Fiscal Year End: 4/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.24 245.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Memorial Healthcare System
3501 Johnson Street
Hollywood, FL 33021
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 201006043020150501201411232015143932
MEMORIAL MANOR
777 SOUTH DOUGLAS ROAD
PEMBROKE PINES, FL 33025
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 201120-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.42 268.04 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 201120123120150101201504302016092301
GULF COAST VILLAGE
1333 SANTA BARBARA BLVD
CAPE CORAL, FL 33991
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 201588-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.68 230.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 201588123120140101201405222015131722
MARY LEE DEPUGH NURSING HOME ASSOCIATION INC
550 W MORSE BLVD
WINTER PARK, FL 32789
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 201651-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.13 251.84 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 201651123120140701201404292015083230
GUARDIAN CARE NURSING & REHABILITATION CENTER
2500 W CHURCH STREET
ORLANDO, FL 32805
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202011-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.52 235.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
The Goodman Group, LLC
1107 Hazeltine Blvd
Chaska, MN 55318
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202011123120140701201404152015163407
WESTCHESTER GARDENS REHABILITATION & CARE CENTER
3301 N MCMULLEN BOOTH RD
CLEARWATER, FL 33761
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202533-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 261.15 259.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202533093020151001201404202016101321
THE ROHR HOME
2120 MARSHALL EDWARDS DR
BARTOW, FL 33830
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202606-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.14 242.40 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202606093020151001201403052016195907
SAMANTHA WILSON CARE CENTER
161A MARINE STREET
SAINT AUGUSTINE, FL 32084
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202703-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 270.55 273.54 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202703073120140801201312092014104903
PINES OF SARASOTA
1501 N ORANGE AVE
SARASOTA, FL 34236
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202711-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 283.32 290.01 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sunnyside Properties Of Sarasota
5201 Bahia Vista Street
Sarasota, FL 34232
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202711123120140701201404222015133250
SUNNYSIDE NURSING HOME
5201 BAHIA VISTA STREET
SARASOTA, FL 34232
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202789-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.77 199.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202789123120150101201503162016100906
CENTER FOR HEALTH CARE OF THE ALLIANCE COMMUNITY
130 W ARMSTRONG AVENUE
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 202941-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.45 229.37 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 202941063020140701201308202015174707
MIRACLE HILL NURSING AND REHABILITATION CENTERS, INC.
1329 ABRAHAM STREET
TALLAHASSEE, FL 32304
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203122-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.48 241.27 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203122123120150101201504252016141703
AVANTE AT LEESBURG, INC.
2000 EDGEWOOD AVE
LEESBURG, FL 34748
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203165-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 266.24 269.10 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Catholic Health Services
4790 N. State Road 7
Lauderdale Lakes, FL 33319
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203165093020151001201404202016114411
VILLA MARIA NURSING CENTER
1050 NE 125TH STREET
NORTH MIAMI, FL 33161
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203203-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.91 259.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Council on Aging of Florida, Inc.
1311 SW 16th Street
Gainesville, FL 32608
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203203022820150301201404272015101317
GLADES HEALTH CARE CENTER
230 SOUTH BARFIELD HIGHWAY
PAHOKEE, FL 33476
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203220-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.13 225.84 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203220123120140601201403172015091954
AVANTE AT INVERNESS
304 S CITRUS AVE
INVERNESS, FL 34452
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203238-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.10 243.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203238123120150101201504132016105134
AVANTE AT LAKE WORTH
2501 N A ST
LAKE WORTH, FL 33460-6013
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203327-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 263.53 264.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Professional Care I, Inc.
10850 SW 113th Place
Miami, FL 33176
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203327013120150801201404272015091640
THE PALACE AT KENDALL NURSING AND REHAB CENTER
11215 SW 84TH STREET
MIAMI, FL 33173
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203335-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.95 239.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203335123120140101201405142015103904
TIMBERRIDGE NURSING & REHAB CENTER
9848 SW 110TH ST
OCALA, FL 34481
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203475-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 228.76 229.23 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203475123120141001201305142015093835
MARIANNA HEALTH & REHABILITATION
4295 FIFTH AVENUE
MARIANNA, FL 32446
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203599-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.49 253.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203599123120140101201403252015144951
THE MANOR AT CARPENTER'S
1001 CARPENTERS WAY
LAKELAND, FL 33809
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203670-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 265.55 271.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203670093020151001201402242016110508
JACKSON MEMORIAL PERDUE MEDICAL CENTER
19590 OLD CUTLER ROAD
CUTLER RIDGE, FL 33157
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203769-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.83 231.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203769123120140101201405292015162643
JOHN KNOX VILLAGE OF POMPANO BEACH
700 S.W. 4TH STREET
POMPANO BEACH, FL 33060
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203815-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.23 211.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203815033120150401201409152015090107
WESTMINSTER TOWERS AND SHORES OF BRADENTON
1533 4TH AVE W
BRADENTON, FL 34205
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 203980-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 175.12 174.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 203980123120140101201405282015081007
LISENBY ON LAKE CAROLINE
1400 W 11TH ST
PANAMA CITY, FL 32401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 204072-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.46 229.43 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 204072073120140801201302172015101322
MEASE CONTINUING CARE
910 NEW YORK AVE
DUNEDIN, FL 34698-6600
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 204161-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.41 246.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 204161093020151001201402242016114807
JACKSON MEMORIAL LONG TERM CARE CENTER
2500 NW 22ND AVE
MIAMI, FL 33142
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 204170-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.95 265.20 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Stirling LTC, Corp
2699 Stirling Road
Suite B100
Ft. Lauderdale, FL 33180
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 204170022820150301201404222015143945
REGENTS PARK NURSING & REHABILITATION CENTER
6363 VERDE TRAIL
BOCA RATON, FL 33433
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 204391-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.88 249.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Evangelical Lutheran Good Samaritan
4800 West 57th Street
Sioux Falls, SD 57117
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 204391123120140101201406042015101034
GOOD SAMARITAN SOCIETY-DAYTONA
325 S SEGRAVE STREET
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 204536-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.31 192.64 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Taylor Foundation Services, Inc.
6601 Chester Avenue
Jacksonville, FL 32217
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 204536083120150901201404292016084321
FANNIE E TAYLOR HOME FOR THE AGED INC
3937 SPRING PARK ROAD
JACKSONVILLE, FL 32207
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 204625-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.86 218.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 204625123120150101201504292016142054
TRI-COUNTY NURSING HOME
7280 SW STATE RD 26
TRENTON, FL 32693
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 205303-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 223.39 224.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Evangelical Lutheran Good Samaritan
4800 West 57th Street
Sioux Falls, SD 57117
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 205303013120160201201504202016132432
GOOD SAMARITAN SOCIETY-KISSIMMEE VILLAGE
1500 SOUTHGATE DRIVE
KISSIMMEE, FL 34746
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 205460-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.64 222.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 205460063020150701201412162015144017
THE VILLAGE ON HIGH RIDGE
1800 SOUTH DRIVE
LAKE WORTH, FL 33461
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 205745-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 261.85 282.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
LifeSpace Communities, Inc.
100 East Grand Ave.
Suite 200
Des Moines, IA 50309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 205745123120140101201404062016132855
ABBEY DELRAY
2105 SW 11TH COURT
DELRAY BEACH, FL 33445
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 205796-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.11 220.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 205796083120140901201310172014090747
COMMONS AT ORLANDO LUTHERAN TOWERS
210 LAKE AVENUE
ORLANDO, FL 32801
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 205800-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 257.90 256.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Catholic Health Services
4790 N. State Road 7
Lauderdale Lakes, FL 33319
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 205800093020151001201406032016150615
ST. JOHN'S NURSING CENTER
3075 NW 35TH AVE
LAUDERDALE LAKES, FL 33311
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 205923-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 273.89 274.36 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 205923123120140101201404212015104559
LOURDES-NOREEN MCKEEN RESIDENCE FOR GERIATRIC CARE, INC.
315 S FLAGLER DR
WEST PALM BEACH, FL 33401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 206300-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 256.47 251.85 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 206300083120150901201401282016170057
SUWANNEE VALLEY NURSING CENTER
427 15TH AVENUE NORTHWEST
JASPER, FL 32052-5874
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 206431-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.31 246.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Baycare Health System
2985 Drew Street
Clearwater, FL 33759
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 206431123120140101201404282016153742
MORTON PLANT REHABILITATION CENTER
400 CORBETT ST
BELLEAIR, FL 33756
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 206521-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.43 296.42 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Acts, Inc
375 Morris Road
West Point, PA 19486
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 206521123120140101201405262015144249
WILLOWBROOKE COURT AT ST ANDREWS ESTATES
6152 N VERDE TRAIL
BOCA RATON, FL 33433
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 206610-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 271.70 285.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Retirement Comm.,Inc.
200 East Grand Avenue
Suite 390
Des Moines, IA 50309-1800
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 206610123120140101201404062016142742
THE WATERFORD
601 UNIVERSE BLVD
JUNO BEACH, FL 33408
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 206865-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 253.08 274.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
LifeSpace Communities, Inc.
100 East Grand Ave.
Suite 200
Des Moines, IA 50309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 206865123120140101201404062016145809
ABBEY DELRAY SOUTH
1717 HOMEWOOD BLVD
DELRAY BEACH, FL 33445
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 207381-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.07 248.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 207381053120150601201410232015160809
JOSEPH L MORSE GERIATRIC CENTER INC
4847 FRED GLADSTONE DRIVE
WEST PALM BEACH, FL 33417
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 207446-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.84 230.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Taylor Foundation Services, Inc.
6601 Chester Avenue
Jacksonville, FL 32217
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 207446083120150901201404282016123345
TAYLOR CARE CENTER
6535 CHESTER AVENUE
JACKSONVILLE, FL 32217
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 207497-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 250.47 248.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Subacute Services, Inc.
4800 Nob Hill Road
Sunrise, FL 33351
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 207497123120150101201504282016084929
SUNRISE HEALTH AND REHABILITATION CENTER
4800 N NOB HILL RD
SUNRISE, FL 33351-4722
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 207527-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.01 225.93 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lyric Healthcare Holdings III, Inc
1423 Clarkview Road
Suite 500
Baltimore, MD 21090
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 207527083120140901201304272015073855
ORCHARD PARK HEALTH AND REHABILITATION
919 OLD WINTER HAVEN RD
AUBURNDALE, FL 33823-4329
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 207683-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 237.89 238.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 207683073120140801201310192014102554
LAKESIDE HEALTH CENTER
2501 N AUSTRALIAN AVENUE
WEST PALM BEACH, FL 33407
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 207799-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.69 248.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HPSA, Inc.
5409 Maryland Way, Suite 304
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 207799013120150801201404212015115942
THE PONCE THERAPY CARE CENTER
1999 OLD MOULTRIE ROAD
SAINT AUGUSTINE, FL 32086
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 208442-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.03 259.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 208442123120150701201504222016145727
BERNARD L SAMSON NURSING CENTER
255 59TH ST N
SAINT PETERSBURG, FL 33710
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 208485-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.82 250.89 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 208485093020151001201403072016093135
JUPITER MEDICAL CENTER PAVILION INC.
