233.28 229.34 9/1/2015 · 2015. 9. 1. · medicaid reimbursement per diem rates provider number: 0...

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Medicaid Reimbursement Per Diem Rates Provider Number: 0 001135-00 Date: 6/25/2015 Fiscal Year End: 7/31/2014 Audit Status: Unaudited Provider Type: Current New Effective Rate Rate Date Nursing Home Single Level 233.28 229.34 9/1/2015 State of Florida Office of Medicaid Cost Reimbursement Planning and Finance 2727 Mahan Drive - Mail Stop 23 Tallahassee, Florida 32308 Rate Type: Interim X Prospective Total Interim X Total Prospective Interim Component Total Prospective with Interim Component Settlement based on cost Prior Provider Prospective data Basis: Budget X Unaudited costs Field audited costs Desk audited costs Changes: X Rate Semester Change Distribution: Contract Management / Fiscal Agent Permanent File For Information Only No Change in Rate Thomas Parker Medicaid Cost Reimbursement Planning and Finance Signature Healthcare LLC 12201 Bluegrass Parkway Louisville, KY 40299 6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001135073120141001201310282014125147 SURREY PLACE CARE CENTER 110 SE LEE AVE LIVE OAK, FL 32060 Home Office:

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  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 001135-00

    Date: 6/25/2015

    Fiscal Year End: 7/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 233.28 229.34 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Signature Healthcare LLC

    12201 Bluegrass Parkway

    Louisville, KY 40299

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001135073120141001201310282014125147

    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: 6/25/2015

    Fiscal Year End: 7/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 234.75 232.80 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Signature Healthcare LLC

    12201 Bluegrass Parkway

    Louisville, KY 40299

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001136073120141001201310302014093349

    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: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 211.03 211.20 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001416123120130101201310292014124509

    FLORIDA BAPTIST RETIREMENT CENTER

    1006 33RD ST

    VERO BEACH, FL 32960

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 002400-00

    Date: 6/25/2015

    Fiscal Year End: 8/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 260.49 260.53 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Greystone Healthcare Management, LLC

    4042 Park Oaks Blvd, Suite 300

    Tampa, FL 33610

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 229.96 233.54 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 234.55 233.76 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 234.74 234.09 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 233.49 231.92 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 243.19 240.86 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 245.59 244.54 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 228.54 225.40 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 241.52 240.35 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 234.07 231.55 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 233.69 232.18 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 247.16 244.30 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 251.53 249.80 9/1/2015

    State of Florida 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

    Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 238.66 236.15 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 231.51 229.69 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 242.75 244.17 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 5/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 234.26 232.61 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Avante Group, Inc.

    4000 Hollywood Blvd, Suite 540-N

    Hollywood, FL 33021-6744

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005701053120140601201310162014143610

    AVANTE AT OCALA

    2021 SW 1ST AVE

    OCALA, FL 34471

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 005811-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 233.34 247.04 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 262.59 261.04 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 228.96 228.86 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 274.00 272.49 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 233.83 232.15 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 232.70 232.24 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 236.59 236.54 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 231.44 230.13 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 242.83 240.69 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 248.16 245.43 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 252.83 251.25 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 234.62 233.42 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Cardinal Resources, LLC

    16 Norcross Street

    Roswell, GA 30075

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 008793123120130101201304232014152455

    WOODS OF MANATEE SPRINGS

    5627 9TH ST E

    BRADENTON, FL 34203

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 010082-00

    Date: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 221.63 224.93 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 010082063020140701201304272015113542

    COURTYARD GARDENS REHABILITATION CENTER

    17781 THELMA AVENUE

    JUPITER, FL 33458

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 010453-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 239.57 238.76 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    HCR Manor Care

    333 North Summit Street

    Toledo, OH 43604

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 010453123120130101201305272014110339

    HEARTLAND HEALTH CARE & REHABILITATION CENTER

    5401 SAWYER RD

    SARASOTA, FL 34233

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 011997-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 232.16 233.42 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    HCR Manor Care

    333 North Summit Street

    Toledo, OH 43604

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 011997123120130101201305272014095952

    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: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 247.85 246.77 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Grace Healthcare, Inc

    7201 Shallowford Rd, STE 200

    Chattanooga, TN 37421

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 011998123120130101201308152014113656

    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: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 242.07 248.02 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Hallmark Accounting

    368 New Hempstead Road #309

    New City, NY 10956

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 209.88 206.85 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Saber Healthcare Group, LLC

    26691 Richmond Road

    Bedford Heights, OH 44146

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 233.33 231.06 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 245.26 243.82 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 240.85 238.40 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 239.41 237.45 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 246.35 243.91 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 246.06 244.55 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 260.56 249.26 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017242063020140101201410122014123221

    GRAND BOULEVARD HEALTH & REHAB. CENTER

    138 SANDESTIN LANE

    MIRAMAR BEACH, FL 32550

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 017301-00

    Date: 6/25/2015

    Fiscal Year End: 6/30/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 226.08 224.08 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017301063020130701201210302013092602