1230 SOUTH OLD DIXIE HWY
JUPITER, FL 33458-7297
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 208507-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.05 233.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Stirling LTC, Corp
2699 Stirling Road
Suite B100
Ft. Lauderdale, FL 33180
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 208507022920160301201504192016093602
CLARIDGE HOUSE NURSING & REHABILITATION CENTER
13900 NE 3RD COURT
NORTH MIAMI, FL 33161
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 208540-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.97 216.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 208540033120150401201409152015100016
WESTMINSTER TOWERS
70 WEST LUCERNE CIRCLE
ORLANDO, FL 32801
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 209325-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 262.87 284.50 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Retirement Housing Foundation
911 N. Studebaker Rd
Long Beach, CA 90815-4900
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 209325093020151001201402252016083929
COURTENAY SPRINGS VILLAGE
1100 SOUTH COURTENAY PARKWAY
MERRITT IS, FL 32952-3804
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 209422-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.00 230.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 209422033120150401201409152015082920
WESTMINSTER COMMUNITIES OF BRADENTON WESTMINSTER MANOR
1700 21ST AVE W
BRADENTON, FL 34205
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 209473-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.85 255.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Catholic Health Services
4790 N. State Road 7
Lauderdale Lakes, FL 33319
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 209473093020151001201404202016151537
ST. ANNE'S NURSING CENTER
11855 QUAIL ROOST DRIVE
MIAMI, FL 33177
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 209511-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.79 256.30 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Retirement Housing Foundation
911 N. Studebaker Rd
Long Beach, CA 90815-4900
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 209511093020151001201402242016152004
BISHOPS GLEN RETIREMENT CENTER
900 LPGA BLVD
HOLLY HILL, FL 32117-3100
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 209848-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.83 210.47 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 209848033120150401201409152015094412
WINTER PARK TOWERS
1111 S LAKEMONT AVE
STE 101
WINTER PARK, FL 32792-5469
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 209856-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.39 239.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 209856083120150901201411052015094043
SUN TERRACE HEALTH CARE CENTER
105 TRINITY LAKES DR
SUN CITY CENTER, FL 33573
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210137-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.75 228.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210137073120140801201310192014113004
LIFE CARE CENTER OF ALTAMONTE SPRINGS
989 ORIENTA AVE
ALTAMONTE SPRINGS, FL 32701
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210188-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 237.34 243.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Covenant Retirement Communities
5700 Old Orchard Road
Skokie, IL 60077
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210188013120160201201504272016173045
COVENANT VILLAGE CARE CENTER
9211 W BROWARD BLVD
PLANTATION, FL 33324
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210285-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 228.88 244.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Baycare Health System
2985 Drew Street
Clearwater, FL 33759
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210285123120140101201406032016152045
JOHN KNOX VILLAGE MED CENTER
4100 E FLETCHER AVE
TAMPA, FL 33613
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210463-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 273.92 275.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210463123120140101201403132015122523
VILLAGE ON THE ISLE
910 TAMIAMI TRAIL SOUTH
VENICE, FL 34285
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210587-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 253.93 254.92 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lee Memorial Health System
636 Del Prado Boulevard
Cape Coral, FL 33990
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210587093020151001201402292016103153
HEALTHPARK CARE CENTER INC.
16131 ROSERUSH COURT
FORT MYERS, FL 33908-3634
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210676-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.98 261.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210676123120150101201504252016163114
AVANTE AT BOCA RATON INC.
1130 NW 15TH STREET
BOCA RATON, FL 33486
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210684-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.26 237.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210684093020151001201402222016090050
EDGEWATER AT WATERMAN VILLAGE
300 BROOKFIELD AVE
MOUNT DORA, FL 32757-9562
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210889-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.92 248.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Florida Dept. of Veterans Affairs
11351 Ulmerton Road, Room 332-I
Largo, Fl 33778-1630
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210889063020150701201411232015112335
EMORY L BENNETT MEMORIAL VETERANS NURSING HOME
1920 MASON AVENUE
DAYTONA BEACH, FL 32117
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 210951-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.94 207.82 9/1/2016
Level U: Fragile Under 21 504.57 507.45 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
The Goodman Group, LLC
1107 Hazeltine Blvd
Chaska, MN 55318
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 210951123120140701201404282015105005
SABAL PALMS HEALTH CARE CENTER
499 ALTERNATE KEENE RD NE
LARGO, FL 33771
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211010-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.34 260.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sunrise Senior Living
7900 W. Park Drive, STE T900
McLean, VA 22102
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211010123120150101201504282016142405
STRATFORD COURT OF BOCA RATON
6343 VIA DE SONRISA DEL SUR
BOCA RATON, FL 33433
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211052-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 266.03 269.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211052093020151001201402292016152859
W FRANK WELLS NURSING HOME
210 N 2ND ST
MACCLENNY, FL 32063
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211281-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 193.42 192.19 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Genesis HealthCare Corp
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211281013120160201201504262016115029
HUNTINGTON PLACE
1775 HUNTINGTON LANE
ROCKLEDGE, FL 32955
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211435-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 194.90 198.38 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Diversicare Healthcare Services Inc.
1621 Galleria Blvd.
Brentwood, TN 30727
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211435123120140101201404272016100630
HARDEE MANOR HEALTHCARE CENTER
401 ORANGE PLACE
WAUCHULA, FL 33873
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211516-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.89 198.62 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lyric Healthcare Holdings III, Inc
1423 Clarkview Road
Suite 500
Baltimore, MD 21090
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211516083120140901201304272015080325
LAUREL POINTE HEALTH AND REHABILITATION
703 S 29TH ST
FORT PIERCE, FL 34947
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211532-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.81 230.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211532073120140801201310192014114408
LIFE CARE CENTER OF CITRUS COUNTY
3325 W JERWAYNE LN
LECANTO, FL 34461
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 211923-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.17 198.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CNH, LLC
46 Third Street NW
Hickory, NC 28601
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 211923022820150901201404232015125849
LAKE PARK OF MADISON
259 SW CAPTAIN BROWN RD
MADISON, FL 32340
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212032-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.51 252.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212032093020151001201402252016132948
EDWARD J HEALEY REHABILITATION AND NURSING CENTER
5101 WEST BLUE HERON BLVD
RIVIERA BEACH, FL 33418
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212083-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.00 230.45 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212083033120150401201409152015091802
WESTMINSTER WOODS ON JULINGTON CREEK
25 STATE ROAD 13
JACKSONVILLE, FL 32259
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212164-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 222.15 224.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212164073120140801201310292014165909
YBOR CITY HEALTHCARE AND REHABILITATION CENTER
1709 TALIAFERRO AVE
TAMPA, FL 33602
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212393-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.07 247.64 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Rohm Service Corp
740 East Avenue
Rochester, NY 14607
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212393123120140101201404282015175551
THE FOUNTAINS NURSING HOME INC
3800 N FEDERAL HWY
BOCA RATON, FL 33431
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212709-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.45 207.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Westminster Services
80 West Lucerne Circle
Orlando, FL 32801
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212709033120150401201409152015084918
WESTMINSTER SUNCOAST
1095 PINELLAS POINT DR S
SAINT PETERSBURG, FL 33705-6272
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212733-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 179.21 177.91 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SMJ Enterprises, LLC
480 Fentress Blvd. Suite H
Daytona Beach, FL 32114
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212733123120140101201405222015150856
OCEANSIDE EXTENDED CARE CENTER
550 9TH STREET
MIAMI BEACH, FL 33139
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212792-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.78 215.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Evangelical Lutheran Good Samaritan
4800 West 57th Street
Sioux Falls, SD 57117
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212792123120150101201504202016130156
GOOD SAMARITAN SOCIETY-FLORIDA LUTHERAN
450 NORTH MCDONALD AVENUE
DELAND, FL 32724
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212806-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 272.20 263.28 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212806013120160201201504192016141734
PALMETTO SUB ACUTE CARE CENTER INC
7600 SW 8TH STREET
MIAMI, FL 33144
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 212971-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 250.51 264.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 212971123120150101201504182016135057
FLORIDA PRESBYTERIAN HOMES INC
909 LAKESIDE AVE
LAKELAND, FL 33803
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213098-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.04 240.43 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Millenium Health Systems
5310 NW 33rd Avenue
Suite 211
Ft. Lauderdale, FL 33309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213098123120140201201406112015101909
TAMARAC REHABILITATION AND HEALTH CENTER
7901 NW 88TH AVENUE
TAMARAC, FL 33321
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213152-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 275.82 286.02 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213152123120150101201504112016143630
WATERS EDGE EXTENDED CARE
1500 SW CAPRI ST
PALM CITY, FL 34990
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213161-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.73 217.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213161073120140801201310152014112024
LIFE CARE CENTER AT WELLS CROSSING
355 CROSSING BLVD
ORANGE PARK, FL 32073
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213322-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.03 225.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213322123120150101201504082016105049
HARBORCHASE OF VENICE
950 PINEBROOK ROAD
VENICE, FL 34285-7147
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213403-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.78 224.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213403123120150801201404182016144349
LIFE CARE CENTER OF ORLANDO
3211 ROUSE ROAD
ORLANDO, FL 32817
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213462-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.51 246.77 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213462123120150801201404292016081638
MADISON HEALTH AND REHABILITATION CENTER
2481 WEST US 90
MADISON, FL 32340-9540
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213837-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 270.02 280.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213837123120140101201405252015185940
VI AT LAKESIDE VILLAGE
2792 DONNELLY DRIVE
LANTANA, FL 33462
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213900-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.41 244.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213900093020151001201403212016153016
PAGE REHABILITATION AND HEALTHCARE CENTER
2310 N AIRPORT ROAD
FORT MYERS, FL 33907
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 213934-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.34 231.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 213934093020141001201303022015134650
TMH SKILLED NURSING FACILITY
1609 MEDICAL DRIVE
TALLAHASSEE , FL 32308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 214035-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 268.52 278.01 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
DOS Health Care, Inc
300 71st Street, Suite 400
Miami, FL 33141
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 214035013120160201201504252016090609
MIAMI SHORES NURSING AND REHAB CENTER
9380 NW 7TH AVENUE
MIAMI, FL 33150
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 214060-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.25 206.54 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 214060123120150801201404172016155907
LIFE CARE CENTER OF HILLIARD
3756 W THIRD ST
HILLIARD, FL 32046
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 214914-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.89 250.30 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Florida Dept. of Veterans Affairs
11351 Ulmerton Road, Room 332-I
Largo, Fl 33778-1630
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 214914063020150701201411232015112441
BALDOMERO LOPEZ MEMORIAL VETERANS NURSING HOME
6919 PARKWAY BLVD
LAND O LAKES, FL 34639
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 216399-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 268.74 278.64 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
LifeSpace Communities, Inc.
100 East Grand Ave.
Suite 200
Des Moines, IA 50309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 216399123120140101201404062016144949
HARBOUR'S EDGE
401 E LINTON BLVD
DELRAY BEACH, FL 33483
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 217263-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.12 217.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
NHS Management
931 Fairfax Park
Tuscaloosa, AL 35406
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 217263063020150701201412082015141054
CRYSTAL RIVER HEALTH AND REHABILITATION CENTER
136 NORTHEAST 12TH AVENUE
CRYSTAL RIVER, FL 34429
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 217395-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.24 203.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
NHS Management
931 Fairfax Park
Tuscaloosa, AL 35406
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 217395063020150701201412082015163250
OCALA HEALTH AND REHABILITATION CENTER
1201 SE 24TH RD
OCALA, FL 34471
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 217727-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.23 226.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
NHS Management
931 Fairfax Park
Tuscaloosa, AL 35406
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 217727063020150701201412082015161551
WEST MELBOURNE HEALTH & REHABILITATION CENTER
2125 WEST NEW HAVEN AVE
WEST MELBOURNE, FL 32904
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 217735-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.29 228.29 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
NHS Management
931 Fairfax Park
Tuscaloosa, AL 35406
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 217735063020150701201412082015164215
ST AUGUSTINE HEALTH AND REHABILITATION CENTER
51 SUNRISE BLVD
SAINT AUGUSTINE, FL 32084
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 217743-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.33 248.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
NHS Management
931 Fairfax Park
Tuscaloosa, AL 35406
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 217743063020150701201412082015153304
DAYTONA BEACH HEALTH AND REHABILITATION CENTER
1055 3RD STREET
DAYTONA BEACH, FL 32117-4196
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 217824-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.39 241.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 217824123120150801201404202016203458
LIFE CARE CENTER OF PORT SAINT LUCIE
3720 SE JENNINGS RD
PORT ST LUCIE, FL 34952-7701
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 218171-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.37 203.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lyric Healthcare Holdings III, Inc
1423 Clarkview Road
Suite 500
Baltimore, MD 21090
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 218171083120140901201304252015112459
WEST JACKSONVILLE HEALTH AND REHABILITATION CENTER
1650 FOURAKER RD
JACKSONVILLE, FL 32221
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 219380-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.46 244.13 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 219380123120150801201404222016104307
LIFE CARE CENTER OF WINTER HAVEN
1510 CYPRESS GARDENS BLVD
WINTER HAVEN, FL 33884
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 220604-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 228.89 229.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 220604073120140801201310292014165059
CENTURY HEALTH AND REHABILITATION CENTER
6020 INDUSTRIAL BLVD
CENTURY, FL 32535
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 220612-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.00 222.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 220612073120140801201310292014163606
SANTA ROSA HEALTH & REHABILITATION CENTER
5386 BROAD ST
MILTON, FL 32570-2235
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 220621-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.61 235.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 220621123120150801201405242016105428
SANDY RIDGE HEALTH AND REHABILITATION
5360 GLOVER LANE
MILTON, FL 32570
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 221465-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.26 201.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 221465123120140101201407022015132834
CLERMONT HEALTH AND REHABILITATION CENTER
151 E MINNEHAHA AVE
CLERMONT, FL 34711
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 221589-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.11 216.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 221589123120150101201504272016144536
DELANEY PARK HEALTH AND REHABILITATION CENTER
215 ANNIE STREET
ORLANDO, FL 32806
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 223239-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.67 243.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Stirling LTC, Corp
2699 Stirling Road
Suite B100
Ft. Lauderdale, FL 33180
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 223239022820150901201404222015134748
REGENTS PARK AT AVENTURA
18905 NE 25TH AVE
AVENTURA, FL 33180
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 223654-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 194.07 193.30 9/1/2016
Level U: Fragile Under 21 493.70 492.93 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 223654123120140701201407072015102451
ORLANDO HEALTH AND REHABILITATION CENTER
830 WEST 29TH STREET
ORLANDO, FL 32805
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 223786-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.84 248.94 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 223786013120160201201504202016213119
LIFE CARE CENTER OF SARASOTA
8104 TUTTLE AVE
SARASOTA, FL 34243-2885
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 223808-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.33 248.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 223808123120150101201504252016144210
AVANTE AT ORLANDO INC.
2000 NORTH SEMORAN BOULEVARD
ORLANDO, FL 32807
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 224341-00
Date: 6/30/2016
Fiscal Year End: 11/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 223.74 244.38 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
M-K Management, LLC
1181 Vickery Lane, Suite 200
Cordova, TN 38016-0633
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 224341113020151201201404212016145124
HAINES CITY HEALTH CARE
409 S 10TH ST
HAINES CITY, FL 33845-1476
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 224910-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.90 214.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 224910063020150701201406102016101251
SOUTH TAMPA HEALTH AND REHABILITATION CENTER
4610 S MANHATTAN AVE
TAMPA, FL 33611
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 225053-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.53 250.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
M-K Management, LLC
1181 Vickery Lane, Suite 200
Cordova, TN 38016-0633
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 225053022820150301201404082015110140
QUALITY HEALTH OF NORTH PORT
6940 OUTREACH WAY
NORTH PORT, FL 34287-0947
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 225274-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.59 220.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
M-K Management, LLC
1181 Vickery Lane, Suite 200
Cordova, TN 38016-0633
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 225274123120140101201404012015103831
QUALITY HEALTH OF FERNANDINA BEACH
1625 LIME STREET
FERNANDINA BEACH, FL 32034
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 225410-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.86 247.80 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
M-K Management, LLC
1181 Vickery Lane, Suite 200
Cordova, TN 38016-0633
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 225410123120140101201404062015142559
QUALITY HEALTH OF ORANGE COUNTY
12751 W COLONIAL DRIVE
WINTER GARDEN, FL 34787
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 225631-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.51 229.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Millenium Health Systems
5310 NW 33rd Avenue
Suite 211
Ft. Lauderdale, FL 33309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 225631022920160301201504252016144731
SPRINGTREE REHABILITATION & HEALTH CARE CENTER
4251 SPRINGTREE DRIVE
SUNRISE, FL 33351-6119
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 225754-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 264.96 261.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Millenium Health Systems
5310 NW 33rd Avenue
Suite 211
Ft. Lauderdale, FL 33309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 225754022820150901201406232015101841
PINECREST REHABILITATION CENTER
13650 NE 3RD COURT
NORTH MIAMI, FL 33161
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 225991-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.30 247.09 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Eden Park Health Services, Inc.
45 Learned Street
Albany, NY 12207
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 225991123120150101201504012016111023
STUART NURSING & RESTORATIVE CARE CENTER
1500 SE PALM BEACH RD
STUART, FL 34994
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226009-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.76 237.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Eden Park Health Services, Inc.
45 Learned Street
Albany, NY 12207
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226009123120140101201403312015093035
PORT ST. LUCIE NURSING AND RESTORATIVE CARE CENTER
7300 OLEANDER AVE
PORT ST LUCIE, FL 34952-8299
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226017-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.09 261.09 9/1/2016
Level U: Fragile Under 21 557.72 560.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Millenium Health Systems
5310 NW 33rd Avenue
Suite 211
Ft. Lauderdale, FL 33309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226017022920160301201504262016080906
PLANTATION NURSING & REHABILITATION CENTER
4250 NW 5TH ST
PLANTATION, FL 33317
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226033-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.06 245.75 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Eden Park Health Services, Inc.
45 Learned Street
Albany, NY 12207
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226033123120150101201504012016114755
MARTIN NURSING AND RESTORATIVE CARE CENTER
6011 SE TOWER DR
STUART, FL 34997
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226068-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.22 245.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Cathedral Foundation, Inc.
4250 Lakeside Drive
Suite 204
Jacksonville, FL 32210
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226068093020151001201403292016155821
CATHEDRAL GERONTOLOGY CENTER INC
333 E ASHLEY ST
JACKSONVILLE, FL 32202
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226335-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 237.63 239.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Millenium Health Systems
5310 NW 33rd Avenue
Suite 211
Ft. Lauderdale, FL 33309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226335022920160301201504252016091027
BROWARD NURSING & REHABILITATION CENTER
1330 S ANDREWS AVE
FORT LAUDERDALE, FL 33316
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226351-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.19 217.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Millenium Health Systems
5310 NW 33rd Avenue
Suite 211
Ft. Lauderdale, FL 33309
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226351123120140201201404282015093842
OCEAN VIEW NURSING & REHABILITATION CENTER LLC
2810 SOUTH ATLANTIC AVENUE
NEW SMYRNA BEACH, FL 32169
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226360-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.32 233.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226360123120140701201407072015115900
SOUTH HERITAGE HEALTH & REHABILITATION CENTER
718 LAKEVIEW AVE S
SAINT PETERSBURG, FL 33705
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 226602-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.50 218.62 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 226602123120140701201404192015111423
TREASURE ISLE CARE CENTER
1735 N TREASURE DRIVE
NORTH BAY VILLAGE, FL 33141
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227226-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 164.06 166.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SMJ Enterprises, LLC
480 Fentress Blvd. Suite H
Daytona Beach, FL 32114
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227226123120140101201405142015103232
FAIR HAVENS CENTER
201 CURTISS PKWY
MIAMI SPRINGS, FL 33166-5291
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227251-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.26 230.19 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227251123120150101201503282016124814
ALPINE HEALTH AND REHABILITATION CENTER
3456 21ST AVE S
SAINT PETERSBURG, FL 33711
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227579-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.20 258.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227579083120140101201411172014114309
WILTON MANORS HEALTH & REHABILITATION CENTER
2675 N ANDREWS AVE
WILTON MANORS, FL 33311
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227587-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.20 238.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227587083120140101201411172014101947
ROCKLEDGE HEALTH AND REHABILITATION CENTER
587 BARTON BLVD
ROCKLEDGE, FL 32955
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227625-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.16 253.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227625083120140101201410092014144935
GREENBRIAR REHABILITATION AND NURSING CENTER
210 21ST AVE W
BRADENTON, FL 34205
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227633-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.42 234.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227633123120150901201404282016233002
APOLLO HEALTH AND REHABILITATION CENTER
1000 24TH ST N
SAINT PETERSBURG, FL 33713
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227641-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.79 238.73 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227641083120140101201410102014111739
NORTH REHABILITATION CENTER
1301 16TH ST N
SAINT PETERSBURG, FL 33705
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227765-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.89 238.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227765123120150901201404292016133321
PARK MEADOWS HEALTH AND REHABILITATION CENTER
3250 SW 41ST PLACE
GAINESVILLE, FL 32608
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227773-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 250.72 254.33 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227773083120140101201409292014121647
THE LODGE HEALTH AND REHABILITATION CENTER
635 SE 17TH STREET
OCALA, FL 34471
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227838-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.83 221.33 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227838123120140701201404192015113818
FIRST COAST HEALTH & REHABILITATION CENTER
7723 JASPER AVENUE
JACKSONVILLE, FL 32211
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 227871-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.94 199.96 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Services Mgt., Inc.