    LAKE BENNETT HEALTH AND REHABILITATION

    1091 KELTON AVE

    OCOEE, FL 34761

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 018066-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 226.59 231.77 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    FiveStar Quality Care Inc

    400 Centre Street

    Newton, MA 02458

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 018066123120140701201404042015134309

    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: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 257.90 262.69 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 018777123120130101201305142014170004

    BAY VILLAGE OF SARASOTA

    8400 VAMO ROAD

    SARASOTA, FL 34231

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 019085-00

    Date: 6/25/2015

    Fiscal Year End: 7/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 227.16 200.26 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Signature Healthcare LLC

    12201 Bluegrass Parkway

    Louisville, KY 40299

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019085073120141001201312172014140247

    GOLFVIEW HEALTHCARE CENTER

    3636 10TH AVE N

    SAINT PETERSBURG, FL 33713

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 019282-00

    Date: 6/25/2015

    Fiscal Year End: 7/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 197.04 191.26 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Signature Healthcare LLC

    12201 Bluegrass Parkway

    Louisville, KY 40299

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019282073120141001201312162014164418

    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: 6/25/2015

    Fiscal Year End: 7/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 210.74 201.47 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Signature Healthcare LLC

    12201 Bluegrass Parkway

    Louisville, KY 40299

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019284073120141001201312172014134846

    SIGNATURE HEALTHCARE OF JACKSONVILLE

    2061 HYDE PARK RD

    JACKSONVILLE, FL 32210

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 019287-00

    Date: 6/25/2015

    Fiscal Year End: 7/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 218.39 215.86 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Signature Healthcare LLC

    12201 Bluegrass Parkway

    Louisville, KY 40299

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019287073120141001201310282014143434

    GOLFCREST HEALTHCARE CENTER

    600 NORTH 17TH AVE

    HOLLYWOOD, FL 33020

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 021261-00

    Date: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 214.01 211.36 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Gulf Coast Healthcare, LLC

    40 South Palafox Place

    Suite 400

    Pensacola, FL 32502

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 8/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 253.39 235.93 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Greystone Healthcare Management, LLC

    4042 Park Oaks Blvd, Suite 300

    Tampa, FL 33610

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 022138083120140101201411142014115530

    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: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 215.75 212.57 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    WW Healthcare Consultants, LLC

    1978 8th Avenue NW

    Hickory, NC 28603

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 022987123120130101201304282014093018

    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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 209.40 220.72 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Senior Care Group, Inc.

    1240 Marbella Plaza Drive

    Tampa, FL 33619

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 022994063020140701201311062014151233

    THE HOME ASSOCIATION, INC.

    1203 E 22ND AVE

    TAMPA, FL 33605

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 023067-00

    Date: 6/25/2015

    Fiscal Year End: 3/31/2015

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 258.71 265.15 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 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: 6/25/2015

    Fiscal Year End: 6/30/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 228.11 212.03 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    Senior Care Group, Inc.

    1240 Marbella Plaza Drive

    Tampa, FL 33619

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 024167063020140701201311102014083423

    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: 6/25/2015

    Fiscal Year End: 12/31/2013

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 257.65 255.80 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 026536123120130101201310272014120537

    WEST BROWARD REHABILITATION AND HEALTHCARE

    7751 W BROWARD BLVD

    PLANTATION, FL 33324

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 030479-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 232.02 230.48 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 030479123120140701201404222015081635

    THE HEALTH CENTER OF WINDERMERE

    4875 CASON COVE DRIVE

    ORLANDO, FL 32811

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 030484-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 241.93 234.33 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 030484123120140701201404212015093359

    THE HEALTH CENTER OF PLANT CITY

    701 N WILDER RD

    PLANT CITY, FL 33566-7547

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 030487-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 237.28 238.09 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim Component Total Prospective with Interim Component

    Settlement based on cost

    Prior Provider Prospective data

    Basis:

    Budget

    X Unaudited costs

    Field audited costs

    Desk audited costs

    Changes:X Rate Semester Change

    Distribution:Contract Management / Fiscal Agent

    Permanent File

    For Information Only

    No Change in Rate

    Thomas Parker

    Medicaid Cost Reimbursement Planning and Finance

    No Home Office

    6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 030487123120140701201404242015124209

    THE HEALTH CENTER OF PENSACOLA

    8475 UNIVERSITY PARKWAY

    PENSACOLA, FL 32514

    Home Office:

  • Medicaid Reimbursement Per Diem Rates

    Provider Number: 0 030490-00

    Date: 6/25/2015

    Fiscal Year End: 12/31/2014

    Audit Status: Unaudited

    Provider Type:Current New Effective

    Rate Rate Date

    Nursing Home Single Level 246.19 247.77 9/1/2015

    State of Florida Office of Medicaid Cost Reimbursement Planning and Finance

    2727 Mahan Drive - Mail Stop 23

    Tallahassee, Florida 32308

    Rate Type:

    Interim X Prospective

    Total Interim X Total Prospective

    Interim