206 Fortress Blvd.
Murfreesboro, TN 37128
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 227871073120140801201310292014123423
AYERS HEALTH AND REHABILITATION CENTER
606 NE 7TH ST
TRENTON, FL 32693
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228001-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 273.36 277.00 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228001083120140101201410032014092241
NORTH BEACH REHABILITATION CENTER
2201 NE 170TH STREET
NORTH MIAMI BEACH, FL 33160
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228320-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 254.49 265.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228320123120150901201404202016214810
THE GARDENS COURT
3803 PGA BOULEVARD
PALM BEACH GARDENS, FL 33410
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228338-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.87 219.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228338022920160301201504222016091531
LIFE CARE CENTER OF MELBOURNE
606 E SHERIDAN RD
MELBOURNE, FL 32901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228401-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.61 203.18 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Care Managers, Inc
2380 Sadler Road Suite 201
Fernandina Beach, FL 32034
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228401123120140101201407282015163637
PARK RIDGE NURSING CENTER
730 COLLEGE STREET
JACKSONVILLE, FL 32204
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228567-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 193.85 195.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Services Mgt., Inc.
206 Fortress Blvd.
Murfreesboro, TN 37128
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228567073120140801201311132014111937
BEAR CREEK NURSING CENTER
8041 STATE RD 52 E
HUDSON, FL 34667
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228575-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.64 206.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Services Mgt., Inc.
206 Fortress Blvd.
Murfreesboro, TN 37128
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228575073120140801201310292014152142
ROYAL OAK NURSING CENTER
37300 ROYAL OAK LANE
DADE CITY, FL 33525
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228591-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.77 205.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Services Mgt., Inc.
206 Fortress Blvd.
Murfreesboro, TN 37128
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228591073120140801201310292014133050
HEATHER HILL HEALTHCARE CENTER
6630 KENTUCKY AVE
NEW PORT RICHEY, FL 34653
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228621-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 290.60 298.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228621123120140101201408102015112002
INN AT SARASOTA BAY CLUB
1303 NORTH TAMIAMI TRAIL
SARASOTA, FL 34236
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228702-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 202.72 200.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228702123120140701201407072015113957
WINTER HAVEN HEALTH AND REHABILITATION CENTER
202 AVE O NE
WINTER HAVEN, FL 33881
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228788-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.50 252.52 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228788123120140101201405262015084517
EAST RIDGE RETIREMENT VILLAGE INC
19225 SW 87TH AVE
CUTLER BAY, FL 33157-8984
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228940-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.69 209.23 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Services Mgt., Inc.
206 Fortress Blvd.
Murfreesboro, TN 37128
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228940073120140801201310292014122822
CYPRESS COVE CARE CENTER
700 SE 8TH AVE
CRYSTAL RIVER, FL 34429
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 228958-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 192.34 193.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Services Mgt., Inc.
206 Fortress Blvd.
Murfreesboro, TN 37128
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 228958073120140801201310292014101359
BROOKSVILLE HEALTHCARE CENTER
1114 CHATMAN BLVD
BROOKSVILLE, FL 34601
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 229202-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.11 240.50 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 229202063020150701201412042015113455
SHELL POINT NURSING PAVILION
15071 SHELL POINT BLVD
FORT MYERS, FL 33908
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 229288-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.38 217.22 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Council on Aging of Florida, Inc.
1311 SW 16th Street
Gainesville, FL 32608
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 229288123120140901201307272015130740
GAINESVILLE HEALTH CARE CENTER
4842 SW ARCHER ROAD
GAINESVILLE, FL 32607
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 229610-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.64 237.91 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 229610123120150101201505102016152855
LAKE VIEW CARE CENTER AT DELRAY
5430 LINTON BLVD
DELRAY BEACH, FL 33484
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 229628-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.49 239.84 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 229628123120150101201505102016150619
MENORAH HOUSE
9945 CENTRAL PARK BLVD N
BOCA RATON, FL 33428-1745
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 229849-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.20 255.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Florida Dept. of Veterans Affairs
11351 Ulmerton Road, Room 332-I
Largo, Fl 33778-1630
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 229849063020150701201411232015113806
ALEXANDER "SANDY" NININGER STATE VETERANS NURSING HOME
8401 W CYPRESS DR
PEMBROKE PINES, FL 33025
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 250988-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.78 252.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
DOS Health Care, Inc
300 71st Street, Suite 400
Miami, FL 33141
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 250988022820150901201404272015084306
HIALEAH SHORES NURSING AND REHAB CENTER
8785 NW 32ND AVENUE
MIAMI, FL 33147
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 251399-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.31 199.52 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 251399073120150801201404272016142506
BRANDYWYNE HEALTH CARE CENTER
1801 N LAKE MARIAM DR
WINTER HAVEN, FL 33884
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 251666-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.38 197.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 251666123120140701201407072015112640
CONCORDIA MANOR
321 13TH AVE N
SAINT PETERSBURG, FL 33701
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 251721-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.28 198.94 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Genesis HealthCare Corp
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 251721013120150801201407142015150939
OAKHURST CENTER
1501 SE 24TH RD
OCALA, FL 34471-6005
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 252018-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.08 249.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 252018123120150101201504252016151722
AVANTE AT MELBOURNE INC
1420 SOUTH OAK STREET
MELBOURNE, FL 32901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 252034-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.87 240.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 252034123120150101201504252016153951
AVANTE AT ORMOND BEACH INC
170 N KINGS ROAD
ORMOND BEACH, FL 32174
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 252042-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 223.10 215.43 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 252042123120140601201402202015173515
AVANTE AT MT DORA INC
3050 BROWN AVE
MOUNT DORA, FL 32757
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 252662-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.04 227.92 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sun Healthcare Group, Inc.
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 252662013120150801201404242015130139
PINEBROOK CENTER
1240 PINEBROOK ROAD
VENICE, FL 34285
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 252671-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.68 207.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Covington Senior Living, LLC
1175 Peachtree Street
Suite 1230
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 252671123120140101201407282015094030
THE PALMS OF SEBRING
725 S PINE ST
SEBRING, FL 33870
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 252689-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.15 195.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Genesis HealthCare Corp
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 252689013120150801201407142015150355
ORCHARD RIDGE
4927 VOORHEES RD
NEW PORT RICHEY, FL 34653
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253014-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.04 217.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Genesis HealthCare Corp
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253014013120160201201504262016113822
SPRINGWOOD CENTER
4602 NORTHGATE COURT
SARASOTA, FL 34234
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253430-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.14 198.46 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sun Healthcare Group, Inc.
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253430013120160201201504262016112622
SUNSET POINT
1980 SUNSET POINT RD
CLEARWATER, FL 33765-1132
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253448-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.99 200.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sun Healthcare Group, Inc.
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253448013120150801201404242015120822
BAY TREE CENTER
2600 HIGHLANDS BLVD N
PALM HARBOR, FL 34684-2114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253456-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.71 217.85 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253456063020150701201411242015101531
HAWTHORNE HEALTH AND REHAB OF OCALA
4100 SW 33RD AVE
OCALA, FL 34474
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253464-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.68 202.01 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sun Healthcare Group, Inc.
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253464013120150801201407142015145525
WEST BAY OF TAMPA
3865 TAMPA RD
OLDSMAR, FL 34677
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253481-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 269.74 273.17 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
FiveStar Quality Care Inc
400 Centre Street
Newton, MA 02458
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253481123120140701201404042015135110
FORUM AT DEER CREEK
3001 DEER CREEK COUNTRY CLUB
DEERFIELD BEACH, FL 33442
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253707-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.69 229.40 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
DOS Health Care
300 71 Street
Suite #400
Miami Beach, Fl 33141
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253707013120150801201404272015083910
EDEN SPRINGS NURSING AND REHAB CENTER
4679 CRAWFORDVILLE HWY
CRAWFORDVILLE , FL 32326
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 253723-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 271.69 272.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 253723022820150301201406052015092911
JACKSON PLAZA NURSING & REHABILITATION CENTER
1861 NW 8TH AVENUE
MIAMI , FL 33136
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 254177-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.31 225.18 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
1601 Management, LLC.
1701 N.E. 26th Street
Wilton Manors, FL 33305
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 254177013120160201201504252016113553
MANOR PINES CONVALESCENT CENTER
1701 NE 26TH ST
WILTON MANORS, FL 33305
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 254291-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 269.47 262.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 254291013120150801201406012015134404
ARCH PLAZA NURSING & REHABILITATION CENTER
12505 NE 16TH AVE
NORTH MIAMI, FL 33161-6019
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 254762-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.98 215.74 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
KR Management, LLC
20001 Gulf Boulevard
Suite 10
Indian Shores, FL 33785
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 254762123120140101201407272015092816
WRIGHTS HEALTHCARE AND REHABILITATION CENTER
11300 110TH AVE N
SEMINOLE, FL 33778-3711
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 254878-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 213.61 214.72 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Putnam Council, Inc.
16 Norcross Street
Roswell, GA 30075
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 254878123120140101201404242015142744
EDGEWOOD NURSING CENTER
1771 EDGEWOOD AVE W
JACKSONVILLE, FL 32208
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 256269-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.31 229.80 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 256269123120150101201504252016094304
DIAMOND RIDGE HEALTH AND REHABILITATION CENTER
2730 W MARC KNIGHTON CT
LECANTO, FL 34461
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 256277-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 259.54 264.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 256277123120150101201504282016145312
SURREY PLACE HEALTHCARE AND REHABILITATION
5525 21ST AVE W
BRADENTON, FL 34209
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 256757-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.65 212.49 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Health Care Managers, Inc
2380 Sadler Road Suite 201
Fernandina Beach, FL 32034
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 256757123120150101201504292016155312
LAKESIDE NURSING AND REHABILITATION CENTER
11411 ARMSDALE ROAD
JACKSONVILLE, FL 32218
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 256846-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.54 200.94 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sun Healthcare Group, Inc.
101 East State Street
Kennett Square, PA 19348
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 256846013120150801201407142015152111
LAKESIDE PAVILION
2900 12TH STREET N
NAPLES, FL 34103
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 256935-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.83 226.62 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
1601 Management, LLC.
1701 N.E. 26th Street
Wilton Manors, FL 33305
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 256935022920160301201504252016123206
MANOR OAKS NURSING & REHABILITATION CENTER
2121 E COMMERCIAL BLVD
FORT LAUDERDALE, FL 33308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 257419-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.61 240.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Provident Resources Group, Inc.
5565 Bankers Ave.
Baton Rouge, LA 70808
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 257419123120140601201405292015105801
CITRUS HEALTH AND REHABILITATION CENTER
701 MEDICAL COURT EAST
INVERNESS, FL 34452
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 258342-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.69 208.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
KR Management, LLC
20001 Gulf Boulevard
Suite 10
Indian Shores, FL 33785
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 258342123120140101201407272015162453
OAK MANOR HEALTHCARE & REHABILITATION CENTER
3500 OAK MANOR LANE
LARGO, FL 33774
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 258750-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.28 232.02 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Fairfax Senior Living
10387 Main Street, Suite 200
Fairfax, VA 22030
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 258750013120150701201408272015152420
INDIGO MANOR
595 N WILLIAMSON BLVD
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 258831-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.34 239.93 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sacred Heart Hospital
5151 North 9th Avenue
PO Box 2700
Pensacola, FL 32513-2700
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 258831063020150701201411232015152404
HAVEN OF OUR LADY OF PEACE
1900 SUMMIT BOULEVARD
PENSACOLA, FL 32503
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259080-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.44 241.75 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259080083120140901201310192014101716
LIFE CARE CENTER AT INVERRARY
4300 ROCK ISLAND ROAD
LAUDERHILL, FL 33319
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259225-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.87 215.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259225123120140101201405262015145406
LAKEVIEW TERRACE SKILLED NURSING FACILITY
110 LODGE TERRACE DR
ALTOONA, FL 32702
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259331-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 194.62 194.32 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259331063020150701201411242015102103
PRUITTHEALTH - SANTA ROSA
5530 NORTHROP ROAD
MILTON, FL 32570
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259357-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.61 228.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259357123120150901201404212016131808
LIFE CARE CENTER OF NEW PORT RICHEY
7400 TROUBLE CREEK ROAD
NEW PORT RICHEY, FL 34653
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259462-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.56 203.94 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
John A. Mccoy, Inc.
3391 Cypress Gardens Road
Winter Haven, FL 33884
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259462123120140101201401212016162118
THE NURSING CENTER AT UNIVERSITY VILLAGE
12250 N 22ND ST
TAMPA, FL 33612-4955
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259586-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.79 268.37 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259586083120150901201402182016162102
HAMLIN PLACE
2180 HYPOLUXO ROAD
LANTANA, FL 33462
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 259870-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.35 236.22 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4601 Sheridan Street
Suite 500
Hollywood, FL 33021-6744
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 259870123120150101201504252016155836
AVANTE AT ST CLOUD INC
1301 KANSAS AVE
SAINT CLOUD, FL 34769-5999
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260355-00
Date: 6/30/2016
Fiscal Year End: 9/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.91 227.30 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260355093020151001201404212016111347
SARASOTA MEMORIAL NURSING AND REHABILITATION CENTER
5640 RAND BLVD
SARASOTA, FL 34238
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260371-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.21 237.23 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260371123120140101201406302015184335
BRIDGEVIEW CENTER
350 S RIDGEWOOD AVENUE
ORMOND BEACH, FL 32174
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260444-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.09 230.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260444123120150101201504222016152411
BAYVIEW CENTER
301 S BAY ST
EUSTIS, FL 32726
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260452-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 235.16 231.53 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260452123120150101201504222016140453
RULEME CENTER
2810 RULEME ST
EUSTIS, FL 32726
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260568-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 223.08 219.36 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260568123120140101201406302015212121
TIERRA PINES CENTER
7380 ULMERTON RD
LARGO, FL 33771
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260576-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.94 221.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260576123120150101201504222016145901
HIGHLANDS LAKE CENTER
4240 LAKELAND HIGHLANDS RD
LAKELAND, FL 33813
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260649-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.48 240.46 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260649123120140101201404242015115855
COQUINA CENTER
170 N CENTER STREET
ORMOND BEACH, FL 32174
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260657-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 237.27 227.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260657123120150101201504222016135329
ISLAND LAKE CENTER
155 LANDOVER PLACE
LONGWOOD, FL 32750
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260665-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.71 226.83 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260665123120150101201504222016144421
INDIAN RIVER CENTER
7201 GREENBORO DR
WEST MELBOURNE, FL 32904
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260673-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.77 206.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260673123120150101201504222016121741
RIVERWOOD CENTER
2802 PARENTAL HOME ROAD
JACKSONVILLE, FL 32216
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260690-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.11 233.10 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
OPIS Management Resources, LLC
10150 Highland Manor Drive
Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260690123120150101201504222016150953
FAIRWAY OAKS CENTER
13806 N 46TH ST
TAMPA, FL 33613
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 260771-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 269.95 267.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 260771013120150801201406052015095756
SINAI PLAZA NURSING & REHAB CENTER
201 NE 112TH STREET
MIAMI, FL 33161
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 261254-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.47 232.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 261254123120150901201404292016133830
ALHAMBRA HEALTH AND REHABILITATION CENTER
7501 38TH AVE N
SAINT PETERSBURG, FL 33710
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 261611-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.90 209.06 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 261611123120140101201404282015092103
TERRA VISTA REHAB AND HEALTH CENTER
1730 LUCERNE TERRACE
ORLANDO, FL 32806
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 261629-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.39 208.27 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Walton Road Mgmt LLC
3599 W Lake Mary Blvd
Ste 1-E
Lake Mary, FL 32746
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 261629123120140101201404282016144535
AVALON HEALTHCARE CENTER
1270 SW MAIN BLVD
LAKE CITY, FL 32025
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 261637-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.52 230.46 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Walton Road Mgmt LLC
3599 W Lake Mary Blvd
Ste 1-E
Lake Mary, FL 32746
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 261637123120150101201506022016135937
EMERALD HEALTH CARE CENTER
1655 SE WALTON ROAD
PORT SAINT LUCIE, FL 34952
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 261670-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.41 219.60 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 261670063020150701201411242015104224
HAWTHORNE HEALTH AND REHAB OF BRANDON
851 WEST LUMSDEN RD
BRANDON, FL 33511
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263389-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.89 208.93 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263389123120150101201504022016171027
ATLANTIC SHORES NURSING AND REHAB CENTER
4251 STACK BLVD
MELBOURNE, FL 32901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263443-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 190.03 191.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263443123120150101201504022016172319
BONIFAY NURSING AND REHAB CENTER
306 WEST BROCK AVENUE
BONIFAY , FL 32425
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263451-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.13 219.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263451123120150101201504022016171716
RIVIERA PALMS REHABILITATION CENTER
926 HABEN BLVD
PALMETTO, FL 34221
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263460-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.06 210.70 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263460123120150101201504022016164701
BOYNTON BEACH REHABILITATION CENTER
9600 LAWRENCE RD
BOYNTON BEACH, FL 33436-3300
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263478-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.92 195.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263478123120150101201504022016170237
ARBOR TRAIL REHAB AND SKILLED NURSING CENTER
611 TURNER CAMP RD
INVERNESS, FL 34453
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263486-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.03 220.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263486123120150101201504022016165009
PINELLAS POINT NURSING AND REHAB CENTER
5601 31ST ST S
SAINT PETERSBURG, FL 33712
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263494-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.56 205.84 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263494123120150101201504022016172922
JACKSONVILLE NURSING AND REHAB CENTER
4134 DUNN AVENUE
JACKSONVILLE , FL 32218
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263508-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.25 223.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263508123120140101201403132015125720
PORT ORANGE NURSING AND REHAB CENTER
5600 VICTORIA GARDENS BLVD
PORT ORANGE, FL 32127
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263516-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.77 197.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263516123120150101201504212016112915
MACCLENNY NURSING AND REHAB CENTER
755 S 5TH ST
MACCLENNY, FL 32063
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263524-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.40 205.18 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263524123120150101201504022016163718
MEDICANA NURSING AND REHAB CENTER
1710 LAKE WORTH ROAD
LAKE WORTH, FL 33460
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263532-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.89 206.19 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263532123120150101201504022016165318
TIFFANY HALL NURSING AND REHAB CENTER
1800 SE HILLMOOR DRIVE
PORT SAINT LUCIE, FL 34952
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263541-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 212.83 217.34 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263541123120150101201504022016165932
METRO WEST NURSING AND REHAB CENTER
5900 WESTGATE DRIVE
ORLANDO, FL 32835
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263559-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.07 223.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263559123120140101201403272015145601
MOULTRIE CREEK NURSING AND REHAB CENTER
200 MARINER HEALTH WAY
SAINT AUGUSTINE, FL 32086
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263567-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.95 199.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263567123120140101201403132015084213
ORANGE CITY NURSING AND REHAB CENTER
2810 ENTERPRISE RD
DEBARY, FL 32713
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263575-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 222.62 225.73 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263575123120150101201504022016173548
BAYSHORE POINTE NURSING AND REHAB CENTER
3117 W GANDY BLVD
TAMPA, FL 33611-2927
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263583-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.86 204.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263583123120140101201403272015145033
ROYAL OAKS NURSING AND REHAB CENTER
2225 KNOX MCRAE DR
TITUSVILLE, FL 32780
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263591-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.38 218.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263591123120150101201504022016165620
TUSKAWILLA NURSING AND REHAB CENTER
1024 WILLA SPRINGS DR
WINTER SPRINGS, FL 32708
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263605-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.32 246.09 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263605123120140101201403272015150044
HUNTERS CREEK NURSING AND REHAB CENTER
14155 TOWN LOOP BLVD
ORLANDO, FL 32837
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263613-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.05 204.09 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263613123120150101201504022016163259
BOULEVARD REHABILITATION CENTER
2839 S SEACREST BLVD
BOYNTON BEACH, FL 33435-7994
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263621-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.56 226.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Southern HealthCare Management, LLC
5887 Glenridge Drive, Suite 150
Atlanta, GA 30328
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263621123120150101201504022016164403
PALM CITY NURSING & REHAB CENTER
2505 SW MARTIN HWY
PALM CITY, FL 34990
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263834-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.98 218.82 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263834123120150101201504082016131514
BAY POINTE NURSING PAVILION
4201 31ST ST S
SAINT PETERSBURG, FL 33712
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263842-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.24 205.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263842123120140101201407012015154417
BOCA RATON REHABILITATION CENTER
755 MEADOWS ROAD
BOCA RATON, FL 33486
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263851-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.87 201.90 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263851123120150101201504082016135921
DEERFIELD BEACH HEALTH AND REHABILITATION CENTER
401 EAST SAMPLE ROAD
POMPANO BEACH, FL 33064
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263869-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.82 216.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263869123120140101201407012015160053
REHAB & HEALTHCARE CENTER OF CAPE CORAL
2629 DEL PRADO BLVD
CAPE CORAL, FL 33904
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263877-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.97 214.77 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263877123120150101201504082016142050
CARROLLWOOD CARE CENTER
15002 HUTCHINSON RD
TAMPA, FL 33625
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263885-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.02 196.33 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263885123120140101201407012015163555
CASA MORA REHABILITATION AND EXTENDED CARE
1902 59TH ST W
BRADENTON, FL 34209
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263893-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.93 213.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263893123120140101201407012015171934
EVERGREEN WOODS
7045 EVERGREEN WOODS TRL
SPRING HILL, FL 34608
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263907-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.72 217.25 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263907123120150101201504242016141918
HIGHLAND PINES REHABILITATION CENTER
1111 S HIGHLAND AVE
CLEARWATER, FL 33756
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263915-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.98 227.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263915123120140101201403222015114809
THE REHABILITATION CENTER OF THE PALM BEACHES
301 NORTHPOINTE PARKWAY
WEST PALM BEACH, FL 33407
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263923-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.81 213.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263923123120150101201504082016132401
POMPANO HEALTH AND REHABILITATION CENTER
51 W SAMPLE ROAD
POMPANO BEACH, FL 33064
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263931-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.35 199.91 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263931123120140101201407022015090429
HEALTHCARE AND REHAB OF SANFORD
950 MELLONVILLE AVE
SANFORD, FL 32771
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263940-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 202.16 218.86 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263940123120150101201504082016144108
REHABILITATION AND HEALTHCARE CENTER OF TAMPA
4411 N HABANA AVE
TAMPA, FL 33614
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263958-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.57 223.40 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263958123120140101201403252015125347
ABBEY REHABILITATION AND NURSING CENTER
7101 DR MARTIN LUTHER KING JR ST N
SAINT PETERSBURG, FL 33702
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263966-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.85 210.84 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263966123120150101201504082016135232
OAKS AT AVON
1010 US 27 N
AVON PARK, FL 33825
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263974-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.08 214.02 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263974123120150101201504082016150039
TITUSVILLE REHABILITATION AND NURSING CENTER
1705 JESS PARRISH CT
TITUSVILLE, FL 32796
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263982-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.68 212.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263982123120140101201403222015112958
SARASOTA HEALTH AND REHABILITATION CENTER
1524 EAST AVENUE SOUTH
SARASOTA, FL 34239
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 263991-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 202.15 205.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 263991123120150101201504082016150755
WINDSOR WOODS REHAB AND HEALTHCARE CENTER
13719 DALLAS DR
HUDSON, FL 34667
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264008-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.90 219.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264008123120140101201403222015113943
WINKLER COURT
3250 WINKLER AVENUE EXTENSION
FORT MYERS, FL 33916
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264482-00
Date: 6/30/2016
Fiscal Year End: 10/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 187.22 188.17 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CNH, LLC
46 Third Street NW
Hickory, NC 28601
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264482103120141101201303172015162537
LAFAYETTE HEALTH CARE CENTER
512 W MAIN ST
MAYO, FL 32066
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264491-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.45 248.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Florida Dept. of Veterans Affairs
11351 Ulmerton Road, Room 332-I
Largo, Fl 33778-1630
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264491063020150701201411232015121832
CLIFFORD CHESTER SIMS STATE VETERANS NURSING HOME
4419 TRAM ROAD
PANAMA CITY, FL 32404
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264512-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.06 237.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264512123120140101201406162015123613
CONWAY LAKES HEALTH & REHABILITATION CENTER
5201 CURRY FORD ROAD
ORLANDO, FL 32812
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264521-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.47 228.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264521123120140101201406162015143404
BELLEAIR HEALTH CARE CENTER
1150 PONCE DE LEON BLVD
CLEARWATER, FL 33756
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264539-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.79 238.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264539123120150101201504202016143830
EAST BAY REHABILITATION CENTER
4470 E BAY DR
CLEARWATER, FL 33764
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264547-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.66 232.62 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264547123120140101201403312015155817
MELBOURNE TERRACE REHABILITATION CENTER
251 FLORIDA AVE
MELBOURNE, FL 32901
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264563-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.75 217.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264563123120150101201504202016153256
CENTRE POINTE HEALTH AND REHAB CENTER
2255 CENTERVILLE ROAD
TALLAHASSEE, FL 32308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 264571-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.41 244.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Clear Choice Health Care, LLC
709 S. Harbor City Blvd. Suite 240
Melbourne, FL 32901
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 264571123120140101201403312015160744
SPRING LAKE REHABILITATION CENTER
1540 6TH ST NW
WINTER HAVEN, FL 33881
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 265381-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.21 243.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 265381063020140701201310192014115218
LIFE CARE CENTER OF ESTERO
3850 WILLIAMS ROAD
ESTERO, FL 33928
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 265560-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 194.97 198.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 265560123120150101201504282016103557
VALENCIA HILLS HEALTH AND REHABILITATION CENTER
1350 SLEEPY HILL RD
LAKELAND, FL 33810
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 265730-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.84 209.74 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 265730123120140101201404212015090128
HIALEAH NURSING AND REHABILITATION CENTER
190 W 28TH STREET
HIALEAH, FL 33010
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 266108-00
Date: 6/30/2016
Fiscal Year End: 1/31/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.29 237.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 266108013120160201201504202016171920
LIFE CARE CENTER OF OCALA
2800 SW 41ST ST
OCALA, FL 34474
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 266124-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.67 246.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 266124123120140101201405222015171641
OASIS HEALTH AND REHABILITATION CENTER
1201 12TH AVENUE SOUTH
LAKE WORTH, FL 33460
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 266612-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 162.04 161.25 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 266612123120140101201407072015162640
WHISPERING OAKS
1514 E CHELSEA ST
TAMPA, FL 33610
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 267724-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.27 242.42 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 267724123120150101201504272016091206
SPRINGS AT BOCA CIEGA BAY
1255 PASADENA AVE S, SUITE C
SOUTH PASADENA, FL 33707
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 267902-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.47 198.02 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SMJ Enterprises, LLC
480 Fentress Blvd. Suite H
Daytona Beach, FL 32114
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 267902123120140101201405222015121356
THE NURSING CENTER AT MERCY
3671 S MIAMI AVENUE
MIAMI, FL 33133
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 268062-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 265.75 265.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 268062123120140101201407132015095616
SUSANNA WESLEY HEALTH CENTER
5300 W 16TH AVENUE
HIALEAH, FL 33012
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 268186-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.89 227.47 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 268186123120150101201504202016183718
LIFE CARE CENTER OF PALM BAY
175 VILLA NUEVA AVE
PALM BAY, FL 32907
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 268585-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 264.75 272.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 268585123120140101201404232015062442
HARBORCHASE OF NAPLES
7801 AIRPORT PULLING ROAD N
NAPLES, FL 34109
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 268755-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.95 251.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Synergy Health Care
1835 Miami Gardens Dr. Suite 167
North Miami Beach, FL 33179
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 268755123120150101201504282016131956
ABBIEJEAN RUSSELL CARE CENTER LLC
700 S 29TH STREET
FORT PIERCE, FL 34947
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 268763-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.14 215.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 268763063020150701201411242015135307
GOOD SAMARITAN CENTER
10676 MARVIN JONES BLVD
LIVE OAK, FL 32060
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 268780-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.97 245.29 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Summit Care II, Inc
2123 Centre Pointe Blvd.
Tallahassee, FL 32308
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 268780123120150101201504292016102444
SPRINGS AT LAKE POINTE WOODS
3280 LAKE POINTE BLVD
SARASOTA, FL 34231
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 269000-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.00 222.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 269000123120150101201504272016162640
MAJESTIC OAKS
901 VETERAN'S MEMORIAL PARKWAY
ORANGE CITY, FL 32763
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 269107-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.82 194.18 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SMJ Enterprises, LLC
480 Fentress Blvd. Suite H
Daytona Beach, FL 32114
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 269107123120140101201405222015141259
HARMONY HEALTH CENTER
9820 N KENDALL DRIVE
MIAMI, FL 33176
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 269492-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 244.48 252.97 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Florida Dept. of Veterans Affairs
11351 Ulmerton Road, Room 332-I
Largo, Fl 33778-1630
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 269492063020150701201411232015124314
DOUGLAS JACOBSON STATE VETERANS NURSING HOME
21281 GRAYTON TERRACE
PORT CHARLOTTE, FL 33954
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 269697-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.32 206.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 269697123120150101201504242016145917
REGENTS PARK OF SUNRISE
9711 W OAKLAND PARK BLVD
SUNRISE, FL 33351
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 269719-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.35 208.31 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 269719123120140101201407082015163747
REGENTS PARK OF WINTER PARK
558 N SEMORAN BLVD
WINTER PARK, FL 32792
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 269727-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.99 206.12 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 269727123120140101201407082015161204
REGENTS PARK OF JACKSONVILLE
8700 A C SKINNER PARKWAY
JACKSONVILLE, FL 32256
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 281743-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 180.52 176.22 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Grace Healthcare, Inc
7201 Shallowford Rd, STE 200
Chattanooga, TN 37421
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 281743123120140101201406242015111034
JACARANDA MANOR
4250 66TH ST N
SAINT PETERSBURG, FL 33709
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 282359-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.21 240.44 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Preferred Care, Inc.
5420 West Plano Parkway
Plano, TX 75093
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 282359123120140101201407162015142800
WEST GABLES HEALTH CARE CENTER
2525 SW 75TH AVENUE
MIAMI, FL 33155
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 282464-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.86 228.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 282464083120140101201410102014112252
RIDGECREST NURSING AND REHABILITATION CENTER
1200 NORTH STONE STREET
DELAND, FL 32720
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 282529-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.28 247.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 282529123120140101201404272015114303
CORAL REEF NURSING & REHABILITATION CENTER
9869 SW 152ND STREET
MIAMI, FL 33157
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 282537-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.07 252.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Cypress Administrative Services, LLC
4 West Red Oak Lane, Suite 201
White Plains, NY 10604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 282537063020140701201310212014130441
PALM TERRACE OF ST PETERSBURG
521 69TH AVE N
SAINT PETERSBURG, FL 33702
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 282618-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 235.01 235.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Cypress Administrative Services, LLC
4 West Red Oak Lane, Suite 201
White Plains, NY 10604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 282618063020140701201310112014161438
PALM TERRACE OF CLEWISTON
301 SOUTH GLORIA ST
CLEWISTON, FL 33440
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 282626-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.23 232.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Cypress Administrative Services, LLC
4 West Red Oak Lane, Suite 201
White Plains, NY 10604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 282626063020140701201310202014121547
PALM TERRACE OF LAKELAND
1919 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 283193-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.93 236.49 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 283193063020140701201310142014083334
LIFE CARE CENTER OF JACKSONVILLE
4813 LENOIR AVENUE
JACKSONVILLE, FL 32216
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 284289-00
Date: 6/30/2016
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 203.59 204.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 284289073120140801201310192014105105
LIFE CARE CENTER OF ORANGE PARK
2145 KINGSLEY AVE
ORANGE PARK, FL 32073
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 284793-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.21 247.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 284793123120140101201404272015103829
BRIGHTON GARDENS OF TAMPA
16702 NORTH DALE MABRY HWY
TAMPA, FL 33618-1055
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 284823-00
Date: 6/30/2016
Fiscal Year End: 2/28/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 293.64 282.54 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 284823022820150901201406082015114210
AVENTURA PLAZA REHABILITATION & NURSING CENTER
1800 N E 168TH STREET
NORTH MIAMI BEACH, FL 33162
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 308251-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.69 246.22 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 308251013120150201201406162015105249
PONCE PLAZA NURSING & REHABILITATION CENTER
335 SW 12 AVENUE
MIAMI, FL 33130
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 309800-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 268.03 272.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Allegro Senior Living, LLC
212 S. Central Avenue
Suite 301
St. Louis, MO 63105
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 309800123120140101201404282015144349
THE ALLEGRO AT COLLEGE HARBOR
4600 54TH AVE S
SAINT PETERSBURG, FL 33711
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 310581-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.40 209.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Lyric Healthcare Holdings III, Inc
1423 Clarkview Road
Suite 500
Baltimore, MD 21090
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 310581083120140901201304272015071513
ATLANTIC HEALTHCARE CENTER
3663 15TH AVE
VERO BEACH, FL 32960
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 310841-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.35 245.57 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 310841123120140101201404292015150350
ST MARK VILLAGE
2655 NEBRASKA AVE
PALM HARBOR, FL 34684
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 311308-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 195.66 198.66 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hebrew Homes Management Services
1800 NE 168th Street, Suite 200
North Miami Beach, FL 33162
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 311308013120150801201403262015155533
SOUTH POINTE PLAZA REHABILITATION AND NURSING CENTER
42 COLLINS AVENUE
MIAMI BEACH, FL 33139
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 311685-00
Date: 6/30/2016
Fiscal Year End: 2/29/2016
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.66 249.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 311685022920160301201504202016215647
LIFE CARE CENTER OF PUNTA GORDA
450 SHREVE STREET
PUNTA GORDA, FL 33950
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312045-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.90 198.61 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Cardinal Resources, LLC
16 Norcross Street
Roswell, GA 30075
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312045123120140101201407172015090508
SANDALWOOD NURSING CENTER
1001 S BEACH STREET
DAYTONA BEACH, FL 32114
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312142-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.29 204.54 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Putnam Council, Inc.
16 Norcross Street
Roswell, GA 30075
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312142123120140101201407172015081853
LAKEWOOD NURSING CENTER
100 N LAKE ST
CRESCENT CITY, FL 32112
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312151-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.96 196.85 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
CNH, LLC
46 Third Street NW
Hickory, NC 28601
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312151093020141001201310282014103043
CROSS CITY REHABILITATION & HEALTH CARE CENTER
583 NE 351 HWY
CROSS CITY, FL 32628
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312274-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.57 198.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Putnam Council, Inc.
16 Norcross Street
Roswell, GA 30075
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312274123120150101201504262016122826
CRESTWOOD NURSING CENTER
501 S PALM AVE
PALATKA, FL 32177
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312312-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.42 231.25 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Living Management Corporation
4661 Johnson Road, Suite 7
Coconut, FL 33073
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312312123120140101201404272015074021
SAVANNAH COVE
2090 N CONGRESS AVE
WEST PALM BEACH, FL 33401
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312550-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 255.02 235.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Living Management Corporation
4661 Johnson Road, Suite 7
Coconut, FL 33073
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312550123120150701201504262016134423
SAVANNAH COVE
1301 W MAITLAND BLVD
MAITLAND, FL 32751
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 312789-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 279.33 290.76 9/1/2016
Level U: Fragile Under 21 578.96 590.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Broward Children's Center, Inc.
200 SE 19th Avenue
Pompano Beach, FL 33072
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 312789073120150801201410012015140943
CHILDREN'S COMPREHENSIVE CARE CENTER INC.
200 SE 19TH AVENUE
POMPANO BEACH, FL 33060
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 313424-00
Date: 6/30/2016
Fiscal Year End: 7/16/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.81 231.21 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Herlee, Inc
1201 North 37th Street
Hollywood, FL 33021
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 313424071620150701201411092015113152
HOLLYWOOD HILLS REHABILITATION CENTER LLC
1200 N 35TH AVE
HOLLYWOOD, FL 33021
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 313718-00
Date: 6/30/2016
Fiscal Year End: 8/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.96 241.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 313718083120150901201402142016081522
LUTHERAN HAVEN NURSING HOME
1525 HAVEN DRIVE
OVIEDO, FL 32765
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 315664-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.46 229.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 315664123120150101201504202016185323
LIFE CARE CENTER OF PENSACOLA
3291 EAST OLIVE RD
PENSACOLA, FL 32514
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 316628-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 185.23 208.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 316628053120150601201410052015073708
LAURELLWOOD NURSING CENTER
3127 57TH AVE N
SAINT PETERSBURG, FL 33714
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 316636-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.40 209.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 316636053120150601201410052015081209
HARBOURWOOD HEALTH AND REHAB CENTER
549 SKY HARBOR DR
BLDG 31
CLEARWATER, FL 33759
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 316644-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 187.23 196.59 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 316644053120150601201410052015072603
GRACEWOOD REHABILITATION AND NURSING CARE
8600 US HWY 19 N
PINELLAS PARK, FL 33782
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 316652-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.52 211.79 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 316652053120150601201410052015071049
BAYWOOD NURSING CENTER
2000 17TH AVE S
SAINT PETERSBURG, FL 33712
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 317349-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.38 241.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Life Care Centers Of America
3570 NW Keith Street
Cleveland, TN 37312
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 317349123120150101201504172016143822
DARCY HALL OF LIFE CARE
2170 PALM BEACH LAKES BLVD
WEST PALM BEACH, FL 33409
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 317578-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.00 239.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 317578123120140401201407172015133427
PARKLANDS REHABILITATION AND NURSING CENTER
1000 SW 16TH AVE
GAINESVILLE, FL 32601
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 317586-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.34 244.50 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 317586123120140401201404272015102730
WILLISTON REHABILITATION AND NURSING CENTER
300 NW 1ST AVE
WILLISTON, FL 32696
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 318795-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.46 250.19 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
FiveStar Quality Care Inc
400 Centre Street
Newton, MA 02458
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 318795123120140701201404042015140713
THE COURT AT PALM AIRE
2701 N COURSE DR
POMPANO BEACH, FL 33069-3058
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 319244-00
Date: 6/30/2016
Fiscal Year End: 6/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 268.43 267.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Emeritus Senior Living
3131 Elliott Avenue,
Suite 500
Seattle, WA 98121
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 319244063020150701201401202016150544
BROOKDALE PALMER RANCH SNF
5111 PALMER RANCH PARKWAY
SARASOTA, FL 34238
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 319325-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.63 241.89 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
SBK Capital, LLC
1935 Garraux Road, Northwest
Atlanta, GA 30327
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 319325123120150101201504202016152217
PORT CHARLOTTE REHABILITATION CENTER
25325 RAMPART BLVD
PORT CHARLOTTE, FL 33983
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 319376-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.33 222.74 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Brookdale Senior Living, Inc.
111 Westwood Place
Suite 400
Brentwood, TN 37027
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 319376123120150101201504272016135247
BROOKDALE ATRIUM WAY 2
9960 ATRIUM WAY
JACKSONVILLE, FL 32225
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320391-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.86 208.49 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Adventist Care Centers
602 Courtland Street, Suite 200
Orlando, FL 32804
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320391123120150101201504282016092121
ZEPHYR HAVEN HEALTH & REHAB CENTER, INC.
38250 A AVE
ZEPHYRHILLS, FL 33542
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320404-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.35 228.56 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sunbelt Health Care Centers,Inc.
602 Courtland Street
Suite 200
Orlando, FL 32804
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320404013120150801201404272015144259
ZEPHYRHILLS HEALTH & REHAB CENTER, INC.
7350 DAIRY RD
ZEPHYRHILLS, FL 33540
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320412-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.42 218.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sunbelt Health Care Centers,Inc.
602 Courtland Street
Suite 200
Orlando, FL 32804
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320412013120150801201404232015140917
SUNBELT HEALTH & REHAB CENTER - APOPKA, INC.
305 EAST OAK STREET
APOPKA, FL 32703
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320421-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.88 246.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sunbelt Health Care Centers,Inc.
602 Courtland Street
Suite 200
Orlando, FL 32804
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320421013120150801201404282015133140
EAST ORLANDO HEALTH & REHAB CENTER, INC.
250 SOUTH CHICKASAW TRAIL
ORLANDO, FL 32825-3308
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320439-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.65 216.03 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Adventist Care Centers
602 Courtland Street, Suite 200
Orlando, FL 32804
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320439123120140101201407152015160537
ADVENTIST CARE CENTERS - COURTLAND, INC.
730 COURTLAND STREET
ORLANDO, FL 32804
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320463-00
Date: 6/30/2016
Fiscal Year End: 1/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.87 231.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Sunbelt Health Care Centers,Inc.
602 Courtland Street
Suite 200
Orlando, FL 32804
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320463013120150801201404272015140833
FLORIDA LIVING NURSING CENTER
3355 E SEMORAN BLVD
APOPKA, FL 32703
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 320978-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.99 261.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 320978083120140101201410092014164424
LEHIGH ACRES HEALTH & REHABILITATION CENTER
1550 LEE BOULEVARD
LEHIGH ACRES, FL 33936
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 321532-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 250.09 252.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 321532123120140101201404262015153531
THE PALMS REHABILITATION AND NURSING CENTER
3370 NW 47TH TERRACE
LAUDERDALE LAKES, FL 33319
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 323772-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.39 233.18 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 323772123120140101201404152015112158
CORAL GABLES NURSING AND REHABILITATION
7060 SW 8TH STREET
MIAMI, FL 33144
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 323781-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 256.94 245.29 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Preferred Care, Inc.
5420 West Plano Parkway
Plano, TX 75093
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 323781123120140101201407162015113635
TARPON POINT NURSING AND REHABILITATION CENTER
5157 PARK CLUB DRIVE
SARASOTA, FL 34235
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 323799-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.16 210.80 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Preferred Care, Inc.
5420 West Plano Parkway
Plano, TX 75093
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 323799123120140101201407162015145602
ST. ANDREW'S BAY SKILLED NURSING AND REHABILITATION
2100 JENKS AVE
PANAMA CITY, FL 32405
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324027-00
Date: 6/30/2016
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.00 259.81 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324027033120151001201404292015121312
HAMPTON COURT NURSING CENTER
16100 NW 2ND AVENUE
NORTH MIAMI BEACH, FL 33169
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324094-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 250.42 251.99 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324094123120140301201404272015105606
ADVANCED REHABILITATION & HEALTH CENTER
401 FAIRWOOD AVE
CLEARWATER, FL 33759
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324108-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 268.99 269.73 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324108123120140301201404132015162606
BAYSIDE REHABILITATION & HEALTH CENTER
811 JACKSON ST N
SAINT PETERSBURG, FL 33705
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324124-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.87 242.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324124123120140301201407202015082424
MADISON POINTE REHABILITATION & HEALTH CENTER
6020 INDIANA AVE
NEW PORT RICHEY, FL 34653-3214
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324132-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 249.57 251.08 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324132123120140301201404272015100951
SHORE ACRES REHABILITATION & HEALTH CENTER
4500 INDIANAPOLIS ST NE
SAINT PETERSBURG, FL 33703
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324141-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.90 254.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324141123120140301201404262015101542
WOODBRIDGE REHABILITATION & HEALTH CENTER
8720 JACKSON SPRINGS RD
TAMPA, FL 33615-3210
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324167-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 270.80 274.26 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324167123120140301201404282015091458
PALMETTO REHABILITATION AND HEALTH CENTER
6750 WEST 22ND COURT
HIALEAH, FL 33016
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324175-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.71 242.73 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324175123120140301201404272015092926
COURTYARDS OF ORLANDO REHABILITATION AND HEALTH CENTER
1900 MERCY DRIVE
ORLANDO, FL 32808
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324213-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 206.82 198.58 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324213123120140101201404082016091922
ROYAL CARE OF AVON PARK
1213 W STRATFORD RD
AVON PARK, FL 33825
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324345-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.97 207.27 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324345073120150801201403142016094627
HERITAGE PARK CARE AND REHABILITATION CENTER
2302 59TH ST W
BRADENTON, FL 34209
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324353-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.56 197.93 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324353073120150801201403142016115242
WASHINGTON REHABILITATION & NURSING CENTER
879 USERY ROAD
CHIPLEY, FL 32428
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324361-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.57 201.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324361073120150801201403142016084817
CHAUTAUQUA REHABILITATION & NURSING CENTER
785 S 2ND STREET
DEFUNIAK SPRINGS, FL 32433
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324370-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.13 215.11 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324370073120150801201403282016134803
SIGNATURE HEALTHCARE OF COLLEGE PARK
13755 GOLF CLUB PKWY
FORT MYERS, FL 33919
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324388-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 200.33 197.98 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324388073120150801201403282016104144
SIGNATURE HEALTHCARE OF GAINESVILLE
4000 SW 20TH AVE
GAINESVILLE, FL 32607
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324396-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 191.02 198.78 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324396073120150801201403142016102924
SIGNATURE HEALTHCARE OF NORTH FLORIDA
1083 SANDERS AVENUE
GRACEVILLE, FL 32440
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324400-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.87 198.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324400073120150801201403142016124238
SIGNATURE HEALTHCARE CENTER OF WATERFORD
8333 W OKEECHOBEE ROAD
HIALEAH GARDENS, FL 33016
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324418-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.41 218.32 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324418073120150801201403112016164932
SIGNATURE HEALTHCARE OF BROOKWOOD GARDENS
1990 S CANAL DRIVE
HOMESTEAD, FL 33035
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324426-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.39 210.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324426073120150801201403142016090206
SIGNATURE HEALTHCARE AT THE COURTYARD
2600 FOREST GLEN TRAIL
MARIANNA, FL 32446
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324434-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.25 211.04 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324434073120150801201403142016095836
SIGNATURE HEALTHCARE OF ORANGE PARK
2029 PROFESSIONAL CENTER DR
ORANGE PARK, FL 32073
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324442-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.24 204.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324442073120150801201403142016110109
SIGNATURE HEALTHCARE OF ORMOND
103 NORTH CLYDE MORRIS BLVD
ORMOND BEACH, FL 32174
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324451-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 193.91 195.75 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324451073120150801201403142016100616
ANCHOR CARE & REHABILITATION CENTER
1515 PORT MALABAR BLVD NE
PALM BAY, FL 32905-5455
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324469-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.80 216.39 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324469073120150801201403142016111510
SIGNATURE HEALTHCARE OF PINELLAS PARK
8701 49TH ST N
PINELLAS PARK, FL 33782
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324477-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 217.84 222.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324477073120150801201403142016101435
SIGNATURE HEALTHCARE OF PORT CHARLOTTE
4033 BEAVER LANE
PORT CHARLOTTE, FL 33952
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324485-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 196.39 205.35 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324485073120150801201403112016163655
THE BRIDGE AT BAY ST. JOE
220 NINTH STREET
PORT SAINT JOE, FL 32456
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324493-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.29 198.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324493073120150801201403142016102207
KENILWORTH CARE AND REHABILITATION CENTER
3011 KENILWORTH BLVD
SEBRING, FL 33870
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324507-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.94 197.77 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324507073120150801201403142016110824
PENINSULA CARE AND REHABILITATION CENTER
900 BECKETT WAY
TARPON SPRINGS, FL 34689
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324515-00
Date: 6/30/2016
Fiscal Year End: 7/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 205.84 203.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324515073120150801201403142016130450
WINTER PARK CARE AND REHABILITATION CENTER
2970 SCARLETT RD
WINTER PARK, FL 32792
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 324566-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.03 211.01 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 324566123120140101201407202015083842
SOUTHERN OAKS REHABILITATION AND NURSING CENTER
600 WEST GREGORY STREET
PENSACOLA, FL 32502-4744
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325031-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 266.85 268.05 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325031123120140301201404282015083455
TERRACES OF LAKE WORTH REHAB AND HEALTH CENTER
1711 6TH AVENUE SOUTH
LAKE WORTH, FL 33460
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325040-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.90 240.45 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325040123120140301201404272015131915
ARBOR VILLAGE NURSING CENTER
490 S OLD WIRE RD
WILDWOOD, FL 34785
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325163-00
Date: 6/30/2016
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 274.75 276.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325163123120140301201404272015094559
NORTH LAKE REHABILITATION AND HEALTH CENTER
750 BAYBERRY DRIVE
LAKE PARK, FL 33403
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325236-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.95 228.64 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325236063020140701201310022014152614
HEARTLAND HEALTH CARE CENTER-JACKSONVILLE
8495 NORMANDY BLVD
JACKSONVILLE, FL 32221
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325244-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 201.18 213.80 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325244123120150701201404192016101055
HEARTLAND HEALTH CARE CENTER-KENDALL
9400 SW 137TH AVENUE
KENDALL, FL 33186
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325252-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.11 221.87 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325252123120151001201404192016102711
HEARTLAND HEALTH CARE CENTER- MIAMI LAKES
5725 NW 186 STREET
HIALEAH, FL 33015
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325261-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 207.65 205.63 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325261123120151001201404192016141821
HEARTLAND HEALTH CARE CENTER-ORANGE PARK
570 WELLS RD
ORANGE PARK, FL 32073-2999
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325279-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.59 206.80 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325279093020141001201310282014095227
MANORCARE NURSING AND REHABILITATION CENTER
2075 LOCH LOMOND DRIVE
WINTER PARK, FL 32792
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325287-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.50 210.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325287053120150601201409222015165254
HEARTLAND HEALTH CARE CENTER OF SOUTH JACKSONVILLE
3648 UNIVERSITY BLVD S
JACKSONVILLE, FL 32216
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325309-00
Date: 6/30/2016
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 204.61 204.71 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325309063020140701201310072014155531
HEARTLAND HEALTH CARE CENTER- BOYNTON BEACH
3600 OLD BOYNTON ROAD
BOYNTON BEACH, FL 33436
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325325-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.37 215.69 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325325093020141001201310282014085204
HEARTLAND HEALTH CARE CENTER-FT. MYERS
1600 MATTHEW DRIVE
FORT MYERS, FL 33907
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325333-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 192.59 193.48 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325333123120150801201404192016143201
HEARTLAND HEALTH CARE CENTER- LAUDERHILL
2599 NW 55TH AVE
LAUDERHILL, FL 33313
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325341-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 219.10 219.85 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325341093020141001201310292014091126
HEARTLAND HEALTH CARE CENTER-PROSPERITY OAKS
11375 PROSPERITY FARMS ROAD
PALM BEACH GARDENS, FL 33410
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325350-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.71 232.16 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325350123120151001201404192016081221
HEARTLAND OF TAMARAC
5901 NW 79TH AVENUE
TAMARAC, FL 33321
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325368-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 199.01 204.14 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325368053120150601201409222015161246
MANORCARE HEALTH SERVICES (BOCA RATON)
375 NW 51ST STREET
BOCA RATON, FL 33431
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325376-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 223.77 218.29 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325376123120150601201504222016081623
MANORCARE HEALTH SERVICES-BOYNTON BEACH
3001 SOUTH CONGRESS AVENUE
BOYNTON BEACH, FL 33426
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325384-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 216.94 202.20 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325384123120150601201504142016105806
MANORCARE HEALTH SERVICES
13881 EAGLE RIDGE DRIVE
FORT MYERS, FL 33912
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325422-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.04 231.68 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325422123120151001201404142016105313
MANOR CARE @ LELY PALMS
6135 RATTLESNAKE HAMMOCK ROAD
NAPLES, FL 34113
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325449-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 225.08 241.34 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325449123120150601201504142016105004
MANOR CARE NURSING AND REHABILITATION CENTER
3601 LAKEWOOD BLVD
NAPLES, FL 34112
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325457-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.89 217.65 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325457123120150601201504192016151825
MANORCARE HEALTH SERVICES (PLANTATION)
6931 W SUNRISE BLVD
PLANTATION, FL 33313
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325465-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 230.99 217.24 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325465053120150601201409232015140238
MANORCARE HEALTH SERVICES-SARASOTA
5511 SWIFT ROAD
SARASOTA, FL 34231
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325473-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 220.34 221.76 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325473123120150601201504192016133238
MANOR CARE HEALTH SERVICES
1450 EAST VENICE AVENUE
VENICE, FL 34292
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325481-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.39 215.07 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325481093020141001201310232014091341
MANORCARE HEALTH SERVICES-WEST PALM BEACH
2300 VILLAGE BLVD
WEST PALM BEACH, FL 33409
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325490-00
Date: 6/30/2016
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.16 227.37 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325490083120140901201310202014154154
HEARTLAND HEALTH CARE CENTER-NORTH SARASOTA
3250 12TH ST
SARASOTA, FL 34237
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325520-00
Date: 6/30/2016
Fiscal Year End: 4/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 190.79 195.77 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325520043020150501201409212015154055
MANORCARE HEALTH SERVICES (DELRAY BEACH)
16200 JOG ROAD
DELRAY BEACH, FL 33446
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325678-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 224.27 228.51 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325678123120150601201504152016085930
MANORCARE HEALTH SERVICES-CARROLLWOOD
3030 BEARSS AVE
TAMPA, FL 33618
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325686-00
Date: 6/30/2016
Fiscal Year End: 9/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 208.02 209.15 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325686093020141001201310272014110005
MANOR-CARE HEALTH SERVICES-DUNEDIN
870 PATRICIA AVE
DUNEDIN, FL 34698
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325694-00
Date: 6/30/2016
Fiscal Year End: 5/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 188.21 193.88 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325694053120150601201409232015080946
MANORCARE HEALTH SERVICES-PALM HARBOR
2851 TAMPA RD
PALM HARBOR, FL 34684
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 325708-00
Date: 6/30/2016
Fiscal Year End: 12/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 198.15 196.45 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 325708123120151001201404192016113439
HEARTLAND OF ZEPHYRHILLS
38220 HENRY DR
ZEPHYRHILLS, FL 33540
Home Office:
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 326011-00
Date: 6/30/2016
Fiscal Year End: 4/30/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.10 237.41 9/1/2016
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Lisa Smith
Medicaid Cost Reimbursement Planning and Finance
No Home Office
2Z0S4 Report Calculated: 6/30/2016 8:16:40 AM Report Printed :7/1/2016 ID: 326011043020150501201410012015094534
MOOSEHAVEN, INC.
1701 PARK AVENUE
ORANGE PARK, FL 32073
Home Office: