STATE OF NEW YORK
PUBLIC HEALTH AND HEALTH PLANNING COUNCIL
AGENDA
October 11, 2012
10:00 a.m.
90 Church Street
4th Floor, Room 4A & 4B
New York City
I.
INTRODUCTION OF OBSERVERS
Dr. William Streck, Chairman
II.
ADOPTION OF THE 2013 MEETING SCHEDULE
Exhibit #1
III.
APPROVAL OF MINUTES
August 9, 2012
IV.
Exhibit #2
PROFESSIONAL
Report of the Committee on Health Personnel and Interprofessional Relations
Dr. Theodore Strange, Chair
Three Cases
V.
PROJECT REVIEW RECOMMENDATIONS AND ESTABLISHMENT ACTIONS
Report of the Committee on Establishment and Project Review
Jeffrey Kraut, Chair
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
1 CATEGORY 1:
Applications Recommended for Approval – No Issues or Recusals,
Abstentions/Interests
Acute Care Services – Construction
Exhibit #3
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121204 C
NYU Hospitals Center
(New York County)
Contingent Approval
2.
121431 C
Nyack Hospital
(Rockland County)
Contingent Approval
Ambulatory Surgery Center – Construction
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121119 C
NYU Hospitals Center
(New York County)
Contingent Approval
2.
121468 C
Montefiore Medical Center –
Henry & Lucy Moses Div
(Bronx County)
Contingent Approval
Residential Health Care Facility – Construction
1.
1.
Exhibit #5
Number
Applicant/Facility
E.P.R.C. Recommendation
121363 C
Sunshine Children’s Home and
Rehab Center
(Westchester County)
Contingent Approval
Upstate Certified Home Health Agencies - Construction
Exhibit #6
Number
Applicant/Facility
E.P.R.C. Recommendation
121288 C
Living Resources Certified Home
Health Agency, Inc.
(Albany County)
Contingent Approval
2 Exhibit #4
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Hospice Services – Construction
1.
Exhibit #7
Number
Applicant/Facility
E.P.R.C. Recommendation
121405 C
Hospice Buffalo Inc
(Erie County)
Mr. Booth - Interest
Contingent Approval
Residential Health Care Facilities – Construction
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121084 C
Pine Haven Home
(Columbia County)
Mr. Fassler - Interest
Contingent Approval
2.
121183 C
Wayne County Nursing Home
(Wayne County)
Mr. Booth - Interest
Contingent Approval
Upstate Certified Home Health Agencies - Construction
Exhibit #9
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121199 C
At Home Care, Inc.
(Otsego County)
Mr. Booth - Interest
Contingent Approval
2.
121225 C
Park Ridge at Home – Park Ridge
Nursing Home, Inc.
(Monroe County)
Mr. Booth – Recusal
Mr. Fassler - Interest
Ms. Hines – Recusal
Mr. Robinson – Recusal
Contingent Approval
3 Exhibit #8
3.
121274 C
Finger Lakes Visiting Nurse
Service, Inc.
(Ontario County)
Mr. Booth – Recusal
Ms. Hines – Recusal
Mr. Robinson – Recusal
Contingent Approval
4.
122122 C
Visiting Nurse Services in
Westchester, Inc.
(Westchester County)
Ms. Regan - Interest
Contingent Approval
5.
122123 C
Dominican Sisters Family Health
Service, Inc.
(Westchester County)
Ms. Regan - Interest
Contingent Approval
Downstate Certified Home Health Agency - Construction
1.
Exhibit #10
Number
Applicant/Facility
E.P.R.C. Recommendation
121203 C
Personal Touch Home Aides of
New York, Inc.
(Kings County)
Mr. Fassler – Interest
Ms. Regan - Interest
Contingent Approval
CATEGORY 3:
Applications Recommended for Approval with the Following:
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by HSA
Upstate Certified Home Health Agencies - Construction
1.
Number
Applicant/Facility
E.P.R.C. Recommendation
121315 C
Home Aide Service of Eastern
New York, Inc.
d/b/a Eddy Visiting Nurse
Service, Inc.
(Rensselaer County)
Ms. Hines – Abstained at EPRC
Approval
4 Exhibit #11
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
NO APPLICATIONS
CATEGORY 5:
Applications Recommended for Disapproval by OHSM or
Establishment and Project Review Committee - with or without
Recusals
Residential Health Care Facilities – Construction
1.
Exhibit #12
Number
Applicant/Facility
E.P.R.C. Recommendation
102376 C
Albany County Nursing Home
(Albany County)
Disapproval
CATEGORY 6: Applications for Individual Consideration/Discussion
Residential Health Care Facility– Construction
1.
B.
Exhibit #13
Number
Applicant/Facility
E.P.R.C. Recommendation
121075 C
Jewish Home Lifecare, Manhattan
(New York County)
Mr. Fassler - Interest
Contingent Approval
APPLICATIONS FOR ESTABLISHMENT AND
CONSTRUCTION OF HEALTH CARE FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or Recusals,
Abstentions/Interests
CON Applications
Ambulatory Surgery Centers – Establish/Construct
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121104 B
AMSC, LLC d/b/a All Surg
(Bronx County)
Contingent Approval
2.
121403 B
Union Square SC, LLC
(New York County)
Contingent Approval
5 Exhibit #14
Diagnostic and Treatment Center – Establish/Construct
Exhibit #15
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121354 E
Hillside Polymedic Diagnostic and
Treatment Center
(Queens County)
Approval
2.
121355 E
A Merryland Operating, LLC d/b/a Contingent Approval
Mermaid Health Center
(Kings County)
3.
122001 E
Beacon Christian Community
Health Center
(Richmond County)
Approval
Residential Health Care Facilities – Establish
1.
Exhibit 16
Number
Applicant/Facility
E.P.R.C. Recommendation
121481 E
Haym Solomon Home for the
Aged
(Kings County)
Contingent Approval
Certificate of Incorporation
1.
Exhibit #17
Applicant
E.P.R.C. Recommendation
Betty’s Be Brave Foundation, Inc.
Approval
HOME HEALTH AGENCY LICENSURES
1.
Number
Applicant/Facility
E.P.R.C. Recommendation
2169 L
Greene County Public Health
Nursing Service
(Greene County)
Contingent Approval
6 Exhibit #18
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Acute Care Services – Establish/Construct
1.
Number
Applicant/Facility
E.P.R.C. Recommendation
122004 E
Fletcher Allen
Partners/Community
Providers, Inc.
(Clinton County)
Mr. Booth – Interest
Dr. Rugge – Abstaining/Interest
Contingent Approval
Residential Health Care Facility – Establish
Exhibit #20
Number
Applicant/Facility
1.
092058 B
HBL SNF, LLC d/b/a The
Contingent Approval
Rehabilitation and Care Institute at
White Plains
(Westchester County)
Mr. Fassler – Recusal
Mr. Fensterman – Recusal
2.
121427 E
JOPAL Sayville, LLC d/b/a Petite
Fleur Nursing Facility
(Suffolk County)
Mr. Fensterman - Recusal
Contingent Approval
3.
121407 E
150 Riverside OP, LLC d/b/a The
Riverside
(New York County)
Mr. Fensterman - Recusal
Contingent Approval
7 Exhibit #19
E.P.R.C. Recommendation
Certified Home Health Agencies – Establish
Exhibit #21
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
112306 E
Hospitals Home Health Care Inc
(Oswego County)
Mr. Booth - Interest
Contingent Approval
2.
121358 E
Catholic Health Care System d/b/a
Archcare
(Kings County)
Dr. Bhat – Recusal
Mr. Fassler - Recusal
Contingent Approval
Upstate Certified Home Health Agencies - Construction
Exhibit #22
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
121318 E
Northern Lights Home Health
Care
(St. Lawrence County)
Mr. Booth – Interest
Contingent Approval
2.
122120 E
CenterLight Certified Home
Health Agency
(Kings)
Mr. Fassler – Recusal
Contingent Approval
3.
122121 E
Jewish Home Lifecare,
Community Services
(New York County)
Mr. Fassler – Interest
Ms. Regan - Interest
Contingent Approval
Certificate of Amendment of the Certificate of Incorporation
1.
Applicant
E.P.R.C. Recommendation
North Shore University Hospital Stern Family Center for
Extended Care and Rehabilitation
Mr. Fensterman – Recusal
Mr. Kraut - Recusal
Approval
8 Exhibit #23
HOME HEALTH AGENCY LICENSURES
Number
Applicant/Facility
E.P.R.C. Recommendation
1.
1991 L
International Home Care Services
of NY, LLC
(Bronx, Queens, Kings,
Richmond, Nassau and New York
Counties)
Ms. Regan – Interest
Contingent Approval
2.
1943 L
Omega Care & Health Inc. d/b/a
Right at Home
(Nassau and Suffolk Counties)
Ms. Regan – Interest
Contingent Approval
3.
2166 L
Tioga County Health Department
(Tioga County)
Mr. Booth – Interest
Contingent Approval
4.
1999 L
Gotham Per Diem, Inc.
(Bronx, Richmond, Kings,
Westchester, New York and
Queens Counties)
Ms. Regan - Interest
Contingent Approval
CATEGORY 3:
Applications Recommended for Approval with the Following:
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by or HSA
NO APPLICATIONS
9 Exhibit #24
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment an Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
Ambulatory Surgery Centers – Establish/Construct
Exhibit #25
Number
Applicant/Facility
121140 B
Endoscopy Center of Niagara
Contingent Approval
(Niagara County)
Mr. Booth – Interest
Dr. Gutiérrez – Abstained at EPRC
Dr. Martin – Abstained at EPRC
CATEGORY 5:
E.P.R.C. Recommendation
Applications Recommended for Disapproval by OHSM or
Establishment and Project Review Committee - with or without
Recusals
NO APPLICATIONS
CATEGORY 6: Applications for Individual Consideration/Discussion
NO APPLICATIONS
VI.
REPORT OF DEPARTMENT OF HEALTH ACTIVITIES
A. Report of the Department of Health
Nirav R. Shah, M.D., M.P.H., Commissioner of Health
B.
Report of the Office of Health Systems Management Activities
Karen Westervelt, Interim Deputy Commissioner, Office of Health Systems Management
C. Report of the Office of Information Technology Transformation
Rachel Block, Deputy Commissioner, Office of Health Information Technology
Transformation
D. Report of the Office of Public Health Activities
Dr. Guthrie Birkhead, Deputy Commissioner, Office of Public Health
10 VII.
PUBLIC HEALTH SERVICES
Report on the Activities of the Committee on Public Health
Dr. Boufford, Chair of the Public Health Committee
VIII.
HEALTH POLICY
John Rugge, M.D., Chair of the Health Planning Committee
A. Report on the Activities of the Committee on Health Planning
John Rugge, M.D., Chair of the Health Planning Committee
B. Adoption of Procedure for Approval of Limited Add-ons to Single Specialty Ambulatory
Surgery Centers
IX.
REGULATION
Report of the Committee on Codes, Regulations and Legislation
Exhibit #26
Angel Gutiérrez, M.D., Chair
For Emergency Adoption
Subpart 86-2 of Title 10 NYCRR – Sprinkler Systems
Part 9 of Title 10 NYCRR – Synthetic Phenethylamines and Synthetic
Cannabinoids Prohibited
For Information
Part 9 of Title 10 NYCRR – Synthetic Phenethylamines and Synthetic
Cannabinoids Prohibited
X.
NEXT MEETINGS
Planning Committee – October 30, 2012, NYC
Ad Hoc Committee to Lead the State Health Improvement Plan – October 31, 2012, NYC
Planning Committee – November 14, 2012, Albany
Committee Day – November 15, 2012, Albany
Full Council – December 6, 2012, Albany
XI.
ADJOURNMENT
11 FOR ADOPTION
Public Health and Health Planning Council
2013 Timeline
PHHPC
Mailing Date
PHHPC
Committee Meeting
Dates
PHHPC
Meeting Dates
PHHPC
Meeting
Location
01/15/13
03/12/13
05/14/13
07/09/13
09/03/13
11/12/13
01/24/13
03/21/13
05/23/13
07/18/13
09/12/13
11/21/13
02/07/13
04/11/13
06/06/13
08/01/13
10/03/13
12/12/13
NYC
Albany
NYC
Rochester
NYC
Albany
PHHPC meetings begin @ 10:00 a.m.
Albany, Empire State Plaza, Concourse Level Meeting Room 6
NYC Location = 90 Church Street, Meeting Rooms A/B, 4th Floor, New York, NY
Rochester = The National Museum of Play at The Strong One Manhattan Square Activity Room C and D
State of New York
Public Health and Health Planning Council
Minutes
August 9, 2012
The meeting of the Public Health and Health Planning Council was held on Thursday,
August 9, 2012, at the Century House, 997 New Loudon Road (Route 9, Main Ball Room
Latham, New York 12110, Chairman, Dr. William Streck presided.
COUNCIL MEMBERS PRESENT:
Dr. William Streck, Chair
Dr. Howard Berliner
Dr. Jodumatt Bhat
Mr. Christopher Booth
Dr. Jo Ivey Boufford
Mr. Michael Fassler
Mr. Howard Fensterman
Dr. Carla Boutin-Foster
Mr. Robert Hurlbut
Ms. Victoria Hines
Mr. Jeffrey Kraut
Mr. Arthur Levin
Dr. Glenn Martin
Ms. Ellen Rautenberg
Ms. Susan Regan
Mr. Peter Robinson
Dr. John Rugge
Dr. Theodore Strange
Dr. Patsy Yang
Commissioner Shah (ex-officio)
DEPARTMENT OF HEALTH STAFF PRESENT:
Mr. Charles Abel
Dr. Guthrie Birkhead
Ms. Rachel Block
Ms. Anna Colello
Mr. Richard Cook
Ms. Barbara DelCogliano
Mr. Christopher Delker
Ms. Colleen Frost
Ms. Rebecca Fuller Gray
Ms. Sandy Haff
Ms. Mary Ellen Hennessy
Ms. Karen Lipson
Mr. Robert Loftus
Mr. Keith McCarthy
Ms. Karen Madden
Ms. Elizabeth Misa
Ms. Sylvia Pirani
Ms. Linda Rush
Mr. Robert Schmidt
Ms. Lisa Thomson
INTRODUCTION:
Dr. Streck called the meeting to order and welcomed Commissioner Shah along with
Council members, meeting participants and observers.
MEETING OVERVIEW:
Dr. Streck gave a brief overview of the Council meeting agenda.
1
APPROVAL OF THE MINUTES OF JUNE 7, 2012 AND AUGUST 7, 2012:
Dr. Streck asked for a motion to approve the June 7, 2012 Minutes of the Public Health
and Health Planning Council meeting. Dr. Berliner motioned for approval which was seconded
by Mr. Booth. The minutes were unanimously adopted. Please refer to page 4 of the attached
transcript.
Dr. Streck asked for a motion to approve the minutes from the August 7, 2012 Special
Full Council meeting. Dr. Berliner motioned to approve, Mr. Booth seconded the motion. The
minutes of the August 7, 2012 Special PHHPC meeting were approved. Please refer to page 5 of
the attached transcript.
REPORT OF DEPARTMENT OF HEALTH ACTIVITIES
Dr. Streck introduced Commissioner Shah to give the Department of Health Activities
Report.
Dr. Shah began his report by thanking the Council for convening for a meeting on
August 7, 2012 that banned synthetic marijuana and bath salts in ways that Commissioner's
orders could not do. There are now enforcement abilities that will end this scurge.
Governor Cuomo in a press event described this scurge as different from cocaine and other drugs
that have been sold over time, by saying that these are the drugs that are being sold over the
counter and marketing them to kids as safe and legal alternatives to marijuana. This is exactly
the kind of work this Council can do in an emergency. The power vested in this body really
showed its strengths on Tuesday. Commissioner Shah applauded the Council members for
coming together on such short notice for this important matter.
Medicaid 1115 waiver
Dr. Shah stated that on Monday, August 6, 2012, the Department submitted the
1115 Medicaid Waiver to CMS. He further reported that the Governor spoke of the
ten billion dollar Medicaid 1115 amendment to a waiver that the Department of Health was
planning to submit and how it would help us realize the vision of Medicaid redesign and improve
on and continue the goals of health care reform nationally. Under the waiver, New York would
be able to reinvest a portion of the seventeen point one billion dollars in federal savings that will
be realized over the course of the next five years as a result of what Medicaid redesign has
already done. Dr. Shah explained one of the Department’s proposals is an expansion of primary
care in New York State, improving access, addressing health disparities. There are thirteen
different sections in that waiver and the entire document is available on the Department’s
website.
Dr. Shah noted that the Governor announced over three hundred million dollars in grants
for forty New York hospitals and nursing homes from the last round of the HEAL funds, the
Health Care Efficiency and Affordability Law funds. The grants will improve the quality of
primary and community-based care by focusing on higher quality, patient-centered care as well
as efficiency and eliminating excess bed capacity in hospitals and nursing homes.
2
Doctor’s Across New York
Dr. Shah updated the members on the Doctors Across New York program which
encourages physicians to practice in under-served areas of the state. In July, seventeen awards
were announced through the program to support the workforce in ambulatory care institutions.
These grants will ensure that New Yorkers continue to receive high quality care in these settings
and expand training opportunities.
Public Health
Next, Dr. Shah addressed public health issues. The Department marked a national H.I.V.
testing day on June 2, 2012 by urging New Yorkers to get tested for H.I.V. AIDS. New York
law mandates that all New Yorkers between the ages of thirteen and sixty-four who receive
hospital or primary-care services must be offered H.I.V. tests. Since this law has been
implemented there has been an increase of thirteen percent in testing across the state.
Dr. Shah advised that mosquito activity has increased around the state and so far this year
two hundred and seventy-one mosquito pools have tested positive for West Nile Virus. The
Department is also very concerned of a far rarer viral disease spread by mosquitoes called
Eastern Equine Encephalitis or Triple E which has been found in Central New York in recent
years. A strong public-awareness campaign has started to inform New Yorkers about the dangers
of West Nile and Triple E and offer strategies to protect individuals from exposure.
Commissioner Shah stated that there is an elevated level of pertussis, commonly known
as whooping cough. In the first six months of 2012, there were more than twelve hundred
reported pertussis cases which is more than were reported all of last year and more than three
times the number of cases reported nationally in 2009. In June, the federal C.D.C. reported that
the U.S. had forty-four percent more pertussis cases this year than last. This bacterial infection is
highly contagious but it's preventable with vaccination. The Department is focusing on
prevention to limit more cases and urging New Yorkers to get vaccinations.
Dr. Shah announced that the Governor has undertaken two initiatives to protect New
York's most vulnerable citizens. First, the Governor has allotted three million dollars through the
federal low income Home Energy Assistance Program to provide air conditioners to low income
New Yorkers who cannot afford them. Heat-related illnesses such as heat stroke and heat
exhaustion can cause serious health problems, especially for the elderly, infants and young
children and people with respiratory ailments or chronic medical conditions. Secondly, the
Governor has also signed into law legislation to protect people with special needs and
disabilities. The Governor strongly believes we have an essential duty to care for our citizens
who cannot care for themselves. This law is creating The Justice Center for the Protection of
People With Special Needs and this is tasked with protecting the welfare of these individuals.
The Justice Center will track and investigate abuse and neglect complaints from facilities and
provider agencies that are operated, certified or licensed by a state agency including the
Department of Health.
Dr. Shah concluded his report and asked members if they had questions.
To review Dr. Shah’s full report and questions and comments please refer to pages 5
through 17 of the attached transcript.
3
Dr. Streck thanked Dr. Shah for his report and moved to the next item on the agenda and
introduced Ms. Misa to give the Report on the Activities of the Office of Health Insurance
Programs.
REPORT OF THE OFFICE OF HEALTH INSURANCE PROGRAMS ACTIVITIES
Ms. Misa began her report by stating that the OHIP has been working on the submission
of the 1115 Waiver amendment. The waiver will reinvest ten billion dollars in M.R.T. servings
over five years to implement an action plan to transform the State's health care system. The super
waiver contains thirteen reform initiatives to improve quality care and lower costs in the
Medicaid program. Specifically, the waiver provides funding to expand access to primary care,
enhance the infrastructure of health homes, create new care models, expand resources to
transform and protect safety-net providers, enhance public health hospital renovations, expand
supportive housing for high cost Medicaid users, transform and prepare long-term care providers
for the move to Medicaid managed care, provide capital stabilization for safety-net hospitals,
increase funding to create and support New York's health care workforce, expand public health
care innovations, and enhance regional health care planning activities.
Ms. Misa stated that OHIP continues to implement phase two of the M.R.T. and is in the
process of implementing over one hundred projects that were enacted during phase two of the
M.R.T. These projects reflect the final recommendations of the nine M.R.T. workgroups. The
workgroups include health disparities, managed long-term care, behavioral health, program
streamlining, basic benefit review, workforce flexibility, payment reform, affordable housing and
Brooklyn Hospitals.
Lastly, Ms. Misa explained the Department continues to monitor the Medicaid global
spending cap. The Department is also on track with Medicaid spending and as of the new report
we are thirty-three million dollars or one point two percent below projections.
Ms. Misa concluded her report and asked members if they had questions.
To review Ms. Misa’s report and view questions, please refer to pages 18 through 23 of
the attached transcript.
REPORT OF THE OFFICE OF HEALTH SYSTEMS MANAGEMENT ACTIVITIES
Dr. Streck turned the meeting over to Mr. Cook to give the report of the Office of Health
Systems Management.
Mr. Cook gave an update on the CHHA RFA process. He stated the Department will
come back to the Council in September with a proposal that will allow the consideration of the
applications that have initially been denied as part of the RFA. Once the upstate reviews are
complete they will be presented at the September meeting. The goal is to bring additional
applications in the November, December framework that would both be recommendations for
additional approvals and then to work with the Council on the next steps for the applications that
have not been approved.
4
Mr. Cook concluded his report. Dr. Streck thanked Mr. Cook for the report. To review
the full report Office of Health Systems Management and the questions and comments please
refer to pages 23 through 35 of the attached transcript.
REPORT OF THE OFFICE OF HEALTH INFORMATION TECHNOLOGY
TRANSFORMATION ACTIVITIES
Dr. Streck introduced Ms. Block to give the report of the Office of Health Information
Technology Transformation activities
Ms. Block began by giving a brief update on OHITT and described the New York
E-Health Collaborative four broad goals. The Department continues to be committed to
successful statewide implementation of the HEAL New York program and the federal health
information technology program and we are making great progress in those areas. There is also
a charge to create an ongoing regulatory and sustainability model to support health I.T. adoption
end use for the public good and to leverage this health I.T. infrastructure to support health reform
and to have greater alignment with other Department programs and systems.
Ms. Block stated that OHITT included in the Medicaid waiver a number of provisions to
help reinforce and continue some of the key health information technology activities. In
particular the Department has teed up the idea with C.M.S. to secure Medicaid's participation, as
part of an ongoing multi-payer arrangement to create a long-term sustainability model for health
information technology adoption in the future. As well as including provisions for funding for
additional technical support for health homes, provisions for funding to increase primary-care
connections to the statewide health information network for New York.
Ms. Block noted that the OHITT continues to work very closely with
Department colleagues in public health as well in terms of building the additional functionality
and partnership as well with the New York City Department of Health and Mental Hygiene.
Ms. Block advised that regulations are necessary for governing the statewide health
information network. A first early draft of the regulation was discussed with the Policy
Committee which was jointly convened with the New York E Health Collaborative. Mr. Levin
is a co-chair and Dr. Martin serves as a member of that Committee. The draft regulation has
received good comments initially through that process.
Ms. Block noted that also as part of our stakeholder consultation, two new forums have
convened, a consumer forum which had its first meeting last week and a provider forum which is
designed to give ongoing clinician input. Ms. Block further advised that the Department has
formalized the RHIO dashboard. NYeC is now contractually obligated to progress in certain key
areas that we defined as part of their contract with the State. There are two specific goals
identified. One, is increasing the number of patient consents and the other is to increase the
number of patient history lookups, which were two key attributes of the success of the statewide
health information network and involve areas.
5
Ms. Block reported progress on Meaningful Use. There are over five thousand
physicians who have either established their attestation for Medicaid or for Medicare and the
number of hospitals that similarly are participating in one or both of those programs with more
than three hundred million dollars now having gone out the door in terms of incentive payments.
Ms. Block concluded her report. To see the complete report, please refer to pages 26
through 41 of the attached transcript.
REPORT OF THE OFFICE OF PUBLIC HEALTH ACTIVITIES
Dr. Streck introduced Dr. Birkhead to give the Report of the Office of Public Health
activities.
Dr. Birkhead provided a follow up on marijuana and bath salts, and synthetic marijuana.
Shortly after the Council met on Tuesday, August 7, 2012, the Department had a conference call
with the thirty-five counties and New York City; the thirty-five counties in the state that do their
own environmental health services plus our State district offices that cover the other twenty-two
counties. The Department then sent out a packet of information. Currently, the county health
departments are going out to locations where bath salts and synthetic marijuana may be sold and
actually serving the Commissioner's order on those sites and putting them on notice. That
information is then fed back to the Department. The departments have been prioritizing this
action. There were two rounds of this in the last year. They are going to locations where they
had identified these products in the past. They're also keying off of any complaints they've
received. The hotline was setup, 1-888-999-SALTS, as part of this initiative. This hotline has
received about a dozen calls with complaints specific to certain locations. Those complaints are
being fed to the county health departments for follow up. Interestingly, the hotline has received
a number of calls from distressed parents whose kids are struggling with bath salts or synthetic
marijuana; those calls have been referred to the Office of Alcoholism and Substance Abuse
services for specific follow up.
Dr. Birkhead then went on to discuss three areas where Public Health work is going on in
the community on a daily basis. The first is an issue of variant influenza; H3N2 strain has
emerged in the mid-west in pigs. There is an influenza epizootic going on in pigs at the moment,
and during the week of August 6th, the number of human cases related to this are now up to over
a hundred in Ohio and Indiana primarily. The upward curve of this outbreak is quite significant.
Earlier in the week we sent out an alert to county health departments, to physicians, hospitals,
and others that if they are seeing cases of influenza or suspected influenza cases, they should
submit samples to the Wadsworth Lab. This variant virus apparently does not react easily with
the rapid influenza A test that clinicians use in their offices, so we really need to get lab samples
submitted for testing. So far, there has not been human-to-human transmission or at least much
documented with this, so it may be a dead end infection. Nevertheless, there's a surveillance
system in place. The Department detected a potential problem and have mobilized both the
clinical end and local Public Health resources try and address it.
6
Dr. Birkhead when on to discuss vibrio infection. This summer we have seen up to
sixteen cases of vibrio infection. Vibrio is a bacteria species that lives in shellfish; vibrio
cholerae is the most well known internationally. We don't have cholera in New York at the
moment; but we do have other strains; in particular, vibrio parahaemolytics which can cause
pretty significant G.I. illness. Also in persons who have other chronic conditions or immune
compromised, vibrio parahaemplytics can cause a severe infection up to and including death. At
this time, there have been no deaths, but there have been sixteen cases. This organism has been
identified in some shellfish in Long Island Sound and those beds were closed for a period of
time. This is another example where through a combination of the clinical community submitting
samples and the lab identifying these unusual organisms. Public Health was able to follow and
identify the source. Thus we have been able to take action to stop the outbreak. Dr. Birkhead
noted that we are following this situation very closely and that this is an example of routine
public health in action.
Dr. Birkhead concluded by mentioning a New Hampshire case where a radiologic
technologist infected with hepatitis C had resulted in an outbreak of over thirty cases of hepatitis
C in a cardiac catheterization clinic. This individual was apparently diverting narcotics in the
cardiac cath lab and using the narcotics and refilling the syringes and placing them back into
circulation. This resulted in over thirty documented cases of hepatitis C infection. Because of
the national network that exists, the Department quickly informed that this individual had
worked in a New York Hospital for a period of time, three or four years ago, in a cardiac cath
lab. Along with the local health department, we have worked with that hospital to identify and
notify all of the patients who were in the cath lab at the time when the individual worked there.
The Department is in the process of getting Hep C testing done. This is another example of
public health in action where reports of disease are just the beginning point of a series of steps
that involve both state and local department. These steps identify problems, remove problems,
and protect public health.
To review the full report of the Office of Public Health, please refer to pages 41 through
49 of the attached transcript.
PUBLIC HEALTH SERVICES
Report on the Activities of the Committee on Public Health
Next, Dr. Streck asked Dr. Boufford to report on the Activities of the Committee on
Public Health.
Dr. Boufford thanked Dr. Birkhead and Ms. Pirani and their staff for their terrific support
to the effort.
Dr. Boufford noted that the Ad Hoc Leadership Group, which is quite
multi-sectoral and statewide geographically, that is steering the revisions of the State Health
Improvement Plan which is a core part of the application of the state for voluntary accreditation.
We have reviewed the prevention agenda and talked spoke in the past about lessons learned
essentially from the last round.
7
Dr. Boufford indicated that she would like to report on three issues:
(1) Many of the localities lacked the resources and capacity to move from planning into
implementation and evaluation. Therefore, we have to keep this in mind as we refine the goals
for the updated prevention agenda and
think about the strategy for rollout.
(2) We have to be aware of what local health departments do and their involvement in
partnerships. We also have to be aware of and
significant continuing health disparities within the goal areas selected, including access to a basic
charity, even though most of our work would be prevention oriented.
(3) Finally, hopefully we will be leaving behind some kind of sustainable partnerships for
population health and community health action at the local level when this process is completed.
Dr. Boufford further stated that we have proposed a set of new priorities
for the revision of the plan. These priorities emerged from a statewide consultation that occurred
when the ad hoc group developed proposals. Dr. Boufford noted that our focus is going to be
very much on upstream prevention in each of these area, but the issue of basic access to services
especially primary program services. A set of activities have taken place. We have developed a
sort of the infrastructure that we're using to move this process along so that we'll have a report in
time for November consideration. There are five work group chairs, one for each of the areas.
Each area is co-chaired by someone from the health department, relevant departmental area or
section, and a private sector colleague, either someone from a professional association, from
business, from academia or an advocacy group.
Dr. Boufford stated that the Committee is really focusing on public/ private partnership at
the chairmanship level as well as broad diversity of interest represented on each of the working
groups. Invitations to working groups on mental health, healthy women and chronic disease
prevention have gone out. The other two group’s invitations will be going out shortly.
Dr. Boufford announced that the final co-chair for the environmental group will be Susan
Klitzman, who is a professor at Hunter School of Public Health. Through support from the
Robert Wood Johnson Foundation, a consultant is working with the staff and support the
infrastructure of this project as it rolls out. There was a competitive process and the Raven
Martin firm has been selected. We will carry though the rollout in January once the working
groups have finished their work and reported.
Dr. Boufford further noted that the Department has developed and refined
a template for priority action plans so that each of the working groups will have this as the
outline for the report that is due from them. The consultants are preparing a guide to help the
other groups work through this schematic and scenario.
Dr. Boufford went on to mention that there are a couple of specialist groups that have
been formed within the Department of Health; one on metrics, another one on data. These
specialty groups will be supporting each of the working groups and that the staff have prepared
very extensive background papers with an evidence base on the effective interventions in each of
the priority areas and these are posted on the website. We have also developed, with the help of
the consultants, a site through a project mechanism which will provide a website for each of the
working groups. This will facilitate the ability to communicate with one another.
8
Dr. Boufford continued to say that the committee will have at least one in-person meeting
over the course of the summer and the other meetings will be done virtually either by televideo
conferencing.
Dr. Boufford noted that there is a steering committee that will be connecting all of the cochairs of the working groups and certain selected members of the ad hoc leadership groups. The
Ad Hoc Leadership group is meeting by phone every two weeks thus affording everyone the
ability to brief each other. Dr. Boufford went on to state that the groups are also going to be
building on existing strategic plans to the degree they exist; for example,
maternal child health and chronic disease for the State.
Dr. Boufford also stated that the Committee hopes to have the Committee drafts by the
end of September. The Ad Hoc Leadership group will then review the drafts for any slight
changes and present to the Health Committee in November and to the PHHPC in December.
The goal is to be able to have a document that would then accompany the State's application for
accreditation. This will enable us to roll it our locally in January.
Dr. Boufford further discussed the role of the Robert Wood Johnson Foundation in
supporting states applying for voluntary accreditation through this new national process. Dr.
Boufford explained the Foundation is very excited that New York State is one of the early larger
states to voluntarily apply for accreditation and that they are providing pro bono communication
support to our overall effort. Dr. Boufford also noted that representatives from the Foundation
did attend the last Ad Hoc Leadership group, and hopes this will be helpful for the January
rollout at the local level. We are pleased to have those resources.
Dr. Boufford concluded by mentioning that the Committee continues to work with the
Health Planning Committee. A number of our Public Health
Subcommittee members have been regularly attending those meetings in hopes of moving
toward identifying two candidate areas in the State, maternal mortality and prison mortality. The
Committee wants to position itself so that work can progress at the beginning of the new year.
To review the full report of the Office of Public Health, please refer to pages 49 through
56 of the attached transcript.
Dr. Streck thanked Dr. Boufford and moved to the next item on the agenda, Health Policy
and introduced Dr. Rugge to give the report on the Activities of the Committee on Health
Planning.
HEALTH POLICY
Report on the Activities of the Committee on Health Planning
Dr. Rugge provided an update on the efforts of the Health Planning Committee. The
Committee met in both June and July with an effort on dealing with background information to
help us achieve a shared understanding of how CON's are performing now, what health planning
was like, and changes in the environment. In June, we undertook a discussion of the measures of
healthcare performance and how New York is doing. The Committee discovered that in some
instances New York not so well, ranking dead last when it comes to avoidable hospitalizations
and cost. Curiously at the same time, there is an enormous regional variation in many areas.
Upstate has low cost in terms of total healthcare experience.
9
Dr. Rugge stated that the Committee developed an array of regulatory tools to be
available in addition to CON. After looking nationwide, it appears there is a considerable lack of
clarity in terms of how important CON is or how effective it is. It does seem clear that CON
really makes sense, not in isolation but as part of a mosaic of how, in this case, the State is
approaching the regulatory responsibilities. The Committee task is to look at how in a changing
environment we can apply CON together with other tools to effect the better outcomes we would
like to see.
Dr. Rugge further stated that in July, he had a discussion with Mr. Greg Burke in an
attempt to pull together the many different threads of a hyper-dynamic healthcare environment.
Mr. Burke gave a masterful presentation. Mr. Burke’s slides are available on the web and also
from Colleen Frost. The implications were unexpected in many ways. The healthcare system
may become more self regulatory than we have seen to date. Yet, if that were to be the case, it
will happen during a period of time, perhaps the five years coinciding with a Medicaid
megawaiver, that would indicate contradictory impulses, contradictory incentives by providers,
and a chance for misuse or abuse in either direction, abuse or overuse, over-supply or
undersupply. Those are issues that are a constant struggle; maybe more so as we look forward as
a Council.
Dr. Rugge noted that they also heard from Health Department staff Mr. Ulberg,
Mr. Roohan, and Mr. Kissinger on new modes of care and the activity the State is undertaking
with regard to financing impacting quality. This was followed by a discussion led by Ms.
Daratsos on the way in which the State is regulating H.M.O.s and the payors at a time when risk
is being shifted from purchaser and payor to providers. Again, profound implications for how
services need to be planned and regulated.
Dr. Rugge stated that that Committee plans to have discussions one by one of all the key
components of CON. There will be two special day-long meetings in September and in three in
October for this purpose. The Committee plans to develop core recommendations which will
then be refined and distilled and clarified. The recommendations will then be presented to the
Council simultaneously with Dr. Boufford in December; hopefully, for recommendation and
approval.
Dr. Rugge concluded by stating that the Health Department has been enormously
supportive. Dr. Rugge thanked Ms. Lipson and stated that the Committee could not do this
without her enormous amount of work in pulling together material from all around the State and
beyond. This enabled us to have a command of the policy environment and the real environment
in pulling this together.
Dr. Streck thanked Dr. Rugge and the Committee. Please see pages 56 through 60 of the
attached transcript.
10
REGULATION
Dr. Streck introduced Mr. Hurlbut to give his Report of the Committee on Codes,
Regulations and Legislation.
For Emergency Adoption
Subpart 86-2 of Title 10 NYCRR – Sprinkler Systems
Mr. Hurlbut introduced Subpart 86-2 of Title 10 NYCRR for emergency adoption
regarding Nursing Homes Sprinkler Systems. Mr. Loftus described the regulation. Mr. Hurlbut
motioned for emergency adoption which was seconded by Mr. Fensterman. The motion to for
emergency adoption carried. Please see page 60 through 64 of the attached transcript.
For Discussion
10-15 Amendment of Section 400.25 of Title 10 NYCRR (Nursing Quality
Indicators)
Next, Mr. Hurlbut briefly discussed the Nursing Quality Indicators proposed amendment.
Mr. Hurlbut concluded his report. Please see pages 60 through 66 to review the details of
the regulations.
PROJECT REVIEW RECOMMENDATIONS AND ESTABLISHMENT ACTIONS
Dr. Streck introduced Mr. Kraut to give the Report of the Committee on Establishment
and Project Review
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or Recusals,
Abstentions/Interests
CON Applications
Acute Care – Construction
1.
Exhibit #3
Number
Applicant/Facility
Council Action
121157 C
Northern Westchester Hospital
(Westchester County)
Contingent Approval
Mr. Kraut introduced application 121157 and motioned for approval which was seconded
by Dr. Berliner. The motion to approve carried. Please refer to pages 66 and 67 of the
attached transcript.
11
Ambulatory Surgery Center – Construction
1.
Exhibit #4
Number
Applicant/Facility
Council Action
112369 C
Memorial Hospital for Cancer and
Allied Diseases
(New York County)
Contingent Approval
Mr. Kraut moved to application 112369 and motioned for approval, the motion was
seconded by Dr. Berliner. When opened for discussion Mr. Kraut raised concerns regarding
the need for facilities to join a RHIO. The motion was amended and a contingency was
added relative to RHIO’s. Mr. Fensterman seconded the motion. The motion with added
contingency passed. Please refer to pages 67 through 72 of the attached transcript.
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Ambulatory Surgery Center – Construction
1.
Exhibit #5
Number
Applicant/Facility
Council Action
121208 C
Hospital for Special Surgery
(New York County)
Ms. Regan - Interest
Contingent Approval
Mr. Kraut introduced application 121208 and motioned for approval with an additional
contingency relative to RHIO’s. Mr. Fensterman seconded the motion. The motion to
approve passed with one member opposed and Ms. Regan’s noted interest. Please refer to
pages 72 through 78 of the attached transcript.
Residential Health Care Facility – Construction
1.
Exhibit #6
Number
Applicant/Facility
Council Action
121432 C
Greater Harlem Nursing Home
Company Inc
(New York County)
Mr. Fassler – Interest
Mr. Fensterman – Recusal
Contingent Approval
Mr. Fensterman exited the meeting room declaring a conflict on application 121432.
Mr. Kraut described the application and motioned for approval which was seconded by
Dr. Berliner. The motion to approve carried with Mr. Fensterman’s noted recusal and
Mr. Fassler’s interest. Please refer to pages 78 and 79 of the attached transcript.
12
CATEGORY 3:
Applications Recommended for Approval with the Following:
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by HSA
NO APPLICATIONS
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
NO APPLICATIONS
CATEGORY 5: Applications Recommended for Disapproval by OHSM or Establishment
and Project Review Committee - with or without Recusals
CON Applications
Residential Health Care Facilities Ventilator Beds – Construction
1.
Exhibit #7
Number
Applicant/Facility
Council Action
071077 C
North Sea Associates, LLC d/b/a
The Hamptons Center for
Rehabilitation and Nursing
(Suffolk County)
Mr. Fensterman – Recusal
Disapproval
Mr. Fensterman remained outside the meeting room to recuse on application 071077.
Mr. Kraut described the application and motioned for disapproval. Dr. Berliner seconded the
motion to disapprove. Dr. Boutin-Foster inquired why this application was recommended for
disapproval. Mr. Abel stated that it did not provide convincing and substantial justification
for local factors. The motion to disapprove passed with Mr. Fensterman’s noted recusal.
Mr. Fensterman re-entered the meeting room. Please refer to pages 79 through 82 of the
attached transcript.
2.
112096 C
Nesconset Acquisition, LLC d/b/a
Nesconset Center for Nursing
and Rehabilitation
(Suffolk County)
Mr. Fensterman – Abstaining
Disapproval
Mr. Kraut moved to application 112096 and motioned for disapproval which was
seconded by Dr. Berliner. The motion to disapprove carried. Please refer to page 82 of the
transcript.
13
3.
071024 C
Long Beach Memorial Nursing
Home, Inc. d/b/a Komanoff Center
for Geriatric and Rehabilitation
Medicine
(Nassau County)
Dr. Bhat – Recusal
Mr. Fassler - Interest
Disapproval
Mr. Kraut described application 071024 and noted for the record that Dr. Bhat has
declared a conflict and has left the room. Mr. Fassler declared an interest. The motion to
disapprove carried with Dr. Bhat’s noted recusal. Dr. Bhat returned to the meeting room.
Please see pages 82 through 83 of the attached transcript.
CATEGORY 6: Applications for Individual Consideration/Discussion
CON Applications
Residential Health Care Facilities Ventilator Beds – Construction
1.
Exhibit #8
Number
Applicant/Facility
Council Action
072112 C
Oakwood Operating Co., LLC
d/b/a Affinity Skilled Living and
Rehabilitation Center (Suffolk
County)
Contingent Approval
Mr. Kraut described application 072112 and motioned for approval. Dr. Berliner
seconded the motion to approve. The motion carried. Please see pages 83 through 84 of the
attached transcript.
B.
APPLICATIONS FOR ESTABLISHMENT AND
CONSTRUCTION OF HEALTH CARE FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or Recusals,
Abstentions/Interests
CON Applications
Ambulatory Surgery Centers – Establish/Construct
1.
Exhibit #9
Number
Applicant/Facility
Council Action
111142 B
Stoneleigh Avenue Pain
Management ASC, LLC
(Putnam County)
Contingent Approval
14
2.
121353 E
Crystal Run Ambulatory Surgery
Center of Middletown
(Orange County)
Dr. Bhat - Interest
Contingent Approval
Mr. Kraut described application 111142 and 121353 and motioned for approval which
was seconded by Dr. Berliner. Dr. Bhat declared an interest on application 121353. The
motion to approve both applications carried. See pages 84 and 85 of the attached transcript.
Diagnostic and Treatment Center – Establish/Construct
1.
Exhibit #10
Number
Applicant/Facility
Council Action
121340 E
Metro Community Health Center
(New York County)
Approval
Mr. Kraut introduced application 121340 and noted for the record that all contingencies
for the application have been satisfied. Mr. Kraut motioned for approval. Dr. Berliner
seconded the motion. The motioned carried. Please see page 85 of the transcript.
Residential Health Care Facilities – Establish/Construct
1.
Exhibit #11
Number
Applicant/Facility
Council Action
121103 E
HRNC Operating, LLC d/b/a
Highland Rehabilitation and
Nursing Center
(Orange County)
Contingent Approval
121168 E
Oak Hollow NC Corp. d/b/a Oak
Hollow Nursing Center
(Suffolk County)
Contingent Approval
Mr. Kraut moved to application 121103 and 121168 and described the applications.
Mr. Kraut motioned to approve the applications, Dr. Berliner seconded the motion. The
motion to approve carried. Please see pages 86 and 87 of the attached transcript.
Number
Applicant/Facility
Council Action
1.
121174 E
Crest Hall Corp. d/b/a Lakeview
Rehabilitation and Care Center
(Suffolk County)
Contingent Approval
2.
121175 E
Crown Nursing Home
Associates, Inc.
d/b/a Crown Nursing and
Rehabilitation Center
(Kings County)
Contingent Approval
Mr. Kraut described application 121174 and 121175 and motioned for approval.
Dr. Berliner seconded the motion. The motion carried. Please see page 87 of the transcript.
15
Restated Certificate of Incorporation
Exhibit #12
Applicant
Council Action
The Methodist Homes For The Aging of the Wyoming
Conference in the State of New York
Approval
Certificate of Dissolution
Exhibit #13
Applicant
Council Action
The Falck Foundation, Inc.
Approval
St. Clare Manor of Lockport, N.Y.
Approval
St. Joseph’s Manor of Olean, N.Y.
Approval
St. Luke Manor of Batavia. N.Y.
Approval
St. Mary’s Manor
Approval
Mr. Kraut motioned for consent to filing the above listed certificates. Dr. Berliner
seconded the motion. The motion carried. Please see pages 87 and 88 of the attached
transcript.
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Diagnostic and Treatment Centers – Establish/Construct
1.
Exhibit #14
Number
Applicant/Facility
Council Action
121180 E
Gotham Health FQHC
(New York County)
Dr. Boufford – Recusal
Mr. Fassler – Interest
Dr. Martin – Interest
Dr. Sullivan – Recusal(not present)
Contingent Approval
Mr. Kraut introduced application 121180. Dr. Boufford declared a conflict and exited the
meeting room. Mr. Fassler and Dr. Martin declared an interest. Dr. Sullivan declared a
conflict at the EPRC meeting however was not present for the Full Council meeting.
Mr. Kraut motioned for approval which was seconded by Dr. Berliner. The motioned carried
with Dr. Boufford’s recusal and the noted interests. Please see pages 88 and 89 of the
transcript.
16
Residential Health Care Facility – Establish
1.
Exhibit #15
Number
Applicant/Facility
Council Action
082143 E
OMOP, LLC d/b/a Orchard
Manor, Inc.
(Orleans County)
Mr. Booth - Interest
Contingent Approval
Mr. Kraut described application 082143 and noted for the record that Mr. Booth has an
interest. Mr. Kraut motioned for approval, Dr. Berliner seconded the motion. The motion to
approve carries. Please see pages 89 and 90 of the attached transcript.
Certified Home Health Agencies – Establish
1.
Exhibit #16
Number
Applicant/Facility
Council Action
121135 E
Genesee Region Home Care
Association, Inc. d/b/a
Lifetime Care
(Monroe County)
Mr. Fassler - Interest
Mr. Booth – Recusal
Ms. Hines- Recusal
Mr. Robinson – Recusal
Approval
Mr. Kraut moved to the next application and introduced application 121135. Mr. Booth,
Ms. Hines and Mr. Robinson declared a conflict and exited the meeting room. Mr. Fassler
declared an interest. Mr. Kraut motioned for approval which was seconded by Dr. Berliner.
The motion carried with the noted recusals and interest. Mr. Booth, Ms. Hines, and
Mr. Robinson re-entered the meeting room. Please see page 90 of the transcript.
2.
121182 C
McAuley-Seton Home Care
Corporation
(Niagara County)
Mr. Booth - Interest
Contingent Approval
Mr. Kraut described application 121182 and noted Mr. Booth’s interest. Mr. Kraut
motioned for approval, Dr. Berliner seconded the motion. The motion to approve carried.
See page 91 of the attached transcript.
HOME HEALTH AGENCY LICENSURES
Exhibit #17
Number
Applicant/Facility
Council Action
2141 L
Clinton County Department of
Health
(Clinton County)
Mr. Booth - Interest
Contingent Approval
17
Mr. Kraut described application 2141-L and motioned for approval which was seconded
by Dr. Berliner. The motion to approve carried with Mr. Booth’s noted interest. Please see
page 91 of the transcript.
CATEGORY 3:
Applications Recommended for Approval with the Following:
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by or HSA
NO APPLICATIONS
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment an Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
NO APPLICATIONS
CATEGORY 5:
Applications Recommended for Disapproval by OHSM or
Establishment and Project Review Committee - with or without
Recusals
NO APPLICATIONS
CATEGORY 6: Applications for Individual Consideration/Discussion
NO APPLICATIONS
VIII.
PROJECT REVIEW RECOMMENDATIONS AND ESTABLISHMENT ACTIONS
BOOK B
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or Recusals,
Abstentions/Interests
NO APPLICATIONS
18
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Certified Home Health Agencies – Construction
Exhibit #18
Mr. Kraut next moved to the Certified Home Health Agencies that were included in
July 26, 2012 Committee Book B. Mr. Kraut read into the record a new contingency and
condition that will be applied to certain applications. Mr. Cook spoke briefly relative to the
RFA CHHA process. Members of the Council had questions relative to the language of the
new contingency. The newly added contingency language was seconded by Mr. Booth.
Please see pages 109 and 110 of the transcript for the language of the contingency. For the
complete discussion, please refer to pages 91 through 110 of the attached transcript.
1.
Number
Applicant/Facility
121210 C
HHC Health and Home Care
Contingent Approval
(New York County)
Dr. Bhat – Recusal
Dr. Boufford – Recusal
Mr. Fassler – Interest
Dr. Martin – Interest
Ms. Regan – Interest
Dr. Sullivan – Recusal (not present)
Council Action
Mr. Kraut noted for the record that Dr. Boufford and Dr. Bhat has declared a conflict on
application 121210 and has left the meeting room. Dr. Sullivan at the EPRC meeting
declared a conflict and was not present at this meeting. Mr. Fassler, Dr. Martin, and
Ms. Regan have declared an interest. Mr. Kraut described the application and motioned for
approval which was seconded by Dr. Berliner. The motion to approve carried with the noted
recusals and interest. Dr. Bhat and Dr. Boufford re-entered the meeting room. Please see
page 110 of the attached transcript.
121226 C
Nursing Sisters Home Care, Inc.
d/b/a Catholic Home Care
(Suffolk County)
Ms. Regan - Interest
Contingent Approval
121249 C
Visiting Nurse Services in
Westchester, Inc.
(Westchester County)
Ms. Regan – Interest
Ms. Hines – Abstaining
Contingent Approval
19
121212 C
Dominican Sisters Family Health
Service, Inc.
(Westchester County)
Ms. Regan – Interest
Contingent Approval
121243 C
United Odd Fellow and Rebekah
Home LTHHCP
(Bronx County)
Mr. Fassler – Interest
Ms. Regan – Interest
Contingent Approval
121216 C
Visiting Nurse Association of
Long Island, Inc.
(Nassau County)
Ms. Regan – Interest
Contingent Approval
121291 C
The Wartburg Home
(Westchester County)
Mr. Fassler – Interest
Ms. Regan – Interest
Approval
121448 C
UPR Care Corp., Inc. d/b/a Cold
Spring Hills Center for
Nursing & Rehabilitation
(Nassau County)
Ms. Regan – Interest
Contingent Approval
121424 C
VillageCare Long Term Home
Health Care Program
(New York County)
Mr. Kraut – Interest
Ms. Regan – Interest
Contingent Approval
Mr. Kraut introduced application 121226, 121249, 121212, 121243, 121216,121291,
121448, and 121424. Mr. Kraut noted for the record that that application 121291 has met all
of its contingencies. Mr. Kraut motions for approval, which is seconded by Dr. Berliner with
the above noted member’s interests. The motion to approve carries. Please see page 111
through 113 of the attached transcript.
CATEGORY 3:
Following:
Applications Recommended for Approval with the
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by HSA
NO APPLICATIONS
20
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
Certified Home Health Agencies – Construction
1.
Exhibit #19
Number
Applicant/Facility
Council Action
121203 C
Personal Touch Home Aides of
New York Inc.
(Kings County)
Ms. Regan – Interest
Deferred
Mr. Kraut described application 121203 and noted Ms. Regan’s interest. Mr. Kraut
motions for approval which was seconded by Dr. Berliner. Mr. Fensterman raised concerns
regarding the applicant’s financials. The motion to approve did not carry. A new motion
was made by Mr. Fensterman to defer the application and to have each member of the
Council receive financial statements and data to evaluate the materials, as well as to bring the
application back to the EPRC. Dr. Berliner seconded the motion to defer. The motion to
defer carried. Please see pages 114 through 125 of the attached transcript.
CATEGORY 5: Applications Recommended for Disapproval by OHSM or Establishment
and Project Review Committee - with or without Recusals
NO APPLICATIONS
CATEGORY 6: Applications for Individual Consideration/Discussion
NO APPLICATIONS
B.
APPLICATIONS FOR ESTABLISHMENT AND
CONSTRUCTION OF HEALTH CARE FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or Recusals,
Abstentions/Interests
NO APPLICATIONS
21
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Certified Home Health Agencies – Establish
1.
Exhibit #20
Number
Applicant/Facility
Council Action
121309 E
Center Light Certified Home
Health Care Agency
(Kings County)
Mr. Fassler – Recusal
Ms. Regan – Interest
Contingent Approval
Mr. Kraut introduced application 121309 and noted that Mr. Fassler has declared a
conflict and has exited the meeting room and noted Ms. Regan’s interest. Mr. Kraut
motioned for approval. Dr. Rugge seconded the motion. The motion carried with
Mr. Fassler’s recusal. Mr. Fassler re-entered the meeting room. Please see page 126 of the
attached transcript.
2.
121256 E
Isabella Care at Home, Inc.
(New York County)
Dr. Berliner – Recusal
Mr. Fassler – Interest
Ms. Regan – Interest
Contingent Approval
Mr. Kraut noted that Dr. Berliner declared a conflict and exited the meeting room.
Mr. Fassler and Ms. Regan declared an interest. Mr. Kraut motioned for approval which was
seconded by Mr. Hurlbut. The motion carried with Dr. Berliner’s noted recusal. Dr. Berliner
returned to the meeting room. Please see pages 126 and 127 of the transcript.
3.
121252 E
Jewish Home Lifecare,
Community Services
(New York County)
Mr. Fassler – Interest
Ms. Regan – Interest
Contingent Approval
4.
121222 E
Lutheran CHHA, Inc.
(Kings County)
Ms. Regan – Interest
Contingent Approval
22
5.
121247 E
Queens Long Island Certified
Home Health Agency, LLC
(Queens County)
Ms. Regan – Interest
Contingent Approval
6.
121446 E
South Nassau Communities
Hospital
(Nassau County)
Ms. Regan – Interest
Contingent Approval
CATEGORY 3:
Applications Recommended for Approval with the Following:
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by or HSA
NO APPLICATIONS
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment an Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
Certified Home Health Agencies – Establish
Exhibit #21
™
1.
Number
Applicant/Facility
Council Action
121286 E
Lott Community Home Health
Care, Inc.
(New York County)
Ms. Regan - Interest
Contingent Approval
Mr. Kraut moved to applications 121252, 121222, 121247, 121446, and 121286 and
noted Ms. Regan’s interests and motioned for approval. The motion was seconded by
Dr. Berliner. The motion to approve carried with one member opposing application 121286.
Please see pages 127 and 128 of the transcript.
CATEGORY 5:
Applications Recommended for Disapproval by OHSM or
Establishment and Project Review Committee - with or without
Recusals
NO APPLICATIONS
CATEGORY 6: Applications for Individual Consideration/Discussion
NO APPLICATION
ADJOURNMENT:
Dr. Streck hearing not further business of the Council adjourned the meeting.
23
Page 1
1
2
NEW YORK STATE
DEPARTMENT OF HEALTH
3
_________________________________________________
4
PHHPC STANDING COMMITTEES
5
6
DATE:
August 9, 2012
TIME:
10:13 a.m to 12:45 p.m.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LOCATION:
Century House
997 New Loudon Road
Latham, New York
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 2
1
8-09-2012 - Latham, New York - Standing Comm.
2
DR. STRECK:
3
Let me welcome you to the Public Health
4
Good morning everyone.
and Health Planning Council.
5
I'm Dr. William Streck, Chair of the
6
Council and have the privilege of calling this meeting
7
to order.
8
the audience that the meeting is subject to the open
9
meeting law and is broadcast over the internet.
I would remind council members, staff in
10
The webcast may be accessed through the
11
Department of Health's website and the on-demand
12
webcast will be available no later than seven days
13
after the meeting for a minimum of thirty days.
14
We always review some basic ground rules
15
here and meeting cap -- we have synchronized
16
captioning.
17
over one another.
18
So, it's important that people not talk
The first time you speak we ask that you
19
briefly identify yourself as a council member or
20
D.O.H. staff.
21
pick up sounds such as rustling of papers or personal
22
conversations that were not intended to be broadcast.
23
So take care.
24
25
The microphones are hot.
They will
There's a record of appearance form
outside the room and as a reminder for our audience
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 3
1
8-09-2012 - Latham, New York - Standing Comm.
2
that is required by the Joint Commission on Public
3
Ethics in accordance with the Executive Law Section
4
166 that you fill out this form.
5
cooperation.
6
We appreciate your
At today's meeting we will have under
7
the category Department of Health Reports, we will
8
hear from Dr. Shah.
9
Ms. Misa will then give her report on
10
the activities of the Office of Health Insurance.
11
Mr. Cook will give an update on the
12
13
14
15
16
17
Office of Health Systems Management.
Ms. Block will report the on activities
of the Office of Health Information Technology.
Dr. Birkhead will give the report on the
activities of the Office of Public Health.
Continuing then at about two p.m., the
18
Public Health Services report will be given -
19
being facetious there - by -- Dr. Boufford will follow
20
those reports with a Public Health Services report.
21
Under the category of health policy, Dr. Rugge will
22
give a report on the activities of Health Planning
23
Committee and under regulation, Mr. Hulbert will give
24
a report of the recent committee meeting and present
25
regulations for emergency adoption and discussion.
Associated Reporters Int'l., Inc.
I'm
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 4
1
8-09-2012 - Latham, New York - Standing Comm.
2
3
We will then move to the Project Review
Committee recommendations and establishment actions.
4
Somewhere in that interim we will pause
5
for lunch, depending on the pace of our
6
accomplishments.
7
Public Health, Health Planning Council that we have to
8
fill out our conflict of interest forms and if you
9
have not done so, please do so.
10
I would remind all members of the
We do the Establishment and Project
11
Review process through a batching of like applications
12
and we will continue that process today.
13
So, if you would just pause for a moment
14
and make sure that all of our conflict of interest
15
forms are complete and I assume that is the case.
16
Then we will move to the next item on
17
our agenda which is the adoption of minutes.
We have
18
two sets of minutes to adopt.
19
adoption of June 7th, 2012 Public Health and Health
20
Planning Committee minutes.
The first is the
21
May I have a motion to adopt those?
22
Moved.
23
Second?
24
Seconded.
25
Any discussion on those
minutes?
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 5
1
8-09-2012 - Latham, New York - Standing Comm.
2
3
Hearing none, those who would approve
those minutes, aye.
4
Any opposition?
Thank you.
5
I then move to ask that the minutes of
6
the meeting of August 7th, that is conducted two days
7
ago, a special -- the Codes and Regulation Committee
8
minutes, be approved by the full council, reflective
9
of the discussion held by a statewide teleconference.
10
11
May I have a motion for approval of
those minutes?
12
Moved and seconded.
13
Further discussion?
14
Hearing none, those
in favor, aye.
15
Any opposed?
16
Thank you.
17
It is now my pleasure to welcome
18
Commissioner Shah, who will update the Council about
19
the Department's activities since Tuesday.
20
COMMISSIONER SHAH:
Thank you, Bill.
21
Well, first I want to start off by
22
thanking this council for the important work they did
23
Tuesday.
24
asking for your participation and -- and we responded
25
of course and were able to convene a very important
Many of you got phone calls over the weekend
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 6
1
8-09-2012 - Latham, New York - Standing Comm.
2
meeting on Tuesday that banned synthetic marijuana and
3
bath salts in ways that Commissioner's orders could
4
not do.
5
really end this scurge once and for all in New York
6
State.
We now have enforcement abilities that will
7
It really came home to me at a news
8
conference that Governor Cuomo hosted later that day
9
in New York City.
He described this scurge as
10
different from cocaine and other drugs that have been
11
sold over time, by saying that these are the drugs
12
that are being sold over the counter.
13
Talk about insidious.
And marketing
14
them to kids as safe and legal alternatives to
15
marijuana.
16
a lot of damage across the state.
17
Neither safe nor legal and really causing
So it was very important work.
It's
18
exactly the kind of work this Council can do in an
19
emergency.
20
showed its strengths on Tuesday.
21
all of you for on short notice coming together for
22
this important purpose.
23
the coming weeks and months the effects of your work
24
and how the numbers go down as a result.
25
you.
The power vested in this body really
Associated Reporters Int'l., Inc.
And I must applaud
And, I think you'll see in
So thank
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 7
1
8-09-2012 - Latham, New York - Standing Comm.
2
I'll begin my report today with an
3
update on the Medicaid 11.15 waiver that the
4
Department submitted to C.M.S. on Monday.
5
It's been a busy week for the
6
Department.
On Monday -- in June Governor Cuomo
7
talked about a ten billion dollar Medicaid 11.15
8
amendment to a waiver that the Department of Health
9
was planning to submit and how it would help us
10
realize the vision of Medicaid redesign and improve on
11
and continue the goals of health-care reform
12
nationally.
13
Under the waiver, New York would be able
14
to reinvest a portion of the seventeen point one
15
billion dollars in federal savings that will be
16
realized over the course of the next five years as a
17
result of what Medicaid redesign has already done.
18
It will help us achieve the triple A
19
better care, better population health and improve
20
lower cost of care.
21
and we are in ongoing conversations with C.M.S. over
22
the next few months.
23
approval of this waiver this calendar year.
24
advance anticipation of spending the money beginning
25
next year.
Associated Reporters Int'l., Inc.
We submitted the waiver on Monday
Our hope is that we will have
In
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 8
1
8-09-2012 - Latham, New York - Standing Comm.
2
Among our proposals are an important
3
expansion of primary care in New York State, improving
4
access, addressing health disparities.
5
entire section on new care models which is worth a
6
read.
7
that waiver and the entire document is available on
8
the website.
9
care, to see how New York State should be delivering
10
health care, how we should have systems of care, the
11
waiver is probably the best document to do so.
There's an
There are thirteen different sections in all in
If you want a crystal ball in health
12
It has the expertise of the entire state.
13
We had extensive engagement of stakeholders, including
14
four public forums across the state, another web
15
survey, reports submitted by many different
16
organizations, individual consultations with many
17
folks and this waiver represents the best of all of
18
that.
19
It's breathtaking.
If you -- if you read some of the kinds
20
of investments we propose, for example, seven hundred
21
and fifty million dollars for supportive housing over
22
the next few years, on top of the seventy-five million
23
that we've already committed to in this year's budget.
24
These are transformative.
25
another stage, another level and across the board.
Associated Reporters Int'l., Inc.
It's taking M.R.T. to
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 9
1
8-09-2012 - Latham, New York - Standing Comm.
2
If there's -- if you have time to read a
3
hundred and fifty-eight pages, I think this would be
4
the next hundred fifty-eight to choose and it's
5
available on our website.
6
7
In addition to the waiver, the Department
of Health has also been busy in giving out grants r.
8
9
Over the last few months, the
Governor -- our Governor has announced over three
10
hundred million dollars in grants for forty New York
11
hospitals and nursing homes from the last round of the
12
HEAL funds, the Health Care Efficiency and
13
Affordability Law funds.
14
These grants are important for two
15
reasons.
First, they'll improve the quality of
16
primary and community-based care by focusing on higher
17
quality, patient-centered care.
18
geared towards efficiency and eliminating excess bed
19
capacity in hospitals and nursing homes.
20
this funding is an investment towards a more
21
sufficient and efficient -- I'm sorry, a more
22
sustainable and efficient long-term plan for health
23
care.
24
We're making it happen in New York by real dollars
25
backing up our efforts.
And second, they're
As such,
These are themes that you hear every meeting.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 10
1
8-09-2012 - Latham, New York - Standing Comm.
2
At previous meetings I've also mentioned
3
the Doctors Across New York program which encourages
4
physicians to practice in under-served areas of the
5
state.
6
through the program to support the workforce in
7
ambulatory care institutions.
8
9
Last month I announced seventeen awards
We need to offer support for hospitals
and community-based sites, if we are to train the next
10
generation of physicians and providers delivering
11
ambulatory care.
12
These grants will ensure that New
13
Yorkers continue to receive high quality care in these
14
settings and expand training opportunities.
15
fund clinical training for nearly one thousand medical
16
residents at forty-three locations around the state.
17
And, grants range from about fifty thousand to two
18
hundred fifty thousand dollars per year for three
19
years.
20
They will
Turning to public health, the Department
21
marked a national H.I.V. testing day on June 27th by
22
urging New Yorkers to get tested for H.I.V. AIDS.
23
As you know, since September 2010, New
24
York State Law mandates that all New Yorkers between
25
the ages of thirteen and sixty-four who receive
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 11
1
8-09-2012 - Latham, New York - Standing Comm.
2
hospital or primary-care services must be offered
3
H.I.V. tests.
4
there have been an increase of -- by thirteen percent
5
in testing across the state.
6
And since that law has been implemented
This increase in testing is encouraging
7
but there's still a lot more for us to do.
For
8
example, twenty percent of New Yorkers currently
9
living with H.I.V. or AIDS are unaware of their
10
status, one in five.
And one in three New Yorkers
11
diagnosed with H.I.V. get their diagnosis so late that
12
they've already progressed to AIDS.
13
Consider too that nearly four thousand
14
New Yorkers are diagnosed with H.I.V. AIDS each year
15
adding to the approximately one hundred and thirty
16
thousand New Yorkers currently living with H.I.V.
17
AIDS.
18
African American and Latino communities.
19
And the outbreak of H.I.V. AIDS is far worse in
In 2010, while Latinos only represented
20
seventeen percent of the New York population, Latino
21
men alone made up for nearly thirty percent of all new
22
cases.
23
So, we must continue to conduct public
24
health and community outreach, particularly in
25
minority and at-risk populations to make sure that
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 12
1
8-09-2012 - Latham, New York - Standing Comm.
2
H.I.V. AIDS tests are offered and done as early as
3
possible.
4
proclaiming the end of AIDS.
5
promise not a reality.
6
You may have seen those headlines
Well, that's really a
We've recently launched public outreach
7
and prevention efforts on other public health issues
8
as well.
9
increased mosquito activity around the state and so
This summer it's been quit hot and has
10
far this year two hundred and seventy-one mosquito
11
pools have tested positive for West Nile Virus.
12
And we're also very concerned of a far
13
rarer viral disease spread by mosquitoes called
14
Eastern Equine Encephalitis or Triple E which has been
15
found in Central New York in recent years.
16
begun a strong public-awareness campaign to inform New
17
Yorkers about the dangers of West Nile and Triple E
18
and offer strategies to protect individuals from
19
exposure.
20
We've
There's a lot of information on our
21
website if you're concerned and especially if you're
22
going picnicking or camping or hiking, be sure to take
23
all these precautions.
24
Furthermore, we've been alarmed this
25
year at the elevated levels of pertussis, commonly
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 13
1
2
8-09-2012 - Latham, New York - Standing Comm.
known as whooping cough.
3
In the first six months of 2012, there
4
were more than twelve hundred reported pertussis cases
5
and this is more than were reported all of last year
6
and more than three times the number of cases reported
7
nationally in 2009.
8
9
In June, the federal C.D.D. reported
that the U.S. had forty-four percent more pertussis
10
cases this year than last.
11
is highly contagious but it's preventable with
12
vaccination.
13
to limit more cases and urging New Yorkers to get
14
vaccinations.
15
This bacterial infection
And as such we're focusing on prevention
I'd like to mention two initiatives the
16
Governor has undertaken to protect New York's most
17
vulnerable citizens.
18
dollars through the federal low income Home Energy
19
Assistance Program to provide air conditioners to low
20
income New Yorkers who cannot afford them.
21
He has allotted three million
Heat-related illnesses such as heat
22
stroke and heat exhaustion can cause serious health
23
problems, especially for the elderly, infants and
24
young children and people with respiratory ailments or
25
chronic medical conditions.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 14
1
8-09-2012 - Latham, New York - Standing Comm.
2
The New York State Home and Community
3
Renewal Agency has also begun to implement this
4
program and is providing delivery and installation of
5
air conditioning units.
6
Funding has been allocated for all of
7
New York's sixty-two counties to ensure the program
8
reaches across the state and New Yorkers who are
9
interested in this program can apply to the Home
10
Energy Assistance program which determines the
11
eligibility requirements.
12
The Governor has also signed into law
13
legislation to protect people with special needs and
14
disabilities.
15
an essential duty to care for our citizens who cannot
16
care for themselves.
17
The Governor strongly believes we have
We've all heard those stories and read
18
about them in The Times and elsewhere about the
19
mistreatment of children and adults with special needs
20
and this bill -- this bill is a major step towards
21
strengthening our safety net to protect such
22
individuals.
23
This law is creating something they are
24
calling The Justice Center for the Protection of
25
People With Special Needs and this is tasked with
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 15
1
2
8-09-2012 - Latham, New York - Standing Comm.
protecting the welfare of these individuals.
3
The Justice Center will track and
4
investigate abuse and neglect complaints from
5
facilities and provider agencies that are operated,
6
certified or licensed by a state agency including the
7
Department of Health.
8
9
In addition, the law will create
standardized outlets and reporting mechanisms to
10
document past abuse and help prevent future incidents.
11
This law is overdue and good news for New Yorkers with
12
special needs and disabilities and their families and
13
the Department will help and do its part to put the
14
law into action.
15
16
This concludes my report and I'm happy
to take any questions.
Thank you.
17
DR. STRECK:
18
Are there questions, comments, for the
19
20
Thank you, Commissioner.
Commissioner?
DR. BHAT:
This is Dr. Bhat.
I would
21
like to hear Dr. Shah's that monies have been
22
allocated for graduate education in primary care.
23
last four or five years with the closing of so many
24
teaching hospitals in New York City area, we've
25
probably lost maybe a thousand residency slots.
Associated Reporters Int'l., Inc.
The
How
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 16
1
8-09-2012 - Latham, New York - Standing Comm.
2
exactly this money is going to be allocated?
You said
3
they're going to be given grants.
4
programs or are we going to be starting new programs a
5
new set up because the residency programs have to get
6
out of the hospital and into the communities.
7
planning to do something in that area?
Is it for existing
Are you
8
COMMISSIONER SHAH:
Absolutely right.
9
So this is -- these funds that were
10
awarded are for existing programs but exactly as you
11
said, we're fostering the broader outreach and
12
training of residents.
13
trains in a rural setting in primary care, they tend
14
to stay there.
15
a life there.
16
We know that when a resident
They find that they can actually make
And, our problem is not training
17
necessarily enough of the right types of physicians,
18
it's keeping them in New York after we've trained
19
them.
20
So there's a multi-pronged approach to
21
this.
One is to, as you suggested, spread the wealth
22
to rural communities, make folks in under-served
23
areas, both in inner cities and in rural regions, have
24
slots where folks are being trained in primary care.
25
So in those settings they understand the value of
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 17
1
2
3
8-09-2012 - Latham, New York - Standing Comm.
working in such settings and chose to stay.
But the second is to make sure that all
4
folks who are trained in primary care specialties,
5
choose New York as their options.
6
a recipient of a federal version of a program like
7
this that keeps us in primary care, kept me in
8
internal medicine by loan forgiveness.
9
one of the bigger areas where folks choose specialties
And I personally am
That's been
10
because they can pay off their loans faster and they
11
can afford to be a doctor.
12
New York State is building off of the
13
federal programs that exist through the National
14
Health Services Corp. and others and with Doctors
15
Across New York adding to the value and creating new
16
programs to keep not only doctors but other
17
primary-care providers in New York State.
18
The website has a lot of information on
19
this ongoing grant program and we are not yet
20
accepting applications for the next round of it, but
21
definitely look at it.
22
23
DR. STRECK:
for the Commissioner?
Other comments or questions
Thank you.
24
Thank you, Commissioner.
25
Before moving on, I just want to clarify
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 18
1
8-09-2012 - Latham, New York - Standing Comm.
2
the process of approval of the minutes of our meeting
3
on Tuesday and I -- my language may not have been
4
precise, but the minutes we approved were minutes of
5
the full council which are at your place.
6
not the minutes of the Committee.
7
They were
So just want the record to reflect that
8
the minutes of the full council's actions were
9
approved today.
10
11
12
Thank you.
We'll now move to the Office of Health
Insurance.
Ms. Misa.
MS. MISA:
Good morning.
And thank you
13
for the opportunity to provide an update on the Office
14
of Health Insurance Programs.
15
O-HIP has been working on many
16
initiatives since our last update.
17
that O-HIP has been working on in conjunction with
18
other partners in the Health Department is the
19
submission of our 11.15 waiver amendment, also known
20
as the super waiver to the federal government.
21
Commissioner mentioned in his remarks, the Department
22
of Health submitted an 11.15 waiver amendment to
23
C.M.S. on Monday.
24
25
The new initiative
As the
The waiver will reinvest ten billion
dollars in M.R.T. servings over five years to
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 19
1
8-09-2012 - Latham, New York - Standing Comm.
2
implement an action plan to transform the state's
3
health care system.
4
thirteen reform initiatives to improve quality care
5
and lower costs in the Medicaid program.
6
The super waiver contains
Specifically, the waiver provides
7
funding to expand access to primary care, enhance the
8
infrastructure of health homes, create new care
9
models, expand resources to transform and protect
10
safety-net providers, enhance public health hospital
11
renovations, expand supportive housing for high cost
12
Medicaid users, transform and prepare long-term care
13
providers for the move to Medicaid managed care,
14
provide capital stabilization for safety-net
15
hospitals, increase funding to create and support New
16
York's health care workforce, expand public health
17
care innovations, and enhance regional health care
18
planning activities.
19
The measure -- to measure the success of
20
these actions the waiver also includes funding to
21
undergo rigorous and thorough evaluation of ongoing as
22
well as new M.R.T. initiatives.
23
The 11.15 waiver amendment is an
24
exciting opportunity for New York's health care system
25
and it will consume a majority of D.O.H. staff time
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 20
1
2
3
8-09-2012 - Latham, New York - Standing Comm.
through the end of the year.
We are operating under a very aggressive
4
timeline and we will begin discussions with C.M.S.
5
beginning tomorrow.
6
with C.M.S. by December with an implementation date
7
for the waiver beginning January 1.
8
9
We hope to finalize discussions
As the Commissioner mentioned, the
waiver is currently online on the M.R.T. website, if
10
anyone is interested in the details.
11
In addition to the 11.15 waiver, O-HIP continues to
12
implement phase two of the M.R.T.
13
O-HIP is in the process of implementing
14
over one hundred projects that were enacted during
15
phase two of the M.R.T.
16
final recommendations of the nine M.R.T. workgroups.
17
The workgroups include health disparities, managed
18
long-term care, behavioral health, program
19
streamlining, basic benefit review, workforce
20
flexibility, payment reform, affordable housing and
21
Brooklyn Hospitals.
22
These projects reflect the
O-HIP meets biweekly to report on the
23
progress with implementation of these initiatives and
24
we are happy to report that we are on track with
25
implementation of all initiatives.
Associated Reporters Int'l., Inc.
Our progress in
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 21
1
8-09-2012 - Latham, New York - Standing Comm.
2
our work plan for M.R.T. phase two will also be up on
3
the website shortly, if anyone is interested in
4
following the steps towards implementation.
5
Lastly, O-HIP continues to monitor the
6
Medicaid global spending cap.
We are also on track
7
with Medicaid spending and as of the new report we are
8
thirty-three million dollars or one point two percent
9
below projections.
10
This concludes my report.
11
DR. STRECK:
12
DR. BERLINER:
Thank you.
Dr. Berliner.
Will the comments of
13
C.M.S. and New York State's response to them also be
14
available to the public online?
15
MS. MISA:
I'm not sure if the comments
16
will be.
I can definitely check on that.
17
just starting tomorrow, but I will definitely check in
18
my e-mail.
19
DR. BERLINER:
20
MS. MISA:
21
DR. STRECK:
22
We were
Thank you.
You're welcome.
Other comments or
questions?
23
I have one, Ms. Misa.
24
health home initiative, is that in your purview as
25
well or is that on a parallel track.
Associated Reporters Int'l., Inc.
In terms of the
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 22
1
2
8-09-2012 - Latham, New York - Standing Comm.
MS. MISA:
Well this is -- this is a new
3
proposal that's in the 11.15 M.R.T. headed by Greg
4
Allen and his shop and there's funding in the 11.15
5
waiver to enhance I.T. infrastructure and enhance the
6
governance structure of health home and to enhance
7
member -- member communication of health homes.
8
9
DR. STRECK:
So there -- additional
funding to the current proposed health home initiative
10
would come from the waiver as well.
11
trying to clarify?
12
MS. MISA:
13
DR. STRECK:
14
COMMISSIONER SHAH:
That's what I'm
Yes.
Okay.
Thank you.
I'll just make a
15
clarification too.
We are happy to take supportive
16
letters for the waiver to include with the final
17
submission of the waiver and you should direct the
18
letters to Kelly -- is that --?
19
MS. MISA:
Karen Delahanty.
20
COMMISSIONER SHAH:
Karen Delahanty in
21
the Department of Health and if you have any trouble
22
finding her, send them to me.
23
But we, you know, if your organization,
24
group, stakeholders, anyone in the public would like
25
to have letters submitted to C.M.S. with the final
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 23
1
8-09-2012 - Latham, New York - Standing Comm.
2
packet, we are already receiving some but are happy to
3
take them with your perspectives on specific parts of
4
it as well.
5
bring to the table, we were limited in terns of how
6
deep we could go in some of the descriptions.
7
already a hundred and fifty pages long but feel free
8
and I know they will take it very seriously.
9
welcome those comments.
10
You know the deeper knowledge that you
DR. STRECK:
Thank you.
It was
So,
Other questions for Ms.
11
Misa?
12
Health Systems Management report from Mr. Cook.
13
We'll now proceed to the Office of
MR. COOK:
Good morning.
The critical
14
issue that we're working on right now, as I'm sure
15
will not be a surprise, is a follow up to the CHHA
16
R.F.A., the home care R.F.A..
17
this council in September with a proposal that will
18
allow us to consider the applications that have
19
initially been denied as part of the R.F.A..
20
We will come back to
We are looking at several specific
21
options.
One may require a regulatory change.
22
may -- I don't want to surprise anyone if we have to
23
come back and request a change in the current
24
regulation that would allow us to consider it.
25
on schedule to finish the upstate reviews within the
Associated Reporters Int'l., Inc.
So we
We are
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 24
1
8-09-2012 - Latham, New York - Standing Comm.
2
next week.
3
they will be presented at the September meeting.
4
Once those upstate reviews are complete
We, again, will only present the ones
5
that we've approved and we will begin discussions with
6
the downstate applications that we have denied at this
7
point in time, probably within the next two weeks.
8
want to finish the upstate reviews so that we assure
9
that we meet all the letter of the law and reg related
We
10
to the confidentiality of an R.F.A..
11
do that.
12
not saying anything.
13
the upstate and so we -- we clearly have been getting
14
a lot of calls of individuals who want to sit down
15
with us.
16
I think we can
I'm looking at my friend, Nick Stone.
He's
Once the review is complete for
We will sit down with as many as we can
17
as quickly as we can.
18
we would be bringing back additional applications in
19
the November, December framework that would both be
20
recommendations for additional approvals and then to
21
work with this council on kind of the next steps for
22
the applications that have not been approved.
23
But our goal here would be that
So in other words, I think we're going
24
to get to a point where there are going to be a
25
significant number of applications that did not meet
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 25
1
8-09-2012 - Latham, New York - Standing Comm.
2
the requirements of the R.F.A., did not rise in the
3
Department's level to a level that we felt comfortable
4
recommending, but I think we -- as mentioned at the
5
meeting, we very much want to continue a process that
6
will allow us to recommend approval of new home-care
7
agencies, but recommend them in the context of the
8
Medicaid redesign initiatives, as well as whether or
9
not there are unique issues relating to access.
10
And as we discussed at the last meeting,
11
the issue that we're going to be challenged by is how
12
do we balance the need to be more successful in the
13
context of Medicaid redesign with the impact in a
14
particular county of how many home-care agencies will
15
be appropriate without being inefficient.
16
17
And I think long term that's really
going to be our challenge is to balance that.
18
Short term, I feel pretty confident, as
19
we discussed, that there are a number of applications
20
that didn't really score at the highest level on the
21
R.F.A., but clearly as we go back and look at some of
22
these questions, they're worthy of bringing back to
23
this council for a discussion.
24
quite frankly besides spending most of the weekend on
25
the blackberry with Colleen Frost, who I think
Associated Reporters Int'l., Inc.
And that -- that's --
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 26
1
8-09-2012 - Latham, New York - Standing Comm.
2
everyone owes a round of applause, and Jim Daring, who
3
has not slept since a week, but it was an
4
extraordinary effort.
5
take questions.
So that's all.
6
DR. STRECK:
7
MR. FASSLER:
I'm happy to
Michael.
Just a question the CHHAs.
8
Received letters people are arguing that certain
9
counties can't afford to have more than one applicant.
10
How do you balance that with the fact that you want
11
consumer choice?
12
that as a council?
13
You know how should we deal with
MR. COOK:
I think that's one of the
14
issues that, you know, we're challenged by right now,
15
but I'm not sure I would agree that there can't be
16
additional CHHAs in a county where there's only one
17
because again I mean what we're trying to balance here
18
is the long-term care system is going to go through a
19
significant change.
20
populations into a managed-care environment.
21
are opportunities to realign the long-term care system
22
within a rural area and it may cross not just one
23
county.
24
25
And the goal is to move the
If there
It may cross several counties.
Then I'm not sure we want to be limited
not to be able to approve an additional CHHA for a
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 27
1
8-09-2012 - Latham, New York - Standing Comm.
2
particular county.
3
the context of what we're trying to accomplish in
4
efficiencies under the Medicaid redesign and I think
5
we also have to look at it in the context of how well
6
existing CHHAs are moving in a direction that we feel
7
comfortable will produce the efficiencies.
8
9
I think we have to look at it in
MR. FASSLER:
Different question.
Regarding the Brooklyn hospital situations.
We read
10
in the paper about one hospital hasn't paid its
11
mortgage about to lose managed care in the fall.
12
13
14
Can you tell us anything new happening
at this facility?
MR. COOK:
I think there -- there
15
actually is a great deal happening and as we have
16
talked about in the past, part of -- there's a lot of
17
negotiations behind the scenes.
18
element is we focused a great deal of effort on
19
Brookdale and Brookdale is beginning, I believe, to
20
stabilize itself and position itself for realignment.
21
I think the article you're referring to talked about
22
Wyckoff and Interfaith and I think in the context of
23
those hospitals, we are encouraging those two
24
hospitals, along with Brooklyn Hospital, to sit down
25
and to continue to negotiate and try and find some
Associated Reporters Int'l., Inc.
The most important
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 28
1
8-09-2012 - Latham, New York - Standing Comm.
2
common ground for integration.
3
recommendation of the second Berger report and we
4
continue to encourage that.
5
That was the
I think we continue to watch the
6
financial circumstances of those hospitals, but I
7
think it's fair to say that in the context of access,
8
the Department is clearly paying very close attention
9
to cash flows and to the financial circumstances of
10
those hospitals.
11
this point in time, but the challenge for these
12
hospitals, several of these hospitals, Brookdale as
13
well as Interfaith, will be to find a way to
14
restructure their debt, to restructure their services,
15
so that they will have a long-term survival.
16
that's a very difficult thing to do and that takes
17
very careful encouragement as well as negotiation.
18
And that's what we're engaged in right now.
19
20
We do not see the crisis point at
DR. STRECK:
And
Other questions for Mr.
Cook?
21
Dr. Rugge.
22
DR. RUGGE:
Just going back to rural
23
areas and the availability of CHHAs, there are some --
24
some rural areas which are so removed or so sparsely
25
populated, that the availability of choice may dilute
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 29
1
8-09-2012 - Latham, New York - Standing Comm.
2
the availability of quality.
Are there standards in
3
place to evaluate the quality of assisted services and
4
to measure on an ongoing basis what the impact of
5
choice includes and do we have a threshold to what
6
level of quality is acceptable or what drives a level
7
of being in jeopardy.
8
Is that better.
9
I'm just saying that there are rural
10
communities that are so sparsely populated that the
11
assurance of choice could dilute quality in terms of
12
critical volume for the providers of home-care
13
services and whether there is a mechanism in place and
14
a threshold for quality of assisted services to be
15
able to monitor over time whether those -- those
16
services are being compromised by the -- by the
17
necessity of offering choice.
18
Reminding everyone that there is at
19
least one county with a population of less than five
20
thousand albeit most of those residents seemingly
21
would be quite elderly.
22
23
24
25
So we have some real issues in terms of
certain communities.
MR. COOK:
I'm going to ask Becky to
comment, but let me first give a kind of broad
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 30
1
8-09-2012 - Latham, New York - Standing Comm.
2
comment.
I mean -- and this is, you know always
3
dangerous.
4
upstate counties, in particular the rural areas, I
5
don't think there's any particular standard that we
6
can point to right now that's going to give us the
7
type of information or comfort that every decision is
8
going to be the right decision.
9
that we have before us and -- and John, you've clearly
But in some respects when we look at the
I think the challenge
10
been involved in this for a very long time, is, you
11
know, how do we encourage the development of quality
12
services within these regions, across very sparsely
13
populated areas and if you have, you know I'm speaking
14
hypothetically.
15
that are in individual counties and they are not
16
working with existing networks or they are not working
17
to integrate themselves in a way that reflects the
18
realignment that's trying to be developed under
19
Medicaid redesign, I think those are the policy issues
20
that we need to bring to this council with a
21
recommendation of why that needs to change.
22
If you have a series of providers
I think we are extraordinarily sensitive
23
to the challenge that we do not want to disrupt or
24
interfere with a quality provider.
25
But, at the same point in time, if that
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 31
1
8-09-2012 - Latham, New York - Standing Comm.
2
provider is not linking themselves to be in a position
3
for change, then we can't sit still and not try and
4
improve that care.
5
are specific standards that we are currently using
6
but --?
7
So, Becky, I don't know if there
MS. FULLER GRAY:
Home health providers
8
who are certified to participate in Medicare and
9
Medicaid are required to submit data based on
10
admission and discharge that is used to develop
11
outcomes measures that measure the quality of services
12
that are provided to individuals who receive care by
13
their agencies.
14
monitor the individual outcome measures for each of
15
the agencies periodically and on survey.
16
We monitor it, those reports and
So we do have an impression of the
17
quality of care that is provided by the individual
18
certified home health agencies.
19
20
21
DR. RUGGE:
Are those quality measures
reported to the FIPA?
MS. FULLER GRAY:
Those quality measures
22
are reported publicly and are available at our website
23
they are updated quarterly on our home care website.
24
25
DR. RUGGE:
It would seem in the context
of an application of a new applicant, it would be
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 32
1
8-09-2012 - Latham, New York - Standing Comm.
2
helpful for the FIPA to know the track record of that
3
particular applicant in other areas, but also the
4
track record and experience of those agencies
5
currently in place in the affected county, so the
6
judgment could be made on the relative quality and the
7
availability of assurances for the future.
8
9
MS. FULLER GRAY:
that.
10
11
We could certainly do
DR. RUGGE:
That'd be helpful.
Additional bit of data for us to work with.
12
MR. COOK:
And we can certainly provide
13
it.
But again I think, you know, that issue we're
14
going to have to balance with the redesign of the
15
system.
16
So I mean we may have and we do have
17
very good providers across the state in all the
18
sectors of home care, but if they are not aligning
19
themselves in a way that is consistent with quite
20
frankly the goals that the C.O.N. reform has talked
21
about and are not making the changes to integrate
22
themselves, then I think those are the difficult
23
decisions.
24
25
You know you want them to move in the
right direction.
Associated Reporters Int'l., Inc.
If they are not and there is a
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 33
1
8-09-2012 - Latham, New York - Standing Comm.
2
competing provider who is, then I think that's the
3
challenge of the department and this council.
4
DR. RUGGE:
I just want to add that we
5
have direct experience with five counties.
6
those counties clearly need new vendors.
7
not.
8
applications come forward.
9
some objective, dispassionate assessment of the
10
Some of
Others do
I would not be allowed to comment when those
So what we really need are
relative performance.
11
DR. STRECK:
12
MR. KRAUT:
Mr. Kraut.
Let's not lose sight of the
13
fact why we increased the number of providers or
14
provided the opportunity.
15
that, you know, some counties that they don't.
16
is all about which providers are going to evolve their
17
clinical model to reflect the new business model,
18
which is inherent in the M.R.T. and Medicare as well.
19
We're going to be for a substantial portion of the
20
home-care business that's post-acute as opposed to
21
kind of chronic long-term.
22
some sort of bundled payment systems.
23
You said you have evidence
This
These are going to be into
So, yes, you may have providers there,
24
but if they don't appropriately change their culture,
25
their business model, their clinical model, they will
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 34
1
8-09-2012 - Latham, New York - Standing Comm.
2
no longer meet the needs under a redesigned system of
3
care and -- and, you know, we -- the measures of -- of
4
quality and outcome are kind of -- are theoretically,
5
and I haven't -- you know we're not there yet, are
6
baked into the value-based payment.
7
So if -- if individual -- you know the
8
whole point of the home-care increase is to let's say
9
decrease reliance on more expensive forms of
10
post-acute care, sub-acute or inpatient rehabilitation
11
and move the patient safely into a home-care setting
12
and making sure that we have agencies out there that
13
can appropriate align because in certain communities
14
where you may have one provider and two is too many.
15
Well, there's a monopolistic approach to that provider
16
that they may be in -- at least there is a choice for
17
the networks of care, be they position groups or
18
hospitals or other providers, have -- you instill
19
still some competition in here that allows a
20
negotiation to occur.
21
continuum holds the rest hostage.
22
don't think we fully appreciate the different models
23
that are going to happen here.
24
25
So not one part of that
DR. RUGGE:
I -- you know I
Jeff, I would contend that
there are two levels of competition.
Associated Reporters Int'l., Inc.
One is
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 35
1
8-09-2012 - Latham, New York - Standing Comm.
2
competition among providers who are certified but
3
there's also the competition to maintain the quality
4
so high and access so high that there is not need
5
for -- for a competitor coming in.
6
concerned about the handful counties in which there is
7
an urban center, the kind of big rural area within the
8
county so that -- so new competition with competitors
9
gladly come into the county for the benefit of the
I'm particular
10
urban population but will not reach out to the more
11
remote communities.
12
particular concern that we're seeing in some
13
locations.
14
So that's -- that's the
DR. STRECK:
It sounds as though we'll
15
have opportunity in Rochester to pursue this
16
discussion.
17
Is there more of this?
MR. BOOTH:
I'm sorry.
I was basically going to
18
make John's point and also indicate that some of these
19
counties, I mean the number of nurses that are
20
available are only employed by the home care agencies
21
and there really is no additional capacity and that's
22
another layer of this that becomes more complex.
23
DR. STRECK:
Other comments or questions
24
on Mr. Cook's report?
25
Office of Health Information Technology
Associated Reporters Int'l., Inc.
Hearing none, we'll move to the
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 36
1
2
8-09-2012 - Latham, New York - Standing Comm.
Transformation.
3
Ms. Block.
4
MS. BLOCK:
Thank you.
I'd like to give
5
you a brief update on some of our recent activities.
6
Like everybody else in D.O.H., we've been busy.
7
not to screw up the technology here.
8
have worked on with the New York E-Health
9
Collaborative has four broad goals which are described
10
Try
The plan that we
here.
11
First, obviously we're -- we continue to
12
be committed to successful statewide implementation of
13
the Heal New York program and the federal health
14
information technology program and we are making great
15
progress in those areas.
16
create an ongoing regulatory and sustainability model
17
to support health I.T. adoption end use for the public
18
good and to leverage this health I.T. infrastructure
19
to support health reform and to have greater alignment
20
with other D.O.H. programs and systems.
21
We also have a charge to
And I mention this because in the
22
Medicaid waiver which was briefly described earlier we
23
have included a number of provisions to help reinforce
24
and continue some of the key health information
25
technology activities which you're generally familiar
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 37
1
2
8-09-2012 - Latham, New York - Standing Comm.
with and many of you are directly involved in.
3
In particular we have teed up the idea
4
with C.M.S. that we would like to secure Medicaid's
5
participation, as part of an ongoing multi-payer
6
arrangement to create a long-term sustainability model
7
for health information technology adoption in the
8
future.
9
We have included provision for funding
10
for additional technical support for health homes as
11
was described earlier and we have also included
12
provisions for funding to increase primary-care
13
connections to the statewide health information
14
network for New York.
15
areas of progress in terms of not only advancing our
16
health I.T. agenda, but also trying to leverage
17
Medicaid resources which a number of other states are
18
currently doing to that end.
So these are very important
19
We continue to work very closely with
20
our colleagues in public health as well in terms of
21
building the additional functionality and partnership
22
as well with the New York City Department of Health
23
and Mental Hygiene.
24
25
As far as the regulatory here is
concerned you may recall, this is just the recap of
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 38
1
8-09-2012 - Latham, New York - Standing Comm.
2
the language that we got in legislation a couple of
3
years ago, that we do have specific legislative
4
authorization to create regulations governing the
5
statewide health information network.
6
After the HEAL program is done we needed
7
an ongoing mechanism to oversee these activities and
8
we have a first early draft of regulations that we
9
have discussed with the Policy Committee which we have
10
jointly convened with the New York E Health
11
Collaborative.
12
of that Policy Committee and Dr. Martin is a member of
13
that Committee and we have gotten a lot of good
14
comments initially through that process.
15
of course, while it is not something which is for the
16
Council's approval, when we get to that point we will
17
share the draft for comments with the council once we
18
get to the point where we will have a more refined
19
draft available.
20
Art Levin is a co-chair along with me
And we will,
Also as part of our stakeholder
21
consultation, we have convened two new forums which I
22
just wanted to briefly mention.
23
which had its first meeting last week.
24
to read this for you, but you'll see we have a number
25
of very ambitious objectives in terms of really
Associated Reporters Int'l., Inc.
A consumer forum
I'm not going
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 39
1
8-09-2012 - Latham, New York - Standing Comm.
2
fleshing out the consumer facing side of our health
3
I.T. agenda, an area that needs a lot more work, but I
4
think in the future is going to become increasingly
5
important in the context of many of the new care
6
models that were discussed.
7
And, we are progressing towards
8
convening our provider forum which is designed to give
9
us ongoing clinician input into everything that we do.
10
Initially there will be a strong focus on health homes
11
since that's one of the areas where we're really
12
trying to build out the clinical functionality, but we
13
will of course be looking more broadly within that.
14
And also to make sure we have clinical input into the
15
privacy and security issues which the Health I.T.
16
Policy Committee is working on.
17
We have formalized our RHIO dashboard.
18
I'm not going to present you with a lot of data today,
19
but I think the important points here are twofold.
20
One is that NICE is now contractually obligated to
21
progress in certain key areas that we defined as part
22
of their contract with the State.
23
have two specific goals that we have identified.
24
25
And as you see we
One, is increasing the number of patient
consents and the other is to increase the number of
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 40
1
8-09-2012 - Latham, New York - Standing Comm.
2
patient history lookups, which were two key attributes
3
of the success of the statewide health information
4
network and involve areas, as you can see in the first
5
quarter of this calendar year, we had had a
6
significant growth in both of those areas.
7
Also in terms of E chart adoption, these
8
are a couple of statistics from some national reports
9
and as you can see, New York is approximately at the
10
same level as the national level for both physician
11
and hospital adoption and that may not seem like a
12
good thing, given all the investment we've made, but
13
in fact this is significant progress from where we
14
were a couple of years ago and I think our HEAL New
15
York investments we will start to see increasing
16
numbers, particularly on a physician office, H.E.R.
17
usage.
18
And finally I have been reporting at
19
your meetings on our progress on meaningful use.
20
you know, we had a little bit of a slow start from the
21
Medicaid side, but we have rapidly ramped up in terms
22
of both the physician and hospital participation in
23
both Medicaid and Medicare.
24
of the end of June.
25
the end of May.
Associated Reporters Int'l., Inc.
As
Medicaid numbers are as
The Medicare numbers are as of
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 41
1
8-09-2012 - Latham, New York - Standing Comm.
2
And as you can see, we are now well over
3
five thousand physicians who have either established
4
their attestation for Medicaid or for Medicare and the
5
number of hospitals that similarly are participating
6
in one or both of those programs with more than three
7
hundred million dollars now having gone out the door
8
in terms of incentive payments.
9
And again this is an area where the
10
curve in terms of increasing participation is going up
11
very rapidly.
12
mentioned at our last meeting that we are
13
participating in a meaningful use acceleration
14
challenge where the federal government has established
15
a goal with us to get ten thousand physicians in New
16
York to meaningful use by the end of the year and we
17
are well on track I think to achieve that goal.
18
So we've very pleased.
19
That concludes by remarks and I'm happy
to take any questions.
20
21
I think I
DR. STRECK:
Pardon me.
Thank you.
Questions?
Questions from the group?
22
Thank you very much.
23
We'll now move to the Office of Public
24
25
Health report.
Dr. Birkhead.
DR. BIRKHEAD:
Associated Reporters Int'l., Inc.
Thanks very much.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 42
1
8-09-2012 - Latham, New York - Standing Comm.
2
I'm going to give a brief update on the
3
follow-through on the bath salts, synthetic marijuana
4
issue and then just touch on three public health
5
vignettes.
6
going to be on state and local public health
7
activities, the state and local public health action.
8
9
And the theme of my talk today I think is
We did a survey a couple of years ago, a
telephone survey, and about a third of the population
10
wasn't aware whether they had a Health Department or
11
whether they were in receipt of any Public Health
12
services and I hope my remarks today will sort of
13
highlight some of the unsung activities that go on in
14
Public Health that people may not be aware of.
15
So in terms of the marijuana, bath
16
salts -- synthetic marijuana, bath salts follow up,
17
shortly after the council met on Tuesday, we had a
18
conference call with the thirty-five counties and New
19
York City, the thirty-five counties in the state that
20
do their own environmental health services plus our
21
state district offices that cover the other twenty-two
22
counties.
23
so what's happening now is the county health
24
departments are going out to locations where bath
25
salts and synthetic marijuana may be sold and actually
And, we sent out a packet of information,
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 43
1
8-09-2012 - Latham, New York - Standing Comm.
2
serving the Commissioner's order on those sites and
3
putting them on notice and then feeding that
4
information back to us.
5
They're prioritizing this.
We've gone
6
through two rounds of this in the last year and so
7
they're going to locations where they had identified
8
these products in the past.
9
of any complaints they've received.
They're also keying off
The -- the
10
hotline that was sent up, 1-888-999-SALTS, as part of
11
this initiative on Tuesday, has received about a dozen
12
calls with complaints specific to specific locations.
13
So those are being fed to the county
14
Health Departments to follow up on.
15
that hotline has gotten a number of calls from
16
distressed parents whose kids are struggling with bath
17
salts or synthetic marijuana and those calls have been
18
referred to the Office of Alcoholism and Substance
19
Abuse services for -- for specific follow up with
20
them.
21
And interestingly
So there's a lot underway.
The Public Health system is really
22
activated around this around the state to serve the
23
order and then where we find these products, there
24
will be compliance checks back to be sure they've been
25
removed from the shelves.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 44
1
8-09-2012 - Latham, New York - Standing Comm.
2
If not, then we will work through the
3
process with our Bureau of Narcotics Enforcement in
4
the State Health Department, the State Police, the
5
Attorney General and local police to take stronger
6
action to move ahead.
7
So an example of where the delivery arm
8
of a lot of this activity is -- is our local -- local
9
Public Health presence.
10
I want -- in the same vein, just touch
11
on three quick areas.
12
reports about these three, but where Public Health
13
work is going on in the community on a daily basis.
14
And the first is an issue of variant influenza, H3N2
15
strain has emerged in the mid-west in pigs.
16
You may have seen some of these
Apparently there's an influenza
17
epizootic going on in pigs at the moment and in the
18
last week the number of human cases related to this
19
are now up to over a hundred in Ohio and Indiana
20
primarily.
21
this outbreak is -- is quite significant and in fact
22
those emergency C.D.C. nationwide call this afternoon
23
with state Health Departments to talk about this.
24
25
But this -- this -- the upward curve of
Earlier in the week we sent out an alert
to county Health Departments, to physicians,
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 45
1
8-09-2012 - Latham, New York - Standing Comm.
2
hospitals, and others that if they are seeing cases of
3
influenza we are early now before the influenza season
4
gets going, but suspect influenza cases, they should
5
submit samples into the Wadsworth Lab.
6
This variant virus apparently does not
7
react easily with the rapid influenza A test that
8
clinicians use in their offices, so we really need to
9
get lab samples submitted for testing.
10
So far, I think the good news is that
11
there has not been human-to-human transmission or at
12
least much documented with this, so it may be a
13
deadend infection but nevertheless this -- there's a
14
surveillance system in place for this.
15
potential problem and have mobilized both the clinical
16
end and local Public Health resources to -- to try and
17
address it.
We detected a
18
A second quick update and again you may
19
have seen articles about this, particularly if you're
20
in the New York City, Long Island area, but this
21
summer we have seen now up to sixteen cases of vibrio
22
infection.
23
shellfish, vibrio cholerae is the most well known
24
internationally.
25
the moment, but we do have other strains, in
Vibrio is a bacteria species that lives in
Associated Reporters Int'l., Inc.
We don't have cholera in New York at
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 46
1
8-09-2012 - Latham, New York - Standing Comm.
2
particular vibrio parahaemolytics which can cause
3
pretty significant G.I. illness and can also in
4
persons who have other chronic conditions or immune
5
compromised, can cause a severe infection up to and
6
including death.
7
We've not had any deaths, but we've had
8
sixteen cases and there has -- this organism has been
9
identified in some shellfish in Long Island Sound and
10
those beds were closed for a period of time.
11
is another example where through a combination of the
12
clinical community submitting samples, the lab
13
identifying these unusual organisms and Public Health
14
following up to identify the source, that we've been
15
able to take action to remove the pump handle in
16
the -- in the old term to -- to stop the outbreak.
17
But this
And so we're following this situation
18
very closely, but this is an example of routine public
19
health in action.
20
wanted to mention is people probably saw news reports
21
of a New Hampshire case where a radiologic
22
technologist infected with hepatitis C had resulted in
23
an outbreak of over thirty cases of hepatitis C in a
24
cardiac catheterization clinic and this individual was
25
apparently diverting narcotics in -- in the cardiac
Associated Reporters Int'l., Inc.
And, then, the final thing I just
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 47
1
8-09-2012 - Latham, New York - Standing Comm.
2
cath lab and using -- using the narcotics and
3
refilling the syringes and placing them back into
4
circulation and resulted in a thirty -- over thirty
5
documented cases now of hepatitis C infection.
6
Because of the national network that exists,
7
we -- it was -- we were quickly informed that this
8
individual had worked in a New York Hospital at a
9
period of time, three or four years ago, in a cardiac
10
cath lab.
11
department have worked with that hospital to identify
12
and send out letters to all of the patients who were
13
in the cath lab at that time when the individual
14
worked there, and we are in the process of getting Hep
15
C testing done.
16
So we, along with the local health
So, again, I think another example of
17
public health in action where reports of disease are
18
just the beginning point of a series of steps that
19
involve both state and local, involve the laboratory
20
and other -- other activities to identify problems,
21
remove problems, protect public health.
22
23
So in the vein of some public health
vignette, that's my report for today.
24
25
MR. STRECK:
Questions?
Comments?
Associated Reporters Int'l., Inc.
Thanks.
Thank you, Dr. Birkhead.
Dr. Martin?
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 48
1
8-09-2012 - Latham, New York - Standing Comm.
2
MR. MARTIN:
No, I was just curious from
3
the West Nile outbreaks at the moment where do we
4
stand compared to history?
5
MR. BIRKHEAD:
This is -- as the
6
Commissioner indicated in his opening remarks, this is
7
looking like a heavy year for West Nile.
8
another activity that many counties, particularly in
9
the New York City area and Upstate carry out is
We --
10
mosquitoes surveillance.
So we do weekly mosquito
11
trapping and submit those to Wadsworth for testing.
12
And we began to find increased levels of
13
West Nile, whether it's due to the -- the dry weather,
14
which I would have thought would have depressed
15
mosquitoes, but apparently concentrates the existing
16
mosquitoes and birds around the sources of water
17
and -- and leads to -- may lead to increased
18
transmission.
19
At least that's the speculation.
So, for whatever reason, we are seeing
20
increased levels earlier in the season than normal.
21
We've had several human cases, none severe so far, but
22
we're watching very closely.
23
indicated, in the central New York area, we have a
24
particular zone of Eastern Equine Encephalitis.
25
we have had two equine cases -- two horse cases, which
Associated Reporters Int'l., Inc.
And as the Commissioner
And
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 49
1
8-09-2012 - Latham, New York - Standing Comm.
2
may -- and are an early warning, but we've not so far
3
identified the virus in mosquitoes there, but watching
4
very closely.
5
We have had deaths, human deaths from
6
E.E.E. in the last three years, a single case each
7
year in young kids.
8
a banner year despite the dry weather.
9
DR. STRECK:
So -- so it -- it's looking like
Other questions or
10
comments?
11
with the report on the Committee on Public Health.
12
And we have these slides at our places.
13
do.
14
Thank you, Gus.
Now, move to Dr. Boufford
DR. BOUFFORD:
Yes.
Joe?
Thank you.
Yes, we
Good
15
morning.
16
on -- on our work.
17
Silvia Peroni for -- and their staff for terrific
18
support to the effort.
19
Just very briefly just to give you an update
And thanks to Gus Birkhead and
We -- you will recall, and we've
20
reported in the past to this Council, that we do have
21
an ad hoc leadership group, which is quite
22
multi-sectoral and statewide geographically that's
23
sort of overall steering the revisions of the State
24
Health Improvement Plan.
25
of the application of the state for voluntary
Associated Reporters Int'l., Inc.
And -- which is a core part
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 50
1
8-09-2012 - Latham, New York - Standing Comm.
2
accreditation.
3
agenda and talked to you about lessons learned
4
essentially from the last round.
5
The -- we have reviewed the prevention
And I think the two elements that we --
6
we would like to address specifically, perhaps three
7
from the last time.
8
localities when the local health departments and
9
hospitals and other stakeholders, were -- did get
One is that many of the
10
together they really lacked the resources and capacity
11
to move from planning into implementation and
12
evaluations.
13
So, that's very much on our minds as we
14
refine the goals for the updated prevention agenda and
15
think about the strategy for rollout.
16
point about the knowledge at the local level about
17
what local health departments do and their involvement
18
in partnerships is a really important outcome we hope
19
to see.
20
I think Gus's
And, then also very strong desire in
21
this process to address remaining -- significant
22
continuing health disparities in -- within the goal
23
areas selected, including access to a basic charity,
24
even though most of our work would be prevention
25
oriented.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 51
1
8-09-2012 - Latham, New York - Standing Comm.
2
And then, finally, hopefully leaving --
3
leaving behind some kind of sustainable partnerships
4
for population health and community health action at
5
the local level when this process is completed.
6
We have proposed a set of new priorities
7
for -- for the revision of the plan, which are these,
8
which should be familiar as well.
9
them to you in the past and these were emerged from a
We've presented
10
statewide consultation that occurred when the ad hoc
11
group developed as proposals and these were agreed and
12
I think we discussed some of the minor changes that
13
were made at that point.
14
As I said, our focus is going to be very
15
much on upstream prevention in each of these area, but
16
the issue of basic access to services and --
17
especially primary program services is on each and
18
every one's mind.
19
place.
20
infrastructure that we're using to move this process
21
along, so that we'll have a report to do in time for
22
November consideration.
23
briefly, there are five work group chairs, one for
24
each of the areas.
25
A set of activities have taken
We have -- these are sort of the
And each of these very
Each are co-chaired by someone from the
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 52
1
8-09-2012 - Latham, New York - Standing Comm.
2
The health department, relevant departmental area or
3
section and a private sector colleague, either someone
4
from a professional association, from business, from
5
academia or an advocacy group.
6
So, we are really focusing on public/
7
private partnership at the chairmanship level as well
8
as broad diversity of interest represented on each of
9
the working groups.
Invitations to -- the working
10
groups on mental health, healthy women and chronic
11
disease prevention have gone out and the other two
12
will be going out shortly.
13
co-chair for the environmental group, which will be
14
Susan Plittsman, who's a professor at -- at Hunter
15
School of Public Health.
16
We just got our final
We have, through support from the Robert
17
Wood Johnson Foundation, been able to bring on a
18
consultant to work with the staff and support the
19
infrastructure of this project as it rolls out.
20
was a competitive process, and the Raven Martin firm
21
was selected.
22
help with and that we'll carry though the rollout in
23
January and preparing for that once the working groups
24
are finished their work and reported.
25
There
You can see the activities that they'll
The Department has developed and refined
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 53
1
8-09-2012 - Latham, New York - Standing Comm.
2
a -- a template for priority action plans where each
3
of the working groups will have this as the outline
4
for the report that is due from them and the
5
consultants are preparing a sort of guide to help the
6
other working groups work through this schematic and
7
scenario.
8
9
There is -- there are a couple of
specialist groups that are -- have been formed within
10
the Department of Health staff, one on metrics,
11
another one on data that will be in -- supporting
12
the -- each of the working groups and the staff have
13
prepared very extensive background papers with an
14
evidence base on the effective interventions in each
15
of the priority areas and those are posted on a
16
website.
17
This is a sample of the website -- not
18
the sample, but the page that's now in play.
19
have developed, with the help of the consultants,
20
identified a site through a project mechanism which
21
will provide a website for each of the working groups
22
to have -- to be able to communicate with one another.
23
And all of them we hope will have at least one
24
in-person meeting over the course of the summer and
25
the other meetings will be done virtually either by
Associated Reporters Int'l., Inc.
And we
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 54
1
8-09-2012 - Latham, New York - Standing Comm.
2
televideo conferencing or just telephone conferencing.
3
There's a steering committee that will
4
be keeping or connecting all of the co-chairs of the
5
working groups and certain selected members of the ad
6
hoc leadership group are also on that.
7
is meeting by phone every two weeks and using it as an
8
opportunity for everyone to brief each other.
9
think also as was pointed out in one of the early
And that group
And I
10
steering committee meetings, some of the working group
11
work could overlap and while redundancy is useful to a
12
point, we don't want people reinventing the wheel in
13
their own the working groups.
14
will -- they are also going to be building on existing
15
strategic plans to the degree they exist anyway, like
16
maternal child health and chronic disease for the
17
state at any rate.
18
Let me see.
And -- and also we
I think that's it.
Then
19
this is our time table.
With very rapid and effective
20
work, we hope to have committee drafts by the end of
21
September.
22
review those drafts for any tweaking and then we would
23
hope to be able to present to the Committee -- Public
24
Health Committee in November and to the FIPIC. in
25
December.
The ad hoc leadership group will then
So we're on that kind of time table with
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 55
1
8-09-2012 - Latham, New York - Standing Comm.
2
the goal of that being the document that then would
3
accompany the State's application for accreditation
4
and then we'll begin to roll it out locally in
5
January.
6
We also because, you know, the Robert
7
Wood Johnson Foundation is supporting states applying
8
for voluntary accreditation through this new national
9
process, and they're very excited that New York State
10
is one of the early large states to do that, they are
11
providing pro bono communication support to our
12
overall effort.
13
And representatives from the foundation
14
did attend the last ad hoc leadership group.
15
hope that will be helpful especially in the rollout --
16
in the January rollout at the local level.
17
pleased to have those resources.
18
And I
So we're
Two other quick points, we are
19
continuing to work with John Rugge's Planning
20
Committee.
21
Subcommittee members have been attending those
22
meetings regularly.
23
said we would work on is -- is identifying two areas
24
to move the needle on specific health issues in the
25
State.
A number of our -- our Public Health
And the last item that we had
We had initial conversation at our last
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 56
1
8-09-2012 - Latham, New York - Standing Comm.
2
Committee meeting in two candidate areas that we'll be
3
sort of fleshing out and -- and thinking about in our
4
upcoming meetings.
5
before the end of the calendar year, but to get in
6
position so that we can work on it in the next months
7
are maternal mortality and prison health.
8
those -- that's my report.
9
This is not a thing to happen
MR. STRECK:
Thank you.
And so
Are there
10
questions or comments in regard to this extensive --
11
extensive effort?
12
we'll have the document by December?
This is -- it's impressive.
13
MS. BOUFFORD:
14
MR. STRECK:
So
That's right.
That's impressive.
Are
15
there other comments that want to be offered here?
16
guess not.
17
continue with the report on the Health Planning
18
Committee?
19
Okay.
Thanks, John.
MR. RUGGE:
I
John, you want to
The Health Planning
20
Committee is trying to keep up with Dr. Boufford.
21
We've been meeting in both June and July with an
22
effort to deal with the background information to have
23
a shared understanding of how C.O.N.'s performing now,
24
what health planning was like and changes in the -- in
25
the environment.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 57
1
8-09-2012 - Latham, New York - Standing Comm.
2
In June, we undertook a discussion of
3
the measures of healthcare performance and how New
4
York is doing, in some instances not so well, ranking
5
dead last when it comes to avoidable hospitalizations
6
and cost.
7
enormous regional variation in many areas, especially
8
Upstate, actually, low cost in terms of -- of total
9
healthcare experience.
10
And yet curiously at the same time, there's
We have developed an array of the
11
regulatory tools available in addition to C.O.N.
12
important consideration in the -- in looking
13
nationwide, it appears there's lots of -- lots of lack
14
of clarity in terms of how important C.O.N. is or how
15
effective it is.
16
really makes sense not in isolation and is part of a
17
mosaic of how, in this case, the State is approaching
18
the -- the regulatory responsibilities.
19
our task really is to look at how in a -- in a
20
changing environment, we can apply C.O.N. together
21
with other tools to effect the -- the better outcomes
22
we would like to see.
23
An
It does seem clear that C.O.N.
And so
So moving on to July, I had a discussion
24
leading off with Greg Burke trying to pull together
25
the many different threads of a dynamic --
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 58
1
8-09-2012 - Latham, New York - Standing Comm.
2
hyperdynamic healthcare environment.
Really a -- to
3
my mind, a masterful presentation and to pulling it
4
all together.
5
also from Colleen.
His slides are available on the web and
6
The implications are -- are interesting
7
in that -- that -- it would -- he would imply that in
8
ways, maybe unexpected ways, the healthcare system may
9
become more self regulatory than we have seen to date.
10
And, yet, if it were to be the case,
11
it'll happen during a period of time, perhaps the five
12
years coinciding with a Medicaid megawaiver that would
13
indicate contradictory impulses, contradictory
14
incentives by providers and a chance for misuse or
15
abuse in either direction abuse or overuse.
16
or -- over-supply or undersupply.
17
issues that we are -- that are a constant struggle,
18
but maybe more so as we look forward as a -- as a
19
council.
20
Supply
And those are
We also heard from Health Department
21
staff, Jon Oberg, Pat Rohan, and Mark Kissinger on new
22
modes of care and, the -- the activity the State is
23
undertaking with -- with regard to financing to impact
24
quality.
25
And then a discussion by Anita DeRotsos
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 59
1
8-09-2012 - Latham, New York - Standing Comm.
2
on the way in which the State is regulating H.M.O.s
3
and -- and the payors at a time when risk is being
4
shifted from purchaser and payor to providers, with,
5
again, profound implications for how services need to
6
be planned and regulated.
7
That was the easy part, at least for the
8
Committee.
Coming up are discussions one by one of
9
all the key components of C.O.N. starting with not
10
one, but two special day-long meetings in September.
11
That not being good enough for October, when we will
12
have three -- count them, three meetings.
13
through looking to develop core recommendations which
14
then in two successive meetings will be refined and
15
distilled and clarified, bringing to the Council
16
simultaneously with Dr. Boufford in December
17
recommendations for consideration and hope for
18
approval.
19
Punching
I can only say in addition that the --
20
the Health Department has been enormous -- enormously
21
supportive.
22
name, but we couldn't do this without an -- an
23
enormous amount of work in pulling together material
24
all around the State and beyond so that we have a
25
command -- we wish we have a command of -- of the
Karen Lipson hates it when I mention her
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 60
1
8-09-2012 - Latham, New York - Standing Comm.
2
policy environment and the real environment in pulling
3
that together.
4
Thank you.
MR. STRECK:
Questions for Dr. Rugge.
5
So we should all look at our schedules for the
6
December meeting.
7
advice I would offer to book your rooms for that
8
particular day.
9
none, we'll move on.
That would be one of the pieces of
Other questions or comments?
Mr. Hurlbut, if you would take
10
over the report on the Codes and Regulations
11
activities.
12
Hearing
MR. HURLBUT:
My pleasure.
The Codes
13
and Regulations Committee reviewed two regulations on
14
July 25th.
15
sprinkler systems for emergency adoption and -- and
16
one other regulation concerning nursing quality
17
indicators for discussion.
18
The first regarding nursing homes
The nursing homes sprinkler regulation
19
was -- first was presented for a second emergency
20
adoption.
21
that there are about ninety-eight nursing homes in the
22
State of New York that are financially distressed and
23
are barely holding on.
24
25
To preface, what this really means is -- is
So, in other words, they're not eligible
to go to a bank or other forms of lending because
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 61
1
8-09-2012 - Latham, New York - Standing Comm.
2
they're not making it.
3
requiring that all nursing homes be fully sprinklered.
4
So I think that that is sort of -- about as quick as I
5
can adopt.
6
here?
7
And the federal government is
Mr. Loftus, would you like to take it from
MR. LOFTUS:
Sure, Bob.
Thank you.
As
8
Bob described this regulation was brought and approved
9
on an emergency basis on June 7th in front of the
10
Council.
11
source of confidence to lenders for those homes that
12
are in financial need and may not be able to access
13
credit markets.
14
It's to assist nursing homes and provide a
What it does is it allows the Department
15
to accelerate depreciation or payment to those
16
providers that show the need and requires them to
17
deposit in accounts the -- the amounts owed to the
18
lenders, hopefully, encouraging lenders to provide
19
funds for these nursing homes that must meet the
20
mandate by August 13th, 2013.
21
Since this was last presented to the
22
council, there have been a few changes to the reg.
23
They're technical in nature for the most part and
24
there's also one change where we had some redundancy
25
in language that we've cleaned up.
Associated Reporters Int'l., Inc.
And we can go over
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 62
1
8-09-2012 - Latham, New York - Standing Comm.
2
those changes before and if you have any questions,
3
obviously, we'll take questions before you vote on
4
the -- on the continued emergency regulation.
5
If you turn to page one of the reg in your packet, we
6
changed the word that was previously in there that
7
said 'subdivision' in paragraph one to 'section'.
8
That's just a technical change.
9
On page two, we eliminated the word
10
'each' -- eliminated the word 'such' and added 'each
11
eligible facility'.
12
the rest of that paragraph there we have deleted some
13
of wording that basically formerly said that 'other
14
such information as may be required by the
15
Commissioner prior to the due date of the first debt
16
service payment related to such financing, each
17
facility shall prepare a report'.
18
wording is already included in that paragraph in other
19
places.
20
days prior to the debt service.
21
Again, a technical change.
And
Because that
And we talk about a six -- prior to sixty
So just felt that that wording was just
22
redundant in nature.
23
began changed the word 'subdivision' to 'section'.
24
And then under the regulatory impact statement, the
25
statutory authority has been changed -- a technical
Associated Reporters Int'l., Inc.
Also on page three we have again
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 63
1
8-09-2012 - Latham, New York - Standing Comm.
2
change to it where we've removed some of the wording
3
describing Part 86.23 or 2.41.
4
regulation is the same as it was voted on at the June
5
7th meeting.
6
wording change I'd be glad to answer any questions.
Other than that the
If there's any questions on -- on the
7
MR. HURLBUT:
8
MR. LOFTUS:
9
MR. HURLBUT:
Great.
Thank you.
The Committee unanimously
10
voted to recommend adoption to the full council and I
11
so move, Mr. Chairman.
12
MR. STRECK:
Are there questions?
May I
13
have a second.
14
a question that is somewhat tangential, but while
15
applauding the provision of k funds to sprinkler
16
bankrupt nursing homes, are there activities existent
17
in regard to the problem of the bankruptcy of the
18
nursing homes that cannot be sprinklered?
19
guess that would be -- I realize that's not a Code
20
Committee question, but it seems to me one that is
21
pertinent to the topic.
22
Second.
So there's a motion.
MR. HURLBUT:
I have
I -- I
Well, how do I -- let's
23
see.
There are several reasons why nursing homes are
24
not doing well.
25
time to explain it, but part of it is the Medicaid
Associated Reporters Int'l., Inc.
And I think it would take a very long
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 64
1
8-09-2012 - Latham, New York - Standing Comm.
2
rate itself, part of it is the fact that there are
3
changes in the nursing home business where occupancy
4
has gone down.
5
have to change the way they do things as they
6
Commissioner has spoken about earlier about the whole
7
long term care, and as Dick Cook has talked about, or
8
they are not going to make it.
9
And some of them are either going to
So the ones that -- this regulation
10
doesn't really go into the ones that are really
11
depressed, but the issue we have is it's a federal
12
mandate that we have to do this.
13
So I know that the Health Department is
14
working with each of those nursing homes that aren't
15
doing well.
16
to make sure that the payments will be made back to
17
the banks.
And I know that Bob and others are going
18
MR. STRECK:
19
MR. HURLBUT:
20
MR. STRECK:
Thank you.
It's a complicated issue.
Other questions or
21
comments?
Hearing none, those who would vote in favor
22
of the resolution as proposed please say aye.
23
FROM THE FLOOR:
24
MR. STRECK:
25
Aye.
Opposed?
Thank you.
The
motion passes.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 65
1
8-09-2012 - Latham, New York - Standing Comm.
2
MR. HURLBUT:
The next item on the
3
agenda was the discussion concerning the Nursing
4
Quality indicator provision.
5
about as a result of the Nursing Quality -- Nursing
6
Care Quality Protection Act, which was intended for
7
hospitals and nursing homes to disclose data on
8
nursing staffing indicators and also information about
9
patient outcome indicators upon request.
10
This regulation came
The information is to be compiled and
11
made available to the public, so that the public can
12
make better decisions about their healthcare delivery
13
and which entities could better serve them and their
14
needs.
15
On the hospital side, the National
16
Database of Nursing Quality Indicators was chosen.
17
While the residential healthcare facilities will use
18
the minimum dataset known as the M.G.S. three point o
19
to serve as a basis of obtaining information.
20
that information is readily available and should not
21
cause any extraordinary burden for providers.
22
Most of
Disclosure for both the hospital and
23
residential healthcare facilities will include
24
substantiated outcomes from the investigations which
25
issue a statement of deficiencies, where there's
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 66
1
8-09-2012 - Latham, New York - Standing Comm.
2
evidence to support provider non-compliance with
3
federal and state requirements.
4
information only.
5
my report.
6
And this is really
And, Mr. Chairman, that concludes
MR. STRECK:
Are there additional
7
questions or comments for Mr. Hurlbut in regard to the
8
Committee's work?
9
Thank you.
10
In view of the expeditious progress
11
we've made, we will move on now to the project review,
12
recommendations and establishment actions and I'll
13
turn the microphone over to Mr. Kraut as chair of that
14
committee.
15
MR. KRAUT:
Thank you.
I'm going to
16
report of the July 26th meeting of the Establishment
17
and Project Review Committee.
18
The first application we have is
19
121157C, Northern Westchester Hospital, Westchester
20
County, to construct six new operating rooms and a
21
thirteen bed post anesthesia care unit in the existing
22
space, O.H.S.M. and the Project Review Committee
23
recommend approval with conditions and contingencies.
24
And I so move.
25
UNIDENTIFIED FEMALE:
Associated Reporters Int'l., Inc.
Second.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 67
1
8-09-2012 - Latham, New York - Standing Comm.
2
MR. STRECK:
3
and seconded.
4
presented?
5
6
The motion has been made
Is there discussion on the motion as
Hearing none, those in favor of the
motion as presented, please say aye.
7
FROM THE FLOOR:
8
MR. STRECK:
9
passes.
Aye.
Opposed?
The motion
Thank you.
10
MR. KRAUT:
Application 12 -- 112369(c),
11
Memorial Hospital for Cancer and Allied Diseases in
12
New York County to certify and construct an ambulatory
13
extensions clinic at 1133 York Avenue to be known as
14
the Outpatient Surgery Center.
15
approval.
16
Establishment Committee.
O.H.S.N. recommended
Conditions and contingencies as did the
And I so move.
17
UNIDENTIFIED MALE:
18
DR. STRECK:
19
and seconded.
MR. KRAUS:
21
DR. STRECK:
23
The motion has been made
Is there a discussion?
20
22
Second.
I have a point.
Mr. Kraut?
An additional
point?
MR. KRAUT:
Additional point.
I'd like
24
to add an additional contingency to this application
25
in light of two pieces of information.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 68
1
8-09-2012 - Latham, New York - Standing Comm.
2
You heard Ms. Block's report on the
3
importance of meaningful use and the sharing of health
4
data and getting more providers involved in health
5
information exchange.
6
this is something we should come back to.
7
next application are the only two hospitals in New
8
York County that did -- have not joined a Health
9
Information Exchange.
10
Memorial Hospital -- and -- and
And the
And so, in the past, we have added
11
contingencies to applications that have a technology
12
component compelling that -- that activity and I -- I
13
think time has come possibly that all applicants at
14
this day -- stage in where we are to not participate
15
in Health Information Exchange, the importance we're
16
putting on that policy initiative, I just don't think
17
is appropriate.
18
And I'd like to add a contingency to
19
this project that in order for it to move forward,
20
they must also join a Health Information Exchange.
21
And I would just say if we could also
22
have a -- a report possibly at a subsequent meeting of
23
what other licensed providers have failed to join
24
these Health Information Exchanges, we should be aware
25
of that periodically and make a decision as
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 69
1
2
8-09-2012 - Latham, New York - Standing Comm.
appropriate.
3
We may find it's very few or we may find
4
it's a lot.
5
County, this was brought to my attention.
6
I'm not sure.
This just -- in New York
And, so, I'd like to just amend the
7
approval with an additional contingency to show
8
evidence of an executed agreement to participate in a
9
Health Information Exchange.
10
11
DR. STRECK:
motion.
12
13
Is there a second to amend the original
motion?
14
15
We'll consider that a
It's been seconded to amend the original
motion.
16
So the vote will first be on the
17
amendment.
18
as proposed by Mr. Kraut?
19
And is there a discussion on the amendment
Dr. Berliner?
DR. BERLINER:
Jeff, I mean I -- I
20
understand you're not the applicant and can't speak
21
for the applicant, but do you have any sense of why
22
they haven't joined?
23
MR. KRAUT:
24
applicant.
25
it this way.
I -- I've not spoken to the
I -- if -- if the applicant -- let me put
If -- if there's a valid reason, I'd
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 70
1
8-09-2012 - Latham, New York - Standing Comm.
2
like to under -- I certainly want to know about it.
3
I -- I -- I don't know what that is, so I -- I can't
4
speak to it.
5
6
DR. STRECK:
And, Dr. Martin, you had a
DR. MARTIN:
Yeah.
comment?
7
I mean with -- with
8
the obvious interest that I do one of these in Queens,
9
I would ask the same question, just that the applicant
10
may actually have a rational reason for not doing it
11
because of the change in the market in New York City
12
at the moment, doesn't know one -- doesn't know which
13
one to join.
14
Doesn't know --.
15
MR. KRAUT:
to join.
16
17
Oh, I'm not saying which one
DR. MARTIN:
No, I understand.
I just
have no idea why they're not --
18
MR. KRAUT:
I'm just saying join one.
19
So it's a little hard for me to mandate something at
20
the last minute when they haven't had an -- an
21
opportunity --
22
DR. STRECK:
23
MR. KRAUT:
Okay.
-- to respond to this.
24
Look, I'm all for it as a policy.
25
me as a little odd to do it at this last second in
Associated Reporters Int'l., Inc.
But it just strikes
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 71
1
8-09-2012 - Latham, New York - Standing Comm.
2
this process, without having had had a more public
3
discussion.
4
little concerned about doing it right now.
I'd be thrilled to do it, but I'm just a
5
DR. STRECK:
6
MR. KRAUT:
Want to defer it.
Well, I -- I -- the only
7
other recommendation would be to defer it and I'm not
8
sure that that's fair for this as well.
9
DR. STRECK:
10
the amendment.
11
So --.
So we're still discussing
Any additional comments, Dr. Rugge?
DR. RUGGE:
Jeff, would it be
12
appropriate to ask the Department to add this as a
13
contingency to all construction proposals that come
14
forward?
15
MR. KRAUT:
Well, I would like to do
16
that, but I don't think it's -- I would discuss that
17
maybe in the Planning Committee or this -- but I
18
think -- I think at this point in time, yes.
19
that -- we should put everybody on notice that don't
20
bother, you know.
21
22
DR. RUGGE:
25
It's -- it's in a formal
suggestion perhaps.
23
24
I think
MR. KRAUT:
Yes.
It's -- it's strongly
recommended.
DR. STRECK:
Associated Reporters Int'l., Inc.
To the amendments.
Other
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 72
1
8-09-2012 - Latham, New York - Standing Comm.
2
comments on the amendments?
Hearing none, then those
3
in favor of the amendment as proposed by Mr. Kraut and
4
seconded to add the contingencies please say aye.
5
FROM THE FLOOR:
6
DR. STRECK:
7
Those in favor, please raise your hand.
8
9
Maybe we should vote.
So the amendment passes.
proposed and seconded.
11
the application?
12
We'll now
Is there further discussion on
Hearing none, those in favor of the
application as proposed, please say aye.
14
FROM THE FLOOR:
15
DR. STRECK:
16
Okay.
return to the original application which has been
10
13
Aye.
is approved.
17
Aye.
Opposed?
The application
Thank you?
MR. KRAUT:
Application 121208C,
18
Hospital for Special Surgery.
Certify a single
19
specialty ambulatory services census at the Hospital
20
for Special Surgery Extension Clinic, perform
21
renovations.
22
O.H.S.M. and the Committee recommended approval of
23
conditions and contingencies.
An interest is declared by Ms. Regan.
And I so move.
24
UNIDENTIFIED FEMALE:
25
DR. STRECK:
Associated Reporters Int'l., Inc.
Second.
Moved and seconded.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 73
1
8-09-2012 - Latham, New York - Standing Comm.
2
Discussion on this application?
3
in favor, aye.
4
MR. KRAUT:
5
DR. STRECK:
6
back for a moment.
Hearing none, those
I -- I'd like to --.
Let's pull those ayes right
Mr. Kraut?
Yes?
7
MR. KRAUT:
8
contingency to this applicant as well.
9
other hospital that's not participating.
10
11
DR. STRECK:
MR. KRAUT:
13
motion -- a motion to --
14
So would you
I would like to amend the
DR. STRECK:
Make a motion that includes
the contingency.
16
17
Okay.
This is the
rephrase your motion as --
12
15
I'd like to add the same
MR. KRAUT:
-- that includes the
contingency to participate in an R.H.I.O.
18
DR. STRECK:
So the motion is approval
19
with an -- an additional contingency.
20
single motion on the floor.
21
that single motion.
22
there discussion on the motion?
23
in favor?
That's the
Do I have a second for
Thank you, Mr. Fensterman.
Is
Hearing none, those
Aye?
24
FROM THE FLOOR:
25
DR. STRECK:
Associated Reporters Int'l., Inc.
Aye.
Opposed?
Thank you.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 74
1
8-09-2012 - Latham, New York - Standing Comm.
2
3
MR. KRAUT:
the whole motion.
DR. STRECK:
5
MR. KRAUT:
Do we have -- that was the
DR. STRECK:
No, no.
MR. KRAUT:
Okay.
Fine.
DR. STRECK:
12
UNIDENTIFIED MALE:
13
DR. STRECK:
14
UNIDENTIFIED MALE:
There we go.
There's one nay.
We had a nay?
DR. STRECK:
17
motion.
18
you.
Yeah.
No.
I thought we
This was on the entire
So we'll put a -- record a nay.
19
DR. STRECK:
20
UNIDENTIFIED MALE:
22
You're good.
were going to make a motion.
16
21
It's all a
single motion.
11
15
You just took out
a --
9
10
I beg your pardon?
amendment you just voted --.
7
8
And I get to go to
Right?
4
6
Okay.
moment.
Mr. Robinson?
Okay.
Thank
Application 1212 --
I'm sorry.
Pardon me just a
MR. ROBINSON:
Yes?
This is just really a --
23
a question not -- not directed towards the specific
24
motion, but following up on it, which is the mechanism
25
for ongoing support of R.H.I.O.s, which we all agree
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 75
1
8-09-2012 - Latham, New York - Standing Comm.
2
are critical.
3
those are coming principally from the providers, that
4
funding.
5
In most instances I understand that
So it could be that -- maybe this isn't
6
even a question, it's just a statement.
I think that
7
that the issue could be fiscal, meaning that I -- I
8
believe we pay on a per discharge basis for -- for
9
funding of R.H.I.O.
And I'm just curious as to
10
whether that might be the -- the reason for
11
non-participation.
12
MR. KRAUT:
You -- you mean that
13
Memorial is -- is -- is too poor?
14
so.
15
I don't want to speculate what their rationales are.
16
I -- I could imagine it, but I do know, you know, M.D.
17
Anderson, Dana-Farber.
18
R.H.I.O. in Houston.
19
don't know what the rationale is.
20
be a discussion point and if the Department -- I'm
21
sure we'll hear from the applicants.
But I'm -- I'm not, you know, I don't want to --
22
23
24
25
No, I don't think
M.D. Anderson founded its
So I -- I'd be, you know, I
DR. STRECK:
Yeah.
But maybe that'll
Other comments or
questions?
UNIDENTIFIED MALE:
Could I just make a
brief comment, Mr. Chairman?
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 76
1
8-09-2012 - Latham, New York - Standing Comm.
2
DR. STRECK:
3
MS. BLOCK:
Ms. Block.
The issue of sustainability
4
of the Statewide Health Information Network, of which
5
the R.H.I.O.s are a very important component, is part
6
of our work plan over the next eighteen months or so.
7
There is at this time great variability in terms of
8
how the R.H.I.O.s are funded.
9
typically the health plans are significant funding
And in Upstate
10
partners, downstate the providers have been
11
significant funding partners.
12
that we remove barriers to participation, some of
13
which are financial, some of which may be other,
14
including insufficient technology capability at this
15
time to -- to meaningfully participate.
16
We'd like to make sure
So the overall sustainability plan that
17
I just briefly described earlier is intended to
18
address all of these issues and come up with a system
19
that will serve us in the long term and also remove
20
barriers to participation and hopefully bring about
21
some more consistency in terms of how these issues are
22
dealt with.
23
MR. KRAUT:
Mr. Martin?
24
DR. STRECK:
Thank you.
25
DR. MARTIN:
I -- I would just say that
Associated Reporters Int'l., Inc.
Dr. Martin?
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 77
1
8-09-2012 - Latham, New York - Standing Comm.
2
in addition to sustainability that -- that R.H.I.O.s
3
don't do a whole lot other than governance in the
4
sense that they're not -- they get together people who
5
are agreeing to -- to share information.
6
participation agreements around that.
7
discussions about the rules about consenting, about
8
the use of information, on who could access it, what
9
you would do with it and the like, that aren't
There are
And there are
10
necessarily directly public health related.
11
there are reasons why various participants have been
12
over the years reluctant to join for one reason or
13
another.
14
And that
So, I'm saying it's not necessarily a
15
simple question of finances when you're talking about
16
people working together the way it's set up now,
17
because you don't have a direct link into just the
18
pipeline where you're sharing information with others.
19
You have to agree with other people
20
geographically to do certain things with it, including
21
such things as data mining conceivably or other things
22
going forward.
23
So, I'm saying it's just not as simple
24
as saying that everyone should be sharing information.
25
There's an easy way to do that.
Associated Reporters Int'l., Inc.
Everyone's on a level
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 78
1
8-09-2012 - Latham, New York - Standing Comm.
2
playing field.
Let's all agree.
So I'm saying I
3
don't want to cast any aspersions on anyone who has
4
not joined at the moment.
5
good and rational reasons for doing it.
6
hand, from the public health perspective and -- and
7
the like I certainly agree that this should be a goal
8
that we have.
9
these two people at the last minute to do this when
There could be some very
On the other
So I said I was just reluctant to force
10
they may have very rational reasons not to at the
11
moment.
12
everyone else is working to make this smooth as
13
possible going forward.
14
record.
15
16
17
And I know that Rachel's department and
DR. STRECK:
I just wanted that for the
Thank you.
Other comments?
Go ahead, Mr. Kraut?
MR. KRAUT:
Application 12143 -- 4323C,
18
Greater Harlem Nursing Home Company.
19
has declared a conflict and is leaving the room.
20
interest has been declared by Mr. Fassler.
21
Applicant is a member of a trade organization of which
22
he is an officer.
23
for renovation of an existing facility, land purchase
24
building construction and decertification of 28 -- 25
25
R.H.C.F. beds and develop a thirty bed assisted living
Associated Reporters Int'l., Inc.
Mr. Fensterman
Mr. Fensterman has left.
An
The -- the
This is
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 79
1
8-09-2012 - Latham, New York - Standing Comm.
2
program.
O.H.S.M. and the Committee recommended
3
approval of conditions and contingencies.
4
And I so move.
5
UNIDENTIFIED MALE:
6
DR. STRECK:
7
and seconded.
8
those in favor, aye.
Second.
The motion has been moved
9
Is there discussion?
FROM THE FLOOR:
10
DR. STRECK:
11
MR. KRAUT:
Hearing none,
Aye.
Opposed?
Thank you.
Application 071077C, North
12
Sea Associates doing business as the Hampton Center
13
for Rehabilitation and Nursing in Suffolk County.
14
Fensterman has declared a conflict and is out of the
15
room.
16
service by conversion of twenty-two residential
17
facilities -- twenty-two residential health facility
18
beds two twenty-two ventilator beds.
19
Committee recommended disapproval of the application
20
and I so move.
Certify a twenty-two bed ventilation dependent
21
UNIDENTIFIED MALE:
22
DR. STRECK:
23
for disapproval.
24
seconded.
25
Mr.
O.H.S.M. and the
Second.
The motion on the floor is
The motion has been made and
Is there discussion?
MS. BOUTIN-FOSTER:
Associated Reporters Int'l., Inc.
Can you tell us a
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 80
1
2
8-09-2012 - Latham, New York - Standing Comm.
little bit why?
3
DR. STRECK:
4
MR. KRAUT:
5
Yeah.
Anything
DR. STRECK:
Recommended
Yeah.
disapproval.
10
11
MS. BOUTIN-FOSTER:
in --.
8
9
Why this application has
been disapproved?
6
7
Why?
MR. KRAUT:
Charlie, I would leave that
MR. COLBY:
I'll call members attention
to you.
12
13
to a July 19th memo that I put together referencing --
14
and sent to the members -- referencing this
15
competitive batch, which was originally brought to the
16
December PHHPC meeting for Long Island.
17
four applicants that were at that time, all
18
recommended for disapproval because the Long Island
19
region was -- showed no need for additional vent beds.
20
At that meeting, the -- the PHHPC requested that the
21
Department go back and -- and review the need, numbers
22
and methodology separately for Nassau and Suffolk,
23
which we did.
24
-three beds over-bedded with respect to vent beds and
25
Suffolk was thirty-three beds under-bedded.
There are
The result was that Nassau was thirty
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 81
1
8-09-2012 - Latham, New York - Standing Comm.
2
As a result we -- we reached out to
3
local hospitals and discharge planners.
We reached
4
out to the applicants to obtain additional local
5
factors arguments that could factor into a -- our
6
decision.
7
decided that a recommendation for a -- an applicant in
8
Suffolk County made sense.
And weighing all that information, we
9
And with respect to the Suffolk County
10
applicants, there was one applicant that did -- that
11
gave us a convincing and substantial justification for
12
local factors that supported its proposal.
13
making a recommendation for approval -- and the other
14
applicants did not.
15
So we're
So we're making a recommendation for
16
approval of one applicant from the batch and this one
17
is one of the applicants that we're recommending for
18
disapproval.
19
Thank you.
DR. STRECK:
Thank you.
Are there
20
additional questions or comments on the motion as made
21
and seconded that is before the group?
22
for disapproval of the application.
23
the motion as presented, please say aye.
24
FROM THE FLOOR:
25
DR. STRECK:
Associated Reporters Int'l., Inc.
The motion is
Those in favor of
Aye.
Opposed?
Motion carried.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 82
1
8-09-2012 - Latham, New York - Standing Comm.
2
3
MR. KRAUT:
Thank you.
We could ask Mr.
Fensterman to return.
4
Application 112096C, Nesconset
5
Acquisition, L.L.C. doing business as Nesconset Center
6
for Nursing and Rehabilitation in Suffolk County.
7
This is to convert twenty residential healthcare
8
facilities beds into ten adult and ten pediatric
9
ventilator beds with requisite construction.
10
and the Committee recommend disapproval.
11
one member abstaining.
12
UNIDENTIFIED MALE:
13
MR. KRAUT:
14
DR. STRECK:
15
Approved.
O.H.S.M.
There was
Second.
And I so move.
The motion is for approval.
Right?
16
MR. KRAUT:
17
DR. STRECK:
Disapproval.
Disapproval.
Disapproval.
Right.
18
Disapproval and the motion has been seconded.
Is
19
there further discussion?
20
favor of the motion for disapproval, please say aye.
Hearing none, those in
21
FROM THE FLOOR:
22
DR. STRECK:
23
MR. KRAUT:
Aye.
Opposed?
Thank you.
Application 071024C Long
24
Beach Memorial Nursing Home, Inc. doing business as
25
the Komanoff Center for Geriatric and Rehabilitative
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 83
1
2
8-09-2012 - Latham, New York - Standing Comm.
Medicine in Nassau County.
3
Dr. Bhat has declared a conflict and is
4
leaving the room.
5
Mr. Fassler.
6
An interest has been declared by
Dr. Bhat has left the room.
The proposal is to convert ten mixed use
7
healthcare facility beds to ten ventilator dependent
8
beds.
9
disapproval and I so move.
O.H.S.M. and the Committee recommends
10
UNIDENTIFIED MALE:
11
DR. STRECK:
The motion is for
12
disapproval.
13
discussion?
14
motion as presented, say aye.
15
FROM THE FLOOR:
16
DR. STRECK:
17
MR. KRAUT:
18
19
Second.
The motion has been seconded.
Is there
Hearing none, those in favor of the
Aye.
Opposed?
Okay.
Thank you.
We ask Dr. Bhat to
return.
Application 072112C Oakwood Operating
20
Company, L.L.C. doing business as Affinity Skilled
21
Living and Rehabilitation Center in Suffolk County, to
22
construct a twenty bed ventilator dependent services
23
through conversion of twenty residential healthcare
24
facility beds with no change in bed capacity.
25
Approval with conditions and contingencies were
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 84
1
8-09-2012 - Latham, New York - Standing Comm.
2
recommended by O.H.S.M. and the Committee and I so
3
move.
4
UNIDENTIFIED MALE:
5
DR. STRECK:
Second.
The motion is for -- the
6
motion is for approval and has been seconded.
7
there further discussion?
8
favor of the motion, please say aye.
9
Hearing none, those in
FROM THE FLOOR:
10
DR. STRECK:
11
MR. KRAUT:
Is
Aye.
Opposed?
Thank you.
I'm going to batch the next
12
two applicants -- applications for establishment of
13
construction.
14
Avenue Pain Management A.S.C. in Putnam County, which
15
is to establish and construct a diagnostic and
16
treatment center certified as a single specialty
17
free-standing ambulatory surgery center that
18
specializes in pain management services.
19
This is Application 111142B, Stonleigh
An application 12135E, Crystal Run
20
Ambulatory Surgery Center of Middletown and Orange
21
County to transfer interest of thirty-seven new
22
members of Crystal Run Healthcare, L.L.P.
23
application Dr. Bhat has an interest.
24
and the Committee recommended approval with
25
contingencies.
Associated Reporters Int'l., Inc.
This
Both O.H.S.M.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 85
1
8-09-2012 - Latham, New York - Standing Comm.
2
UNIDENTIFIED MALE:
3
MR. KRAUT:
4
Second.
And conditions for the first
one.
5
DR. STRECK:
So we have a batch here
6
with two different applications, both have been made
7
for approval and the motion for approval of both has
8
been seconded.
9
those in favor of the motion to approve both items say
10
Is there discussion?
Hearing none,
aye.
11
FROM THE FLOOR:
12
DR. STRECK:
13
MR. KRAUT:
Aye.
Opposed?
Thank you.
Application 12134E, Metro
14
Community Health Center in New York County to
15
establish as the new operator of four diagnostic and
16
treatment centers currently operated by Cerebral Palsy
17
Association of New York State and as a safety net.
18
just want to note for the record that contingency
19
number one has now been satisfied.
20
contingencies are now satisfied.
21
Committee recommended approval with conditions and any
22
outstanding conditions or contingencies.
23
move.
24
UNIDENTIFIED MALE:
25
DR. STRECK:
Associated Reporters Int'l., Inc.
I
All the
So O.H.S.M. and the
And I so
Second.
The motion for approval
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 86
1
2
8-09-2012 - Latham, New York - Standing Comm.
moved and seconded.
Discussion?
3
FROM THE FLOOR:
4
DR. STRECK:
5
MR. KRAUT:
Those in favor, aye.
Aye.
Opposed?
Thank you.
I'm going to batch the next
6
two applications.
This is application 121103E
7
H.R.N.C. Operating, L.L.C. doing business as the
8
Highland Rehabilitation and Nursing Center in Orange
9
County to establish it as the new operator of St.
10
Theresa's Nursing and Rehabilitation Center.
I'm
11
going to recommend approval with conditions and
12
contingencies, O.H.S.M. and the Committee.
13
application 121168E, Oak Hollow N.C., Corp. doing
14
business as Oak Hollow Nursing Center in Suffolk
15
County, which is the transfer of eighty-four percent
16
of Dr. Jacob Dimant's share as follows:
17
of Rose Dimant, forty percent to Elliott Dimant and
18
forty percent to Kevin Titler.
19
Committee recommended approval with contingencies.
20
And I so move.
And
Four percent
21
UNIDENTIFIED MALE:
22
DR. STRECK:
O.H.S.M. and the
Second.
A batch motion of two
23
applications has been proposed.
24
Those in favor of approval of both applications please
25
say aye.
Associated Reporters Int'l., Inc.
There's a second.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 87
1
8-09-2012 - Latham, New York - Standing Comm.
2
FROM THE FLOOR:
3
DR. STRECK:
4
MR. KRAUT:
Aye.
Opposed?
Thank you.
I'm now going to batch two
5
more applications.
This is application 12174E, Crest
6
Hall Corporation doing business as Lakeview
7
Rehabilitation and Care Center to transfer eighty-four
8
percent of Dr. Jacob Dimant's shares, four percent to
9
Rose Dimant, forty percent to Elliott Dimant and forty
10
percent to Kevin Titler.
Application 121175E, Crown
11
Nursing Home Associates doing business as Crown
12
Nursing Home and Rehabilitation Center in King's
13
County.
14
Dimant's shares as follows:
15
Dimant, forty percent to Elliott Dimant, forty percent
16
to Kevin Titler.
17
contingencies as did the Committee.
Transfer ninety percent of Dr. Joseph
Ten percent to Rose
O.H.S.M. recommends approval with
18
UNIDENTIFIED MALE:
19
DR. STRECK:
20
It has been seconded.
21
none, those in favor aye.
Second.
The motion is for approval.
Is there a discussion?
22
FROM THE FLOOR:
23
DR. STRECK:
24
MR. KRAUT:
25
And I so move.
Hearing
Aye.
Opposed?
Thank you.
I'm going to now move the
certificate of estate -- certificate of incorporation
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 88
1
8-09-2012 - Latham, New York - Standing Comm.
2
as a batch and certificates of dissolution.
3
have for the Methodist Homes of the Aging for Wyoming
4
Conference in the State of New York will change its
5
corporate name to U.M.H. N.Y. Corp.
6
recommends approval and the certificates of
7
dissolution for the Faulk Foundation, St. Claire's
8
Manor of Lockport, St. Joseph's Manor of Olean, St.
9
Luke Manor of Batavia and St. Mary's Manor, the
10
The Committee
Committee recommends approval.
11
DR. STRECK:
Second?
Is there a motion for
12
approval?
13
in favor of the motion, aye.
Discussion?
Hearing none.
14
FROM THE FLOOR:
15
DR. STRECK:
Opposed?
16
MR. KRAUT:
All right.
17
Okay.
Okay.
Those
Aye.
Thank you.
Okay.
going to move category two applications.
18
I'm now
The first --
Then I'm not going to batch these
19
three.
20
Gotham Health F.Q.H.C. New York County.
21
The -- we
This is going to be application 12180E
Dr. Boufford has declared a conflict as
22
did Dr. Sullivan during the initial voting.
23
Boufford has left the room.
Dr. Sullivan is not
24
attending today's meeting.
An interest has been
25
declared by Mr. Fassler and Dr. Martin.
Associated Reporters Int'l., Inc.
Dr.
This is to
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 89
1
8-09-2012 - Latham, New York - Standing Comm.
2
establish Gotham Health F.Q.H.C. as the co-operator of
3
six diagnostic and treatment centers currently
4
operates solely by the New York City Health and
5
Hospital Corporation, as a safety net provider.
6
O.H.S.M. and the Committee recommended approval with
7
contingencies.
And I so move.
8
UNIDENTIFIED MALE:
9
DR. STRECK:
Second.
The motion is for approval.
10
There is a second.
Is there a discussion?
11
none, those in favor do please say aye.
12
FROM THE FLOOR:
13
DR. STRECK:
14
Hearing
Aye.
Thank you.
Opposed.
Thank
you.
15
Could we ask Dr. Boufford to return.
16
Application 0182143E O.M.O.P., L.L.C. doing business
17
as Orchard Manor Inc., in Orleans County to establish
18
it as a new operator of Orchard Manor and transfer the
19
entire membership interest of Nathan Stern to Mosha
20
Shiner resulting in one hundred percent membership
21
interest from Mr. Shiner, O.H.S.M. and the committee
22
recommended approval with contingencies, and I so
23
move.
24
Discussion?
25
The motion is for approval with a second.
Hearing none, those in favor aye.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 90
1
8-09-2012 - Latham, New York - Standing Comm.
2
FROM THE FLOOR:
3
DR. STRECK:
4
MR. KRAUT:
Aye.
Opposed.
Thank you.
Now I'm going to move
5
applications for certified home health agencies for
6
establishment and construction.
7
Application 121135 E Genesee Regional
8
Home Care Association doing business as Lifetime Care,
9
Monroe County.
We have a conflict declared by Mr.
10
Booth, Ms. Hines, and Mr. Robinson, all of which are
11
leaving the room.
12
13
An interest has been declared by Mr.
Fassler.
14
Those individuals have left the room.
15
We're going to transfer ownership of Yates County
16
Certified Home Health Agency to Genesee Region Home
17
Care Association doing business as Lifetime Care.
18
O.H.S.M. and the committee recommends approval and I
19
so move.
20
second.
21
in favor aye.
Motion is for approval.
Is there a discussion?
22
FROM THE FLOOR:
23
DR. STRECK:
24
25
There has been a
Hearing none, those
Aye.
Opposed.
Thank you.
You
can ask them to please return.
MR. KRAUT:
Associated Reporters Int'l., Inc.
I'm going to Application
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 91
1
8-09-2012 - Latham, New York - Standing Comm.
2
121182E McAuley-Seton Home Care Corporation in Niagara
3
County.
4
acquire and merge Niagara County Department Nursing
5
Divisions of Certified Home Health Agency and Long
6
Term Home Healthcare Program.
7
committee recommend approval with a contingency.
An interest has been declared by Mr. Booth to
8
9
DR. STRECK:
approval.
O.H.S.M. and the
Motion -- the motion is for
And a second has been provided.
10
discussion?
11
motion please say aye.
Is there a
Hearing none, those in favor of the
12
FROM THE FLOOR:
13
DR. STRECK:
14
MR. KRAUT:
Aye.
Thank you.
Okay.
Application 2141L,
15
which is a Home Health Agency Licensure for Clinton
16
County Department of Health.
17
an interest.
18
19
Approval with contingencies are
recommended and I so move.
20
21
DR. STRECK:
Discussion?
Moved and seconded.
Those in favor, aye.
22
FROM THE FLOOR:
23
DR. STRECK:
24
MR. KRAUT:
25
Mr. Booth has declared
Aye.
Opposed.
Okay.
Thank you.
Now we'll go into the
applications that had appeared in Book B.
Associated Reporters Int'l., Inc.
Now before
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 92
1
8-09-2012 - Latham, New York - Standing Comm.
2
I do this I'm going to read into the record a
3
contingency and condition which we had asked to be
4
inserted into every application.
5
meeting.
6
This was a long
Let me just -- okay.
So this will apply to all the applicants
7
which we are going to -- where it's appropriate, and
8
which we're going to approve, so I don't have to
9
repeat it consistently.
10
The -- the contingency that would be
11
added into the record for these applications, is the
12
applicant must submit a plan acceptable to the
13
Department of Health that details how it will achieve
14
compliance with a provision of no less than two
15
percent charity care in accordance with all the
16
requirements outlined in Section 763.11A
17
subparagraph -- subline Eleven of Title 10 NYCRR.
18
The next condition -- the other
19
condition that we're going to add to the application
20
is pursuant to 10 NYCRR 762.2 it's either L or I or a
21
One.
22
is the subject of this application within ninety days
23
of receipt of the commissioner's approval of the
24
application, and be providing services in the entire
25
geographic area approved within one year of the
The applicant shall implement the project that
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 93
1
2
3
8-09-2012 - Latham, New York - Standing Comm.
council's recommendations for approval.
Failure to implement and approve the
4
application for the prescribed time shall constitute
5
an abandonment of the application by the applicant and
6
an expiration of the commissioner's approval.
7
That was added because there was a
8
concern expressed by some of the committee members for
9
applicants who added several counties that they had no
10
intent of serving those counties, but rather just
11
submitted it just to cover themselves, and were only
12
interested in one or two of those five counties.
13
And the -- the -- the concern was,
14
therefore, leaving other applicants from, you know,
15
taking up need in those counties.
16
the -- of the committee was that we would add that as
17
a condition that they -- if they didn't serve all the
18
counties they agreed to serve and legally set up the
19
offices in each of the counties, that they needed to
20
to comply with the -- the federal regs within one year
21
of the approval, then the approval would be withdrawn
22
from that applicant.
23
24
25
So the concern of
So they have a year to do what they said
they did -- they're going to do.
DR. STRECK:
Associated Reporters Int'l., Inc.
For all counties.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 94
1
8-09-2012 - Latham, New York - Standing Comm.
2
MR. KRAUT:
Well for the counties that
3
they asked to be approved and they expect to open up
4
business in.
5
DR. STRECK:
6
MR. KRAUT:
Okay.
So they couldn't just wait
7
three or four years to say I'm going to get into that
8
county or that -- that was the issue.
9
I'm sorry.
10
MR. HULBERT:
Mr. Hulbert.
So if an applicant applied
11
in five counties and only really wanted to deal with
12
two, so the other three they haven't done in a year,
13
does he -- does he -- does that applicant lose all
14
five or just gets bounced out of the three --?
15
16
MR. KRAUT:
I know what I would say but
I'll leave it up to the department.
17
DR. STRECK:
That was really my question
18
too because if -- because if it is all five this would
19
be a little late moment for those groups to learn that
20
fact.
Charlie.
21
22
MR. ABEL:
have to defer to -- to Becky Gray who -- who
23
24
25
Yeah, and I -- I'm going to
MR. KRAUT:
-- oh --
Going to have to talk a
little louder.
MR. ABEL:
Associated Reporters Int'l., Inc.
I'm sorry.
I -- I'm going to
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 95
1
8-09-2012 - Latham, New York - Standing Comm.
2
have to defer to Becky Gray who really was the --
3
the -- the crafts person for that condition.
4
MS. GRAY:
Becky.
The department would expect
5
to see them operational in each county that they were
6
approved to provide services to.
7
this R.F.A. to expand their service area into five
8
counties that they had previously not been approved to
9
provide services to within one year we would expect
If they applied via
10
the applicant to be operational in each of those five
11
counties that they're being approved to provide
12
service in.
13
14
DR. STRECK:
And the question is if they
are not?
15
MS. GRAY:
If they are not then I think
16
they wouldn't have met the contingent approval and
17
your council would have to decide what to do about it.
18
DR. STRECK:
19
though.
20
other words --?
Well, that doesn't help
Are they going to get bounced or not?
21
MS. GRAY:
22
DR. STRECK:
In
Bounced by the department?
Yeah.
I mean, it's -- it's
23
sort of -- if you're putting this condition on them
24
and they're in two counties right now and they're
25
applying for five more and they don't do it, do they
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 96
1
8-09-2012 - Latham, New York - Standing Comm.
2
lose those five counties they applied for and
3
subsequently the two counties that they're in?
4
mean, it just -- with all these applications going on
5
it just sort of -- if they're not going to go into the
6
counties that they're supposed to, it's creating a lot
7
of angst for those counties.
8
9
MR. FENSTERMAN:
I
Mr. Fensterman.
Yeah.
It seems to me
that following up on what Bob said, if there --
10
they -- in my view should not lose what they currently
11
have but if they submitted an application to the
12
department for X number of counties, and it is a
13
contingency, the contingency is a contingency in its
14
entirety.
15
It's not a contingency in part.
So they should lose the counties for
16
which they made application and retain that which they
17
currently have.
18
department shouldn't be put to the task of approving
19
additional counties for an applicant that doesn't have
20
any intention to fulfill the execution of that.
That's -- that's my view, because the
21
DR. STRECK:
22
MR. HINES:
But -- Miss Hines.
Well, I would just
23
respectfully disagree and when we discussed this two
24
weeks ago, I voted yes for the contingency with the
25
understanding that if somebody applied for ten and was
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 97
1
8-09-2012 - Latham, New York - Standing Comm.
2
able to open seven within the -- is it a year,
3
eighteen month period, that those seven would be
4
retained, but they would lose the ability to open the
5
remaining -- or remaining three.
6
DR. STRECK:
7
MR. KRAUT:
8
view of it.
9
be clear.
10
Mr. Kraut?
I had a -- I had a different
But, you know, so if you -- well, let's
If you're approved today and you have three
counties, nobody's taking those away.
11
This -- this is -- you know, with
12
grandfather, you know, my impression was we're
13
grandfathering.
14
going to open up in five counties and you have no
15
intention of doing that, then you shouldn't have
16
applied.
17
If you applied and you said you're
And what we're doing IS we're putting a
18
condition on here so if you want to rethink what you
19
submitted, just withdraw your application.
20
not -- if you have no intention of opening up there,
21
but you're on notice that you have to open up in --
22
in -- within the year in the other three -- if you
23
have two -- serving two and you want to now serve
24
three more, you -- you have to serve those counties.
25
That -- that was the expectation.
Associated Reporters Int'l., Inc.
If you're
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 98
1
8-09-2012 - Latham, New York - Standing Comm.
2
DR. STRECK:
But the key question here
3
before the group is this, Jeff.
4
counties?
5
6
MR. KRAUT:
Well, I -- you don't lose
what you're currently licensed --
7
8
Do you lose all five
DR .STRECK:
That's the nub of the
question here.
9
MR. KRAUT:
At least my -- this is --
10
you can't lose what you're currently licensed for,
11
it's only what we're giving you permission to do.
12
DR. STRECK:
13
MR. KRAUT:
Okay.
That's -- that's --.
But it's like a C.O.N.
If
14
you don't do what you say you're going to do in the
15
application, if I don't open up an Am/Surg center and
16
serve -- I lose -- lose the approval.
17
18
19
DR. STRECK:
row.
Okay.
Let's -- go down the
Mr. Hulbert.
MR. HULBERT:
That wasn't the question.
20
I wasn't here for discussion but, what I'm asking is
21
if -- if a -- an applicant is going into five new
22
counties within the given year they have to have an
23
office opened up within those five counties.
24
25
Now if they don't within a year, let's
just say they're only in three counties of the, you
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 99
1
8-09-2012 - Latham, New York - Standing Comm.
2
know, of the five, are they going to lose the two
3
counties that they're not in?
4
lose the five counties entirely?
5
6
7
DR. STRECK:
Or are they going to
Well, I'm glad the
committee discussed this beforehand.
MR. HINES:
Miss Hines?
It -- so -- so two concerns.
8
One is we don't know the intention or if people do
9
know intention they were unaware when they submitted
10
their application that this would be a contingency.
11
So all of the applicants that have been or would be
12
approved today or have been deferred to date don't
13
know about this.
14
So if they had an intent versus the --
15
the other question is capability.
16
applied for ten believing you could accomplish it and
17
then, you know, the world is rapidly changing.
18
this is a -- this is a -- an unprecedented sort of
19
unknown process we're going through, and I don't know
20
that it's fair to add that contingency for all
21
counties if they're unable to open in one.
22
DR. STRECK:
23
MR. KRAUT:
You may have
So
Mr. Kraut?
I would only say that we
24
discussed this before the applicant's came up.
25
applicant that was approved was aware of it when they
Associated Reporters Int'l., Inc.
Every
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 100
1
2
8-09-2012 - Latham, New York - Standing Comm.
spoke to us.
3
No applicant spoke against it.
MR. HINES:
Except that I -- I did not
4
understand that we were talking about every single
5
county.
6
applicants didn't understand that as well.
7
I -- and so I would imagine that some
MR. KRAUT:
I -- I -- well, I would only
8
say if you go back to the record, I think we were
9
exquisitely clear and we have this on tape.
You can
10
review it, but not one applicant even asked us a
11
question about it.
12
the -- and we have -- to my knowledge, we have not
13
received one letter saying that they could not comply
14
with it.
So I -- I would make the point
15
DR. STRECK:
16
DR. BERLINER:
Dr. Berliner?
My -- my question is --
17
is it goes to -- to the heart of it which is what
18
happens to the counties they are operating in?
19
And -- and Rick, correct me if I'm
20
wrong, but I think when you were discussing the
21
approval process they -- in some cases applications
22
were -- were approved because they were in multiple
23
counties or reaching areas that, you know, that other
24
places didn't reach?
25
be if they were approved because they said they were
Associated Reporters Int'l., Inc.
And so the question would then
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 101
1
8-09-2012 - Latham, New York - Standing Comm.
2
going to be in a particular county and then they're
3
not in that county, I mean, shouldn't the whole thing
4
be -- be voided if you will, I mean, at -- at some
5
point?
6
MR. COOK:
I -- I believe we -- we had
7
the same understanding as described by Jeff in -- in
8
the sense that the applications that came in, less so
9
for downstate than upstate, were -- a -- a request for
10
either an expansion or a license and with -- in the
11
areas designated.
12
request, and so we didn't evaluate them, you know,
13
simply based on that -- that we would approve them
14
only in one county.
15
So we evaluated them based on that
If we only approved them in one county
16
we made that decision in the R.F.A., so that -- so in
17
some respects, I think if we were to -- to go
18
differently and say to these entities, you have a
19
contingency based on the approval to operate in five
20
counties, that -- that's the action we're taking.
21
we were to say to them now it's okay for you to only
22
operate in two, then I think that goes against the
23
basic principles of the C.O.N.
24
25
If
Approval.
I mean, that -- that is what we
approved, and the contingency, and, Becky, Linda,
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 102
1
8-09-2012 - Latham, New York - Standing Comm.
2
correct me if I'm wrong, I mean, that was our
3
expectation.
4
five counties, then they should not have applied for
5
those five counties, because to do otherwise then, you
6
know, basically if -- if we had known right now in
7
reviewing the R.F.A.'s, that they were not capable,
8
because remember the review criteria, organizational
9
capability, quality assurance programs, they've
And if they did not want to open up in
10
identified need within those areas.
If we had known
11
that they were not going -- not going to be able to
12
get up and running in a particular county, we might
13
not have approved them.
14
Or we might have approved someone else.
15
So I -- I don't know how we change the rules based on
16
that because we -- we then, quite frankly, go against
17
the principles of the R.F.A. because we might have --
18
we might have recommended something different.
19
DR. RUGGE:
Just a technical question.
20
What satisfies a contingency?
21
office, seeing a set number of patients within that
22
county, would opening an office at Mailboxes Are Us
23
qualify as being a presence?
24
MS. GRAY:
25
Operational means that you're actually
Associated Reporters Int'l., Inc.
No.
Is it opening an
It's Becky.
No.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 103
1
8-09-2012 - Latham, New York - Standing Comm.
2
providing services to individuals in the county that
3
reside in the county throughout the county.
4
DR. RUGGE:
5
MS. GRAY:
Throughout the --?
They have to demonstrate that
6
they are providing services in the entire service
7
area, which is defined as the entire county.
8
9
DR. RUGGE:
So is it -- does that imply
a -- a minimum number of patients being served to --
10
to represent countywide involvement?
11
MS. GRAY:
One would expect to see a --
12
a number of patients served, depending on the county
13
that they're -- some counties now as you said are
14
relatively small, do not have a large volume of
15
patients that are provided services to.
16
So it would be hard to come up with a
17
definitive number, but I would expect to see more than
18
one patient served.
19
20
DR. RUGGE:
But like Jeff said how do
you know when you see it I take it?
21
MR. COOK:
Yes.
And I think, I mean,
22
Becky, correct me if I'm wrong.
The one-year
23
requirement is -- is exactly what's in place right
24
now.
25
seventeen or eighteen years, anyone who's doing
So even though we haven't approved any CHHAs in
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 104
1
8-09-2012 - Latham, New York - Standing Comm.
2
business as a home care agency, because I believe that
3
was the question that came up is -- was the
4
expectation that within one year they needed to be up
5
and running.
6
So I -- I -- I don't think, again, I
7
would be very concerned if we were to go against that.
8
You have to be -- you have to meet the criteria and
9
conditions that we approved as part of the R.F.A. that
10
you sent to us, because if we were to do otherwise
11
then the principles -- we would be going against the
12
principles of the R.F.A.
13
would have acted differently.
14
looked at other applications and circumstances.
15
MR. HINES:
And we -- we -- we clearly
We -- we would have
I -- I understand your
16
point.
Can we -- I'd like to request that as we
17
design the process, you know, you have noted that
18
we'll continue to look at how we'll do an ongoing
19
review of CHHAs that part of that process be that a
20
year from now if there's an organization that, from a
21
capability perspective because as you said the world
22
is changing rapidly, I -- I would want for them to
23
have the opportunity to come back and state their
24
case.
25
in one county to speak to that and keep approval for
If they're incapable of opening, for example,
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 105
1
2
3
8-09-2012 - Latham, New York - Standing Comm.
the others that they were successful at.
MR. COOK:
I think we would pledge to
4
come back on, you know, a quarterly basis to let you
5
know where things are going.
6
the intent here is kind of -- I -- I see this as a
7
technical legal intent to comply with the principles
8
of the R.F.A. and the C.O.N. process.
9
Look at -- our -- the --
I think there's a second element here of
10
making sure that individuals who have applied, have
11
thought through this process and didn't try and gain a
12
license to keep someone else out.
13
And we have had that circumstance in
14
nursing home beds.
We've had that circumstance in
15
other programs.
16
trying to get at with that one year extension and say,
17
if you've come through and been approved you can't
18
hold this forever and then prevent us from looking at
19
other applications that might be necessary.
And so that's -- that's what we're
20
DR. STRECK:
This side of the room okay?
21
This side of the room okay?
22
So we have the proposed universal
23
contingency that I think we would want to vote on
24
first that -- and then it would be applicable to each
25
of the applications that will follow.
Associated Reporters Int'l., Inc.
Okay.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 106
1
8-09-2012 - Latham, New York - Standing Comm.
2
MR. KRAUT:
3
DR. STRECK:
4
MR. KRAUT:
Let me just clarify -Okay.
Pardon me.
-- the charity care
5
requirement is a contingency which you sat -- you
6
know, you acknowledge and you satisfy after you opened
7
the -- a condition or -- and the issue about the one
8
year is a condition which you have to be operational,
9
correct?
10
the approval and then we look one year later.
11
12
You have to agree to it as a condition of
DR. STRECK:
So we have -- we are adding
a condition and a contingency.
13
MR. KRAUT:
14
DR. STRECK:
That's correct.
One of each to each of
15
these applications and then egalitarian manner to --
16
to each of these.
17
Okay.
MS. REGAN:
Sue.
Question.
On the two
18
percent I -- I thought I heard you to say that we're
19
just asking them to tell us how they're going to do
20
it.
21
see that they have done it before they're given their
22
whatever it is.
23
But is there any checking up at the other side to
MR. KRAUT:
First I would say that
24
almost all the applicants who are current here had a
25
charity care requirement.
Associated Reporters Int'l., Inc.
You know, we looked at
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 107
1
8-09-2012 - Latham, New York - Standing Comm.
2
their, you know, their Medicaid accessibility and we
3
looked at charity care.
4
answer.
5
to answer, about, you know -- what's the post approval
6
audit.
So I -- I don't know the
Somebody from the department's going to have
7
MS. REGAN:
Right.
8
DR. STRECK:
9
MR. FENSTERMAN:
Right.
Mr. Fensterman.
In the last part of
10
what the chairman of the establishment committee
11
as the condition, are you adding in that if the
12
counties are not opened that the approval is then
13
voided?
14
15
MR. KRAUT:
That -- let me just read
that line.
16
Failure to implement an approved
17
application within the prescribed time shall
18
constitute abandonment of the application by the
19
applicant and an expiration of the commissioner's
20
approval.
21
said
MR. HINES:
So I guess my concern is how
22
might we formalize.
23
develop the process for further review to allow that
24
applicant to come back, but how might we formalize
25
that to assure that it occurs?
Associated Reporters Int'l., Inc.
I know there's an intent as we
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 108
1
8-09-2012 - Latham, New York - Standing Comm.
2
DR. STRECK:
May I suggest on that point
3
that in the approval letter would it be helpful,
4
Charlie, to reemphasize the point that this approval
5
letter constitutes this fact and that if they were
6
unaware of that you want to reaffirm that that is the
7
action that was taken by the council so they know from
8
the start that they have the one year?
9
would that address your concern, Vicki?
10
MR. HINES:
In part.
Would that --
I -- I think
11
I'm -- I'm more talking about the last point that I
12
just made about if a year later they've been able to
13
operationalize all but one of ten counties, would they
14
have the opportunity to come back to the department?
15
MR. COOK:
16
sound -- I don't -- I'll just say it.
17
us getting into now kind of formalizing process for
18
them to come back might give an expectation that
19
that's something they can do.
20
that.
21
Vicki, the -- this may
My concern with
I don't want to do
I mean, they -- they submitted an application.
I think what we need to pledge to the
22
council as well as to the applicants is if there are
23
changes in circumstances and we need to go back and
24
revisit, we will come back with reports to this
25
council for a decision.
Associated Reporters Int'l., Inc.
But I -- I'm concerned here
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 109
1
8-09-2012 - Latham, New York - Standing Comm.
2
of again giving any kind of expectation other than
3
what we have a decision on.
4
And if -- I think Dr. Streck's point is
5
a really good point.
6
circumstances have changed and if they for some reason
7
weren't serious about their proposal, then they should
8
understand that we will not allow them to simply open
9
in two counties and not pay attention to the other
10
In the letter that we send, if
three that they applied for.
11
MR. HINES:
I'm comfortable with that.
12
DR. STRECK:
Okay.
We are I believe now
13
ready to vote for the addition of the condition and
14
the contingency to the applications we will
15
subsequently consider.
16
could you move those again, Jeff, just for me?
17
MR. KRAUT:
So just for clarification
Yeah.
I'd like to move that
18
the following contingency will be added into the
19
record of the applicants I'll mention.
20
must submit a plan acceptable to the Department of
21
Health that details how they'll achieve compliance
22
with a provision of no less than two percent charity
23
care in accordance with the requirements outlined in
24
Title 10 -- in the relevant section of Title 10, and
25
will add a
The applicant
condition pursuant to Title 10 as 762.2 L
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 110
1
8-09-2012 - Latham, New York - Standing Comm.
2
the applicant shall implement the project that is the
3
subject of this application within ninety days of
4
receipt of the commissioner's approval of the
5
application and be providing services in the entire
6
geographic area approved within one year of the
7
council's recommendations for approval.
8
9
Failure to implement an approved
application within the prescribed time shall
10
constitute an abandonment of the application by the
11
applicant and an expiration of the commissioner's
12
approval.
13
DR. STRECK:
There is a motion and a
14
second.
Is there further discussion on this?
15
none those in favor of the motion as
16
proposed please say aye.
17
FROM THE FLOOR:
18
DR. STRECK:
19
So those -- the condition and
Hearing
Aye.
Opposed.
Thank you.
20
contingency now apply to those projects you will
21
enumerate.
22
MR. KRAUT:
23
DR. STRECK:
24
MR. KRAUT:
25
Health and Home Care, New York County.
Associated Reporters Int'l., Inc.
I will enumerate.
Proceed.
Application 12120C HHC
We have a
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 111
1
8-09-2012 - Latham, New York - Standing Comm.
2
conflict declared by Dr. Bhat, Dr. Boufford, Dr.
3
Sullivan who is not here.
4
are leaving the room.
5
by Mr. Fassler, Dr. Martin and Miss Regan.
6
Dr. Bhat and Dr. Boufford
An interest has been declared
Dr. Bhat has left the room with Dr.
7
Boufford.
O.H.S.M. and the committee recommended
8
approval.
The committee recommended approval with the
9
added condition and contingency as previously
10
approved.
11
And I so move.
DR. STRECK:
We have a motion and a
12
second.
Is there a discussion on the application?
13
Hearing none those in favor aye.
14
FROM THE FLOOR:
15
DR. STRECK:
Aye.
Opposed.
Thank you.
Could
16
you ask Dr. Bhat and Dr. Boufford to come back?
17
that was just with the added condition you said, okay
18
on the previous.
19
MR. KRAUT:
So
I'm going to batch the next
20
eight applications because we have no conflicts here
21
and there were no issues discussed.
22
Application 121226C Nursing Sisters Home
23
Care Inc., doing business as Catholic Home Care in
24
Suffolk County.
25
And interest declared by Miss Regan.
121249 C Visiting Nurse Services in
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 112
1
8-09-2012 - Latham, New York - Standing Comm.
2
Westchester.
3
Hines abstained from voting.
4
disapproval as proposed and contingent approval is
5
being amended by the department to serve the Bronx
6
County with a contingency recommended and the added of
7
condition.
8
9
Interest declared by Miss Regan, Miss
O.H.S.M. recommended
The committee recommended disapproval as
proposed.
Contingent approval was amended by the
10
department to serve the Bronx County with contingency.
11
And add condition was recommended with one member
12
abstaining.
13
121212C Dominican Sisters Family Health
14
Services.
15
is in Westchester.
16
recommended disapproval as proposed but contingent
17
approval as amended by the department to serve Kings,
18
Nassau, New York, Queens and Richmond counties with a
19
contingency and an added condition recommended.
20
An interest declared by Miss Regan.
This
The O.H.S.M. and the committee
121243C United Odd Fellow and Rebekah
21
Home LTHHCP of Bronx County interest declared by Miss
22
Regan and Mr. Fassler.
23
Approval by the committee with the added condition.
24
25
Approval by O.H.S.M..
Application 121216 C Visiting Nurse
Association of Long Island and Nassau County.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 113
1
8-09-2012 - Latham, New York - Standing Comm.
2
Interest declared by Miss Regan.
3
The committee approval with added condition.
4
O.H.S.M. approval.
121291C the Wartburg Home in Westchester
5
County.
6
Regan.
7
All the contingencies have now been satisfied for this
8
applicant.
9
committee recommended approval with the added
10
An interest declared by Mr. Fassler and Miss
Contingency Number One has been satisfied.
O.H.S.M. recommended approval and the
condition.
11
UPR Care Corp, Inc., doing business as
12
Cold Spring Hills Center for Nursing and
13
Rehabilitation in Nassau County.
14
Miss Regan.
15
contingency as did the committee at -- including the
16
added condition which was recommended.
17
Interest declared by
O.H.S.M. recommended approval with
Application 121424C Village Care Long
18
Term Home Health Care Program in New York County.
19
interest declared by Mr. Kraut and Miss Regan.
20
O.H.S.M. recommended approval as did the committee
21
with the added contingency and condition and I so
22
move.
23
DR. STRECK:
So we have these -- this
24
batched group.
25
Is there discussion on any of the applicants?
Associated Reporters Int'l., Inc.
An
A motion and a second on the floor.
Hearing
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 114
1
8-09-2012 - Latham, New York - Standing Comm.
2
none, those favor of all those proposed please say
3
aye.
4
FROM THE FLOOR:
5
DR. STRECK:
6
MR. KRAUT:
Aye.
Opposed.
Thank you.
Application 121203C Personal
7
Touch Home Aides of New York Inc., Kings County.
An
8
interest was declared by Miss Regan and Mr. Fassler.
9
Miss Hines and Dr. Martin abstained from voting on
10
this application.
O.H.S.M. recommended approval with
11
contingencies.
12
with a contingency and have added condition.
13
was an issue on this application -- well, I so move.
The committee recommended approval
There
14
MS. FOSTER:
Second.
15
DR. STRECK:
There's a motion and a
16
second.
17
Mr. Fassler?
18
Is there a discussion on this application?
MR. KRAUT:
Well, let me just make the
19
point.
There was an issue on this application
20
regarding the financial condition of the applicant
21
with negative equity and working capital, working --
22
not working capitals, negative equity or negative
23
assets.
24
Abel to that point.
25
raised that we would discuss at today's committee, so
You should have received a letter from Mr.
Associated Reporters Int'l., Inc.
There was a question that was
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 115
1
2
8-09-2012 - Latham, New York - Standing Comm.
Mr. Abel will.
3
4
DR. STRECK:
Okay.
Mr. Abel and then
Mr. Fensterman.
5
MR. ABEL:
We -- as a result of the --
6
the concerns expressed at the committee meeting I --
7
we worked on a memo -- the August 7th memo laying out
8
our -- an overview of the financial position of the
9
applicant detail well beyond what we had in our -- in
10
our exhibit.
Although all of the conditions that we
11
reviewed and that were detailed in the memo certainly
12
were part of our financial review prior to bringing it
13
to council and I'll be glad to address any questions
14
that any committee members may have after that --
15
after taking into consideration that memo.
16
DR. STRECK:
Thank you.
17
MR. FENSTERMAN:
Thank you.
Mr. Fensterman.
Yes, Mr. Chairman.
My
18
problem with this application is my intention to make
19
a motion to defer the application.
20
position is as follows, and I think that Mr. Abel
21
wrote a -- a very good memo on it.
22
we have an entity here that is in both negative
23
working capital and in negative stockholder equity.
24
So it has two -- if there was an Article 28
25
application we wouldn't even be talking about it
Associated Reporters Int'l., Inc.
This basis of my
My concern is that
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 116
1
2
3
8-09-2012 - Latham, New York - Standing Comm.
because of those two factors.
So my concern is -- is that I would like
4
to see, and I know that the department reviewed the
5
financial information, but this goes along with one of
6
the concerns that we've raised at establishment and
7
the vice chairman of the establishment committee, Mr.
8
Booth raised and I know that Mr. Cook was kind enough
9
to address in our establishment meeting, which is the
10
amount of data that is available to us first in
11
establishment and then as a committee, the full
12
council as a whole.
13
In this particular instance, I would
14
like to see the full financial statements that have
15
been submitted because in my view this application has
16
a blemish and I'm certain that given the sensitivity
17
of the entire application process, all the discussions
18
that we've had, that in all likelihood the
19
overwhelming majority of the applications that were
20
denied slashed deferred probably were from applicants
21
who were not in negative equity or negative
22
stockholder equity.
23
They were in positive.
We have an application here with some
24
negatives, so while I am not urging the denial of the
25
application, I would like the opportunity that this be
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 117
1
8-09-2012 - Latham, New York - Standing Comm.
2
deferred to establishment.
I would like the financial
3
statements in their entirety and any other financial
4
information that any member of the establishment
5
committee or the council as a whole would like to
6
review be provided to us well in advance of the
7
meeting so that we have the opportunity to review it,
8
digest it and analyze it,
9
and thereupon ask the applicant questions with regard
10
to the fact -- with regard to what these issues are,
11
because in my judgment this is a blemish on the
12
application.
13
And, we don't have that full financial
14
information and one of the things that this goes to
15
the overall issue that we've addressed is the amount
16
of data that's provided to us.
17
And I understand it has to really be
18
done on a case-by-case basis.
19
Deputy Commissioner Cook indicated the establishment
20
committee and I agree with him that we're in danger of
21
being given too much information, and then when an
22
issue arises we may not have enough information.
23
that's why it really has to be on a case-by-case
24
basis.
25
So if we -- I think
So
But I think that when a member of the
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 118
1
8-09-2012 - Latham, New York - Standing Comm.
2
establishment committee in that process which is the
3
only time when we get to ask the applicant questions,
4
has an issue, the data has to be available to analyze
5
relative to that issue.
6
and we -- we don't have it now to -- but we have a --
7
a consolidated statement and a balance sheet, but we
8
don't have the full financials.
9
And we didn't have the data
And given that, Mr. Chairman, my view is
10
this.
That this application should be deferred and
11
they should have that information to all of us and we
12
should digest it.
13
to the issue of the data that is being given to us, so
14
that we're informed before we make these decisions.
15
Thank you.
16
And on the overall issue, it goes
DR. STRECK:
Thank you, Mr. Fensterman.
17
Mr. Kraut has to read something in the record and then
18
we'll --?
19
MR. KRAUT:
I'm sorry.
I -- I just -- I
20
failed in -- we'll put this in the category of
21
obvious.
22
Regan, Mr. -- Ms. Regan and Mr. Fassler and abstention
23
by Miss Hines and Dr. Martin we -- Mr. Fensterman
24
opposed the application.
25
that --.
In addition to the interest declared by Miss
Associated Reporters Int'l., Inc.
So I just had to write
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 119
1
8-09-2012 - Latham, New York - Standing Comm.
2
DR. STRECK:
Okay.
So that -- that
3
takes care of the record keeping.
4
the point just in terms of Roberts Rules here.
5
have a motion on the floor for approval.
6
introduced into discussion by Mr. Fensterman the
7
concept of deferral, so to go through this process we
8
will discuss the motion and if the -- and then if --
9
if the motion is acted upon one way or another,
10
deferral may be considered.
11
MR. BOOTH:
Now we return to
We
We have
Mr. Booth.
My question would be to
12
Rick.
Is -- is there any real implication to the
13
R.F.A. process if we just defer this for -- until
14
September and have the applicant come forward to
15
answer questions?
16
17
MR. COOK:
We -- we could defer it
to September if that's the request of the council.
18
19
No.
DR. STRECK:
Mr. Berliner -- Dr.
Berliner.
20
DR. BERLINER:
Is there a reason why the
21
negative equity
22
I guess following up on that, should it be?
23
MR. FENSTERMAN:
24
DR. BERLINER:
25
criteria isn't part of Article 37 and
Thirty-six.
Thirty-six.
Sorry.
Thank you.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 120
1
8-09-2012 - Latham, New York - Standing Comm.
2
3
DR. STRECK:
I don't know to whom we can
address that question.
4
MS. GRAY:
5
wrote it.
6
that question.
7
I wasn't there when they
I don't know.
MR. LEVIN:
I don't know the answer to
So if somebody -- if
8
somebody was asked for more information when --
9
knowing the data was available I -- I think this is a
10
matter of principle, that if a member or members
11
request data to better -- make a better judgment on
12
the -- on their final decision, I think they should
13
have that opportunity.
14
no consequence -- meaningful consequence in delaying
15
to the next session.
16
And particularly when there's
We -- we want to be data driven.
We're trying to
17
move the healthcare system in that direction so I
18
think it's really, for me, a matter of principle.
19
MR. BOOTH:
Just add my support to that
20
so I assume we have to vote on the motion that's on
21
the floor first and then we can --
22
DR. STRECK:
23
MR. BOOTH:
24
25
Right.
-- take another motion,
right?
DR. STRECK:
Associated Reporters Int'l., Inc.
I -- I believe the way to
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 121
1
8-09-2012 - Latham, New York - Standing Comm.
2
do this is to -- the motion is for approval.
So if
3
the motion for approval does not pass, that does not
4
constitute disapproval.
5
not pass at which time if it is the preference of the
6
group, a motion for deferral could be entered.
It just means the motion did
7
So everybody clear on the approach here?
8
And with that there is a motion for
9
approval from the committee that has been seconded.
10
Those in favor of the motion as initially presented
11
please say aye.
12
13
That motion does not pass.
another motion?
14
Is there
Mr. Fensterman?
MR. FENSTERMAN:
Yes, Mr. Chairman.
I
15
make a motion to defer the application to the
16
establishment committee subject to the department
17
providing each member of the council not merely just
18
the establishment committee but each member of the
19
Council, the financial statements of the applicant as
20
well as any other data any member may require in
21
evaluating their judgment.
22
MS. FOSTER:
Second.
23
DR. STRECK:
There is a motion and a
24
second to defer this.
25
motion?
Is there discussion on the
Mr. Kraut.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 122
1
8-09-2012 - Latham, New York - Standing Comm.
2
MR. KRAUT:
There -- there have -- I
3
mean, I hear it.
4
little pause for thought is any other information.
5
There has to be some materiality and some reason --.
6
7
8
9
It's the last phrase that gave me a
MR. FENSTERMAN:
information.
I'll amend it to financial information.
MR. KRAUT:
But, you know, you -- you
want cancelled checks?
10
MR. FENSTERMAN:
11
MR. KRAUT:
12
I'll say financial
No.
Well, you know, that --
that's where I just don't want to leave it open.
13
MR. FENSTERMAN:
14
MR. KRAUT:
I -- I --.
I just -- not that I'm -- I
15
just -- just to be fair to the applicant --.
16
MR. FENSTERMAN:
The only reason I couch
17
it that way is because I trust the judgment of the
18
people around the table that they're not going to be
19
unreasonable and they're only going to ask for
20
information that is relevant to their making an
21
informed determination.
22
23
24
25
DR. STRECK:
Okay.
material financial information?
MR. FENSTERMAN:
So how about
That language --.
I'm -- I'm prepared to
accept that, Mr. Chairman.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 123
1
8-09-2012 - Latham, New York - Standing Comm.
2
DR. STRECK:
Thank you.
Okay.
So we
3
have a motion and a second to deferral -- for deferral
4
of the application and the submission of material
5
financial information as requested for the full
6
council not just for the committee.
7
MR. FENSTERMAN:
8
DR. STRECK:
9
Correct, Mr. Chairman.
That is the motion.
there a discussion on that motion?
Is
Hearing no further
10
comments, I would ask for those who are in favor of
11
the motion for deferral as presented to say aye.
12
FROM THE FLOOR:
13
DR. STRECK:
14
deferred.
15
Aye.
Opposed.
Proposal is
Thank you.
MR. KRAUT:
Okay.
Application 121309E
16
Center Light Certified Home Health Care Agency, Kings
17
County.
18
leaving the room.
19
O.H.S.M. -- Mr. Fassler has left the room.
20
and the committee recommend disapproval as proposed.
21
A conflict declared by Mr. Fassler who's
An interest declared by Miss Regan.
O.H.S.M.
A contingent approval as amended by the
22
department to serve Bronx, Kings, Nassau and New York,
23
Queens, Richmond, Suffolk and Westchester Counties
24
with the added contingency and added condition
25
recommended by the committee, and I so move.
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 124
1
8-09-2012 - Latham, New York - Standing Comm.
2
MS. FOSTER:
Second.
3
DR. STRECK:
Would you clarify what we
4
are giving a contingent approval or a disapproval?
5
MR. KRAUT:
No, this isn't a -- a --
6
what happened is, I should have made this clearer.
7
The -- some of the applicants applied for counties
8
that were not part of the downstate batch.
9
therefore the department recommended disapproval.
10
So
So let's say if you -- you wanted to
11
serve Westchester and Orange and Rockland, so we
12
weren't considering Orange and Rockland.
13
to do that in September.
14
We're going
So, we recommended a disapproval as the
15
applicant proposed but approval for the counties we
16
were considering at that time.
17
may return in an approval when we consider the upstate
18
batches.
19
those two at that action.
20
based on the geographic batch we were looking at.
21
This applicant likely
And, then, we would just approve them for
DR. STRECK:
So we separated our actions
So what if they don't go
22
into the counties where they were not eligible to go
23
that you disapproved on it and made contingent?
24
I'm just kidding.
25
Okay.
MR. KRAUT:
Associated Reporters Int'l., Inc.
No,
All right.
Well, it's -- nothing will
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 125
1
8-09-2012 - Latham, New York - Standing Comm.
2
happen until we piece the two together.
3
DR. STRECK:
4
MR. KRAUT:
5
DR. STRECK:
So then the motion is for
contingent approval.
8
9
They'll be -- probably be in
one letter is my guess.
6
7
Okay.
MR. KRAUT:
Well, it's the approval with
the contingency and condition we discussed.
We
10
approved -- we just -- what I'm doing is I'm covering
11
ourselves with the language of saying that we discuss
12
at the beginning we're adding to that.
13
DR. STRECK:
Now are those
14
contingencies.
But I'm also -- I'm trying to get
15
clear that the -- this is -- this is an -- a modified
16
application.
17
MR. KRAUT:
18
DR. STRECK:
That's correct.
We have to be clear that
19
the -- the -- so it's a -- a modified application for
20
which we are providing approval?
21
MR. KRAUT:
22
DR. STRECK:
23
that effect on the floor.
24
MS. FOSTER:
Second.
25
DR. STRECK:
Thank you.
Associated Reporters Int'l., Inc.
That's correct.
Okay.
There's a motion to
Did I hear a second?
Is there
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 126
1
8-09-2012 - Latham, New York - Standing Comm.
2
further discussion or any more questions about this?
3
If not I'm --
4
MR. KRAUT:
Certified Light, Certified
5
Home -- I'm -- because we have -- no, no.
6
said -- I just called this because we -- we have two
7
applications with recusals and then I'll batch the
8
rest.
9
10
DR. STRECK:
ready there.
Okay.
FROM THE FLOOR:
12
DR. STRECK:
that passes.
14
15
So -- ready here,
Those -- those in favor aye.
11
13
I just
Aye.
Thank you.
Opposed.
So
Thank you.
MR. KRAUT:
Could we ask Mr. Fassler to
return to the room.
16
Application 121256 C Isabella Care at
17
Home Inc., New York County.
18
Dr. Berliner who is leaving the room.
19
declared by Mr. Fassler and Miss Regan.
20
has left the room.
21
recommend approval with contingencies and the added
22
condition.
23
A conflict declared by
An interest
Dr. Berliner
O.H.S.M. and the committee
I so move.
DR. STRECK:
Mr. Hulbert.
A motion.
24
second.
25
Hearing none those in favor aye.
Associated Reporters Int'l., Inc.
Thank you.
Placed.
A
Discussion.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 127
1
8-09-2012 - Latham, New York - Standing Comm.
2
FROM THE FLOOR:
3
DR. STRECK:
4
MR. KRAUT:
Aye.
Opposed.
Thank you.
Ask Dr. Berliner to return
5
please.
I am now going to batch the next five, and
6
these are the last applications we'll consider.
7
121252E Jewish Home Lifecare Community
8
Services in New York County.
9
Mr. Fassler and Miss Regan.
An interest declared by
O.H.S.M. and the
10
committee similar to the one we discussed before is
11
recommending disapproval as proposed.
12
A contingent approval as amended by the
13
department to serve Bronx, King, Nassau, New York,
14
Queens, Richmond, Suffolk and Westchester Counties
15
with the added contingency and condition as
16
recommended.
17
Application 121222E Lutheran CHHA Inc.,
18
in -- in Kings County.
19
Regan.
20
with the added contingency and condition.
21
An interest declared by Miss
O.H.S.M. and the committee recommend approval
Application 121247E, Queens Long Island
22
Certified Home Health Agency, L.L.C., Queens County.
23
Interest declared by Miss Regan.
24
committee recommending approval with the added
25
condition and contingency.
Associated Reporters Int'l., Inc.
O.H.S.M. and the
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 128
1
8-09-2012 - Latham, New York - Standing Comm.
2
121446E South Nassau Community Hospitals
3
in Nassau County.
4
O.H.S.M. and the committee recommended approval with
5
the added contingency and condition.
6
Interest declared by Miss Regan.
Application 121286E Lott Community Home
7
Care Inc.
Interest declared by Miss Regan.
8
in New York County.
9
recommended approval along with the added condition
O.H.S.M. and the committee
10
and contingency.
11
application and I so move.
12
This is
There was one member opposing this
DR. STRECK:
So the batch has been
13
moved.
We'll be voting on all applications with this
14
motion.
Those in favor of the applicants as proposed
15
in this batch please say aye.
16
FROM THE FLOOR:
17
DR. STRECK:
18
MR. KRAUT:
19
20
Aye.
Opposed.
Thank you.
And that is the report of
the establishment and project review committee.
DR. STRECK:
Thank you for that
21
scintillating report, Mr. Kraut.
22
was a logistical challenge well managed.
23
24
25
MR. KRAUT:
That was a -- that
If you like that don't miss
our September meeting.
DR. STRECK:
Associated Reporters Int'l., Inc.
Right.
And where is our -800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 129
1
2
8-09-2012 - Latham, New York - Standing Comm.
where -- where is our September meeting?
3
MR. KRAUT:
September will be held in
4
beautiful Rochester in the fall.
5
encourage you, you know, spend a weekend there and
6
spend some money in upstate New York.
7
8
It's going to be in Rochester, September
what date?
9
10
Please also we
DR. STRECK:
No, wait a minute.
Karen's
saying no.
11
MR. KRAUT:
I'm sorry.
12
committee gets to go to Rochester.
13
York City again, right.
14
meeting?
15
MR. LEVIN:
Okay.
a council meeting in Rochester.
17
you.
MR. KRAUT:
We just go to New
What day is the next
We -- we could actually have
16
18
The planning
We would love to host
September 19th is planning
19
and September 20 is the regular committee day and it's
20
being held in New York City with a full council in
21
October 11th.
22
October 12th.
23
And we'll -- and another planning on
DR. STRECK:
Okay.
With those
24
clarifications is there other business to come before
25
the council today?
Associated Reporters Int'l., Inc.
I thank -- I thank everyone for
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 130
1
8-09-2012 - Latham, New York - Standing Comm.
2
the high level of participation considering the double
3
duty required of the council this week.
4
There is lunch is available for the
5
council members in an adjacent room.
6
are adjourned.
7
Thank you.
We
(The meeting adjourned)
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health MeetingAssociated Reporters Int'l., Inc.
Page 131
1
2
3
4
5
6
7
8-09-2012 - Latham, New York - Standing Comm.
STATE OF NEW YORK
I, G. Michael France, do hereby certify that the
foregoing was reported by me, in the cause, at the time
and place, as stated in the caption hereto, at Page 1
hereof; that the foregoing typewritten transcription
consisting of pages 1 through 130, is a true record of
all proceedings had at the hearing.
IN WITNESS WHEREOF, I have hereunto
subscribed my name, this the 14th day of August, 2012.
___________________
G. Michael France, Reporter
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 132
A
abandonment 93:5 107:18 110:10
Abel 94:21,25 114:24 115:2,3,5
115:20
abilities 6:4
ability 97:4
able 5:25 7:13 26:25 29:15
46:15 52:17 53:22 54:23 61:12
97:2 102:11 108:12
Absolutely 16:8
abstained 112:3 114:9
abstaining 82:11 112:12
abstention 118:22
abuse 15:4,10 43:19 58:15,15
academia 52:5
accelerate 61:15
acceleration 41:13
accept 122:25
acceptable 29:6 92:12 109:20
accepting 17:20
access 8:4 19:7 25:9 28:7 35:4
50:23 51:16 61:12 77:8
accessed 2:10
accessibility 107:2
accompany 55:3
accomplish 27:3 99:16
accomplishments 4:6
accounts 61:17
accreditation 50:2 55:3,8
achieve 7:18 41:17 92:13 109:21
acknowledge 106:6
acquire 91:4
Acquisition 82:5
Act 65:6
acted 104:13 119:9
action 15:14 19:2 42:7 44:6
46:15,19 47:17 51:4 53:2
101:20 108:7 124:19
actions 4:3 18:8 19:20 66:12
124:19
activated 43:22
activities 3:10,13,16,22 5:19
19:18 36:5,25 38:7 42:7,13
47:20 51:18 52:21 60:11 63:16
activity 12:9 44:8 48:8 58:22
68:12
ad 49:21 51:10 54:5,21 55:14
add 33:4 67:24 68:18 71:12 72:4
73:7 92:19 93:16 99:20 109:25
Associated Reporters Int'l., Inc.
112:11 120:19
added 62:10 68:10 92:11 93:7,9
109:18 111:9,17 112:6,19,23
113:3,9,16,21 114:12 123:24
123:24 126:21 127:15,20,24
128:5,9
adding 11:15 17:15 106:11
107:11 125:12
addition 9:6 15:8 20:11 57:11
59:19 77:2 109:13 118:21
additional 22:8 24:18,20 26:16
26:25 32:11 35:21 37:10,21
66:6 67:21,23,24 69:7 71:10
73:19 80:19 81:4,20 96:19
address 45:17 50:6,21 76:18
108:9 115:13 116:9 120:3
addressed 117:15
addressing 8:4
adjacent 130:5
adjourned 130:6,7
admission 31:10
adopt 4:18,21 61:5
adoption 3:25 4:17,19 36:17
37:7 40:7,11 60:15,20 63:10
adult 82:8
adults 14:19
advance 7:24 117:6
advancing 37:15
advice 60:7
advocacy 52:5
Affinity 83:20
afford 13:20 17:11 26:9
Affordability 9:13
affordable 20:20
African 11:18
afternoon 44:22
agencies 15:5 25:7,14 31:13,15
31:18 32:4 34:12 35:20 90:5
agency 14:3 15:6 90:16 91:5,15
104:2 123:16 127:22
agenda 4:17 37:16 39:3 50:3,14
65:3
ages 10:25
aggressive 20:3
Aging 88:3
ago 5:7 38:3 40:14 42:8 47:9
96:24
agree 26:15 74:25 77:19 78:2,7
106:9 117:20
agreed 51:11 93:18
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 133
agreeing 77:5
agreement 69:8
agreements 77:6
ahead 44:6 78:16
Aides 114:7
AIDS 10:22 11:9,12,14,17,17
12:2,4
ailments 13:24
air 13:19 14:5
alarmed 12:24
albeit 29:20
Alcoholism 43:18
alert 44:24
align 34:13
aligning 32:18
alignment 36:19
Allen 22:4
Allied 67:11
allocated 14:6 15:22 16:2
allotted 13:17
allow 23:18,24 25:6 107:23
109:8
allowed 33:7
allows 34:19 61:14
alternatives 6:14
ambitious 38:25
ambulatory 10:7,11 67:12 72:19
84:17,20
amend 69:6,12,14 73:12 122:7
amended 112:5,9,17 123:21
127:12
amendment 7:8 18:19,22 19:23
69:17,17 71:10 72:3,8 74:6
amendments 71:25 72:2
American 11:18
amount 59:23 116:10 117:15
amounts 61:17
Am/Surg 98:15
analyze 117:8 118:4
Anderson 75:17,17
anesthesia 66:21
angst 96:7
Anita 58:25
announced 9:9 10:5
answer 63:6 107:4,5 119:15
120:5
anticipation 7:24
anyway 54:15
apparently 44:16 45:6 46:25
48:15
Associated Reporters Int'l., Inc.
appearance 2:24
appeared 91:25
appears 57:13
applaud 6:20
applauding 63:15
applause 26:2
applicable 105:24
applicant 26:9 31:25 32:3 69:20
69:21,24,24 70:9 73:8 78:21
81:7,10,16 92:12,21 93:5,22
94:10,13 95:10 96:19 98:21
99:25 100:2,10 107:19,24
109:19 110:2,11 113:8 114:20
115:9 117:9 118:3 119:14
121:19 122:15 124:15,16
applicants 68:13 75:21 80:17
81:4,10,14,17 84:12 92:6 93:9
93:14 99:11 100:6 106:24
108:22 109:19 113:25 116:20
124:7 128:14
applicant's 99:24
application 31:25 49:25 55:3
66:18 67:10,24 68:7 72:9,11
72:13,15,17 73:2 74:19 78:17
79:11,19 80:4 81:22 82:4,23
83:19 84:13,19,23 85:13 86:6
86:13 87:5,10 88:19 89:16
90:7,25 91:14 92:4,19,22,24
93:4,5 96:11,16 97:19 98:15
99:10 107:17,18 108:20 110:3
110:5,9,10,24 111:12,22
112:24 113:17 114:6,10,13,16
114:19 115:18,19,25 116:15,17
116:23,25 117:12 118:10,24
121:15 123:4,15 125:16,19
126:16 127:17,21 128:6,11
applications 4:11 17:20 23:18
24:6,18,22,25 25:19 33:8
68:11 84:12 85:6 86:6,23,24
87:5 88:17 90:5 91:25 92:11
96:4 100:21 101:8 104:14
105:19,25 106:15 109:14
111:20 116:19 126:7 127:6
128:13
applied 94:10 95:6 96:2,25
97:13,16 99:16 102:4 105:10
109:10 124:7
apply 14:9 57:20 92:6 110:20
applying 55:7 95:25
appreciate 3:4 34:22
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 134
approach 16:20 34:15 121:7
approaching 57:17
appropriate 25:15 34:13 68:17
69:2 71:12 92:7
appropriately 33:24
approval 5:10 7:23 18:2 25:6
38:16 59:18 66:23 67:15 69:7
72:22 73:18 79:3 81:13,16
82:14 83:25 84:6,24 85:7,7,21
85:25 86:11,19,24 87:16,19
88:6,10,12 89:6,9,22,23 90:18
90:19 91:7,9,18 92:23 93:2,6
93:21,21 95:16 98:16 100:21
101:19,23 104:25 106:10 107:5
107:12,20 108:3,4 110:4,7,12
111:8,8 112:4,9,17,22,23
113:2,3,8,9,14,20 114:10,11
119:5 121:2,3,9 123:21 124:4
124:15,17 125:7,8,20 126:21
127:12,19,24 128:4,9
approvals 24:20
approve 5:2 26:25 85:9 92:8
93:3 101:13 124:18
approved 5:8 18:4,9 24:5,22
61:8 72:16 82:15 92:25 94:3
95:6,8,11 97:9 99:12,25
100:22,25 101:15,25 102:13,14
103:24 104:9 105:17 107:16
110:6,8 111:10 125:10
approving 96:18
approximately 11:15 40:9
area 15:24 16:7 26:22 35:7 39:3
41:9 45:20 48:9,23 51:15 52:2
92:25 95:7 103:7 110:6
areas 10:4 16:23 17:9 28:23,24
30:4,13 32:3 36:15 37:15
39:11,21 40:4,6 44:11 50:23
51:24 53:15 55:23 56:2 57:7
100:23 101:11 102:10
arguing 26:8
arguments 81:5
arises 117:22
arm 44:7
arrangement 37:6
array 57:10
Art 38:11
article 27:21 115:24 119:21
articles 45:19
asked 92:3 94:3 100:10 120:8
asking 5:24 98:20 106:19
Associated Reporters Int'l., Inc.
aspersions 78:3
assessment 33:9
assets 114:23
assist 61:10
Assistance 13:19 14:10
assisted 29:3,14 78:25
Associates 79:12 87:11
association 52:4 85:17 90:8,17
112:25
assume 4:15 120:20
assurance 29:11 102:9
assurances 32:7
assure 24:8 107:25
attend 55:14
attending 55:21 88:24
attention 28:8 69:5 80:12 109:9
attestation 41:4
Attorney 44:5
attributes 40:2
at-risk 11:25
audience 2:8,25
audit 107:6
August 1:6 5:6 61:20 115:7
131:6
authority 62:25
authorization 38:4
availability 28:23,25 29:2 32:7
available 2:12 8:7 9:5 21:14
31:22 35:20 38:19 57:11 58:4
65:11,20 116:10 118:4 120:9
130:4
Avenue 67:13 84:14
avoidable 57:5
awarded 16:10
awards 10:5
aware 42:10,14 68:24 99:25
aye 5:3,14 64:22,23 67:6,7 72:4
72:5,13,14 73:3,23,24 79:8,9
81:23,24 82:20,21 83:14,15
84:8,9 85:10,11 86:2,3,25
87:2,21,22 88:13,14 89:11,12
89:25 90:2,21,22 91:11,12,21
91:22 110:16,17 111:13,14
114:3,4 121:11 123:11,12
126:10,11,25 127:2 128:15,16
ayes 73:5
a.m 1:7
A.S.C 84:14
B
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 135
B 91:25
back 23:16,23 24:18 25:21,22
28:22 43:4,24 47:3 64:16 68:6
73:6 80:21 100:8 104:23 105:4
107:24 108:14,18,23,24 111:16
background 53:13 56:22
backing 9:25
bacteria 45:22
bacterial 13:10
baked 34:6
balance 25:12,17 26:10,17 32:14
118:7
ball 8:8
bank 60:25
bankrupt 63:16
bankruptcy 63:17
banks 64:17
banned 6:2
banner 49:8
barely 60:23
barriers 76:12,20
base 53:14
based 31:9 101:11,13,19 102:15
124:20
basic 2:14 20:19 50:23 51:16
101:23
basically 35:17 62:13 102:6
basis 29:4 44:13 61:9 65:19
75:8 105:4 115:19 117:18,24
Batavia 88:9
batch 80:15 81:16 84:11 85:5
86:5,22 87:4 88:2,18 111:19
124:8,20 126:7 127:5 128:12
128:15
batched 113:24
batches 124:18
batching 4:11
bath 6:3 42:3,15,16,24 43:16
Beach 82:24
beautiful 129:4
Becky 29:24 31:4 94:22 95:2,3
101:25 102:24 103:22
bed 9:18 66:21 78:25 79:15
83:22,24
beds 46:10 78:25 79:18,18 80:19
80:24,24,25 82:8,9 83:7,8,24
105:14
beg 74:4
began 48:12 62:23
beginning 7:24 20:5,7 27:19
Associated Reporters Int'l., Inc.
47:18 125:12
begun 12:16 14:3
behavioral 20:18
believe 27:19 75:8 101:6 104:2
109:12 120:25
believes 14:14
believing 99:16
benefit 20:19 35:9
Berger 28:3
Berliner 21:11,12,19 69:18,19
100:15,16 119:18,19,20,24
126:18,19 127:4
best 8:11,17
better 7:19,19 29:8 57:21 65:12
65:13 120:11,11
beyond 59:24 115:9
Bhat 15:20,20 83:3,5,17 84:23
111:2,3,6,16
big 35:7
bigger 17:9
bill 5:20 14:20,20
billion 7:7,15 18:24
birds 48:16
Birkhead 3:15 41:24,25 47:24
48:5 49:16
bit 32:11 40:20 80:2
biweekly 20:22
blackberry 25:25
blemish 116:16 117:11
Block 3:13 36:3,4 76:2,3
Block's 68:2
board 8:25
Bob 61:7,8 64:15 96:9
body 6:19
bono 55:11
book 60:7 91:25
Booth 35:17 90:10 91:3,16 116:8
119:10,11 120:19,23
bother 71:20
Boufford 3:19 49:10,14 56:13,20
59:16 88:21,23 89:15 111:2,3
111:7,16
bounced 94:14 95:19,21
BOUTIN-FOSTER 79:25 80:6
breathtaking 8:18
brief 36:5 42:2 54:8 75:25
briefly 2:19 36:22 38:22 49:15
51:23 76:17
bring 23:5 30:20 52:17 76:20
bringing 24:18 25:22 59:15
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 136
19:17,24 20:18 23:16 26:18,21
27:11 31:4,12,17,23 32:18
34:3,10,17 35:20 39:5 58:22
64:7 65:6 66:21 87:7 90:8,8
90:17,17 91:2 92:15 104:2
106:4,25 107:3 109:23 110:25
111:23,23 113:11,17,18 119:3
123:16 126:16 128:7
careful 28:17
carried 81:25
carry 48:9 52:22
case 4:15 46:21 49:6 57:17
58:10 104:24
cases 11:22 13:4,6,10,13 44:18
45:2,4,21 46:8,23 47:5 48:21
48:25,25 100:21
case-by-case 117:18,23
cash 28:9
cast 78:3
category 3:7,21 88:17 118:20
cath 47:2,10,13
catheterization 46:24
Catholic 111:23
C
cause 13:22 46:2,5 65:21 131:3
C 46:22,23 47:5,15 111:25
causing 6:15
112:24 126:16
census 72:19
calendar 7:23 40:5 56:5
center 14:24 15:3 35:7 67:14
call 42:18 44:22 80:12
79:12 82:5,25 83:21 84:16,17
called 12:13 126:6
84:20 85:14 86:8,10,14 87:7
calling 2:6 14:24
87:12 98:15 113:12 123:16
calls 5:23 24:14 43:12,15,17
centers 85:16 89:3
campaign 12:16
central 12:15 48:23
camping 12:22
Century 1:8
cancelled 122:9
Cerebral 85:16
Cancer 67:11
certain 26:8 29:23 34:13 39:21
candidate 56:2
54:5 77:20 116:16
cap 2:15 21:6
certainly 32:8,12 70:2 78:7
capability 76:14 99:15 102:9
115:11
104:21
certificate 87:25,25
capable 102:7
certificates 88:2,6
capacity 9:19 35:21 50:10 83:24 certified 15:6 31:8,18 35:2
capital 19:14 114:21 115:23
84:16 90:5,16 91:5 123:16
capitals 114:22
126:4,4 127:22
caption 131:3
certify 67:12 72:18 79:15 131:2
captioning 2:16
chair 2:5 66:13
cardiac 46:24,25 47:9
chairman 63:11 66:4 75:25
care 2:23 7:19,20 8:3,5,9,10,10
107:10 115:17 116:7 118:9
9:12,16,17,23 10:7,11,13
121:14 122:25 123:7
14:15,16 15:22 16:13,24 17:4
chairmanship 52:7
17:7 19:3,4,7,8,12,13,16,17
chairs 51:23
115:12
broad 29:25 36:9 52:8
broadcast 2:9,22
broader 16:11
broadly 39:13
Bronx 112:5,10,21 123:22 127:13
Brookdale 27:19,19 28:12
Brooklyn 20:21 27:9,24
brought 61:8 69:5 80:15
budget 8:23
build 39:12
building 17:12 37:21 54:14
78:24
bundled 33:22
burden 65:21
Bureau 44:3
Burke 57:24
business 33:17,20,25 52:4 64:3
79:12 82:5,24 83:20 86:7,14
87:6,11 89:16 90:8,17 94:4
104:2 111:23 113:11 129:24
busy 7:5 9:7 36:6
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 137
challenge 25:17 28:11 30:8,23
33:3 41:14 128:22
challenged 25:11 26:14
chance 58:14
change 23:21,23 26:19 30:21
31:3 33:24 61:24 62:8,11 63:2
63:6 64:5 70:11 83:24 88:4
102:15
changed 62:6,23,25 109:6
changes 32:21 51:12 56:24 61:22
62:2 64:3 108:23
changing 57:20 99:17 104:22
charge 36:15
charity 50:23 92:15 106:4,25
107:3 109:22
Charlie 80:10 94:20 108:4
chart 40:7
check 21:16,17
checking 106:20
checks 43:24 122:9
CHHA 23:15 26:25 127:17
CHHAs 26:7,16 27:6 28:23 103:24
104:19
child 54:16
children 13:24 14:19
choice 26:11 28:25 29:5,11,17
34:16
cholera 45:24
cholerae 45:23
choose 9:4 17:5,9
chose 17:2
chosen 65:16
chronic 13:25 33:21 46:4 52:10
54:16
circulation 47:4
circumstance 105:13,14
circumstances 28:6,9 104:14
108:23 109:6
cities 16:23
citizens 13:17 14:15
City 6:9 15:24 37:22 42:19
45:20 48:9 70:11 89:4 129:13
129:20
Claire's 88:7
clarification 22:15 109:15
clarifications 129:24
clarified 59:15
clarify 17:25 22:11 106:2 124:3
clarity 57:14
cleaned 61:25
Associated Reporters Int'l., Inc.
clear 57:15 97:9 100:9 121:7
125:15,18
clearer 124:6
clearly 24:13 25:21 28:8 30:9
33:6 104:12
clinic 46:24 67:13 72:20
clinical 10:15 33:17,25 39:12
39:14 45:15 46:12
clinician 39:9
clinicians 45:8
Clinton 91:15
close 28:8
closed 46:10
closely 37:19 46:18 48:22 49:4
closing 15:23
cocaine 6:10
Code 63:19
Codes 5:7 60:10,12
coinciding 58:12
COLBY 80:12
Cold 113:12
Collaborative 36:9 38:11
colleague 52:3
colleagues 37:20
Colleen 25:25 58:5
combination 46:11
come 22:10 23:16,23 33:8 35:9
68:6,13 71:13 76:18 103:16
104:23 105:4,17 107:24 108:14
108:18,24 111:16 119:14
129:24
comes 57:5
comfort 30:7
comfortable 25:3 27:7 109:11
coming 6:21,23 35:5 59:8 75:3
Comm 2:1 3:1 4:1 5:1 6:1 7:1
8:1 9:1 10:1 11:1 12:1 13:1
14:1 15:1 16:1 17:1 18:1 19:1
20:1 21:1 22:1 23:1 24:1 25:1
26:1 27:1 28:1 29:1 30:1 31:1
32:1 33:1 34:1 35:1 36:1 37:1
38:1 39:1 40:1 41:1 42:1 43:1
44:1 45:1 46:1 47:1 48:1 49:1
50:1 51:1 52:1 53:1 54:1 55:1
56:1 57:1 58:1 59:1 60:1 61:1
62:1 63:1 64:1 65:1 66:1 67:1
68:1 69:1 70:1 71:1 72:1 73:1
74:1 75:1 76:1 77:1 78:1 79:1
80:1 81:1 82:1 83:1 84:1 85:1
86:1 87:1 88:1 89:1 90:1 91:1
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 138
92:1 93:1 94:1 95:1 96:1 97:1
98:1 99:1 100:1 101:1 102:1
103:1 104:1 105:1 106:1 107:1
108:1 109:1 110:1 111:1 112:1
113:1 114:1 115:1 116:1 117:1
118:1 119:1 120:1 121:1 122:1
123:1 124:1 125:1 126:1 127:1
128:1 129:1 130:1 131:1
command 59:25,25
comment 29:25 30:2 33:7 70:6
75:25
comments 15:18 17:22 21:12,15
21:21 23:9 35:23 38:14,17
47:25 49:10 56:10,15 60:8
64:21 66:7 71:10 72:2 75:22
78:15 81:20 123:10
Commission 3:2
Commissioner 5:18,20 15:17,19
16:8 17:23,24 18:21 20:8
22:14,20 48:6,22 62:15 64:6
117:19
commissioner's 6:3 43:2 92:23
93:6 107:19 110:4,11
committed 8:23 36:12
committee 3:23,24 4:3,20 5:7
18:6 38:9,12,13 39:16 49:11
54:3,10,20,23,24 55:20 56:2
56:18,20 59:8 60:13 63:9,20
66:14,17,22 67:16 71:17 72:22
79:2,19 82:10 83:8 84:2,24
85:21 86:12,19 87:17 88:5,10
89:6,21 90:18 91:7 93:8,16
99:6 107:10 111:7,8 112:8,15
112:23 113:3,9,15,20 114:11
114:25 115:6,14 116:7,11
117:5,20 118:2 121:9,16,18
123:6,20,25 126:20 127:10,19
127:24 128:4,8,19 129:12,19
COMMITTEES 1:4
Committee's 66:8
common 28:2
commonly 12:25
communicate 53:22
communication 22:7 55:11
communities 11:18 16:6,22 29:10
29:23 34:13 35:11
community 11:24 14:2 44:13
46:12 51:4 85:14 127:7 128:2
128:6
community-based 9:16 10:9
Associated Reporters Int'l., Inc.
Company 78:18 83:20
compared 48:4
compelling 68:12
competing 33:2
competition 34:19,25 35:2,3,8
competitive 52:20 80:15
competitor 35:5
competitors 35:8
compiled 65:10
complaints 15:4 43:9,12
complete 4:15 24:2,12
completed 51:5
complex 35:22
compliance 43:24 92:14 109:21
complicated 64:19
comply 93:20 100:13 105:7
component 68:12 76:5
components 59:9
compromised 29:16 46:5
conceivably 77:21
concentrates 48:15
concept 119:7
concern 35:12 93:8,13,15 107:21
108:9,16 115:21 116:3
concerned 12:12,21 35:6 37:25
71:4 104:7 108:25
concerning 60:16 65:3
concerns 99:7 115:6 116:6
concludes 15:15 21:10 41:18
66:4
condition 92:3,18,19 93:17 95:3
95:23 97:18 106:7,8,9,12
107:11 109:13,25 110:19 111:9
111:17 112:7,11,19,23 113:3
113:10,16,21 114:12,20 123:24
125:9 126:22 127:15,20,25
128:5,9
conditioners 13:19
conditioning 14:5
conditions 13:25 46:4 66:23
67:15 72:23 79:3 83:25 85:3
85:21,22 86:11 104:9 115:10
conduct 11:23
conducted 5:6
conference 6:8 42:18 88:4
conferencing 54:2,2
confidence 61:11
confident 25:18
confidentiality 24:10
conflict 4:8,14 78:19 79:14
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 139
83:3 88:21 90:9 111:2 123:17
126:17
conflicts 111:20
conjunction 18:17
connecting 54:4
connections 37:13
consenting 77:7
consents 39:25
consequence 120:14,14
consider 11:13 23:18,24 69:10
109:15 124:17 127:6
consideration 51:22 57:12 59:17
115:15
considered 119:10
considering 124:12,16 130:2
consistency 76:21
consistent 32:19
consistently 92:9
consisting 131:4
consolidated 118:7
constant 58:17
constitute 93:4 107:18 110:10
121:4
constitutes 108:5
construct 66:20 67:12 83:22
84:15
construction 71:13 78:24 82:9
84:13 90:6
consultant 52:18
consultants 53:5,19
consultation 38:21 51:10
consultations 8:16
consume 19:25
consumer 26:11 38:22 39:2
contagious 13:11
contains 19:3
contend 34:24
context 25:7,13 27:3,5,22 28:7
31:24 39:5
contingencies 66:23 67:15 68:11
72:4,23 79:3 83:25 84:25
85:20,22 86:12,19 87:17 89:7
89:22 91:18 113:7 114:11
125:14 126:21
contingency 67:24 68:18 69:7
71:13 73:8,15,17,19 85:18
91:7 92:3,10 96:13,13,13,14
96:24 99:10,20 101:19,25
102:20 105:23 106:5,12 109:14
109:18 110:20 111:9 112:6,10
Associated Reporters Int'l., Inc.
112:19 113:6,15,21 114:12
123:24 125:9 127:15,20,25
128:5,10
contingent 95:16 112:4,9,16
123:21 124:4,23 125:7 127:12
continue 4:12 7:11 10:13 11:23
25:5 27:25 28:4,5 36:11,24
37:19 56:17 104:18
continued 62:4
continues 20:11 21:5
continuing 3:17 50:22 55:19
continuum 34:21
contract 39:22
contractually 39:20
contradictory 58:13,13
convene 5:25
convened 38:10,21
convening 39:8
conversation 55:25
conversations 2:22 7:21
conversion 79:16 83:23
convert 82:7 83:6
convincing 81:11
Cook 3:11 23:12,13 26:13 27:14
28:20 29:24 32:12 64:7 101:6
103:21 105:3 108:15 116:8
117:19 119:16
Cook's 35:24
cooperation 3:5
core 49:24 59:13
Corp 17:14 86:13 88:5 113:11
corporate 88:5
Corporation 87:6 89:5 91:2
correct 100:19 102:2 103:22
106:9,13 123:7 125:17,21
cost 7:20 19:11 57:6,8
costs 19:5
couch 122:16
cough 13:2
council 2:4,6,7,19 4:7 5:8,18
5:22 6:18 18:5 23:17 24:21
25:23 26:12 30:20 33:3 38:17
42:17 49:20 58:19 59:15 61:10
61:22 63:10 95:17 108:7,22,25
115:13 116:12 117:5 119:17
121:17,19 123:6 129:16,20,25
130:3,5
council's 18:8 38:16 93:2 110:7
count 59:12
counter 6:12
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 140
counties 14:7 26:9,23 30:4,15
33:5,6,15 35:6,19 42:18,19,22
48:8 93:9,10,12,15,18,19,25
94:2,11 95:8,11,24 96:2,3,6,7
96:12,15,19 97:10,14,24 98:4
98:22,23,25 99:3,4,21 100:18
100:23 101:20 102:4,5 103:13
107:12 108:13 109:9 112:18
123:23 124:7,15,22 127:14
county 25:14 26:16,23 27:2
29:19 32:5 35:8,9 42:23 43:13
44:25 66:20 67:12 68:8 69:5
79:13 81:8,9 82:6 83:2,21
84:14,21 85:14 86:9,15 87:13
88:20 89:17 90:9,15 91:3,4,16
94:8 95:5 100:5 101:2,3,14,15
102:12,22 103:2,3,3,7,12
104:25 110:25 111:24 112:6,10
112:21,25 113:5,13,18 114:7
123:17 126:17 127:8,18,22
128:3,8
countywide 103:10
couple 38:2 40:8,14 42:8 53:8
course 5:25 7:16 38:15 39:13
53:24
cover 42:21 93:11
covering 125:10
co-chair 38:11 52:13
co-chaired 51:25
co-chairs 54:4
co-operator 89:2
crafts 95:3
create 15:8 19:8,15 36:16 37:6
38:4
creating 14:23 17:15 96:6
credit 61:13
Crest 87:5
crisis 28:10
criteria 102:8 104:8 119:21
critical 23:13 29:12 75:2
cross 26:22,23
Crown 87:10,11
crystal 8:8 84:19,22
culture 33:24
Cuomo 6:8 7:6
curious 48:2 75:9
curiously 57:6
current 22:9 23:23 106:24
currently 11:8,16 20:9 31:5
32:5 37:18 85:16 89:3 96:10
Associated Reporters Int'l., Inc.
96:17 98:6,10
curve 41:10 44:20
C.D.C 44:22
C.D.D 13:8
C.M.S 7:4,21 18:23 20:4,6 21:13
22:25 37:4
C.O.N 32:20 56:23 57:11,14,15
57:20 59:9 98:13 101:23 105:8
D
daily 44:13
damage 6:16
Dana-Farber 75:17
danger 117:20
dangerous 30:3
dangers 12:17
Daring 26:2
dashboard 39:17
data 31:9 32:11 39:18 53:11
65:7 68:4 77:21 116:10 117:16
118:4,5,13 120:9,11,16 121:20
Database 65:16
dataset 65:18
date 1:6 20:6 58:9 62:15 99:12
129:8
day 6:8 10:21 60:8 68:14 129:13
129:19 131:6
days 2:12,13 5:6 62:20 92:22
110:3
day-long 59:10
dead 57:5
deadend 45:13
deal 26:11 27:15,18 56:22 94:11
dealt 76:22
death 46:6
deaths 46:7 49:5,5
debt 28:14 62:15,20
December 20:6 24:19 54:25 56:12
59:16 60:6 80:16
decertification 78:24
decide 95:17
decided 81:7
decision 30:7,8 68:25 81:6
101:16 108:25 109:3 120:12
decisions 32:23 65:12 118:14
declared 72:21 78:19,20 79:14
83:3,4 88:21,25 90:9,12 91:3
91:16 111:2,4,24 112:2,14,21
113:2,5,13,19 114:8 118:21
123:17,18 126:17,19 127:8,18
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 141
127:23 128:3,7
decrease 34:9
deep 23:6
deeper 23:4
defer 71:5,7 94:22 95:2 115:19
119:13,16 121:15,24
deferral 119:7,10 121:6 123:3,3
123:11
deferred 99:12 116:20 117:2
118:10 123:14
deficiencies 65:25
defined 39:21 103:7
definitely 17:21 21:16,17
definitive 103:17
degree 54:15
Delahanty 22:19,20
delaying 120:14
deleted 62:12
delivering 8:9 10:10
delivery 14:4 44:7 65:12
demonstrate 103:5
denial 116:24
denied 23:19 24:6 116:20
department 1:2 2:11 3:7 7:4,6,8
9:6 10:20 15:7,13 18:18,21
22:21 28:8 33:3 37:22 42:10
44:4 47:11 52:2,25 53:10
58:20 59:20 61:14 64:13 71:12
75:20 78:11 80:21 91:4,16
92:13 94:16 95:4,21 96:12,18
108:14 109:20 112:5,10,17
116:4 121:16 123:22 124:9
127:13
departmental 52:2
departments 42:24 43:14 44:23
44:25 50:8,17
department's 5:19 25:3 107:4
dependent 79:15 83:7,22
depending 4:5 103:12
deposit 61:17
depreciation 61:15
depressed 48:14 64:11
Deputy 117:19
DeRotsos 58:25
described 6:9 36:9,22 37:11
61:8 76:17 101:7
describing 63:3
descriptions 23:6
design 104:17
designated 101:11
Associated Reporters Int'l., Inc.
designed 39:8
desire 50:20
despite 49:8
detail 115:9
detailed 115:11
details 20:10 92:13 109:21
detected 45:14
determination 122:21
determines 14:10
develop 31:10 59:13 78:25
107:23
developed 30:18 51:11 52:25
53:19 57:10
development 30:11
diagnosed 11:11,14
diagnosis 11:11
diagnostic 84:15 85:15 89:3
Dick 64:7
different 6:10 8:6,15 27:8
34:22 57:25 85:6 97:7 102:18
differently 101:18 104:13
difficult 28:16 32:22
digest 117:8 118:12
dilute 28:25 29:11
Dimant 86:17,17 87:9,9,15,15
Dimant's 86:16 87:8,14
direct 22:17 33:5 77:17
directed 74:23
direction 27:6 32:25 58:15
120:17
directly 37:2 77:10
disabilities 14:14 15:12
disagree 96:23
disapproval 79:19,23 80:9,18
81:18,22 82:10,16,16,17,18,20
83:9,12 112:4,8,16 121:4
123:20 124:4,9,14 127:11
disapproved 80:5 124:23
discharge 31:10 75:8 81:3
disclose 65:7
Disclosure 65:22
discuss 71:16 114:25 119:8
125:11
discussed 25:10,19 38:9 39:6
51:12 96:23 99:6,24 111:21
125:9 127:10
discussing 71:9 100:20
discussion 3:25 4:24 5:9,13
25:23 35:16 57:2,23 58:25
60:17 65:3 67:3,19 69:17 71:3
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 142
72:10 73:2,22 75:20 79:7,24
82:19 83:13 84:7 85:8 86:2
87:20 88:12 89:10,24 90:20
91:10,21 98:20 110:14 111:12
113:25 114:16 119:6 121:24
123:9 126:2,24
discussions 20:4,5 24:5 59:8
77:7 116:17
disease 12:13 47:17 52:11 54:16
Diseases 67:11
disparities 8:4 20:17 50:22
dispassionate 33:9
disrupt 30:23
dissolution 88:2,7
distilled 59:15
distressed 43:16 60:22
district 42:21
diversity 52:8
diverting 46:25
Divisions 91:5
doctor 17:11
doctors 10:3 17:14,16
document 8:7,11 15:10 55:2
56:12
documented 45:12 47:5
doing 37:18 57:4 63:24 64:15
70:10 71:4 78:5 79:12 82:5,24
83:20 86:7,13 87:6,11 89:16
90:8,17 97:15,17 103:25
111:23 113:11 125:10
dollar 7:7
dollars 7:15 8:21 9:10,24 10:18
13:18 18:25 21:8 41:7
Dominican 112:13
door 41:7
double 130:2
downstate 24:6 76:10 101:9
124:8
dozen 43:11
Dr 2:2,5 3:8,15,19,21 15:17,20
15:20,21 17:22 21:11,11,12,19
21:21 22:8,13 23:10 26:6
28:19,21,22 31:19,24 32:10
33:4,11 34:24 35:14,23 38:12
41:20,24,25 47:24,25 49:9,10
49:14 56:20 59:16 60:4 67:18
67:21 69:10,18,19 70:5,5,7,16
70:22 71:5,9,10,11,21,25 72:6
72:15,25 73:5,10,14,18,25
74:4,7,11,13,16,19 75:22 76:2
Associated Reporters Int'l., Inc.
76:24,24,25 78:15 79:6,10,22
80:3,8 81:19,25 82:14,17,22
83:3,5,11,16,17 84:5,10,23
85:5,12,25 86:4,16,22 87:3,8
87:13,19,23 88:11,15,21,22,22
88:23,25 89:9,13,15 90:3,23
91:8,13,20,23 93:25 94:5,17
95:13,18,22 96:21 97:6 98:2,7
98:12,17 99:5,22 100:15,15,16
102:19 103:4,8,19 105:20
106:3,11,14 107:8 108:2 109:4
109:12 110:13,18,23 111:2,2,2
111:3,3,5,6,6,11,15,16,16
113:23 114:5,9,15 115:3,16
118:16,23 119:2,18,18,20,24
120:2,22,25 121:23 122:22
123:2,8,13 124:3,21 125:3,6
125:13,18,22,25 126:9,12,18
126:19,23 127:3,4 128:12,17
128:20,25 129:9,23
draft 38:8,17,19
drafts 54:20,22
driven 120:16
drives 29:6
drugs 6:10,11
dry 48:13 49:8
due 48:13 53:4 62:15
duty 14:15 130:3
dynamic 57:25
D.O.H 2:20 19:25 36:6,20
E
E 12:14,17 38:10 40:7 90:7
earlier 36:22 37:11 44:24 48:20
64:6 76:17
early 12:2 38:8 45:3 49:2 54:9
55:10
easily 45:7
Eastern 12:14 48:24
easy 59:7 77:25
education 15:22
effect 57:21 125:23
effective 53:14 54:19 57:15
effects 6:23
efficiencies 27:4,7
efficiency 9:12,18
efficient 9:21,22
effort 26:4 27:18 49:18 55:12
56:11,22
efforts 9:25 12:7
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 143
egalitarian 106:15
eight 111:20
eighteen 76:6 97:3 103:25
eighty-four 86:15 87:7
either 41:3 52:3 53:25 58:15
64:4 92:20 101:10
elderly 13:23 29:21
element 27:18 105:9
elements 50:5
elevated 12:25
Eleven 92:17
eligibility 14:11
eligible 60:24 62:11 124:22
eliminated 62:9,10
eliminating 9:18
Elliott 86:17 87:9,15
emerged 44:15 51:9
emergency 3:25 6:19 44:22 60:15
60:19 61:9 62:4
employed 35:20
enacted 20:14
Encephalitis 12:14 48:24
encourage 28:4 30:11 129:5
encouragement 28:17
encourages 10:3
encouraging 11:6 27:23 61:18
Energy 13:18 14:10
enforcement 6:4 44:3
engaged 28:18
engagement 8:13
enhance 19:7,10,17 22:5,5,6
enormous 57:7 59:20,23
enormously 59:20
ensure 10:12 14:7
entered 121:6
entire 8:5,7,12 74:16 89:19
92:24 103:6,7 110:5 116:17
entirely 99:4
entirety 96:14 117:3
entities 65:13 101:18
entity 115:22
enumerate 110:21,22
environment 26:20 56:25 57:20
58:2 60:2,2
environmental 42:20 52:13
epizootic 44:17
equine 12:14 48:24,25
equity 114:21,22 115:23 116:21
116:22 119:21
especially 12:21 13:23 51:17
Associated Reporters Int'l., Inc.
55:15 57:7
essential 14:15
essentially 50:4
establish 84:15 85:15 86:9 89:2
89:17
established 41:3,14
establishment 4:3,10 66:12,16
67:16 84:12 90:6 107:10 116:6
116:7,9,11 117:2,4,19 118:2
121:16,18 128:19
estate 87:25
Ethics 3:3
evaluate 29:3 101:12
evaluated 101:11
evaluating 121:21
evaluation 19:21
evaluations 50:12
everybody 36:6 71:19 121:7
Everyone's 77:25
evidence 33:14 53:14 66:2 69:8
evolve 33:16
exactly 6:18 16:2,10 103:23
example 8:20 11:8 44:7 46:11,18
47:16 104:24
excess 9:18
exchange 68:5,9,15,20 69:9
Exchanges 68:24
excited 55:9
exciting 19:24
executed 69:8
execution 96:20
Executive 3:3
exhaustion 13:22
exhibit 115:10
exist 17:13 54:15
existent 63:16
existing 16:3,10 27:6 30:16
48:15 54:14 66:21 78:23
exists 47:6
expand 10:14 19:7,9,11,16 95:7
expansion 8:3 101:10
expect 94:3 95:4,9 103:11,17
expectation 97:25 102:3 104:4
108:18 109:2
expeditious 66:10
expensive 34:9
experience 32:4 33:5 57:9
expertise 8:12
expiration 93:6 107:19 110:11
explain 63:25
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 144
Fellow 112:20
felt 25:3 62:21
FEMALE 66:25 72:24
Fensterman 73:21 78:18,22 79:14
82:3 96:7,8 107:8,9 115:4,16
115:17 118:16,23 119:6,23
121:13,14 122:6,10,13,16,24
123:7
field 78:2
fifty 8:21 10:17,18 23:7
fifty-eight 9:3,4
fill 3:4 4:8
F
final 20:16 22:16,25 46:19
facetious 3:19
52:12 120:12
facilities 15:5 65:17,23 79:17 finalize 20:5
82:8
finally 40:18 51:2
facility 27:13 62:11,17 78:23
finances 77:15
79:17 83:7,24
financial 28:6,9 61:12 76:13
facing 39:2
114:20 115:8,12 116:5,14
fact 26:10 33:13 40:13 44:21
117:2,3,13 121:19 122:6,7,23
64:2 94:20 108:5 117:10
123:5
factor 81:5
financially 60:22
factors 81:5,12 116:2
financials 118:8
failed 68:23 118:20
financing 58:23 62:16
Failure 93:3 107:16 110:8
find 16:14 27:25 28:13 43:23
fair 28:7 71:8 99:20 122:15
48:12 69:3,3
fall 27:11 129:4
finding 22:22
familiar 36:25 51:8
Fine 74:9
families 15:12
finish 23:25 24:8
Family 112:13
finished 52:24
far 11:17 12:10,12 37:24 45:10 FIPA 31:20 32:2
48:21 49:2
FIPIC 54:24
Fassler 26:7 27:8 78:20 83:5
firm 52:20
88:25 90:13 111:5 112:22
first 2:18 4:18 5:21 9:15 13:3
113:5 114:8,17 118:22 123:17
29:25 36:11 38:8,23 40:4
123:19 126:14,19 127:9
44:14 60:14,19 62:15 66:18
faster 17:10
69:16 85:3 88:17 105:24
Faulk 88:7
106:23 116:10 120:21
favor 5:14 64:21 67:5 72:3,7,12 fiscal 75:7
73:3,23 79:8 81:22 82:20
five 7:16 11:10 15:23 18:25
83:13 84:8 85:9 86:2,24 87:21
29:19 33:5 41:3 51:23 58:11
88:13 89:11,25 90:21 91:10,21
93:12 94:11,14,18 95:7,10,25
110:15 111:13 114:2 121:10
96:2 97:14 98:3,21,23 99:2,4
123:10 126:10,25 128:14
101:19 102:4,5 127:5
fed 43:13
fleshing 39:2 56:3
federal 7:15 13:8,18 17:6,13
flexibility 20:20
18:20 36:13 41:14 61:2 64:11
floor 64:23 67:7 72:5,14 73:20
66:3 93:20
73:24 79:9,22 81:24 82:21
feeding 43:3
83:15 84:9 85:11 86:3 87:2,22
feel 23:7 25:18 27:6
88:14 89:12 90:2,22 91:12,22
exposure 12:19
expressed 93:8 115:6
exquisitely 100:9
extension 72:20 105:16
extensions 67:13
extensive 8:13 53:13 56:10,11
extraordinarily 30:22
extraordinary 26:4 65:21
E-Health 36:8
e-mail 21:18
E.E.E 49:6
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 145
110:17 111:14 113:24 114:4
119:5 120:21 123:12 125:23
126:11 127:2 128:16
flows 28:9
focus 39:10 51:14
focused 27:18
focusing 9:16 13:12 52:6
folks 8:17 16:22,24 17:4,9
follow 3:19 23:15 42:16 43:14
43:19 105:25
following 21:4 46:14,17 74:24
96:9 109:18 119:22
follows 86:16 87:14 115:20
follow-through 42:3
force 78:8
foregoing 131:3,4
forever 105:18
forgiveness 17:8
form 2:24 3:4
formal 71:21
formalize 107:22,24
formalized 39:17
formalizing 108:17
formed 53:9
formerly 62:13
forms 4:8,15 34:9 60:25
forty 9:10 86:17,18 87:9,9,15
87:15
forty-four 13:9
forty-three 10:16
forum 38:22 39:8
forums 8:14 38:21
forward 33:8 58:18 68:19 71:14
77:22 78:13 119:14
FOSTER 114:14 121:22 124:2
125:24
fostering 16:11
found 12:15
foundation 52:17 55:7,13 88:7
founded 75:17
four 8:14 11:13 15:23 36:9 47:9
80:17 85:15 86:16 87:8 94:7
framework 24:19
France 131:2,7
frankly 25:24 32:20 102:16
free 23:7
free-standing 84:17
friend 24:11
front 61:9
Frost 25:25
Associated Reporters Int'l., Inc.
fulfill 96:20
full 5:8 18:5,8 63:10 116:11,14
117:13 118:8 123:5 129:20
FULLER 31:7,21 32:8
fully 34:22 61:3
functionality 37:21 39:12
fund 10:15
funded 76:8
funding 9:20 14:6 19:7,15,20
22:4,9 37:9,12 75:4,9 76:9,11
funds 9:12,13 16:9 61:19 63:15
further 5:13 72:10 82:19 84:7
107:23 110:14 123:9 126:2
Furthermore 12:24
future 15:10 32:7 37:8 39:4
F.Q.H.C 88:20 89:2
G
G 131:2,7
gain 105:11
geared 9:18
General 44:5
generally 36:25
generation 10:10
Genesee 90:7,16
geographic 92:25 110:6 124:20
geographically 49:22 77:20
Geriatric 82:25
getting 24:13 47:14 68:4 108:17
give 3:9,11,15,22,23 29:25 30:6
36:4 39:8 42:2 49:15 108:18
given 3:18 16:3 40:12 98:22
106:21 116:16 117:21 118:9,13
giving 9:7 98:11 109:2 124:4
glad 63:6 99:5 115:13
gladly 35:9
global 21:6
go 6:24 23:6 25:21 26:18 42:13
60:25 61:25 64:10 74:2,11
78:16 80:21 91:24 96:5 98:17
100:8 101:17 102:16 104:7
108:23 119:7 124:21,22 129:12
129:12
goal 24:17 26:19 41:15,17 50:22
55:2 78:7
goals 7:11 32:20 36:9 39:23
50:14
goes 100:17 101:22 116:5 117:14
118:12
going 12:22 16:2,3,4 24:23,24
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 146
25:11,17 26:18 28:22 29:24
30:6,8 32:14 33:16,19,21
34:23 35:17 38:23 39:4,18
41:10 42:2,6,24 43:7 44:13,17
45:4 51:14 52:12 54:14 64:4,8
64:15 66:15 74:15 77:22 78:13
84:11 86:5,11 87:4,24 88:17
88:18,19 90:4,15,25 92:2,7,8
92:19 93:24 94:7,21,23,25
95:19 96:4,5 97:14 98:14,21
99:2,3,19 101:2 102:11,11
104:11 105:5 106:19 107:4
111:19 122:18,19 124:12 127:5
129:7
good 2:2 15:11 18:12 23:13
32:17 36:18 38:13 40:12 45:10
49:14 59:11 74:11 78:5 109:5
115:21
Gotham 88:20 89:2
gotten 38:13 43:15
governance 22:6 77:3
governing 38:4
government 18:20 41:14 61:2
Governor 6:8 7:6 9:9,9 13:16
14:12,14
graduate 15:22
grandfather 97:12
grandfathering 97:13
grant 17:19
grants 9:7,10,14 10:12,17 16:3
Gray 31:7,21 32:8 94:22 95:2,4
95:15,21 102:24 103:5,11
120:4
great 27:15,18 36:14 63:7 76:7
greater 36:19 78:18
Greg 22:3 57:24
ground 2:14 28:2
group 22:24 41:21 49:21 51:11
51:23 52:5,13 54:6,6,10,21
55:14 81:21 98:3 113:24 121:6
groups 34:17 52:9,10,23 53:3,6
53:9,12,21 54:5,13 94:19
growth 40:6
guess 56:16 63:19 107:21 119:22
125:5
guide 53:5
Gus 49:10,16
Gus's 50:15
G.I 46:3
Associated Reporters Int'l., Inc.
H
Hall 87:6
Hampshire 46:21
Hampton 79:12
hand 72:7 78:6
handful 35:6
handle 46:15
happen 9:24 34:23 56:4 58:11
125:2
happened 124:6
happening 27:12,15 42:23
happens 100:18
happy 15:15 20:24 22:15 23:2
26:4 41:18
hard 70:19 103:16
Harlem 78:18
hates 59:21
headed 22:3
headlines 12:3
Heal 9:12 36:13 38:6 40:14
health 1:2 2:3,4 3:7,10,12,14
3:16,18,20,21,22 4:7,7,19,19
7:8,19 8:4,8,10 9:7,12,22
10:20 11:24 12:7 13:22 15:7
17:14 18:10,14,18,22 19:3,8
19:10,16,16,17,24 20:17,18
21:24 22:6,7,9,21 23:12 31:7
31:18 35:25 36:13,17,18,19,24
37:7,10,13,16,20,22 38:5,10
39:2,10,15 40:3 41:24 42:4,6
42:7,10,11,14,20,23 43:14,21
44:4,9,12,23,25 45:16 46:13
46:19 47:10,17,21,22 49:11,24
50:8,17,22 51:4,4 52:2,10,15
53:10 54:16,24 55:20,24 56:7
56:17,19,24 58:20 59:20 64:13
68:3,4,8,15,20,24 69:9 76:4,9
77:10 78:6 79:17 85:14 88:20
89:2,4 90:5,16 91:5,15,16
92:13 109:21 110:25 112:13
113:18 123:16 127:22
healthcare 57:3,9 58:2,8 65:12
65:17,23 82:7 83:7,23 84:22
91:6 120:17
healthy 52:10
Health's 2:11
health-care 7:11
hear 3:8 9:23 15:21 75:21 122:3
125:23
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 147
heard 14:17 58:20 68:2 106:18
hearing 5:2,13 35:24 60:8 64:21
67:5 72:2,12 73:2,22 79:7
82:19 83:13 84:7 85:8 87:20
88:12 89:10,25 90:20 91:10
110:14 111:13 113:25 123:9
126:25 131:5
heart 100:17
heat 13:21,22
Heat-related 13:21
heavy 48:7
held 5:9 129:3,20
help 7:9,18 15:10,13 36:23
52:22 53:5,19 95:18
helpful 32:2,10 55:15 108:3
Hep 47:14
hepatitis 46:22,23 47:5
hereof 131:4
hereto 131:3
hereunto 131:5
HHC 110:24
high 10:13 19:11 35:4,4 130:2
higher 9:16
highest 25:20
Highland 86:8
highlight 42:13
highly 13:11
hiking 12:22
Hills 113:12
Hines 90:10 96:21,22 99:6,7
100:3 104:15 107:21 108:10
109:11 112:3 114:9 118:23
history 40:2 48:4
hoc 49:21 51:10 54:6,21 55:14
hold 105:18
holding 60:23
holds 34:21
Hollow 86:13,14
home 6:7 13:18 14:2,9 21:24
22:6,9 23:16 31:7,18,23 32:18
35:20 64:3 78:18 82:24 87:11
87:12 90:5,8,16,16 91:2,5,6
91:15 104:2 105:14 110:25
111:22,23 112:21 113:4,18
114:7 123:16 126:5,17 127:7
127:22 128:6
homes 9:11,19 19:8 22:7 37:10
39:10 60:14,18,21 61:3,10,11
61:19 63:16,18,23 64:14 65:7
88:3
Associated Reporters Int'l., Inc.
home-care 25:6,14 29:12 33:20
34:8,11
hope 7:22 20:5 42:12 50:18
53:23 54:20,23 55:15 59:17
hopefully 51:2 61:18 76:20
horse 48:25
hospital 11:2 16:6 19:10 27:9
27:10,24 40:11,22 47:8,11
65:15,22 66:19 67:11 68:5
72:18,19 73:9 89:5
hospitalizations 57:5
hospitals 9:11,19 10:8 15:24
19:15 20:21 27:23,24 28:6,10
28:12,12 34:18 41:5 45:2 50:9
65:7 68:7 81:3 128:2
host 129:16
hostage 34:21
hosted 6:8
hot 2:20 12:8
hotline 43:10,15
House 1:8
housing 8:21 19:11 20:20
Houston 75:18
Hulbert 3:23 94:8,10 98:18,19
126:24
human 44:18 48:21 49:5
human-to-human 45:11
hundred 8:20 9:3,4,10 10:18
11:15 12:10 13:4 20:14 23:7
41:7 44:19 89:20
Hunter 52:14
Hurlbut 60:9,12 63:7,9,22 64:19
65:2 66:7
Hygiene 37:23
hyperdynamic 58:2
hypothetically 30:14
H.E.R 40:16
H.I.V 10:21,22 11:3,9,11,14,16
11:17 12:2
H.M.O.s 59:2
H.R.N.C 86:7
H3N2 44:14
I
idea 37:3 70:17
identified 39:23 43:7 46:9 49:3
53:20 102:10
identify 2:19 46:14 47:11,20
identifying 46:13 55:23
illness 46:3
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 148
illnesses 13:21
imagine 75:16 100:5
immune 46:4
impact 25:13 29:4 58:23 62:24
implement 14:3 19:2 20:12 92:21
93:3 107:16 110:2,8
implementation 20:6,23,25 21:4
36:12 50:11
implemented 11:3
implementing 20:13
implication 119:12
implications 58:6 59:5
imply 58:7 103:8
importance 68:3,15
important 2:16 5:22,25 6:17,22
8:2 9:14 27:17 37:14 39:5,19
50:18 57:12,14 76:5
impression 31:16 97:12
impressive 56:11,14
improve 7:10,19 9:15 19:4 31:4
Improvement 49:24
improving 8:3
impulses 58:13
incapable 104:24
incentive 41:8
incentives 58:14
incidents 15:10
include 20:17 22:16 65:23
included 36:23 37:9,11 62:18
includes 19:20 29:5 73:14,16
including 8:13 15:6 46:6 50:23
76:14 77:20 113:15
income 13:18,20
incorporation 87:25
increase 11:4,6 19:15 34:8
37:12 39:25
increased 12:9 33:13 48:12,17
48:20
increasing 39:24 40:15 41:10
increasingly 39:4
Indiana 44:19
indicate 35:18 58:13
indicated 48:6,23 117:19
indicator 65:4
indicators 60:17 65:8,9,16
individual 8:16 30:15 31:14,17
34:7 46:24 47:8,13
individuals 12:18 14:22 15:2
24:14 31:12 90:14 103:2
105:10
Associated Reporters Int'l., Inc.
inefficient 25:15
infants 13:23
infected 46:22
infection 13:10 45:13,22 46:5
47:5
influenza 44:14,16 45:3,3,4,7
inform 12:16
information 3:14 12:20 17:18
30:7 35:25 36:14,24 37:7,13
38:5 40:3 42:22 43:4 56:22
62:14 65:8,10,19,20 66:4
67:25 68:5,9,15,20,24 69:9
76:4 77:5,8,18,24 81:6 116:5
117:4,14,21,22 118:11 120:8
122:4,7,7,20,23 123:5
informed 47:7 118:14 122:21
infrastructure 19:8 22:5 36:18
51:20 52:19
inherent 33:18
initial 55:25 88:22
initially 23:19 38:14 39:10
121:10
initiative 18:16 21:24 22:9
43:11 68:16
initiatives 13:15 18:16 19:4,22
20:23,25 25:8
inner 16:23
innovations 19:17
inpatient 34:10
input 39:9,14
inserted 92:4
insidious 6:13
installation 14:4
instance 116:13
instances 57:4 75:2
instill 34:18
institutions 10:7
insufficient 76:14
Insurance 3:10 18:11,14
integrate 30:17 32:21
integration 28:2
intended 2:22 65:6 76:17
intent 93:10 99:14 105:6,7
107:22
intention 96:20 97:15,20 99:8,9
115:18
interest 4:8,14 52:8 70:8 72:21
78:20 83:4 84:21,23 88:24
89:19,21 90:12 91:3,17 111:4
111:24 112:2,14,21 113:2,5,13
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 149
113:19 114:8 118:21 123:18
126:18 127:8,18,23 128:3,7
interested 14:9 20:10 21:3
93:12
interesting 58:6
interestingly 43:14
Interfaith 27:22 28:13
interfere 30:24
interim 4:4
internal 17:8
internationally 45:24
internet 2:9
interventions 53:14
introduced 119:6
investigate 15:4
investigations 65:24
investment 9:20 40:12
investments 8:20 40:15
Invitations 52:9
involve 40:4 47:19,19
involved 30:10 37:2 68:4
involvement 50:17 103:10
in-person 53:24
Isabella 126:16
Island 45:20 46:9 80:16,18
112:25 127:21
isolation 57:16
issue 23:14 25:11 32:13 42:4
44:14 51:16 64:11,19 65:25
75:7 76:3 94:8 106:7 114:13
114:19 117:15,22 118:4,5,12
118:13
issues 12:7 25:9 26:14 29:22
30:19 39:15 55:24 58:17 76:18
76:21 111:21 117:10
item 4:16 55:22 65:2
items 85:9
it'll 58:11
I.T 22:5 36:17,18 37:16 39:3,15
J
Jacob 86:16 87:8
January 20:7 52:23 55:5,16
Jeff 34:24 69:19 71:11 98:3
101:7 103:19 109:16
jeopardy 29:7
Jewish 127:7
Jim 26:2
Joe 49:12
John 30:9 55:19 56:16,16
Associated Reporters Int'l., Inc.
Johnson 52:17 55:7
John's 35:18
join 68:20,23 70:13,15,18 77:12
joined 68:8 69:22 78:4
Joint 3:2
jointly 38:10
Jon 58:21
Joseph 87:13
Joseph's 88:8
judgment 32:6 117:11 120:11
121:21 122:17
July 56:21 57:23 60:14 66:16
80:13
June 4:19 7:6 10:21 13:8 40:24
56:21 57:2 61:9 63:4
Justice 14:24 15:3
justification 81:11
K
k 63:15
Karen 22:19,20 59:21
Karen's 129:9
keep 17:16 56:20 104:25 105:12
keeping 16:18 54:4 119:3
keeps 17:7
Kelly 22:18
kept 17:7
Kevin 86:18 87:10,16
key 36:24 39:21 40:2 59:9 98:2
keying 43:8
kidding 124:24
kids 6:14 43:16 49:7
kind 6:18 24:21 29:25 33:21
34:4 35:7 51:3 54:25 105:6
108:17 109:2 116:8
kinds 8:19
King 127:13
Kings 112:17 114:7 123:16,22
127:18
King's 87:12
Kissinger 58:21
know 10:23 16:12 22:23 23:4,8
26:11,14 30:2,11,13 31:4 32:2
32:13,24 33:15 34:3,5,7,21
40:20 55:6 64:13,15 70:2,3,12
70:12,13 71:20 75:14,16,16,18
75:19 78:11 93:14 94:15 97:8
97:11,12 99:2,8,9,13,17,19
100:23 101:12 102:6,15 103:20
104:17 105:4,5 106:6,25 107:2
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 150
107:3,5,22 108:7 116:4,8
120:2,5,5 122:8,11 129:5
knowing 120:9
knowledge 23:4 50:16 100:12
known 13:2 18:19 45:23 65:18
67:13 102:6,10
Komanoff 82:25
KRAUS 67:20
Kraut 33:11,12 66:13,15 67:10
67:21,23 69:18,23 70:14,18,23
71:6,15,23 72:3,17 73:4,6,7
73:12,16 74:2,5,9 75:12 76:23
78:16,17 79:11 80:4,10 82:2
82:13,16,23 83:17 84:11 85:3
85:13 86:5 87:4,24 88:16 90:4
90:25 91:14,24 94:2,6,15,23
97:6,7 98:5,9,13 99:22,23
100:7 106:2,4,13,23 107:14
109:17 110:22,24 111:19
113:19 114:6,18 118:17,19
121:25 122:2,8,11,14 123:15
124:5,25 125:4,8,17,21 126:4
126:14 127:4 128:18,21,23
129:3,11,18
L
L 92:20 109:25
lab 45:5,9 46:12 47:2,10,13
laboratory 47:19
lack 57:13
lacked 50:10
Lakeview 87:6
land 78:23
language 18:3 38:2 61:25 122:23
125:11
large 55:10 103:14
Lastly 21:5
late 11:11 94:19
Latham 1:9 2:1 3:1 4:1 5:1 6:1
7:1 8:1 9:1 10:1 11:1 12:1
13:1 14:1 15:1 16:1 17:1 18:1
19:1 20:1 21:1 22:1 23:1 24:1
25:1 26:1 27:1 28:1 29:1 30:1
31:1 32:1 33:1 34:1 35:1 36:1
37:1 38:1 39:1 40:1 41:1 42:1
43:1 44:1 45:1 46:1 47:1 48:1
49:1 50:1 51:1 52:1 53:1 54:1
55:1 56:1 57:1 58:1 59:1 60:1
61:1 62:1 63:1 64:1 65:1 66:1
67:1 68:1 69:1 70:1 71:1 72:1
Associated Reporters Int'l., Inc.
73:1 74:1 75:1 76:1 77:1 78:1
79:1 80:1 81:1 82:1 83:1 84:1
85:1 86:1 87:1 88:1 89:1 90:1
91:1 92:1 93:1 94:1 95:1 96:1
97:1 98:1 99:1 100:1 101:1
102:1 103:1 104:1 105:1 106:1
107:1 108:1 109:1 110:1 111:1
112:1 113:1 114:1 115:1 116:1
117:1 118:1 119:1 120:1 121:1
122:1 123:1 124:1 125:1 126:1
127:1 128:1 129:1 130:1 131:1
Latino 11:18,20
Latinos 11:19
launched 12:6
law 2:9 3:3 9:13 10:24 11:3
14:12,23 15:8,11,14 24:9
layer 35:22
laying 115:7
lead 48:17
leadership 49:21 54:6,21 55:14
leading 57:24
leads 48:17
learn 94:19
learned 50:3
leave 80:10 94:16 122:12
leaving 51:2,3 78:19 83:4 90:11
93:14 111:4 123:18 126:18
left 78:22 83:5 88:23 90:14
111:6 123:19 126:20
legal 6:14,15 105:7
legally 93:18
legislation 14:13 38:2
legislative 38:3
lenders 61:11,18,18
lending 60:25
lessons 50:3
letter 24:9 100:13 108:3,5
109:5 114:23 125:5
letters 22:16,18,25 26:8 47:12
let's 33:12 34:8 63:22 73:5
78:2 97:8 98:17,24 124:10
level 8:25 25:3,3,20 29:6,6
40:10,10 50:16 51:5 52:7
55:16 77:25 130:2
levels 12:25 34:25 48:12,20
leverage 36:18 37:16
Levin 38:11 120:7 129:15
license 101:10 105:12
licensed 15:6 68:23 98:6,10
Licensure 91:15
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 151
life 16:15
Lifecare 127:7
Lifetime 90:8,17
light 67:25 123:16 126:4
likelihood 116:18
limit 13:13
limited 23:5 26:24
Linda 101:25
line 107:15
link 77:17
linking 31:2
Lipson 59:21
little 40:20 70:19,25 71:4 80:2
94:19,24 122:4
lives 45:22
living 11:9,16 78:25 83:21
loan 17:8
loans 17:10
local 42:6,7 44:5,8,8 45:16
47:10,19 50:8,16,17 51:5
55:16 81:3,4,12
localities 50:8
locally 55:4
LOCATION 1:8
locations 10:16 35:13 42:24
43:7,12
Lockport 88:8
Loftus 61:5,7 63:8
logistical 128:22
long 23:7 25:16 30:10 45:20
46:9 63:24 64:7 76:19 80:16
80:18 82:23 91:5 92:4 112:25
113:17 127:21
longer 34:2
long-term 9:22 19:12 20:18
26:18,21 28:15 33:21 37:6
look 17:21 25:21 27:2,5 30:3
57:19 58:18 60:5 70:24 104:18
105:5 106:10
looked 104:14 106:25 107:3
looking 23:20 24:11 39:13 48:7
49:7 57:12 59:13 105:18
124:20
lookups 40:2
lose 27:11 33:12 94:13 96:2,10
96:15 97:4 98:3,5,10,16,16
99:2,4
lost 15:25
lot 6:16 11:7 12:20 17:18 24:14
27:16 38:13 39:3,18 43:20
Associated Reporters Int'l., Inc.
44:8 69:4 77:3 96:6
lots 57:13,13
Lott 128:6
louder 94:24
Loudon 1:9
love 129:16
low 13:18,19 57:8
lower 7:20 19:5
LTHHCP 112:21
Luke 88:9
lunch 4:5 130:4
Lutheran 127:17
L.L.C 82:5 83:20 86:7 89:16
127:22
L.L.P 84:22
M
Mailboxes 102:22
maintain 35:3
major 14:20
majority 19:25 116:19
making 9:24 32:21 34:12 36:14
61:2 81:13,15 105:10 122:20
MALE 67:17 74:12,14,20 75:24
79:5,21 82:12 83:10 84:4 85:2
85:24 86:21 87:18 89:8
managed 19:13 20:17 27:11
128:22
managed-care 26:20
management 3:12 23:12 84:14,18
mandate 61:20 64:12 70:19
mandates 10:24
manner 106:15
Manor 88:8,8,9,9 89:17,18
marijuana 6:2,15 42:3,15,16,25
43:17
Mark 58:21
marked 10:21
market 70:11
marketing 6:13
markets 61:13
Martin 38:12 47:25 48:2 52:20
70:5,7,16 76:23,24,25 88:25
111:5 114:9 118:23
Mary's 88:9
masterful 58:3
material 59:23 122:23 123:4
materiality 122:5
maternal 54:16 56:7
matter 120:10,18
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 152
McAuley-Seton 91:2
mean 26:17 30:2 32:16 35:19
69:19 70:7 75:12 95:22 96:4
101:3,4,24 102:2 103:21
108:20 122:3
meaning 75:7
meaningful 40:19 41:13,16 68:3
120:14
meaningfully 76:15
means 60:20 102:25 121:4
measure 19:19,19 29:4 31:11
measures 31:11,14,19,21 34:3
57:3
mechanism 29:13 38:7 53:20
74:24
mechanisms 15:9
Medicaid 7:3,7,10,17 19:5,12,13
21:6,7 25:8,13 27:4 30:19
31:9 36:22 37:17 40:21,23,23
41:4 58:12 63:25 107:2
Medicaid's 37:4
medical 10:15 13:25
Medicare 31:8 33:18 40:23,24
41:4
medicine 17:8 83:2
meet 24:9,25 34:2 61:19 104:8
meeting 2:6,8,9,13,15 3:6,24
5:6 6:2 9:23 18:2 24:3 25:5
25:10 38:23 41:12 53:24 54:7
56:2,21 60:6 63:5 66:16 68:22
80:16,20 88:24 92:5 115:6
116:9 117:7 128:24 129:2,14
129:16 130:7
meetings 10:2 40:19 53:25 54:10
55:22 56:4 59:10,12,14
meets 20:22
megawaiver 58:12
member 2:19 22:7,7 38:12 78:21
82:11 112:11 117:4,25 120:10
121:17,18,20 128:10
members 2:7 4:6 54:5 55:21
80:12,14 84:22 93:8 115:14
120:10 130:5
membership 89:19,20
memo 80:13 115:7,7,11,15,21
Memorial 67:11 68:5 75:13 82:24
men 11:21
mental 37:23 52:10
mention 13:15 36:21 38:22 46:20
59:21 109:19
Associated Reporters Int'l., Inc.
mentioned 10:2 18:21 20:8 25:4
41:12
merely 121:17
merge 91:4
met 42:17 95:16
Methodist 88:3
methodology 80:22
metrics 53:10
Metro 85:13
Michael 26:6 131:2,7
microphone 66:13
microphones 2:20
Middletown 84:20
mid-west 44:15
million 8:21,22 9:10 13:17 21:8
41:7
mind 51:18 58:3
minds 50:13
minimum 2:13 65:18 103:9
mining 77:21
minor 51:12
minority 11:25
minute 70:20 78:9 129:9
minutes 4:17,18,20,25 5:3,5,8
5:11 18:2,4,4,6,8
Misa 3:9 18:11,12 21:15,20,23
22:2,12,19 23:11
mistreatment 14:19
misuse 58:14
mixed 83:6
mobilized 45:15
model 33:17,17,25,25 36:16 37:6
models 8:5 19:9 34:22 39:6
modes 58:22
modified 125:15,19
moment 4:13 44:17 45:25 48:3
70:12 73:6 74:21 78:4,11
94:19
Monday 7:4,6,20 18:23
money 7:24 16:2 129:6
monies 15:21
monitor 21:5 29:15 31:13,14
monopolistic 34:15
Monroe 90:9
month 10:5 97:3
months 6:23 7:22 9:8 13:3 56:6
76:6
morning 2:2 18:12 23:13 49:15
mortality 56:7
mortgage 27:11
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 153
mosaic 57:17
Mosha 89:19
mosquito 12:9,10 48:10
mosquitoes 12:13 48:10,15,16
49:3
motion 4:21 5:10 63:12 64:25
67:2,3,6,8,18 69:11,13,15
73:11,13,13,14,18,20,21,22
74:3,10,15,17,24 79:6,22,23
81:20,21,23,25 82:14,18,20
83:11,12,14 84:5,6,8 85:7,9
85:25 86:22 87:19 88:11,13
89:9,23 90:19 91:8,8,11
110:13,15 111:11 113:24
114:15 115:19 119:5,8,9
120:20,23 121:2,3,4,6,8,10,12
121:13,15,23,25 123:3,8,9,11
125:6,22 126:23 128:14
move 4:2,16 5:5 18:10 19:13
26:19 32:24 34:11 35:24 41:23
44:6 49:10 50:11 51:20 55:24
60:9 63:11 66:11,24 67:16
68:19 72:23 79:4,20 82:13
83:9 84:3 85:23 86:20 87:17
87:24 88:17 89:7,23 90:4,19
91:19 109:16,17 111:10 113:22
114:13 120:17 123:25 126:22
128:11
moved 4:22 5:12 72:25 79:6 86:2
91:20 128:13
moving 17:25 27:6 57:23
multiple 100:22
multi-payer 37:5
multi-pronged 16:20
multi-sectoral 49:22
M.D 75:16,17
M.G.S 65:18
M.R.T 8:24 18:25 19:22 20:9,12
20:15,16 21:2 22:3 33:18
N
name 59:22 88:5 131:6
narcotics 44:3 46:25 47:2
Nassau 80:22,23 83:2 112:18,25
113:13 123:22 127:13 128:2,3
Nathan 89:19
national 10:21 17:13 40:8,10
47:6 55:8 65:15
nationally 7:12 13:7
nationwide 44:22 57:13
Associated Reporters Int'l., Inc.
nature 61:23 62:22
nay 74:12,13,17
nearly 10:15 11:13,21
necessarily 16:17 77:10,14
necessary 105:19
necessity 29:17
need 10:8 25:12 30:20 33:6,8
35:4 45:8 59:5 61:12,16 80:19
80:21 93:15 102:10 108:21,23
needed 38:6 93:19 104:4
needle 55:24
needs 14:13,19,25 15:12 30:21
34:2 39:3 65:14
negative 114:21,22,22 115:22,23
116:21,21 119:21
negatives 116:24
neglect 15:4
negotiate 27:25
negotiation 28:17 34:20
negotiations 27:17
Neither 6:15
Nesconset 82:4,5
net 14:21 85:17 89:5
network 37:14 38:5 40:4 47:6
76:4
networks 30:16 34:17
nevertheless 45:13
new 1:2,9,9 2:1 3:1 4:1 5:1 6:1
6:5,9 7:1,13 8:1,3,5,9 9:1,10
9:24 10:1,3,12,22,23,24 11:1
11:8,10,14,16,20,21 12:1,15
12:16 13:1,13,16,20 14:1,2,7
14:8 15:1,11,24 16:1,4,5,18
17:1,5,12,15,15,17 18:1,16
19:1,8,15,22,24 20:1 21:1,7
21:13 22:1,2 23:1 24:1 25:1,6
26:1 27:1,12 28:1 29:1 30:1
31:1,25 32:1 33:1,6,17 34:1
35:1,8 36:1,8,13 37:1,14,22
38:1,10,21 39:1,5 40:1,9,14
41:1,15 42:1,18 43:1 44:1
45:1,20,24 46:1,21 47:1,8
48:1,9,23 49:1 50:1 51:1,6
52:1 53:1 54:1 55:1,8,9 56:1
57:1,3 58:1,21 59:1 60:1,22
61:1 62:1 63:1 64:1 65:1 66:1
66:20 67:1,12 68:1,7 69:1,4
70:1,11 71:1 72:1 73:1 74:1
75:1 76:1 77:1 78:1 79:1 80:1
81:1 82:1 83:1 84:1,21 85:1
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 154
85:14,15,17 86:1,9 87:1 88:1
88:4,20 89:1,4,18 90:1 91:1
92:1 93:1 94:1 95:1 96:1 97:1
98:1,21 99:1 100:1 101:1
102:1 103:1 104:1 105:1 106:1
107:1 108:1 109:1 110:1,25
111:1 112:1,18 113:1,18 114:1
114:7 115:1 116:1 117:1 118:1
119:1 120:1 121:1 122:1 123:1
123:22 124:1 125:1 126:1,17
127:1,8,13 128:1,8 129:1,6,12
129:20 130:1 131:1,2
news 6:7 15:11 45:10 46:20
Niagara 91:2,4
NICE 39:20
Nick 24:11
Nile 12:11,17 48:3,7,13
nine 20:16
ninety 87:13 92:22 110:3
ninety-eight 60:21
nobody's 97:10
non-compliance 66:2
non-participation 75:11
normal 48:20
North 79:11
Northern 66:19
note 85:18
noted 104:17
notice 6:21 43:3 71:19 97:21
November 24:19 51:22 54:24
nub 98:7
number 13:6 24:25 25:19 33:13
35:19 36:23 37:17 38:24 39:24
39:25 41:5 43:15 44:18 55:20
85:19 96:12 102:21 103:9,12
103:17 113:6
numbers 6:24 40:16,23,24 80:21
Nurse 111:25 112:24
nurses 35:19
nursing 9:11,19 60:14,16,18,21
61:3,10,19 63:16,18,23 64:3
64:14 65:3,5,5,7,8,16 78:18
79:13 82:6,24 86:8,10,14
87:11,12 91:4 105:14 111:22
113:12
NYCRR 92:17,20
N.C 86:13
N.Y 88:5
O
Associated Reporters Int'l., Inc.
o 65:18
Oak 86:13,14
Oakwood 83:19
Oberg 58:21
objective 33:9
objectives 38:25
obligated 39:20
obtain 81:4
obtaining 65:19
obvious 70:8 118:21
obviously 36:11 62:3
occupancy 64:3
occur 34:20
occurred 51:10
occurs 107:25
October 59:11 129:21,22
odd 70:25 112:20
offer 10:8 12:18 60:7
offered 11:2 12:2 56:15
offering 29:17
office 3:10,12,14,16 18:10,13
23:11 35:25 40:16 41:23 43:18
98:23 102:21,22
officer 78:22
offices 42:21 45:8 93:19
oh 70:14 94:22
Ohio 44:19
okay 22:13 56:16 70:22 72:7
73:10 74:2,9,17 83:17 88:16
88:18,19 91:14,24 92:5 94:5
98:12,17 101:21 105:20,21,25
106:3,16 109:12 111:17 115:3
119:2 122:22 123:2,15 124:24
125:3,22 126:9 129:13,23
old 46:16
Olean 88:8
once 6:5 24:2,12 38:17 52:23
ones 24:4 64:9,10
one's 51:18
one-year 103:22
ongoing 7:21 17:19 19:21 29:4
36:16 37:5 38:7 39:9 74:25
104:18
online 20:9 21:14
on-demand 2:11
open 2:8 94:3 97:2,4,14,21
98:15 99:21 102:3 109:8
122:12
opened 98:23 106:6 107:12
opening 48:6 97:20 102:20,22
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 155
104:24
operate 101:19,22
operated 15:5 85:16
operates 89:4
operating 20:3 66:20 83:19 86:7
100:18
operational 95:5,10 102:25
106:8
operationalize 108:13
operator 85:15 86:9 89:18
opportunities 10:14 26:21
opportunity 18:13 19:24 33:14
35:15 54:8 70:21 104:23
108:14 116:25 117:7 120:13
opposed 5:15 33:20 64:24 67:8
72:15 73:25 79:10 81:25 82:22
83:16 84:10 85:12 86:4 87:3
87:23 88:15 89:13 90:3,23
91:23 110:18 111:15 114:5
118:24 123:13 126:12 127:3
128:17
opposing 128:10
opposition 5:4
options 17:5 23:21
Orange 84:20 86:8 124:11,12
Orchard 89:17,18
order 2:7 43:2,23 68:19
orders 6:3
organism 46:8
organisms 46:13
organization 22:23 78:21 104:20
organizational 102:8
organizations 8:16
oriented 50:25
original 69:12,14 72:9
originally 80:15
Orleans 89:17
outbreak 11:17 44:21 46:16,23
outbreaks 48:3
outcome 31:14 34:4 50:18 65:9
outcomes 31:11 57:21 65:24
outlets 15:9
outline 53:3
outlined 92:16 109:23
Outpatient 67:14
outreach 11:24 12:6 16:11
outside 2:25
outstanding 85:22
overall 49:23 55:12 76:16
117:15 118:12
Associated Reporters Int'l., Inc.
overdue 15:11
overlap 54:11
oversee 38:7
overuse 58:15
overview 115:8
overwhelming 116:19
over-bedded 80:24
over-supply 58:16
owed 61:17
owes 26:2
ownership 90:15
O-HIP 18:15,17 20:11,13,22 21:5
O.H.S.M 66:22 72:22 79:2,18
82:9 83:8 84:2,23 85:20 86:12
86:18 87:16 89:6,21 90:18
91:6 111:7 112:3,15,22 113:2
113:8,14,20 114:10 123:19,19
126:20 127:9,19,23 128:4,8
O.H.S.N 67:14
O.M.O.P 89:16
P
pace 4:5
packet 23:2 42:22 62:5
page 53:18 62:5,9,22 131:3
pages 9:3 23:7 131:4
paid 27:10
pain 84:14,18
Palsy 85:16
paper 27:10
papers 2:21 53:13
paragraph 62:7,12,18
parahaemolytics 46:2
parallel 21:25
pardon 41:21 74:4,20 106:3
parents 43:16
part 15:13 23:19 27:16 34:20
37:5 38:20 39:21 43:10 49:24
57:16 59:7 61:23 63:3,25 64:2
76:5 96:14 104:9,19 107:9
108:10 115:12 119:21 124:8
participants 77:11
participate 31:8 68:14 69:8
73:17 76:15
participating 41:5,13 73:9
participation 5:24 37:5 40:22
41:10 76:12,20 77:6 130:2
particular 25:14 27:2 30:4,5
32:3 35:5,12 37:3 46:2 48:24
60:8 101:2 102:12 116:13
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 156
particularly 11:24 40:16 45:19
48:8 120:13
partners 18:18 76:10,11
partnership 37:21 52:7
partnerships 50:18 51:3
parts 23:3
pass 121:3,5,12
passes 64:25 67:9 72:8 126:13
Pat 58:21
patient 34:11 39:24 40:2 65:9
103:18
patients 47:12 102:21 103:9,12
103:15
patient-centered 9:17
pause 4:4,13 122:4
pay 17:10 75:8 109:9
paying 28:8
payment 20:20 33:22 34:6 61:15
62:16
payments 41:8 64:16
payor 59:4
payors 59:3
pediatric 82:8
people 2:16 13:24 14:13,25 26:8
42:14 46:20 54:12 77:4,16,19
78:9 99:8 122:18
percent 11:4,8,20,21 13:9 21:8
86:15,16,17,18 87:8,8,9,10,13
87:14,15,15 89:20 92:15
106:18 109:22
perform 72:20
performance 33:10 57:3
performing 56:23
period 46:10 47:9 58:11 97:3
periodically 31:15 68:25
permission 98:11
Peroni 49:17
person 95:3
personal 2:21 114:6
personally 17:5
persons 46:4
perspective 78:6 104:21
perspectives 23:3
pertinent 63:21
pertussis 12:25 13:4,9
phase 20:12,15 21:2
PHHPC 1:4 80:16,20
phone 5:23 54:7
phrase 122:3
physician 40:10,16,22
Associated Reporters Int'l., Inc.
physicians 10:4,10 16:17 41:3
41:15 44:25
pick 2:21
picnicking 12:22
piece 125:2
pieces 60:6 67:25
pigs 44:15,17
pipeline 77:18
place 18:5 29:3,13 32:5 45:14
51:19 103:23 131:3
Placed 126:23
places 49:12 62:19 100:24
placing 47:3
plan 9:22 19:2 21:2 36:7 49:24
51:7 76:6,16 92:12 109:20
planned 59:6
planners 81:3
planning 2:4 3:22 4:7,20 7:9
16:7 19:18 50:11 55:19 56:17
56:19,24 71:17 129:11,18,21
plans 53:2 54:15 76:9
play 53:18
playing 78:2
please 4:9 64:22 67:6 72:4,7,13
81:23 82:20 84:8 86:24 89:11
90:24 91:11 110:16 114:2
121:11 127:5 128:15 129:4
pleased 41:11 55:17
pleasure 5:17 60:12
pledge 105:3 108:21
Plittsman 52:14
plus 42:20
point 7:14 21:8 24:7,24 28:10
28:11 30:6,25 34:8 35:18
38:16,18 47:18 50:16 51:13
54:12 65:18 67:20,22,23 71:18
75:20 100:11 101:5 104:16
108:2,4,11 109:4,5 114:19,24
119:4
pointed 54:9
points 39:19 55:18
police 44:4,5
policy 3:21 30:19 38:9,12 39:16
60:2 68:16 70:24
pools 12:11
poor 75:13
populated 28:25 29:10 30:13
population 7:19 11:20 29:19
35:10 42:9 51:4
populations 11:25 26:20
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 157
portion 7:14 33:19
position 27:20 31:2 34:17 56:6
115:8,20
positive 12:11 116:22
possible 12:3 78:13
possibly 68:13,22
post 66:21 107:5
posted 53:15
post-acute 33:20 34:10
potential 45:15
power 6:19
practice 10:4
precautions 12:23
precise 18:4
preface 60:20
preference 121:5
prepare 19:12 62:17
prepared 53:13 122:24
preparing 52:23 53:5
prescribed 93:4 107:17 110:9
presence 44:9 102:23
present 3:24 24:4 39:18 54:23
presentation 58:3
presented 24:3 51:8 60:19 61:21
67:4,6 81:23 83:14 121:10
123:11
pretty 25:18 46:3
prevent 15:10 105:18
preventable 13:11
prevention 12:7 13:12 50:2,14
50:24 51:15 52:11
previous 10:2 111:18
previously 62:6 95:8 111:9
primarily 44:20
primary 8:3 9:16 15:22 16:13,24
17:4,7 19:7 51:17
primary-care 11:2 17:17 37:12
principally 75:3
principle 120:10,18
principles 101:23 102:17 104:11
104:12 105:7
prior 62:15,19,20 115:12
priorities 51:6
prioritizing 43:5
priority 53:2,15
prison 56:7
privacy 39:15
private 52:3,7
privilege 2:6
pro 55:11
Associated Reporters Int'l., Inc.
probably 8:11 15:25 24:7 46:20
116:20 125:4
problem 16:16 45:15 63:17
115:18
problems 13:23 47:20,21
proceed 23:11 110:23
proceedings 131:5
process 4:11,12 18:2 20:13 25:5
38:14 44:3 47:14 50:21 51:5
51:20 52:20 55:9 71:2 99:19
100:21 104:17,19 105:8,11
107:23 108:17 116:17 118:2
119:7,13
proclaiming 12:4
produce 27:7
products 43:8,23
professional 52:4
professor 52:14
profound 59:5
program 10:3,6 13:19 14:4,7,9
14:10 17:6,19 19:5 20:18
36:13,14 38:6 51:17 79:2 91:6
113:18
programs 16:4,4,5,10 17:13,16
18:14 36:20 41:6 102:9 105:15
progress 20:23,25 36:15 37:15
39:21 40:13,19 66:10
progressed 11:12
progressing 39:7
project 4:2,10 52:19 53:20
66:11,17,22 68:19 92:21 110:2
128:19
projections 21:9
projects 20:14,15 110:20
promise 12:5
proposal 22:3 23:17 81:12 83:6
109:7 123:13
proposals 8:2 51:11 71:13
propose 8:20
proposed 22:9 51:6 64:22 69:18
72:3,10,13 86:23 105:22
110:16 112:4,9,16 114:2
123:20 124:15 127:11 128:14
protect 12:18 13:16 14:13,21
19:9 47:21
protecting 15:2
Protection 14:24 65:6
provide 13:19 18:13 19:14 32:12
53:21 61:10,18 95:6,9,11
provided 31:12,17 33:14 91:9
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 158
103:15 117:6,16
provider 15:5 30:24 31:2 33:2
34:14,15 39:8 66:2 89:5
providers 10:10 17:17 19:10,13
29:12 30:14 31:7 32:17 33:13
33:16,23 34:18 35:2 58:14
59:4 61:16 65:21 68:4,23 75:3
76:10
provides 19:6
providing 14:4 55:11 92:24
103:2,6 110:5 121:17 125:20
provision 37:9 63:15 65:4 92:14
109:22
provisions 36:23 37:12
public 2:3 3:2,16,18,20 4:7,19
8:14 10:20 11:23 12:6,7 19:10
19:16 21:14 22:24 36:17 37:20
41:23 42:4,6,7,11,14 43:21
44:9,12 45:16 46:13,18 47:17
47:21,22 49:11 52:6,15 54:23
55:20 65:11,11 71:2 77:10
78:6
publicly 31:22
public-awareness 12:16
pull 57:24 73:5
pulling 58:3 59:23 60:2
pump 46:15
Punching 59:12
purchase 78:23
purchaser 59:4
purpose 6:22
pursuant 92:20 109:25
pursue 35:15
purview 21:24
put 15:13 69:24 71:19 74:17
80:13 96:18 118:20
Putnam 84:14
putting 43:3 68:16 95:23 97:17
p.m 1:7 3:17
question 26:7 27:8 63:14,20
70:9 74:23 75:6 77:15 94:17
95:13 98:2,8,19 99:15 100:11
100:16,24 102:19 104:3 106:17
114:24 119:11 120:3,6
questions 15:16,18 17:22 21:22
23:10 25:22 26:5 28:19 35:23
41:19,20,21 47:25 49:9 56:10
60:4,8 62:2,3 63:5,6,13 64:20
66:7 75:23 81:20 115:13 117:9
118:3 119:15 126:2
quick 44:11 45:18 55:18 61:4
quickly 24:17 47:7
quit 12:8
quite 25:24 29:21 32:19 44:21
49:21 102:16
R
r 9:7
Rachel's 78:11
radiologic 46:21
raise 72:7
raised 114:25 116:6,8
ramped 40:21
range 10:17
ranking 57:4
rapid 45:7 54:19
rapidly 40:21 41:11 99:17
104:22
rarer 12:13
rate 54:17 64:2
rational 70:10 78:5,10
rationale 75:19
rationales 75:15
Raven 52:20
reach 35:10 100:24
reached 81:2,3
reaches 14:8
reaching 100:23
react 45:7
Q
read 8:6,19 9:2 14:17 27:9
38:24 92:2 107:14 118:17
qualify 102:23
quality 9:15,17 10:13 19:4 29:2 readily 65:20
ready 109:13 126:9,10
29:3,6,11,14 30:11,24 31:11
reaffirm 108:6
31:17,19,21 32:6 34:4 35:3
58:24 60:16 65:4,5,6,16 102:9 real 9:24 29:22 60:2 119:12
realign 26:21
quarter 40:5
realignment 27:20 30:18
quarterly 31:23 105:4
reality 12:5
Queens 70:8 112:18 123:23
realize 7:10 63:19
127:14,21,22
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 159
realized 7:16
really 6:5,7,15,19 12:4 25:16
25:20 33:8 35:21 38:25 39:11
43:21 45:8 50:10,18 52:6
57:16,19 58:2 60:20 64:10,10
66:3 74:22 94:11,17 95:2
109:5 117:17,23 120:18
reason 48:19 69:25 70:10 75:10
77:12 109:6 119:20 122:5,16
reasons 9:15 63:23 77:11 78:5
78:10
Rebekah 112:20
recall 37:25 49:19
recap 37:25
receipt 42:11 92:23 110:4
receive 10:13,25 31:12
received 26:8 43:9,11 100:13
114:23
receiving 23:2
recipient 17:6
recommend 25:6,7 63:10 66:23
82:10 86:11 91:7 123:20
126:21 127:19
recommendation 28:3 30:21 71:7
81:7,13,15
recommendations 4:3 20:16 24:20
59:13,17 66:12 93:2 110:7
recommended 67:14 71:24 72:22
79:2,19 80:8,18 84:2,24 85:21
86:19 89:6,22 91:19 102:18
111:7,8 112:3,6,8,11,16,19
113:8,9,14,16,20 114:10,11
123:25 124:9,14 127:16 128:4
128:9
recommending 25:4 81:17 127:11
127:24
recommends 83:8 87:16 88:6,10
90:18
record 2:24 18:7 32:2,4 74:17
78:14 85:18 92:2,11 100:8
109:19 118:17 119:3 131:4
recusals 126:7
redesign 7:10,17 25:8,13 27:4
30:19 32:14
redesigned 34:2
redundancy 54:11 61:24
redundant 62:22
reemphasize 108:4
referencing 80:13,14
referred 43:18
Associated Reporters Int'l., Inc.
referring 27:21
refilling 47:3
refine 50:14
refined 38:18 52:25 59:14
reflect 18:7 20:15 33:17
reflective 5:8
reflects 30:17
reform 7:11 19:4 20:20 32:20
36:19
reg 24:9 61:22 62:5
Regan 72:21 106:17 107:7 111:5
111:24 112:2,14,22 113:2,6,14
113:19 114:8 118:22,22 123:18
126:19 127:9,19,23 128:3,7
regard 56:10 58:23 63:17 66:7
117:9,10
regarding 27:9 60:14 114:20
region 80:19 90:16
regional 19:17 57:7 90:7
regions 16:23 30:12
regs 93:20
regular 129:19
regularly 55:22
regulated 59:6
regulating 59:2
regulation 3:23 5:7 23:24 60:16
60:18 61:8 62:4 63:4 64:9
65:4
regulations 3:25 38:4,8 60:10
60:13,13
regulatory 23:21 36:16 37:24
57:11,18 58:9 62:24
rehabilitation 34:10 79:13 82:6
83:21 86:8,10 87:7,12 113:13
Rehabilitative 82:25
reinforce 36:23
reinventing 54:12
reinvest 7:14 18:24
related 24:9 44:18 62:16 77:10
relating 25:9
relative 32:6 33:10 118:5
relatively 103:14
relevant 52:2 109:24 122:20
reliance 34:9
reluctant 77:12 78:8
remaining 50:21 97:5,5
remarks 18:21 41:18 42:12 48:6
remember 102:8
remind 2:7 4:6
reminder 2:25
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 160
Reminding 29:18
remote 35:11
remove 46:15 47:21 76:12,19
removed 28:24 43:25 63:2
Renewal 14:3
renovation 78:23
renovations 19:11 72:21
repeat 92:9
rephrase 73:11
report 3:9,13,15,18,20,22,24
7:2 15:15 20:22,24 21:7,10
23:12 28:3 35:24 41:24 47:23
49:11 51:21 53:4 56:8,17
60:10 62:17 66:5,16 68:2,22
128:18,21
reported 13:4,5,6,8 31:20,22
49:20 52:24 131:3
Reporter 131:7
reporting 15:9 40:18
reports 3:7,20 8:15 31:13 40:8
44:12 46:20 47:17 108:24
represent 103:10
representatives 55:13
represented 11:19 52:8
represents 8:17
request 23:23 65:9 101:9,12
104:16 119:17 120:11
requested 80:20 123:5
require 23:21 121:20
required 3:2 31:9 62:14 130:3
requirement 103:23 106:5,25
requirements 14:11 25:2 66:3
92:16 109:23
requires 61:16
requiring 61:3
requisite 82:9
reside 103:3
residency 15:25 16:5
resident 16:12
residential 65:17,23 79:16,17
82:7 83:23
residents 10:16 16:12 29:20
resolution 64:22
resources 19:9 37:17 45:16
50:10 55:17
respect 80:24 81:9
respectfully 96:23
respects 30:3 101:17
respiratory 13:24
respond 70:23
Associated Reporters Int'l., Inc.
responded 5:24
response 21:13
responsibilities 57:18
rest 34:21 62:12 126:8
restructure 28:14,14
result 6:24 7:17 65:5 80:23
81:2 115:5
resulted 46:22 47:4
resulting 89:20
retain 96:16
retained 97:4
rethink 97:18
return 72:9 82:3 83:18 89:15
90:24 119:3 124:17 126:15
127:4
review 2:14 4:2,11 20:19 24:12
54:22 66:11,17,22 80:21
100:10 102:8 104:19 107:23
115:12 117:6,7 128:19
reviewed 50:2 60:13 115:11
116:4
reviewing 102:7
reviews 23:25 24:2,8
revision 51:7
revisions 49:23
revisit 108:24
RHIO 39:17
Richmond 112:18 123:23 127:14
Rick 100:19 119:12
right 16:8,17 23:14 26:14 28:18
30:6,8 32:25 56:13 71:4 73:5
74:3 82:15,17 88:16 95:24
102:6 103:23 107:7,7 120:22
120:24 124:24 128:25 129:13
rigorous 19:21
rise 25:2
risk 59:3
Road 1:9
Robert 52:16 55:6
Roberts 119:4
Robinson 74:21,22 90:10
Rochester 35:15 129:4,7,12,16
Rockland 124:11,12
Rohan 58:21
roll 55:4
rollout 50:15 52:22 55:15,16
rolls 52:19
room 2:25 78:19 79:15 83:4,5
88:23 90:11,14 105:20,21
111:4,6 123:18,19 126:15,18
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 161
screw 36:7
scurge 6:5,9
Sea 79:12
season 45:3 48:20
second 4:23 9:17 17:3 28:3
45:18 60:19 63:13,13 66:25
67:17 69:12 70:25 72:24 73:20
79:5,21 82:12 83:10 84:4 85:2
85:24 86:21,23 87:18 88:12
89:8,10,23 90:20 91:9 105:9
110:14 111:12 113:24 114:14
114:16 121:22,24 123:3 124:2
125:23,24 126:24
seconded 4:24 5:12 67:3,19
69:14 72:4,10,25 79:7,24
81:21 82:18 83:12 84:6 85:8
86:2 87:20 91:20 121:9
section 3:3 8:5 52:3 62:7,23
92:16 109:24
sections 8:6
sector 52:3
sectors 32:18
secure 37:4
security 39:15
S
see 6:22 8:9 28:10 38:24 39:22
s 56:23 102:7
40:4,9,15 41:2 50:19 52:21
safe 6:14,15
54:18 57:22 63:23 95:5 103:11
safely 34:11
103:17,20 105:6 106:21 116:4
safety 14:21 85:17 89:5
116:14
safety-net 19:10,14
seeing 35:12 45:2 48:19 102:21
salts 6:3 42:3,16,16,25 43:17
seemingly 29:20
sample 53:17,18
seen 12:3 44:11 45:19,21 58:9
samples 45:5,9 46:12
selected 50:23 52:21 54:5
sat 106:5
self 58:9
satisfied 85:19,20 113:6,7
send 22:22 47:12 109:5
satisfies 102:20
sense 57:16 69:21 77:4 81:8
satisfy 106:6
101:8
savings 7:15
sensitive 30:22
saw 46:20
sensitivity 116:16
saying 6:11 24:12 29:9 70:14,18 sent 42:22 43:10 44:24 80:14
77:14,23,24 78:2 100:13
104:10
125:11 129:10
separated 124:19
scenario 53:7
separately 80:22
scenes 27:17
September 10:23 23:17 24:3
schedule 23:25
54:21 59:10 119:14,17 124:13
schedules 60:5
128:24 129:2,3,7,18,19
schematic 53:6
series 30:14 47:18
School 52:15
serious 13:22 109:7
scintillating 128:21
seriously 23:8
score 25:20
serve 43:22 65:13,19 76:19
126:20 130:5
rooms 60:7 66:20
Rose 86:17 87:9,14
round 9:11 17:20 26:2 50:4
rounds 43:6
routine 46:18
row 98:18
Rugge 3:21 28:21,22 31:19,24
32:10 33:4 34:24 56:19 60:4
71:10,11,21 102:19 103:4,8,19
Rugge's 55:19
rules 2:14 77:7 102:15 119:4
Run 84:19,22
running 102:12 104:5
rural 16:13,22,23 26:22 28:22
28:24 29:9 30:4 35:7
rustling 2:21
R.F.A 23:16,16,19 24:10 25:2,21
95:7 101:16 102:7,17 104:9,12
105:8 119:13
R.H.C.F 78:25
R.H.I.O 73:17 75:9,18
R.H.I.O.s 74:25 76:5,8 77:2
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 162
93:17,18 97:23,24 98:16 112:5
112:10,17 123:22 124:11
127:13
served 103:9,12,18
service 62:16,20 79:16 95:7,12
103:6
services 3:18,20 11:2 17:14
28:14 29:3,13,14,16 30:12
31:11 42:12,20 43:19 51:16,17
59:5 72:19 83:22 84:18 92:24
95:6,9 103:2,6,15 110:5
111:25 112:14 127:8
serving 43:2 93:10 97:23
servings 18:25
session 120:15
set 16:5 51:6,18 77:16 93:18
102:21
sets 4:18
setting 16:13 34:11
settings 10:14 16:25 17:2
seven 2:12 8:20 97:2,3
seventeen 7:14 10:5 11:20
103:25
seventy-five 8:22
seventy-one 12:10
severe 46:5 48:21
Shah 3:8 5:18,20 16:8 22:14,20
Shah's 15:21
share 38:17 77:5 86:16
shared 56:23
shares 87:8,14
sharing 68:3 77:18,24
sheet 118:7
shellfish 45:23 46:9
shelves 43:25
shifted 59:4
Shiner 89:20,21
shop 22:4
short 6:21 25:18
shortly 21:3 42:17 52:12
show 61:16 69:7
showed 6:20 80:19
side 39:2 40:21 65:15 105:20,21
106:20
sight 33:12
signed 14:12
significant 24:25 26:19 40:6,13
44:21 46:3 50:21 76:9,11
Silvia 49:17
similar 127:10
Associated Reporters Int'l., Inc.
similarly 41:5
simple 77:15,23
simply 101:13 109:8
simultaneously 59:16
single 49:6 72:18 73:20,21
74:10 84:16 100:4
Sisters 111:22 112:13
sit 24:14,16 27:24 31:3
site 53:20
sites 10:9 43:2
situation 46:17
situations 27:9
six 13:3 62:19 66:20 89:3
sixteen 45:21 46:8
sixty 62:19
sixty-four 10:25
sixty-two 14:7
Skilled 83:20
slashed 116:20
slept 26:3
slides 49:12 58:4
slots 15:25 16:24
slow 40:20
small 103:14
smooth 78:12
sold 6:11,12 42:25
solely 89:4
somebody 96:25 107:4 120:7,8
somewhat 63:14
sorry 9:21 35:16 74:21 94:9,25
118:19 119:24 129:11
sort 33:22 42:12 49:23 51:19
53:5 56:3 61:4 95:23 96:5
99:18
sound 46:9 108:16
sounds 2:21 35:14
source 46:14 61:11
sources 48:16
South 128:2
space 66:22
sparsely 28:24 29:10 30:12
speak 2:18 69:20 70:4 104:25
speaking 30:13
special 5:7 14:13,19,25 15:12
59:10 72:18,20
specialist 53:9
specializes 84:18
specialties 17:4,9
specialty 72:19 84:16
species 45:22
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 163
specific 23:3,20 31:5 38:3
39:23 43:12,12,19 55:24 74:23
specifically 19:6 50:6
speculate 75:15
speculation 48:18
spend 129:5,6
spending 7:24 21:6,7 25:24
spoke 100:2,2
spoken 64:6 69:23
spread 12:13 16:21
Spring 113:12
sprinkler 60:15,18 63:15
sprinklered 61:3 63:18
St 86:9 88:7,8,8,9
stabilization 19:14
stabilize 27:20
staff 2:7,20 19:25 49:17 52:18
53:10,12 58:21
staffing 65:8
stage 8:25 68:14
stakeholder 38:20
stakeholders 8:13 22:24 50:9
stand 48:4
standard 30:5
standardized 15:9
standards 29:2 31:5
Standing 1:4 2:1 3:1 4:1 5:1
6:1 7:1 8:1 9:1 10:1 11:1
12:1 13:1 14:1 15:1 16:1 17:1
18:1 19:1 20:1 21:1 22:1 23:1
24:1 25:1 26:1 27:1 28:1 29:1
30:1 31:1 32:1 33:1 34:1 35:1
36:1 37:1 38:1 39:1 40:1 41:1
42:1 43:1 44:1 45:1 46:1 47:1
48:1 49:1 50:1 51:1 52:1 53:1
54:1 55:1 56:1 57:1 58:1 59:1
60:1 61:1 62:1 63:1 64:1 65:1
66:1 67:1 68:1 69:1 70:1 71:1
72:1 73:1 74:1 75:1 76:1 77:1
78:1 79:1 80:1 81:1 82:1 83:1
84:1 85:1 86:1 87:1 88:1 89:1
90:1 91:1 92:1 93:1 94:1 95:1
96:1 97:1 98:1 99:1 100:1
101:1 102:1 103:1 104:1 105:1
106:1 107:1 108:1 109:1 110:1
111:1 112:1 113:1 114:1 115:1
116:1 117:1 118:1 119:1 120:1
121:1 122:1 123:1 124:1 125:1
126:1 127:1 128:1 129:1 130:1
131:1
Associated Reporters Int'l., Inc.
start 5:21 40:15,20 108:8
starting 16:4 21:17 59:9
state 1:2 6:6,16 8:3,9,12,14
10:5,16,24 11:5 12:9 14:2,8
15:6 17:12,17 32:17 39:22
42:6,7,19,21 43:22 44:4,4,23
47:19 49:23,25 54:17 55:9,25
57:17 58:22 59:2,24 60:22
66:3 85:17 88:4 104:23 131:2
stated 131:3
statement 62:24 65:25 75:6
118:7
statements 116:14 117:3 121:19
states 37:17 55:7,10
statewide 5:9 36:12 37:13 38:5
40:3 49:22 51:10 76:4
state's 19:2 21:13 55:3
statistics 40:8
status 11:10
statutory 62:25
stay 16:14 17:2
steering 49:23 54:3,10
step 14:20
steps 21:4 24:21 47:18
Stern 89:19
stockholder 115:23 116:22
Stone 24:11
Stonleigh 84:13
stop 46:16
stories 14:17
strain 44:15
strains 45:25
strategic 54:15
strategies 12:18
strategy 50:15
streamlining 20:19
Streck 2:2,5 15:17 17:22 21:11
21:21 22:8,13 23:10 26:6
28:19 33:11 35:14,23 41:20
47:24 49:9 56:9,14 60:4 63:12
64:18,20,24 66:6 67:2,8,18,21
69:10 70:5,22 71:5,9,25 72:6
72:15,25 73:5,10,14,18,25
74:4,7,11,13,16,19 75:22 76:2
76:24 78:15 79:6,10,22 80:3,8
81:19,25 82:14,17,22 83:11,16
84:5,10 85:5,12,25 86:4,22
87:3,19,23 88:11,15 89:9,13
90:3,23 91:8,13,20,23 93:25
94:5,17 95:13,18,22 96:21
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 164
97:6 98:2,7,12,17 99:5,22
100:15 105:20 106:3,11,14
107:8 108:2 109:12 110:13,18
110:23 111:11,15 113:23 114:5
114:15 115:3,16 118:16 119:2
119:18 120:2,22,25 121:23
122:22 123:2,8,13 124:3,21
125:3,6,13,18,22,25 126:9,12
126:23 127:3 128:12,17,20,25
129:9,23
Streck's 109:4
strengthening 14:21
strengths 6:20
strikes 70:24
stroke 13:22
strong 12:16 39:10 50:20
stronger 44:5
strongly 14:14 71:23
structure 22:6
struggle 58:17
struggling 43:16
Subcommittee 55:21
subdivision 62:7,23
subject 2:8 92:22 110:3 121:16
subline 92:17
submission 18:19 22:17 123:4
submit 7:9 31:9 45:5 48:11
92:12 109:20
submitted 7:4,20 8:15 18:22
22:25 45:9 93:11 96:11 97:19
99:9 108:20 116:15
submitting 46:12
subparagraph 92:17
subscribed 131:6
subsequent 68:22
subsequently 96:3 109:15
Substance 43:18
substantial 33:19 81:11
substantiated 65:24
sub-acute 34:10
success 19:19 40:3
successful 25:12 36:12 105:2
successive 59:14
Sue 106:16
sufficient 9:21
Suffolk 79:13 80:22,25 81:8,9
82:6 83:21 86:14 111:24
123:23 127:14
suggest 108:2
suggested 16:21
Associated Reporters Int'l., Inc.
suggestion 71:22
Sullivan 88:22,23 111:3
summer 12:8 45:21 53:24
super 18:20 19:3
Supply 58:15
support 10:6,8 19:15 36:17,19
37:10 49:18 52:16,18 55:11
66:2 74:25 120:19
supported 81:12
supporting 53:11 55:7
supportive 8:21 19:11 22:15
59:21
supposed 96:6
sure 4:14 11:25 12:22 17:3
21:15 23:14 26:15,24 34:12
39:14 43:24 61:7 64:16 69:4
71:8 75:21 76:11 105:10
surgery 67:14 72:18,20 84:17,20
surprise 23:15,22
surveillance 45:14 48:10
survey 8:15 31:15 42:8,9
survival 28:15
Susan 52:14
suspect 45:4
sustainability 36:16 37:6 76:3
76:16 77:2
sustainable 9:22 51:3
synchronized 2:15
synthetic 6:2 42:3,16,25 43:17
syringes 47:3
system 19:3,24 26:18,21 32:15
34:2 43:21 45:14 58:8 76:18
120:17
systems 3:12 8:10 23:12 33:22
36:20 60:15
T
table 23:5 54:19,25 122:18
take 2:23 12:22 15:16 22:15
23:3,8 26:5 41:19 44:5 46:15
60:9 61:5 62:3 63:24 103:20
120:23
taken 51:18 108:7
takes 28:16 119:3
talk 2:16 6:13 42:5 44:23 62:19
94:23
talked 7:7 27:16,21 32:20 50:3
64:7
talking 77:15 100:4 108:11
115:25
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 165
tangential 63:14
tape 100:9
task 57:19 96:18
tasked 14:25
teaching 15:24
technical 37:10 61:23 62:8,11
62:25 102:19 105:7
technologist 46:22
technology 3:14 35:25 36:7,14
36:25 37:7 68:11 76:14
teed 37:3
teleconference 5:9
telephone 42:9 54:2
televideo 54:2
tell 27:12 79:25 106:19
template 53:2
ten 7:7 18:24 41:15 82:8,8 83:6
83:7 87:14 96:25 99:16 108:13
tend 16:13
term 25:16,18 46:16 64:7 76:19
91:6 113:18
terms 21:23 29:11,22 37:15,20
38:25 40:7,21 41:8,10 42:15
57:8,14 76:7,21 119:4
terns 23:5
terrific 49:17
test 45:7
tested 10:22 12:11
testing 10:21 11:5,6 45:9 47:15
48:11
tests 11:3 12:2
thank 5:4,16,20 6:24 15:16,17
17:23,24 18:9,12 21:10,19
22:13 23:11 36:4 41:20,22
47:24 49:10,14 56:9 60:3 61:7
63:8 64:18,24 66:9,15 67:9
72:16 73:21,25 74:17 76:24
78:15 79:10 81:18,19 82:2,22
83:16 84:10 85:12 86:4 87:3
87:23 88:15 89:13,13 90:3,23
91:13,23 110:18 111:15 114:5
115:15,16 118:15,16 119:25
123:2,14 125:25 126:12,13,24
127:3 128:17,20 129:25,25
130:5
thanking 5:22
thanks 41:25 47:23 49:16 56:16
That'd 32:10
theme 42:5
themes 9:23
Associated Reporters Int'l., Inc.
theoretically 34:4
Theresa's 86:10
thing 28:16 40:12 46:19 56:4
101:3
things 64:5 77:20,21,21 105:5
117:14
think 6:22 9:3 24:10,23 25:4,16
25:25 26:13 27:2,4,14,21,22
28:5,7 30:5,8,19,22 32:13,22
33:2 34:22 39:4,19 40:14
41:11,17 42:5 45:10 47:16
50:5,15,15 51:12 54:9,18 61:4
63:24 68:13,16 71:16,18,18,18
75:6,13 95:15 100:8,20 101:17
101:22 103:21 104:6 105:3,9
105:23 108:10,21 109:4 115:20
117:18,25 120:9,12,18
thinking 56:3
third 42:9
thirteen 8:6 10:25 11:4 19:4
66:21
thirty 2:13 11:15,21 46:23 47:4
47:4 78:25 80:23
thirty-five 42:18,19
thirty-seven 84:21
Thirty-six 119:23,24
thirty-three 21:8 80:25
thorough 19:21
thought 48:14 74:14 105:11
106:18 122:4
thousand 10:15,17,18 11:13,16
15:25 29:20 41:3,15
threads 57:25
three 9:9 10:18 11:10 13:6,17
41:6 42:4 44:11,12 47:9 49:6
50:6 59:12,12 62:22 65:18
80:24 88:19 94:7,12,14 97:5,9
97:22,24 98:25 109:10
threshold 29:5,14
thrilled 71:3
time 1:7 2:18 6:11 9:2 19:25
24:7 28:11 29:15 30:10,25
46:10 47:9,13 50:7 51:21
54:19,25 57:6 58:11 59:3
63:25 68:13 71:18 76:7,15
80:17 93:4 107:17 110:9 118:3
121:5 124:16 131:3
timeline 20:4
times 13:6 14:18
Title 92:17 109:24,24,25
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 166
Titler 86:18 87:10,16
today 4:12 7:2 18:9 39:18 42:5
42:12 47:23 97:9 99:12 129:25
today's 3:6 88:24 114:25
tomorrow 20:5 21:17
tools 57:11,21
top 8:22
topic 63:21
total 57:8
touch 42:4 44:10 114:7
track 15:3 20:24 21:6,25 32:2,4
41:17
trade 78:21
train 10:9
trained 16:18,24 17:4
training 10:14,15 16:12,16
trains 16:13
transcription 131:4
transfer 84:21 86:15 87:7,13
89:18 90:15
transform 19:2,9,12
Transformation 36:2
transformative 8:24
transmission 45:11 48:18
trapping 48:11
treatment 84:16 85:16 89:3
triple 7:18 12:14,17
trouble 22:21
true 131:4
trust 122:17
try 27:25 31:3 36:6 45:16
105:11
trying 22:11 26:17 27:3 30:18
37:16 39:12 56:20 57:24
105:16 120:16 125:14
Tuesday 5:19,23 6:2,20 18:3
42:17 43:11
turn 62:5 66:13
Turning 10:20
tweaking 54:22
twelve 13:4
twenty 11:8 82:7 83:22,23
twenty-two 42:21 79:15,16,17,18
two 3:17 4:18 5:6 9:14 10:17
12:10 13:15 20:12,15 21:2,8
24:7 27:23 34:14,25 38:21
39:23 40:2 43:6 48:25,25 50:5
52:11 54:7 55:18,23 56:2
59:10,14 60:13 62:9 67:25
68:7 78:9 79:18 84:12 85:6
Associated Reporters Int'l., Inc.
86:6,22 87:4 88:17 92:14
93:12 94:12 95:24 96:3,23
97:23,23 99:2,7 101:22 106:17
109:9,22 115:24 116:2 124:19
125:2 126:6
twofold 39:19
type 30:7
types 16:17
typewritten 131:4
typically 76:9
U
unable 99:21
unanimously 63:9
unaware 11:9 99:9 108:6
undergo 19:21
understand 16:25 69:20 70:16
75:2 100:4,6 104:15 109:8
117:17
understanding 56:23 96:25 101:7
undersupply 58:16
undertaken 13:16
undertaking 58:23
undertook 57:2
underway 43:20
under-bedded 80:25
under-served 10:4 16:22
unexpected 58:8
UNIDENTIFIED 66:25 67:17 72:24
74:12,14,20 75:24 79:5,21
82:12 83:10 84:4 85:2,24
86:21 87:18 89:8
unique 25:9
unit 66:21
United 112:20
units 14:5
universal 105:22
unknown 99:19
unprecedented 99:18
unreasonable 122:19
unsung 42:13
unusual 46:13
upcoming 56:4
update 3:11 5:18 7:3 18:13,16
36:5 42:2 45:18 49:15
updated 31:23 50:14
UPR 113:11
upstate 23:25 24:2,8,13 30:4
48:9 57:8 76:8 101:9 124:17
129:6
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 167
upstream 51:15
upward 44:20
urban 35:7,10
urging 10:22 13:13 116:24
usage 40:17
use 36:17 40:19 41:13,16 45:8
65:17 68:3 77:8 83:6
useful 54:11
users 19:12
U.M.H 88:5
U.S 13:9
vulnerable 13:17
W
Wadsworth 45:5 48:11
wait 94:6 129:9
waiver 7:3,8,13,20,23 8:7,11,17
9:6 18:19,20,22,24 19:3,6,20
19:23 20:7,9,11 22:5,10,16,17
36:22
want 5:21 8:8 17:25 18:7 23:22
24:8,14 25:5 26:10,24 30:23
32:24 33:4 44:10 54:12 56:15
V
56:16 70:2 71:5 75:14,15 78:3
85:18 97:18,23 102:3 104:22
vaccination 13:12
105:23 108:6,19 120:16 122:9
vaccinations 13:14
122:12
valid 69:25
wanted 38:22 46:20 78:13 94:11
value 16:25 17:15
124:10
value-based 34:6
warning 49:2
variability 76:7
Wartburg 113:4
variant 44:14 45:6
wasn't 42:10 98:19,20 120:4
variation 57:7
watch 28:5
various 77:11
watching 48:22 49:3
vein 44:10 47:22
water 48:16
vendors 33:6
way 28:13 30:17 32:19 59:2 64:5
vent 80:19,24
69:25 77:16,25 119:9 120:25
ventilation 79:15
122:17
ventilator 79:18 82:9 83:7,22
ways 6:3 58:8,8
version 17:6
wealth 16:21
versus 99:14
weather 48:13 49:8
vested 6:19
web 8:14 58:4
vibrio 45:21,22,23 46:2
webcast 2:10,12
vice 116:7
website 2:11 8:8 9:5 12:21
Vicki 108:9,15
17:18 20:9 21:3 31:22,23
view 66:10 96:10,17 97:8 116:15
53:16,17,21
118:9
week 7:5 24:2 26:3 38:23 44:18
vignette 47:23
44:24 130:3
vignettes 42:5
weekend 5:23 25:24 129:5
Village 113:17
weekly 48:10
viral 12:13
weeks 6:23 24:7 54:7 96:24
virtually 53:25
weighing 81:6
virus 12:11 45:6 49:3
welcome 2:3 5:17 21:20 23:9
vision 7:10
welfare 15:2
Visiting 111:25 112:24
weren't 109:7 124:12
voided 101:4 107:13
West 12:11,17 48:3,7,13
volume 29:12 103:14
Westchester 66:19,19 112:2,15
voluntary 49:25 55:8
113:4 123:23 124:11 127:14
vote 62:3 64:21 69:16 72:6
105:23 109:13 120:20
we'll 18:10 23:11 35:14,24
voted 63:4,10 74:6 96:24
41:23 51:21 52:22 55:4 56:2
voting 88:22 112:3 114:9 128:13
56:12 60:9 62:3 69:10 72:8
Associated Reporters Int'l., Inc.
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 168
74:17 75:21 91:24 104:18,18
118:18,20 127:6 128:13 129:21
we're 9:24 12:12 13:12 16:11
23:14 24:23 25:11 26:14,17
27:3 28:18 32:13 33:19 34:5
35:12 36:11 39:11 46:17 48:22
51:20 54:25 55:16 68:15 71:9
81:12,15,17 90:15 92:8,19
97:12,17,17 98:11 99:19
101:20 105:15 106:18 117:20
118:14 120:16 124:12 125:12
we've 8:23 12:6,15,24 14:17
15:24 16:18 24:5 36:6 40:12
41:11 43:5 46:7,7,14 48:21
49:2,19 51:8 56:21 61:25 63:2
66:11 105:14 116:6,18 117:15
wheel 54:12
WHEREOF 131:5
whooping 13:2
William 2:5
wish 59:25
withdraw 97:19
withdrawn 93:21
WITNESS 131:5
women 52:10
Wood 52:17 55:7
word 62:6,9,10,23
wording 62:13,18,21 63:2,6
words 24:23 60:24 95:20
work 5:22 6:17,18,23 21:2 24:21
32:11 37:19 39:3 44:2,13
49:16 50:24 51:23 52:18,24
53:6 54:11,20 55:19,23 56:6
59:23 66:8 76:6
worked 36:8 47:8,11,14 115:7
workforce 10:6 19:16 20:19
workgroups 20:16,17
working 17:2 18:15,17 23:14
30:16,16 39:16 52:9,9,23 53:3
53:6,12,21 54:5,10,13 64:14
77:16 78:12 114:21,21,22
115:23
world 99:17 104:21
worse 11:17
worth 8:5
worthy 25:22
wouldn't 95:16 115:25
write 118:24
wrong 100:20 102:2 103:22
wrote 115:21 120:5
Associated Reporters Int'l., Inc.
Wyckoff 27:22
Wyoming 88:3
X
X 96:12
Y
Yates 90:15
Yeah 70:7 74:14 75:22 80:6,8
94:21 95:22 96:8 109:17
year 7:23,25 10:18 11:14 12:10
12:25 13:5,10 20:2 40:5 41:16
43:6 48:7 49:7,8 56:5 92:25
93:20,23 94:12 95:9 97:2,22
98:22,24 104:4,20 105:16
106:8,10 108:8,12 110:6
years 7:16 8:22 10:19 12:15
15:23 18:25 38:3 40:14 42:8
47:9 49:6 58:12 77:12 94:7
103:25
year's 8:23
York 1:2,9 2:1 3:1 4:1 5:1 6:1
6:5,9 7:1,13 8:1,3,9 9:1,10
9:24 10:1,3,24 11:1,20 12:1
12:15 13:1 14:1,2 15:1,24
16:1,18 17:1,5,12,15,17 18:1
19:1 20:1 21:1,13 22:1 23:1
24:1 25:1 26:1 27:1 28:1 29:1
30:1 31:1 32:1 33:1 34:1 35:1
36:1,8,13 37:1,14,22 38:1,10
39:1 40:1,9,15 41:1,16 42:1
42:19 43:1 44:1 45:1,20,24
46:1 47:1,8 48:1,9,23 49:1
50:1 51:1 52:1 53:1 54:1 55:1
55:9 56:1 57:1,4 58:1 59:1
60:1,22 61:1 62:1 63:1 64:1
65:1 66:1 67:1,12,13 68:1,8
69:1,4 70:1,11 71:1 72:1 73:1
74:1 75:1 76:1 77:1 78:1 79:1
80:1 81:1 82:1 83:1 84:1 85:1
85:14,17 86:1 87:1 88:1,4,20
89:1,4 90:1 91:1 92:1 93:1
94:1 95:1 96:1 97:1 98:1 99:1
100:1 101:1 102:1 103:1 104:1
105:1 106:1 107:1 108:1 109:1
110:1,25 111:1 112:1,18 113:1
113:18 114:1,7 115:1 116:1
117:1 118:1 119:1 120:1 121:1
122:1 123:1,22 124:1 125:1
126:1,17 127:1,8,13 128:1,8
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 169
129:1,6,13,20 130:1 131:1,2
Yorkers 10:13,22,24 11:8,10,14
11:16 12:17 13:13,20 14:8
15:11
York's 13:16 14:7 19:16,24
young 13:24 49:7
Z
zone 48:24
0
0182143E 89:16
071024C 82:23
071077C 79:11
072112C 83:19
1
1 20:7 131:3,4
1-888-999-SALTS 43:10
10 92:17,20 109:24,24,25
10:13 1:7
11th 129:21
11.15 7:3,7 18:19,22 19:23
20:11 22:3,4
111142B 84:13
112096C 82:4
112369(c) 67:10
1133 67:13
12 67:10
12th 129:22
12:45 1:7
121103E 86:6
121135 90:7
121157C 66:19
121168E 86:13
121175E 87:10
121182E 91:2
1212 74:19
12120C 110:24
121203C 114:6
121208C 72:17
121212C 112:13
121216 112:24
121222E 127:17
121226C 111:22
121243C 112:20
121247E 127:21
121249 111:25
121252E 127:7
121256 126:16
Associated Reporters Int'l., Inc.
121286E 128:6
121291C 113:4
121309E 123:15
12134E 85:13
12135E 84:19
121424C 113:17
12143 78:17
121446E 128:2
12174E 87:5
12180E 88:19
13th 61:20
130 131:4
14th 131:6
166 3:4
19th 80:13 129:18
2
2.41 63:3
20 129:19
2009 13:7
2010 10:23 11:19
2012 1:6 4:19 13:3 131:6
2013 61:20
2141L 91:14
25 78:24
25th 60:14
26th 66:16
27th 10:21
28 78:24 115:24
3
37 119:21
4
4323C 78:17
7
7th 4:19 5:6 61:9 63:5 115:7
762.2 92:20 109:25
763.11A 92:16
8
8-09-2012 2:1 3:1 4:1 5:1 6:1
7:1 8:1 9:1 10:1 11:1 12:1
13:1 14:1 15:1 16:1 17:1 18:1
19:1 20:1 21:1 22:1 23:1 24:1
25:1 26:1 27:1 28:1 29:1 30:1
31:1 32:1 33:1 34:1 35:1 36:1
37:1 38:1 39:1 40:1 41:1 42:1
43:1 44:1 45:1 46:1 47:1 48:1
800.523.7887
800.523.7887
8-9-2012, Latham, NY, Public Health Meeting
Associated Reporters Int'l., Inc.
Page 170
49:1 50:1 51:1 52:1 53:1 54:1
55:1 56:1 57:1 58:1 59:1 60:1
61:1 62:1 63:1 64:1 65:1 66:1
67:1 68:1 69:1 70:1 71:1 72:1
73:1 74:1 75:1 76:1 77:1 78:1
79:1 80:1 81:1 82:1 83:1 84:1
85:1 86:1 87:1 88:1 89:1 90:1
91:1 92:1 93:1 94:1 95:1 96:1
97:1 98:1 99:1 100:1 101:1
102:1 103:1 104:1 105:1 106:1
107:1 108:1 109:1 110:1 111:1
112:1 113:1 114:1 115:1 116:1
117:1 118:1 119:1 120:1 121:1
122:1 123:1 124:1 125:1 126:1
127:1 128:1 129:1 130:1 131:1
86.23 63:3
9
9 1:6
997 1:9
Associated Reporters Int'l., Inc.
800.523.7887
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or
Recusals, Abstentions/Interests
Acute Care Services – Construction
Number
Applicant/Facility
1.
121204 C
NYU Hospitals Center
(New York County)
2.
121431 C
Nyack Hospital
(Rockland County)
Ambulatory Surgery Center – Construction
Number
Applicant/Facility
1.
121119 C
NYU Hospitals Center
(New York County)
2.
121468 C
Montefiore Medical Center –
Henry & Lucy Moses Div
(Bronx County)
Residential Health Care Facility – Construction
1.
Number
Applicant/Facility
121363 C
Sunshine Children’s Home and
Rehab Center
(Westchester County)
Exhibit #3
E.P.R.C.
Recommendation
Contingent Approval
Contingent Approval
Exhibit #4
E.P.R.C.
Recommendation
Contingent Approval
Contingent Approval
Exhibit #5
E.P.R.C.
Recommendation
Contingent Approval
Upstate Certified Home Health Agencies - Construction
1.
Number
Applicant/Facility
121288 C
Living Resources Certified
Home Health Agency, Inc.
(Albany County)
Exhibit #6
E.P.R.C.
Recommendation
Contingent Approval
Public Health and Health
Planning Council
Project # 121204-C
NYU Hospitals Center
County: New York (New York)
Purpose: Construction
Program: Acute Care Services
Submitted: April 12, 2012
Executive Summary
Description
NYU Hospitals Center (NYU), an 879-bed not-for-profit
hospital located in Manhattan, requests approval to
construct a new clinical pavilion – the Helen L.. and Martin
S. Kimmel Pavilion. NYU is not adding any net new beds or
services with this application, but is re-tooling and
enhancing the hospital by building this 830,200 SF facility.
This proposed project is based on the hospital enhancing
services by:
•
•
•
•
•
•
Coordinating patient care through the use of electronic
medical records;
Reducing length-of-stay over time;
Improving inpatient bed capacity management;
Providing weekend elective surgery;
Decreasing admissions for preventable conditions, and
Improving cost structure and staffing efficiencies.
As part of its transformation plan, NYU will focus on
providing more community-based care to prevent illness
and hospitalizations, and on improving quality of care. NYU
projects market share to remain constant during this period.
The transformation plan includes demolishing the Rusk
Institute Building, the Perelman Building and North Service
Wing to make way for the new Kimmel Pavilion.
Renovating the current buildings would be inefficient, and
more costly than building a replacement facility.
needs of the Hospital Center’s patients. NYU’s bed
complement is as follows:
Bed Category
Medical/Surgical
Coronary Care
Intensive Care
Bone Marrow Transplant
Physical Medical and
Rehabilitation* (PM&R)
Maternity
Neonatal Intensive Care
Neonatal Intermediate Care
Pediatric
Pediatric ICU
Psychiatric
Special Use
Total
Upon
Capacity Proposed Completion
443
- 34
409
6
-6
0
37
124
161
6
6
174
36
7
18
39
9
22
82
879
- 22
-5
25
- 82
0
152
36
7
18
34
34
22
0
879
* The decrease in PM&R beds resulted from Administrative CON
#102362-C, which relocated those beds to the Rusk Institute.
Program Summary
Based on the results of this review, a favorable
recommendation can be made regarding the facility’s
current compliance pursuant to PHL Section 2802-(3)(e).
Financial Summary
Project costs will be met via equity of $758,083,393 and
$474,269,888 in tax-exempt bonds.
Total project costs are estimated at $1,232,353,281.
Incremental Budget:
DOH Recommendation
Contingent approval.
Need Summary
The Kimmel Pavilion will address many of the limitations
of the existing hospital, and provide enhanced support
systems for the existing facility, as well as meet the future
Revenues:
Expenses:
Gain/(Loss):
$209,464,293
236,412,073
($26,947,780)
The incremental loss is due to a large capital expense,
but can be absorbed through operations.
Subject to the noted contingencies, it appears that the
applicant has demonstrated the capability to proceed in a
financially feasible manner.
Project # 121204-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Submission of a board resolution for a Medicaid hold-harmless agreement that is acceptable to the Department of
Health. [BFA]
3. Submission of a Dormitory Authority of the State of New York (DASNY) design review recommendation found
acceptable to the Department of Health, in accordance with the memorandum of understanding (MOU) executed
between the Department and DASNY. [AER]
Approval conditional upon:
1. This project is approved to be initially funded with NYU Hospital variable line of credit financing and equity with the
prospect that the project will be permanently financed. The interest rate is projected at 5.88% financed as part of
a future NYU tax-exempt bond financing through The Dormitory Authority for a term of 30 years. The financing will
be structured in tranches, which will replenish the variable rate credit line to avoid excessive interest charges, and
negative arbitrage costs. Financing is conditioned upon the Department having the opportunity to review the final
financing proposed in advance to ensure that it meets approval standards. [BFA]
2. The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
Council Action Date
October 11, 2012.
Project # 121204-C Exhibit Page 2
Need Analysis
Background
NYU Hospitals Center (NYU) is an 879-bed acute care hospital located at 550 First Avenue New York, 10016, in New
York County. The facility seeks CON approval to construct a new clinical pavilion and rearrange its inpatient beds to
meet the needs of its patients. The new pavilion will be called the Helen L. and Martin S. Kimmel Pavilion (Kimmel
Pavilion). When this project is completed, there will be no net new beds added to the facility’s certified capacity.
NYU Hospitals Center has the following certified beds and services:
Table 1:
NYU Hospitals Center-Tisch: Certified Bed Capacity by Service
Bed Category
Capacity
Proposed
Upon Completion
Medical-Surgical
443
- 34
409
Coronary Care
6
-6
0
Intensive Care
37
124
161
Bone Marrow
6
6
Physical Medical & Rehabilitation
174
- 22
152
Maternity
36
36
Neonatal Intensive Care
7
7
Neonatal Intermediate Care
18
18
Pediatric
39
-5
34
Pediatric Intensive Care Unit
9
25
34
Psychiatric
22
22
Special Use
82
- 82
0
Total
879
0
879
Table 2:
New York University Hospitals Center: Certified Services
Ambulatory Surgery - Multi Specialty
Audiology O/P
CT Scanner
Cardiac Catheterization - Adult Diagnostic
Cardiac Catheterization - Electrophysiology (EP) Cardiac Catheterization - Pediatric Diagnostic
Cardiac Catheterization - Percutaneous
Cardiac Surgery - Adult
Coronary Intervention (PCI)
Cardiac Surgery – Pediatric
Clinical Laboratory Service
Coronary Care
Emergency Department
Epilepsy Comprehensive Services
Intensive Care
Linear Accelerator
Magnetic Resonance Imaging
Maternity
Medical Social Services
Medical/Surgical
Neonatal Intensive Care
Neonatal Intermediate Care
Nuclear Medicine - Diagnostic
Nuclear Medicine - Therapeutic
Pediatric
Pediatric Intensive Care
Pharmaceutical Service
Physical Medical Rehabilitation
Physical Medicine and Rehabilitation O/P
Primary Medical Care O/P
Psychiatric
Psychology O/P
Radiology - Diagnostic
Radiology-Therapeutic
Renal Dialysis - Acute
Respiratory Care
Therapy - Occupational O/P
Therapy - Physical O/P
Therapy - Speech Language Pathology
Therapy - Vocational Rehabilitation O/P
Transplant - Bone Marrow
Transplant - Kidney
Transplant - Liver
Project # 121204-C Exhibit Page 3
The hospital is authorized to operate hospital extension clinics at 13 other locations in New York and Queens
Counties, offering services such as: Ambulatory Surgery, Occupational and Physical Therapy, Physical Medicine and
Rehabilitation, Psychology, Primary Medical Care, Medical Social Services and Nuclear Medicine – Diagnostic.
State Designations:
A. Regional Perinatal Center; and
B. Stroke Center.
The new Kimmel Pavilion will provide the hospital with space for needed expansion in procedure capacity and allow
for improvements in patient flow and work efficiency. The rooms will all be single bedded with a higher proportion of
critical and intermediate care beds. The new building will connect at various floors to the existing Tisch Hospital
building and will function as an extension and expansion of many of the existing programs within Tisch and on the
NYU Hospitals Center campus. The Center’s vision for its campus is to promote and enhance the integration of patient
care, education and research, and to meet community needs by:
•
•
•
•
Upgrading, standardizing, and integrating acute patient care services into a new North Clinical Campus;
Extending ambulatory care and other resources to the “urban campus” of the surrounding neighborhood
as well as distributing ambulatory services to the neighborhoods of its patient communities;
Concentrating and expanding research and educational efforts primarily in the southeast corner of the
campus, while developing further capacity in off-campus locations; and
Building a robust and scalable infrastructure that meets the needs of the community.
Analysis
Patient Origin and Population
SPARCS inpatient data show that about 75 percent of the Center’s patients resided in New York, Kings, and Queens
Counties. Patients from these counties accounted for 32.1 percent, 25.7 percent and 11.7 percent of the hospital’s
total inpatient discharges, respectively.
In 2000, the combined population for these three counties was 6,232,100 residents. By 2010, the census for these
counties increased by 1.4 percent to 6,321,295 persons. The greater proportion of growth occurred in New York
County, which increased by 3.2 percent from 1,537,395 residents in 2000 to 1,585,873 in 2010. The population of
Kings and Queens Counties increased by 1.6 percent and 0.1 percent, respectively. Projections for 2020 and 2030
show increased growth for all three counties. The population of the three (3) counties is expected to increase by 3.0
percent, from 6,321,295 in 2010 to 6,512,945 in 2020 (Table 3).
Table 3:
Population Statistics: Kings, New York and Queens Counties
County
2000
2010
2020
Kings County
2,465,326
2,504,700
2,567,047
New York
County
1,537,395
1,585,873
1,611,039
Queens County
2,229,379
2,230,722
2,334,859
Total
6,232,100
6,321,295
6,512,945
2030
2,592,364
1,613,772
2,413,499
6,619,635
Source: Census 2000 and 2010; Projections Cornell University Program on Applied Demographics 2020 and 2030
Inpatient Utilization
In 2007, New York University Hospital Center-Tisch recorded 32,426 total inpatient discharges. By 2010, these
discharges increased by 5.3 percent, to 34,132. During the period, 6 of the 7 major service categories experienced
increases in discharges, ranging from 1.5 percent to 140.8 percent. Major service category Pediatric posted a decline
in discharges of 7.0 percent from 2,226 in 2007 to 2,071 in 2010.
Project # 121204-C Exhibit Page 4
During the review period, the hospital’s total average daily census (ADC) ranged from 498 to 511 patients on any
given day. In comparison to the total number of certified beds, the hospital experienced modest occupancy rates.
These rates were a reflection of the hospital’s relatively low average length of stay of less than 6.0 days (Table 4).
Table 4:
New York University Hospitals Center: Inpatient Utilization by Major Service Category
Service
2007
2008
2009
2010
Beds
Discharges
Medical/Surgical
21,872
21,609
21,632
22,197
Pediatric
2,226
2,187
2,149
2,071
Obstetric
4,559
4,702
4,529
4,643
General Psychiatric
431
402
414
479
Chemical Dependency
49
71
69
118
High Risk Neonates
320
398
401
452
Subtotal
29,457
29,369
29,194
29,960
Healthy Newborns
2,969
4,225
4,068
4,172
Grand Total
32,426
33,594
33,262
34,132
Average Daily Census
Medical/Surgical
390
371
369
367
Pediatric
36
36
36
36
Obstetric
38
38
36
37
General Psychiatric
15
15
16
18
Chemical Dependency
1
1
1
2
High Risk Neonates
12
16
13
20
Subtotal
491
477
471
480
Healthy Newborns
20
29
27
27
Grand Total
511
506
498
507
Average Length of Stay
Medical/Surgical
6.5
6.3
6.2
6.0
Pediatric
5.9
6.0
6.2
6.3
Obstetric
3.0
2.9
2.9
2.9
General Psychiatric
13.0
13.9
14.4
13.9
Chemical Dependency
4.0
3.6
4.7
4.7
High Risk Neonates
13.1
15.0
12.0
16.0
Subtotal
6.1
5.9
5.9
5.8
Healthy Newborns
2.5
2.5
2.4
2.4
Grand Total
5.8
5.5
5.5
5.4
Occupancy Based on Current Beds
Medical/Surgical
52.1
49.6
49.3
49.1
748
Pediatric
74.6
75.4
75.6
74.8
48
Obstetric
105.6
104.4
99.7
103.3
36
General Psychiatric
69.5
69.5
74.1
83.2
22
Chemical Dependency
0.0
0.0
0.0
0.0
0
High Risk Neonates
46.0
65.2
52.8
79.6
25
Total
55.8
54.3
53.6
54.6
879
Source: SPARCS 2007- 2010
Project # 121204-C Exhibit Page 5
Emergency Department and Selected Outpatient Utilization
In 2007, NYU Hospitals Center recorded 38,539 total Emergency Department visits, 27.1 percent of which resulted in
an inpatient admission. By 2010, the facility’s total ED visits increased by 19.5 percent to 46,059. During the same
period, the hospital recorded noticeable increases in ambulatory surgery procedures as well as rehabilitation and
general clinic visits. Utilization in these service categories increased by 5.8 percent and 5.0 percent, respectively
(Table 5).
Table 5:
New York University Hospitals Center: Emergency Depart and Selected Outpatient Statistics
% of Emergency Department
Total Emergency
Visits Resulting
Amb/Surg
Rehab and
Year
Department Visits
in Inpatient Admission
Procedures
General Clinic Visits
2007
38,539
27.1
24,267
137,668
2008
40,536
26.9
22,826
148,580
2009
42,482
26.5
23,436
145,378
2010
46,059
25.8
25,671
144,498
Source: Institutional Cost Reports, 2007 - 2008
Conclusion
NYU Hospitals Center –Tisch inpatient and outpatient services are well utilized by the residents of New York City. The
construction of a new pavilion will allow the hospital to modernize its facility and reorganize its inpatient beds to meet
the needs for its acute care services and address the limitations of the current campus. The project will provide the
hospital with the opportunity to improve patient outcomes, increase patient, visitor and staff satisfaction, and to
function in an effective and efficient manner.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Project Proposal
NYU Hospitals Center requests approval to construct a new 22-story clinical pavilion and reconfigure various bed
types, with no change to the total bed count, staffing, or services.
Compliance with Applicable Codes, Rules and Regulations
This facility has no outstanding Article 28 enforcement actions and, based on the most recent surveillance information,
is deemed to be currently operating in substantial compliance with all applicable State and Federal codes, rules and
regulations. This determination was made based on a review of the files of the Department of Health, including all
pertinent records and reports regarding the facility’s enforcement history and the results of routine Article 28 surveys
as well as investigations of reported incidents and complaints.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Total Project Cost and Financing
Total project cost, which is for new construction, and the acquisition of moveable equipment is estimated at
$1,232,353,281, itemized as follows:
Project # 121204-C Exhibit Page 6
New Construction
Fixed Equipment
Asbestos Abatement and Removal
Design Contingency
Construction Contingency
Planning Consulting Fees
Architect Engineering Fees
Construction Manager Fees
Other Fees (Consultant)
Moveable Equipment
Telecommunications
Financing Costs
Interim Interest Expense
Application Fee
Additional Processing Fees
Total Project Costs
$707,330,400
56,943,765
2,802,522
68,165,742
35,071,861
1,423,681
65,046,542
30,638,295
10,007,139
111,519,008
42,049,045
22,599,766
72,012,658
2,000
6,740,857
$1,232,353,281
Project costs are estimated based on a March 1, 2013 start date and a 54-month construction period.
Project Financing
Project Financing is presented below:
Equity
*Fund Raising
DASNY fixed rate loan (5.88% for 30 years)**
Total
$178,083,393
580,000,000
474,269,888
$1,232,353,281
* Currently NYU has raised $370,000,000 in fund raising investment.
** Rate is subject to change due to market conditions. Bonds are proposed to be unenhanced due to positive bond rating
according to Moody’s. The applicant indicates that the current Moody’s rating is an A3.
Feasibility Assumptions
The applicant has provided an internal feasibility study relative to this project. BFA Attachments B through D present
historical and forecasted results pertaining to the facility utilization and financial performance. Presented as
Attachment E, is the cost analysis of the impact of the project. The following are the significant assumptions with
respect to the applicant’s budget:
Market Share Projections (Inpatient & Outpatient Visits)
BFA Attachment D presents historical and forecasted demand for Outpatient Visits and Inpatient Discharges based on
the following assumptions:
•
•
•
The number of Discharges in 2011 was 42,070 which represents a 71% occupancy rate and is projected to
increase to 47,323 discharges or 82% occupancy rate by 2021 based on feasibility study.
The number of visits in 2011 to NYU Langone Medical Center was 589,700 in 2011 and is expected to
increase by approximately 32% or to 779,929 visits by year 2021 based on feasibility study.
NYU currently is serving 63 zip codes as its primary service and an additional 194 zip codes as its secondary
service. Discharges are projected to grow by an average of 3.3% per year and outpatient visits will grow by an
average of 3% per year, which is consistent with historical growth since 2010.
Forecasted Financial Statements
Presented as BFA Attachment B and C are the forecasted balance sheet and statement of forecasted revenues and
expenses for NYU Medical Center. Each statement’s underlying results and assumptions are summarized below:
Project # 121204-C Exhibit Page 7
Balance Sheet:
•
•
As shown on Attachment B, NYU has a positive working capital and a positive net asset position during
the period shown.
Debt service coverage ratio on outstanding debt for 2011 and the final two years projection period are as
follows:
2011
5.94
2020
4.78
2021
4.70
Forecasted Statement of Revenues over Expenses:
As shown on BFA Attachment C, NYU has projected an excess of revenues over expenses for the period
shown, which is consistent with historical experience.
•
Operating margin ratio for 2011 and the projection for Year 1 and Year 3 are as follows:
2011
10.8%
2017
10.4%
2020
9.6%
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, summarized
below:
Year One
$59,046,592
Year Three
$209,464,293
Expenses:
Operating:
Capital:
Total Expenses:
$76,619,166
54,896,950
$131,516,116
$159,641,479
76,770,594
$236,412,073
Excess Revenues:
($72,469,524)
($26,947,780)
15,314
1,407
38,564
5,371
$32,183,902
22,713,048
$31,344,497
45,426,097
Revenues:
Utilization: (Visits)
Discharges:
Capital cost breakdown by interest and depreciation:
Interest:
Depreciation:
Utilization by payor source for outpatient services for the first and third years is as follows:
Medicare Fee-for-Service
Medicare Managed Care
Medicaid Fee-for-Service
Medicaid Managed Care
Commercial Fee-for-Service
Commercial Managed Care
Private
Year One
27.79%
4.34%
4.16%
6.59%
48.88%
3.80%
.53%
Year Three
28.29%
4.28%
4.05%
6.50%
48.80%
3.70%
.53%
Project # 121204-C Exhibit Page 8
Charity Care
Other
1.08%
2.83%
1.07%
2.78%
Utilization by payor source for inpatient services for the first and third years is as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Managed Care
Medicare Fee-for-Service
Commercial Fee-for-Service
Commercial Managed Care
Private
Charity Care
Other
Year One
3.29%
5.61%
5.22%
30.59%
50.61%
2.25%
.25%
.47%
1.71%
Year Three
3.34%
5.68%
5.41%
31.33%
49.67%
2.21%
.24%
.45%
1.67%
The Hospital Center’s Kimmel project will enable the facility to promote efficient use of space that currently impedes
programs from functioning together more seamlessly, emphasizes a patient centered service delivery, and enhances
medical and health information technologies that should increase quality, efficiency, and patient safety.
A design team was used to study the utilization assumptions and provide data with industry guidelines/standards using
a “per square foot” model for productivity, and taking into account historical utilization patterns and the future model of
our changing healthcare environment.
Expense assumptions are based on staff productivity after the new building project is completed. Accordingly, staff
levels will increase slightly due to the implementation of new systems and increased services.
Capability and Feasibility
NYU will provide equity and fund raising in the amount of $758,083,393 to satisfy project costs and the remainder will
be provided through a tax-exempt DASNY loan for $474,269,888 at 5.98% fixed rate for a 30 year term. A letter of
interest has been received for the stated amount. Also, NYU will undertake a tranching strategy for the permanent
debt associated with this project in order to avoid negative arbitrage costs. Presented as BFA Attachment A is the
financial summary of NYU Hospital’s Center, which indicates the availability of sufficient funds to meet the equity
contribution of $178,083,393. Also, it should be noted that a fundraising campaign with a goal of $580,000,000 has
been started and $370,000,000 has already been received. In the event contributions do not meet the required need,
the applicant will use equity from its current investment fund to meet all necessary financial requirements.
The submitted budget indicates an incremental excess of expenses over revenues of $72,469,524 and $26,947,780
during the first and third years, respectively. The budget used current utilization data and reimbursement
methodologies for the visits and discharges. The reason for the projected incremental loss is due to capital investment
into the replacement facility, which will be absorbed by operations. The budget appears reasonable.
Presented as BFA Attachment A is a financial summary of the NYU Hospitals Center. As shown on BFA Attachment
sA, NYU maintained an average positive working capital position and an average net asset position during the period
shown. Also, the facility achieved an average annual excess of operating revenues over expenses of $143,474,000
for the last two years.
Subject to the noted contingencies, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 121204-C Exhibit Page 9
Attachments
BFA Attachment A
Financial Summary, (Audited), NYU Hospitals Center 2010 & 2011
BFA Attachment B
Historical and Forecasted Balance Sheet
BFA Attachment C
Historical and Forecasted Income Statement
BFA Attachment D
Historical and Forecasted Projections
BFA Attachment E
Summary of Detailed Budget
BHFP Attachment
Map
Project # 121204-C Exhibit Page 10
Public Health and Health
Planning Council
Project # 121431-C
Nyack Hospital
County: Rockland (Nyack)
Purpose: Construction
Program: Acute Care Services
Submitted: June 11, 2012
Executive Summary
Description
Nyack Hospital, a 375-bed, not-for-profit hospital
located in Rockland County, requests approval to
certify 26 psychiatric beds through a conversion of
medical/surgical (M/S) beds, undertake plant
expansion and renovation, and relocate Rockland
County’s Mental Health Crisis Center to Nyack
Hospital. Nyack Hospital is proposing a Behavioral
Health Program consisting of two primary functional
components – a Crisis Intervention Program and an
Inpatient Behavioral Health Unit. Specific components
of the expansion and renovation are as follows:
•
•
•
•
•
•
Renovate space within Nyack Hospital’s
Emergency Department to house the County of
Rockland Mental Health Crisis Center, which will
become The Crisis Intervention Program.
Renovate the third floor of the Maize Building to
create a 26-bed inpatient behavioral health unit,
separated into two distinct patient units.
Relocate medical/surgical units within the hospital.
Relocate the Medical ICU into newly-constructed
space within a 5,040 square foot building addition
on the 4th floor of the hospital.
Relocate various administrative, non-clinical and
ancillary clinical functions into renovated space
throughout the hospital
Relocate professional offices into renovated space
located in a medical office building situated off of
the hospital campus.
Need Summary
The total number of certified inpatient beds will remain
the same upon project completion. Occupancy at the
hospital fluctuated between 44.5% and 47.4% from
2008 through 2010. Occupancy rates for psychiatric
patients at Summit Park declined by 4.4% from 2008 to
2010, from 65.1% to 60.7%.
Program Summary
Based on the results of this review, a favorable
recommendation can be made regarding the facility’s
current compliance pursuant to 2802-(3)(e) of the New
York State Public Health Law.
Financial Summary
Project costs will be met with a $7,800,000 HEAL NY –
Phase 18 grant and $204,891 of accumulated funds.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 7,514,566
7,467,876
$
46,690
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Total project costs are estimated at $8,004,891.
DOH Recommendation
Contingent approval.
Project # 121431-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Final approval from the Office of Mental Health. [RNR]
3. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP
Drawing Submission Guidelines DSG-01. [AER]
4. The following contingency has been added "Decertification of 26 psychiatric beds by County of Rockland Summit
Park Hospital. [PMU]"
Approval conditional upon:
1. The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
2. The applicant shall complete construction by April 14, 2014 in accordance with 10 NYCRR Part 710.2(b)(5) and
710.10(a), if construction is not completed on or before that date, this may constitute abandonment of the approval
and this approval shall be deemed cancelled, withdrawn and annulled without further action by the Commissioner.
[AER]
Council Action Date
October 11, 2012.
Project # 121431-C Exhibit Page 2
Need Analysis
Background
Nyack Hospital is a 375-bed acute care facility located at 160 North Midland Avenue Nyack, 10960, in Rockland
County. The facility seeks approval to convert 26 medical/surgical beds to 26 psychiatric beds and undertake major
physical plant expansion for the relocation of Rockland County's Mental Health Crisis Center.
Nyack Hospital has the following certified beds and services:
Table 1:
Nyack Hospital: Certified Beds by Service Category
Current Requested
Bed Category
Capacity
Action
Chemical Dependence - Rehabilitation
20
Chemical Dependence - Detoxification
10
Coronary Care
10
Intensive Care
22
Maternity
21
Medical / Surgical
273
-26
Neonatal Intermediate Care
10
Pediatric
9
Psychiatric
0
+26
Total
375
0
Table 2:
Nyack Hospital: Certified Services
Ambulatory Surgery - Multi Specialty
Chemical Dependence – Rehabilitation
Chemical Dependence – Withdrawal O/P
Clinical Laboratory Service
CT Scanner
Health Fairs O/P
Lithotripsy
Maternity
Medical/Surgical
Nuclear Medicine – Diagnostic
Pediatric
Pharmaceutical Service
Renal Dialysis – Acute
Therapy - Speech Language Pathology O/P
Upon
Completion
20
10
10
22
21
247
10
9
26
375
Chemical Dependence - Detoxification
Chemical Dependence - Rehabilitation O/P
Clinic Part Time Services
Coronary Care
Emergency Department
Intensive Care
Magnetic Resonance Imaging
Medical Social Services
Neonatal Intermediate Care
Nuclear Medicine - Therapeutic
Pediatric O/P
Radiology - Diagnostic
Therapy - Occupational O/P
Add:
Psychiatric
Nyack Hospital is authorized to operate one (1) hospital extension clinic in Spring Valley that provides Chemical
Dependence - Rehabilitation O/P services and has the following state designations:
•
•
•
Area Trauma Center;
Level 2 Perinatal Center; and
Stroke Center.
Project # 121431-C Exhibit Page 3
The project will result in the following:
•
•
•
•
•
•
•
the conversion of 26 medical/surgical beds to 26 psychiatric beds;
the certification of Nyack Hospital to provide inpatient psychiatric services;
the relocation of the Rockland County Mental Health Crisis Center to Nyack Hospital’s Emergency
Department (ED);
the Mental Health Crisis Center will be staffed and operated by Nyack Hospital as an integral part of the
ED;
the center is expected to shorten length of stay and increase the number of patients served as well as
prevent hospitalizations and readmissions for individuals experiencing an acute episode of mental illness;
the County of Rockland Summit Park Hospital (SPH) adult inpatient unit will close; and
Nyack Hospital will renovate space on its campus to house the new 26-bed unit.
The relocation of the Mental Health Service to Nyack Hospital will allow the hospital to meet the community’s
continuing need for mental health services. Nyack Hospital will be the sole acute care hospital in Rockland County
certified to provide inpatient psychiatric services. The new unit will be sized based on the 2009 - 2010 average
occupancy of the Rockland County unit.
Nyack Hospital has 305 total medical/surgical beds, including intensive care and coronary care. From 2008 to 2010,
the total number of inpatient discharges increased by 4.6 percent from 9,944 to 10,398. In 2008, the average daily
census (ADC) for any given day was 145 medical/surgical patients. By 2009, this had declined to 136 patients and
was 137 in 2010. The associated average length of stay (ALOS) was 5.3 days in 2008 and 4.8 days in 2009 and 2010.
During this interval, the occupancy rates for medical surgical patients fluctuated between 44.5 percent and 47.4
percent.
The creation of the new psychiatric unit at Nyack Hospital will provide inpatient care for the patients who previously
received care at Summit Park Hospital (SPH). In 2008, SPH had 517 inpatient psychiatric discharges. By 2010, the
number of discharges increased by 11.0 percent to 574. However, during the period, the average daily census
declined by 7.1 percent from 28 patients on any given day to 26. The average length of stay recorded by the
psychiatric patients at the hospital declined by 15.7 percent from 19.7 days in 2008 to 16.6 in 2010. Due to the
declining psychiatric ADC and ALOS, the psychiatric occupancy rates at SPH declined by 6.8 percent, from 65.1
percent in 2008 to 60.7 percent in 2010 (Table 3).
Table 3:
Utilization for Major Service Categories:
Nyack Hospital Medical /Surgical Inpatient
and Summit Park Hospital General Psychiatric Inpatient
Hospital/Service Category
Nyack Hospital - Medical/Surgical
Discharges
Average Daily Census
Average Length of Stay
Occupancy Based on Current Beds
Summit Park Hospital – Psychiatric
Discharges
Average Daily Census
Average Length of Stay
Occupancy Based on Current Beds
Current
Beds
2008
2009
2010
9,944
145
5.3
47.4
10,324
136
4.8
44.5
10,398
137
4.8
44.8
2008
2009
2010
305
Current
Beds
517
28
19.7
65.1
489
24
17.6
54.9
574
26
16.6
60.7
43
Source: SPARCS 2008 – 2010
Project # 121431-C Exhibit Page 4
Summary
The relocation of the Rockland County Mental Health Crisis Center to Nyack Hospital and the creation of a new
26-bed inpatient unit at the hospital will provide the residents of Rockland County with emergency and inpatient
psychiatric care in keeping with community needs.
Based on Nyack Hospital’s historical medical/surgical utilization and its revised occupancy rates, the conversion of 26
medical/surgical beds to psychiatric beds will not have a negative impact on its medical/surgical unit.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Background
Nyack Hospital requests approval to convert 26 medical/surgical beds to 26 inpatient psychiatric beds and relocate, to
the hospital, a mental health crisis clinic which has been operated by Rockland County. The project includes physical
plant renovations and expansion to support the project. It is anticipated that Summit Park Hospital will submit a CON
to decertify 43 psychiatric beds as part of this project.
Staffing will increase by 62 FTEs by the end of year three.
Compliance with Applicable Codes, Rules and Regulations
This facility has no outstanding Article 28 surveillance or enforcement actions and, based on the most recent
surveillance information, is deemed to be currently operating in substantial compliance with all applicable State and
Federal codes, rules and regulations. This determination was made based on a review of the files of the Department of
Health, including all pertinent records and reports regarding the facility’s enforcement history and the results of routine
Article 28 surveys, as well as investigations of reported incidents and complaints.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Total Project Cost And Financing
Total project costs for new construction, renovations and movable equipment are estimated at $8,004,891, itemized as
follows:
New Construction
Renovation & Demolition
Design Contingency
Construction Contingency
Architect/Engineering Fees
Construction Manager Fees
Consultant Fees
Movable Equipment
Application Fee
Additional Processing Fee
Total Project Cost
$1,666,383
3,481,658
514,804
431,485
525,636
486,159
427,991
425,000
2,000
43,775
$8,004,891
Project # 121431-C Exhibit Page 5
Project costs are based on a January 2, 2013 construction start date and a fourteen month and fifteen day
construction period. The applicant’s financing plan appears as follows:
HEAL NY – Phase 18
Accumulated Funds
$7,800,000
$204,891
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years of operation,
summarized below:
Revenues:
Expenses:
Operating:
Depreciation:
Total Expenses:
Net Income:
Utilization:
Inpatient days
Cost per day
Outpatient visits
Cost per visit
Years One and Three
$7,514,566
7,067,631
400,245
$7,467,876
$46,690
9,125
$577.00
4,500
$530.06
The following is noted with respect to the submitted Nyack Hospital budget:
•
•
The inpatient cost per patient day is inclusive of $26.98 capital cost.
The outpatient cost per visit is inclusive of $34.24 of capital cost.
Utilization by payor source, for the first and third years, is projected as follows:
Inpatient
Commercial Fee for Service
Medicare Fee for Service
Medicare Managed Care
Medicaid Fee for Service
Medicaid Managed Care
Private Pay
Years One and Three
8%
46%
1%
31%
6%
8%
Outpatient
Commercial Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Medicaid Fee-for-Service
Medicaid Managed Care
Years One and Three
20%
30%
20%
20%
10%
Expense and utilization assumptions are based on the historical experience of Nyack Hospital and Rockland County’s
Mental Health Crisis Center.
Project # 121431-C Exhibit Page 6
Capability And Feasibility
Total project costs of $8,004,891 will be met with a $7,800,000 DOH approved and executed HEAL NY – Phase 18
grant and $204,891 of accumulated funds.
Presented as BFA Attachment A is the financial summary of Nyack Hospital, which indicates the availability of
sufficient funds. The submitted budget projects a net income of $46,690 for the first and third years of operations.
Revenues are based on prevailing payment methodologies and current payment rates. The budget appears
reasonable.
As shown on BFA Attachment A, a financial summary of Nyack Hospital and Subsidiaries, the hospital has
experienced negative working capital, maintained an average positive net asset position and net income from
operations of $3,019,157 and $4,820,374 for 2010 and 2011, respectively.
Nyack Hospital has operated with a working capital deficiency since 2001. The Hospital has been able to significantly
improve its working capital through better financial performance as a result of steady growth in revenue since 2005.
The Hospital expects to completely eliminate the working capital deficiency during the next year and improve liquidity
as a result of approximate income of $10,000,000 from a Rural Floor Budget Neutrality Appeal settlement, ARRA
incentive payments from Medicare and Medicaid, monetization of antenna rentals, and reduction in account
receivables due to the resolution of 2010 related issues. As of April 30, 2012 the Hospital’s working capital has
improved by approximately $3,500,000.
Based on the preceding, it appears that the applicant has demonstrated the capability to proceed in a financially
feasible manner, and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary for Nyack Hospital- 2011
BFA Attachment B
Internal Financial Summary for Nyack Hospital as of April 30, 2012
BHFP Attachment
Map
Project # 121431-C Exhibit Page 7
Public Health and Health
Planning Council
Project # 121119-C
NYU Hospitals Center
County: New York (New York)
Purpose: Construction
Program: Ambulatory Surgery Center
Submitted: March 7, 2012
Executive Summary
Description
NYU Hospitals Center (NYU), an 879-bed not-for-profit
hospital located in Manhattan, requests approval to
relocate its outpatient gastrointestinal endoscopy
program from its current location on the 2nd floor of
Tisch Hospital at 560 First Avenue, New York, 10016,
in New York County to leased space on the 23rd floor
of the existing Verizon Building at 240 East 38th Street.
At the current site, the applicant currently provides
Radiology Services and Transfusion Services, and
proposes adding the following services:
Gastroenterology, Intestinal Endoscopy, Pain
Management, Ultrasound and Physical Therapy
Services. The center will be called The NYU
Gastrointestinal Endoscopy Program.
Currently, all of these services are offered at NYU, but
services and support are located throughout various
parts of the hospital and in different departments. Due
to the aging population, NYU will centralize these
services at the proposed new extension clinic.
Utilization service is projected to increase because
many of the patients would be closer to the extension
clinic. This would allow NYU to consolidate services,
allowing patients to move more rapidly through the
system, creating more efficient scheduling and
registration practices.
There will be no changes in the operating certificate of
NYU Hospitals Center as a result of this application,
only to the extension clinic’s operating certificate.
Total project costs are estimated at $6,024.844.
DOH Recommendation
Contingent approval.
Need Summary
The number of proposed visits is as follows:
Current Year:
First Year:
Third Year:
2,325
2,982
3,183
The relocation is necessary to accommodate the larger
NYU building project to construct a new patient tower.
It will also allow for increased capacity to meet growing
demand for endoscopy services.
Program Summary
Based on the results of this review, a favorable
recommendation can be made regarding the facility’s
current compliance pursuant to 2802-(3)(e) of the New
York State Public Health Law.
Financial Summary
Project costs will be met via cash equity.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 3,102,473
2,819,130
$
283,343
The applicant has demonstrated the capability to
proceed in a financially feasible manner.
The NYU Gastrointestinal Endoscopy Program at the
Verizon Building will provide patient services in four (4)
procedure rooms, five (5) patient pre-op stations, 10
recovery stations, and one (1) exam room.
Project # 121119-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA review of this project.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fIfty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Submission of an executed building lease that is acceptable to the Department of Health. [BFA]
3. Submission of a Dormitory Authority of the State of New York (DASNY) design review recommendation found
acceptable to the Department of Health, in accordance with the memorandum of understanding (MOU) executed
between the Department and DASNY. [AER]
Approval conditional upon:
1.
2.
3.
4.
5.
The staff of the facility must be separate and distinct from staff of other entities. [HSP]
The signage must clearly denote the facility is separate and distinct from other adjacent entities. [HSP]
The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
The clinical space must be used exclusively for the approved purpose. [HSP]
The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
Council Action Date
October 11, 2012.
Project # 121119-C Exhibit Page 2
Need Analysis
Background
The relocation of the gastrointestinal endoscopy program is required as part of NYU’s building project. The site of the
relocation is in the same zip code as the Tisch Building, and there will be no change in services or continuity of patient
care.
Analysis
The number of proposed visits is as follows:
Current Year:
First Year:
Third Year:
2,325
2,982
3,183
Conclusion
The relocation is necessary to accommodate the larger NYU building project to construct a new patient tower. It will
also allow for increased capacity to meet growing demand for endoscopy services.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
NYU Hospitals Center requests approval to construct a single specialty gastroenterology ambulatory surgery
extension clinic. The extension clinic is for the relocation of services currently provided at the hospital.
Site Name:
Site Address:
Surgical Specialties:
Procedure Rooms:
Hours of Operation:
NYU Langone Medical Center Endoscopy Center
240 East 38th Street, 23rd Floor, New York
Gastronenterology
4
Monday through Friday from 8:00 am to 8:00 pm
There will be no changes to staffing or services concurrent with approval of this application.
Compliance with Applicable Codes, Rules and Regulations
This facility has no outstanding Article 28 surveillance or enforcement actions and, based on the most recent
surveillance information, is deemed to be currently operating in substantial compliance with all applicable State and
Federal codes, rules and regulations. This determination was made based on a review of the files of the Department of
Health, including all pertinent records and reports regarding the facility’s enforcement history and the results of routine
Article 28 surveys as well as investigations of reported incidents and complaints.
Recommendation
From a programmatic perspective, approval is recommended.
Project # 121119-C Exhibit Page 3
Financial Analysis
Lease Agreement
The applicant has submitted a draft lease agreement for the site that they will occupy, which is summarized below:
Premises:
Lessor:
Lessee:
Term:
Rental:
Provisions:
9,559 Sq. Ft. located at 240 East 38th Street, New York
NYU School of Medicine
NYU Hospitals University Hospital
5 Year Term
Year One - $620,332 ($64.89 per Sq. Ft.)
Year Three - $639,970 ($66.95 per Sq. Ft.)
NYU Hospital will pay rental fees based on actual cost in operating and maintaining the
premises. This will include taxes, utilities, maintenance, and all costs associated with the
site. The NYU School of Medicine owns the building that will be occupied by NYU Hospital.
The applicant has submitted two letters indicating rent reasonableness. Also, there is no relationship between the
lessor and lessee.
Total Project Cost and Financing
Total project cost, which is for the renovation and moveable equipment, is estimated at $6,024,844, broken down as
follows:
Renovation and Demolition
Design Contingency
Construction Contingency
Architect Fees
Construction Manager Fees
Other Fees
Moveable Equipment
Telecommunications
Application Fee
Additional Processing Fee
Total Costs
$3,366,537
225,000
325,000
246,864
63,912
15,000
1,357,741
404,776
2,000
18,014
$6,024,844
Project cost is based on a November 1, 2012 start date and a five-month construction period. The applicant will pay
for this project via cash.
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years of operation,
summarized below:
Revenues:
Year One
$2,839,545
Year Three
$3,102,473
Expenses:
Operating:
Capital:
Total Expenses:
$1,697,818
662,955
$2,360,773
$1,796,038
1,023,092
$2,819,130
Excess Revenues:
$478,772
$283,343
Utilization: (Visits)
Cost Per Visit:
2,982
$791.67
3,183
$885.68
Project # 121119-C Exhibit Page 4
Presented as BFA Attachment B is a detailed budget summary for NYU Medical Center.
Utilization by payor source for outpatient services for the first and third years is as follows:
Medicaid Managed Care
Medicaid Fee-For-Service
Medicare Fee-For-Service
Medicare Managed Care
Commercial Fee-For-Service
Private Pay
Charity Care
Years One and Three
4.4%
1.4%
35.3%
4.4%
54.0%
0.2%
0.3%
Utilization and expense assumptions are based on historical experience of the existing operation at NYU.
Capability and Feasibility
The hospital will meet project cost of $6,024,844 via cash equity. Presented as BFA Attachment A is a financial
summary of NYU Hospital Center, which indicates the availability of sufficient funds for the equity contribution.
The submitted incremental budget projects excess revenues over expenses of $478,772 and $283,343 during the first
and third years, respectively. The applicant’s revenues reflect current reimbursement methodologies and rates of
payment for endoscopic services, which are currently provided at the hospital. The budget appears reasonable.
Presented as BFA Attachment A is a financial summary of the New York University Hospitals Center. As shown on
BFA Attachment A, NYU maintained an average positive working capital position and an average net asset position
during the period shown. Also, the facility achieved an average annual excess operating revenues over expenses of
$143,474,500 during the period shown.
Subject to the noted contingency, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary, NYU Hospital’s Center
BFA Attachment B
Summary Detailed Budget
Project # 121119-C Exhibit Page 5
Public Health and Health
Planning Council
Project # 121468-C
Montefiore Medical Center – Henry & Lucy Moses Division
County: Bronx (Bronx)
Purpose: Construction
Program: Ambulatory Surgery Center
Submitted: June 28, 2012
Executive Summary
Description
Montefiore Medical Center-Henry & Lucy Moses Division, the
726-bed main hospital site of the not-for-profit Montefiore
Medical Center, is located at 111 E. 210th Street, Bronx. Via
this CON, the applicant proposes to certify and construct an
ambulatory surgery center extension clinic to be located at
1250 Waters Place, Bronx, to be known as the Montefiore
Hutch Ambulatory Care Center. The purpose of the project
is to:
•
•
•
•
•
•
•
•
Better manage and care for the Montefiore population;
Relocate a portion of the existing adult ambulatory
surgery cases being performed in the hospital operating
rooms at the Moses, Weiler and North Divisions to a
more efficient and patient friendly environment;
Relocate, consolidate and expand some of Montefiore’s
ambulatory clinical practices from various sites;
Relocate and expand pediatric and adult primary care
practices; and
Initiate multispecialty programs in specific clinical areas
which focus on collaboration among departments;
Provide an opportunity for future growth for ambulatory
surgery, imaging services, ambulatory specialty
practices, primary care and multidisciplinary programs,
Relocate and expand pediatric and adult primary care
practices; and
Improve access to care and patient satisfaction with
care, in order to retain patients in the system, critical to
an accountable care organization
The proposed Montefiore Hutch Ambulatory Care Center will
have 12 operating rooms, 4 procedure rooms, pre-op testing,
laboratory services, pharmacy, and outpatient imaging
center, outpatient surgical specialty clinical programs, and
primary care services. .
Total project costs are estimated at $142,254,486.
DOH Recommendation
Contingent approval.
Need Summary
Montefiore proposes this project in order to meet increasing
demand for ambulatory surgery services. It is projected that
this facility will perform 11,788 ambulatory surgeries, 11,534
imaging studies, provide 41,835 primary care visits and
103,045 clinical specialty visits and office based tests and
procedures in year 1. In the third year of operation, it is
projected that there will be 14,939 ambulatory surgeries
23,737 imaging studies, provide 47,460 primary care visits
and 190,844 clinical specialty visits and office based tests
and procedures.
Program Summary
Based on the results of this review, a favorable
recommendation can be made regarding the facility’s current
compliance pursuant to 2802-(3)(e) of the New York State
Public Health Law.
Financial Summary
Total project costs will be funded via $35,000,000 TELP
lease (5 yrs. @ 1.31%), $14,254,486 cash and a
$93,000,000 loan from M&T Bank (16 yrs. at 3.5%).
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 130,156,134
118,451,091
$ 11,705,043
The applicant indicates that due to the project’s size, it will
take time for the facility to ramp up to full operations and the
facility will have an incremental loss in year one of
operations. By year three however, the building will be more
optimally utilized and the ambulatory volume will be almost
double that of year one. Also, increased inpatient activity
resulting from referrals from the increased outpatient activity,
as well as operating room capacity increasing due to the
relocation of the ambulatory surgery volume, allows the
facility to project a positive financial position in year three of
operations.
Subject to the noted contingencies, the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
Project # 121468-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Submission of a loan commitment that is acceptable to the Department. [BFA]
3. Submission of an executed building lease that is acceptable to the Department. [BFA]
4. Submission of documentation of receipt of Public Authorities Control Board approval of the TELP financing that is
acceptable to the Department of Health. [BFA]
5. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP
Drawing Submission Guidelines DSG-01. [AER]
Approval conditional upon:
1. The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
2. The applicant shall complete construction by July 1, 2014 in accordance with 10 NYCRR Part 710.2(b)(5) and
710.10(a), if construction is not completed on or before that date, this may constitute abandonment of the approval
and this approval shall be deemed cancelled, withdrawn and annulled without further action by the Commissioner.
[AER]
3. The staff of the facility must be separate and distinct from staff of other entities. [HSP]
4. The signage must clearly denote the facility is separate and distinct from other adjacent entities. [HSP]
5. The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
6. The clinical space must be used exclusively for the approved purpose. [HSP]
Council Action Date
October 11, 2012
Project # 121468-C Exhibit Page 2
Need Analysis
Background
Montefiore Medical Center - Henry & Lucy Moses Division seeks approval to certify an extension clinic at 1250 Waters
Place, Bronx, 10461, in Bronx County. The name of the new clinic will be Montefiore Hutch Ambulatory Care Center.
The new facility will be a 12-story 262,701 square foot building. The extension clinic will provide many services,
including multi-specialty ambulatory surgery, and will allow the hospital to decant and consolidate some of its
ambulatory services at the new site.
Montefiore provides one third of all patient care and half of all the tertiary care for the 1.4 million residents of the
Bronx. Through its IPA, Montefiore assumes full risk for 150,000 patients. Through its Pioneer ACO and lead Health
Home, it is responsible for the quality and cost of care for another 40,000 patients.
Analysis
Montefiore Hutch Ambulatory Care Center will have the following certified services:
Service
Ambulatory Surgery - Multi Specialty
Audiology
CT Scanner
Family Planning O/P
Health Fairs O/P
Magnetic Resonance Imaging
Medical Social Services
Nuclear Medicine - Diagnostic
Nutritional
Ophthalmology O/P
Optometry O/P
Pediatric O/P
Physical Medicine and Rehabilitation
Primary Medical Care O/P
Psychology
Radiology - Diagnostic
Therapy - Speech Language Pathology
Well Child Care O/P
Proposed Action
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
9
Ambulatory Surgical Facility
The applicant’s delivery system priorities include the development of a state-of-the-art ambulatory surgery facility that
meets the community need for surgical services, and increases capacity to primary and specialty ambulatory
practices.
This project will relocate existing ambulatory surgery volume from the hospitals in the Montefiore System to the new
extension clinic and provide for additional capacity for ambulatory surgery volume growth. The project will also
relocate and consolidate gastroenterology and vascular surgery ambulatory specialty services and primary care
services to the new site that are currently provided in various locations. In addition, there will be capacity for additional
clinical specialty services and multidisciplinary clinical programs at the new location.
Montefiore does not have any ambulatory surgery capabilities outside of its hospitals. By reconfiguring and expanding
its ambulatory clinical programs, Montefiore will meet the following needs:
•
•
•
•
outpatient growth outpacing inpatient demand;
limited capacity and access in current clinical programs, which constrains access and limits the
opportunity for growth;
appointment waiting times that exceed 30 days;
outmigration of patients;
Project # 121468-C Exhibit Page 3
•
•
a need to balance and integrate a multi-disciplinary ambulatory delivery system; and
the need to provide ambulatory services in an efficient, flexible, and patient friendly environment.
Ambulatory surgery that is performed in the hospitals’ operating rooms competes for time with inpatient and
emergency cases and creates capacity constraints that prohibits additional growth.
The annual ambulatory surgery volume at the three Montefiore hospitals has increased by 6.5 percent from 27,976
cases in 2008 to 29,804 in 2011 as shown in Table 1. During the same period, inpatient surgical discharges increased
by 1.5 percent from 26,428 to 26,832 as indicated in Table 2.
Table 1:
Montefiore Hospitals Ambulatory Surgery Volume
Hospital
2008
2009
Montefiore - Einstein
7,680
7,768
Montefiore Moses
14,431
14,624
Montefiore - Mercy
5,865
6,670
Total
27,976
29,062
2010
7,497
15,916
6,783
30,196
2011
7,475
15,662
6,667
29,804
2010
8,581
15,147
3,061
26,789
2011
8,604
15,307
2,921
26,832
Source: SPARCS 2008 – 2011
Table 2:
Montefiore Hospitals Inpatient Surgical Discharges
Hospital
2008
2009
Montefiore - Einstein
8,058
8,639
Montefiore - Moses
15,126
15,157
Montefiore - Mercy
3,244
3,339
Total
26,428
27,135
Source: SPARCS 2008 – 2011
In addition to an increase in ambulatory surgery volume, the applicant states that Montefiore physicians perform about
1,000 cases at other ambulatory surgery facilities.
Currently, Bronx County has five (5) Freestanding Ambulatory Surgery Centers. The type of ambulatory surgery
service and number of cases performed at the centers are listed below in Table 3:
Table 3:
Existing Ambulatory Surgery Centers: Bronx County
AS Type
Name
Single – Endoscopy
Advanced Endoscopy Center
Multi Specialty
Ambulatory Surgery Ctr Greater NY
Single - Gastroenterology New York GI Center, LLC
Multi Specialty
Surgicare Ambulatory Surgery Ctr NY
Multi Specialty
East Tremont Medical Center
Total
2009
8,140
9,558
8,606
3,749
7,279
37,332
2010
8,802
10,455
7,973
3,464
8,725
39,419
2011*
8,278
9,854
6,825
3,537
7,685
36,179
Source: SPARCS 2009 – 2011.
* SPARCS reporting for 2011 is incomplete.
The services that will be housed in this extension clinic are:
•
•
•
•
Ambulatory Surgery Center – Multispecialty;
12 operating rooms;
4 - procedure rooms; and
other services such as MRI, primary medical care and well child care.
Projected Volumes
In the first year of operation, it is projected that this facility will perform 11,788 ambulatory surgeries, 11,534 imaging
studies, provide 41,835 primary care visits and 103,045 clinical specialty visits and office based tests and procedures.
Project # 121468-C Exhibit Page 4
In the third year of operation, it is projected that this facility will perform 14,939 ambulatory surgeries 23,737 imaging
studies, provide 47,460 primary care visits and 190,844 clinical specialty visits and office based tests and procedures.
It is also projected that there will be an increase in inpatient cases as a result of opening this extension clinic, partially
due to the reduction in the outmigration of Bronx residents for services.
Services at Montefiore Hutch Ambulatory Care Center will be available Monday through Friday, between the hours of
7:00 am and 7:00 pm. The back-up hospital is Montefiore Medical Center, Einstein Division. The approximate travel
time between the outpatient center location and the hospital is approximately less than five (5) minutes and the
distance a distance of less than one-half (1/2) mile.
The ambulatory services extension clinic will serve the health care needs of the Bronx and Lower Westchester County
communities.
Conclusion
Montefiore Medical Center is proposing to construct an extension clinic that will include an ambulatory surgery center,
imaging services, ambulatory clinical practices, primary care, and multidisciplinary specialty programs. This will allow
Montefiore to expand access to care and more efficiently manage patient needs.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Project Proposal
Montefiore Medical Center is requesting permission to construct an extension clinic at 1250 Waters Place, Bronx, to
include ambulatory surgery, imaging services, primary care and specialty outpatient programs, as well as necessary
ancillary services.
It is anticipated the project will result in an additional 260 FTEs in the first year and 538 FTEs by year three.
Compliance with Applicable Codes, Rules and Regulations
This facility has no outstanding Article 28 surveillance or enforcement actions and, based on the most recent
surveillance information, is deemed to be currently operating in substantial compliance with all applicable State and
Federal codes, rules and regulations. This determination was made based on a review of the files of the Department of
Health, including all pertinent records and reports regarding the facility’s enforcement history and the results of routine
Article 28 surveys as well as investigations of reported incidents and complaints.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Lease Rental Agreement
The applicant will lease approximately 262,701 square feet in a to-be built building at 1250 Waters Place, Bronx, N.Y.
(Bronx County), under the terms of the draft lease agreement summarized below:
Address:
Lessor:
Lessee:
Term:
1250 Waters Place, Bronx, N.Y.
Hutch Tower II, LLC
Montefiore Medical Center
16 years with (3) 5 year renewal terms
Project # 121468-C Exhibit Page 5
Rental:
Provisions:
$8,400,000 for year 1 (31.98 per sq. ft), with a 2.5% non compounding basis increase for years
2-4(.80 per sq. ft) and a 3% non compounding basis increase for years 5-16(.96 per sq. ft).
Triple net lease
The applicant has indicated that the lease arrangement will be an arms length lease arrangement. Realtor letters
have been provided attesting to the rental rate being of fair market value.
Total Project Cost and Financing
Total project cost for new construction and equipment is estimated at $142,254,486 itemized below:
New Construction
Design Contingency
Construction Contingency
Planning Consultant Fees
Architect/Engineering Fees
Other Fees (Consultant)
Movable Equipment
Telecommunications
Financing Costs
Interim Interest Expense
Con Application Fee
Additional CON Processing Fee
Total Project Cost
$66,741,960
5,251,000
3,337,000
1,525,290
2,783,546
2,139,541
44,314,576
9,073,150
2,588,314
3,720,000
2,000
778,109
142,254,486
Total costs are based on a January 1, 2013 start date with an eighteen month construction period.
The applicant’s financing plan appears as follows:
Telp Lease 5 years at 1.31%
Cash
M& T bank loan 3.5% for 16 years
Total
$35,000,000
14,254,486
93,000,000
$142,254,486
Operating Budget
The applicant has submitted the first and third year’s incremental operating budgets, in 2012 dollars, as summarized
below:
Inpatient
Revenues
Other
Total Revenues
Expenses:
Operating
Capital
Total Expenses
Excess Revenue over Expenses
Utilization: (Patient discharges)
Cost per Patient discharge
First Year
$25,348,713
349,056
$25,697,769
Third Year
$65,114,870
349,056
$65,463,926
16,240,666
0
16,240,666
42,162,591
0
42,162,591
9,457,103
23,301,335
1,070
$15,178
2,697
$15,633
It is projected that there will be an increase in inpatient cases as a result of opening this extension clinic, partially due
to the reduction in the outmigration of Bronx residents for services.
Project # 121468-C Exhibit Page 6
Outpatient
Revenues
Total Revenues
Expenses:
Operating
Capital
Total Expenses
Excess Revenue over Expenses
Utilization: (Visits)
Operating Cost per Visit
Capital cost per visit
Total cost per visit
First Year
$30,603,893
Third Year
$64,692,208
$30,603,893
$64,692,208
$28,558,667
$17,348,311
$45,906,978
$52,907,301
$23,381,199
$76,288,500
($15,303,085)
107,438
$265.77
$161.52
$427.29
($11,596,292)
216,218
$244.69
$108.14
$352.83
First Year
$55,952,606
349,056
56,301,662
Third Year
$129,807,078
349,056
130,156,134
44,799,333
17,348,311
62,147,644
95,069,892
23,381,199
118,451,091
(5,845,982)
11,705,043
Total
Revenues
Other
Total Revenues
Expenses:
Operating
Capital
Total Expenses
Excess Revenue over Expenses
Inpatient utilization by payor source for the first and third years is as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Commercial Manage Care
All Other
Charity Care
Year 1
15.89%
15.61%
27.48%
21.31%
9.72%
8.13%
.33%
1.53%
Year 3
15.91%
15.61%
27.44%
21.32%
9.75%
8.08%
.34%
1.55%
Outpatient utilization by payor source for the first and third years is as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Commercial Manage Care
All Other
Charity Care
Year 1
8.85%
24.95%
2.69%
1.88%
34.95%
16.18%
1.89%
8.61%
Year 3
8.98%
25.06%
2.66%
1.95%
34.88%
15.92%
1.90%
8.65%
Expenses are based upon a specific model in which six separate specialty areas were chosen; ambulatory surgery,
specialty physician practice, primary care, imaging services, multidisciplinary centers and inpatient care. Per unit,
Project # 121468-C Exhibit Page 7
historical revenues and expenses in each area are calculated and modified to reflect only the expenses associated
with the growth in volume. The incremental capital and space costs were also added. Utilization assumptions are
based on a comprehensive market analysis and needs assessment, as well as a review and an update of Montefiore’s
mission, vision and values statements, and environmental assessments that analyzed both Montefiore’s current
competitive position within local and regional markets and emerging regional and national healthcare trends to
evaluate how these would impact Montefiore.
Capability and Feasibility
Total project cost of $142,254,486 will be funded as shown above.
Presented as BFA Attachment A are the 2010 and 2011 certified financial statements for Montefiore Medical Center,
which shows that the facility had positive working capital and net asset positions during the period shown. The facility
also generated an average net income of $83,418,500 during the period 2010-2011. Working capital requirements are
estimated at $19,741,849, which appear reasonable based on two months of third year budgeted expenses.
Based on BFA Attachment A, the facility has sufficient resources to fund both their working capital requirements and
their equity requirements for the project.
The incremental budget for the first year and third years’ of operations projects a loss of $5,845,982 and net revenue
of $11,705,043, respectively.
It appears that the applicant has demonstrated the capability to proceed in a financially feasible manner, and
contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary for 2011 and 2010, Montefiore Medical Center
BHFP Attachment
Map
Project # 121468-C Exhibit Page 8
Public Health and Health
Planning Council
Project # 121363-C
Sunshine Children’s Home and Rehab Center
County: Westchester (Ossining)
Purpose: Construction
Program: Residential Health Care Facility
Submitted: May 2, 2012
Executive Summary
Description
Sunshine Children’s Home and Rehab Center
(Sunshine) is an existing proprietary 44-bed pediatric
residential health care facility (RHCF), located at 15
Spring Valley Road, Ossining. Via this CON, Sunshine
requests approval for the permanent certification of the
facility’s six existing temporary pediatric beds and the
permanent certification of four additional pediatric
beds, increasing the total certified capacity from 44 to
54 pediatric RHCF beds. The facility currently has
capped its waiting list to 20 pediatric patients seeking
admission to the facility, and can immediately fill the
four additional beds from its waiting list. The existing
50 pediatric RHCF beds are currently operating at
100% capacity. The applicant began operating the
facility on September 1, 2009.
Current Beds
Proposed Net New Beds
Beds Upon Project Approval
44
10
54
On May 12, 2011, the facility requested temporary
emergency approval to operate six additional pediatric
beds at the facility in order to meet the demand for
pediatric services in the community. On June 3, 2011,
the Department granted temporary approval to the
facility, effective June 13, 2011, to operate three
additional pediatric beds, with the understanding that
once additional renovations were completed at the
facility, the Department would approve an additional
three pediatric beds. On November 8, 2011, the
Department granted the temporary approval for an
additional three pediatric beds, increasing the facility’s
capacity to 50 pediatric RHCF beds.
Need Summary
Sunshine consistently has a waiting list and only allows
for 20 patients to be on the list at any time. This forces
children that do not make the list to travel outside of
New York State in search of treatment. The approval
of this project will decrease this problem and help keep
the patients and their families closer to home.
Program Summary
The renovation project has created a more pleasant
and functional facility for the children who live there,
with the added benefit of easing the demand for
pediatric placements. The unique living arrangement
of multiple-bedded rooms without single bedrooms has
been shown to be a beneficial configuration to meet
the needs of the children and infants in the nursing
home. Programmatic survey of the nursing home has
continuously reinforced the appropriateness of
operating the nursing home without single bedrooms,
and the residential environment has been improved by
the renovation project, even as the number of beds
has increased.
Financial Summary
There is no project cost associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 2,411,046
1,723,445
$ 687,601
Subject to the noted contingency, it appears that the
applicant has demonstrated the capability to proceed
in a financially feasible manner.
DOH Recommendation
Contingent approval.
Project # 121363-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a waiver of 10 NYCRR 713-3.4(4) from the applicant, and approval from the Bureau of Licensure
and Certification. [LTC]
2. Submission of a working capital loan commitment that is acceptable to the Department. [BFA]
Council Action Date
October 11, 2012.
Project # 121363-C Exhibit Page 2
Need Analysis
Background
Sunshine Children’s Home and Rehab Center is a 44-bed pediatric residential health care facility (RHCF) located at 15
Spring Valley Road Ossining, 10562, in Westchester County. The facility seeks to make 6 temporary beds permanent,
and add 4 additional net new beds. This will increase total capacity from 44 to 54 beds.
Analysis
Westchester County Nursing Home utilization is higher than Westchester County for 2008, 2009, but was lower in
2010 as shown in the table below:
RHCF Occupancy
Sunshine Children’s Home
Westchester County
2008
98.9%
93.2%
2009
99.2%
93.3%
2010
92.2%*
92.8%
*The facility may not have complete data for 2010. The facility is 100% full on a normal basis.
As indicated below in the table below, the project 2016 bed need for Westchester County is -279. However, this need
is for all residential nursing home beds. The Department of Health does not calculate need specifically for pediatric
RHCF beds.
County RHCF Bed Need
2016 Projected Need
Current Beds
Beds Under Construction
Unmet Need
Westchester
6,716
6,643
352
-279
Conclusion
The lack of pediatric access to long term care beds is a problem that forces families to seek treatment in other regions
of New York or out of state. This project will help to alleviate that problem in Westchester County.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Facility Information
Facility Name
Address
RHCF Capacity
ADHC Program Capacity
Type Of Operator
Class Of Operator
Operator
Existing
Sunshine Children’s Home
and Rehab Center
15 Spring Valley Road,
Ossining, NY 10562
44 + 6 temporary
0
Proprietary
Limited Liability Company
MSAF Group, LLC
Proposed
Same
Same
54
Same
Same
Same
Same
Project # 121363-C Exhibit Page 3
Program Review
Sunshine Children’s Home and Rehab Center (Sunshine) is a 44-bed pediatric nursing home located on Spring Valley
Road in Mount Vernon. Sunshine is a unique nursing home, specializing in the long term care of children ranging from
toddlers to pre-teenagers. Due to the nature of its resident population, Sunshine includes multiple three-bedded and
four- bedded rooms. The quad bedrooms contain cribs, with additional nursing staff assigned to each room to meet
the needs of this age group. The triples are generously sized affording privacy and opportunities for socialization.
Sunshine employs significantly greater staffing to provide the necessary developmental and educational resources for
the children.
Physical Environment
In June, 2010 Sunshine was approved for a $1.8 million project to renovate the facility, including the installation of a
mandated sprinkler system, and to upgrade the residential areas and expand the substandard rehabilitation space. In
order to expand therapy space the rehabilitation program was relocated into a modular structure, with the now vacant
occupational and physical therapy rooms available for use as decanting space. This space was renovated and
subsequently used as transition bedrooms as the room by room renovation progressed. Upon completion of the
project these transition bedrooms became available to meet a spike in demand for pediatric placements from area
hospitals. In June, 2011 Sunshine received emergency approval to operate 3 additional temporary beds, and in
November, 2011 received approval for an additional 3 temporary beds to be located in the transition bedrooms.
The noted renovation project also addressed the overall living environment of the nursing home, with the nursing
supervisory functions decentralized into resident-centered modules. This reorganization eliminated the glass walled
central nursing station, creating additional space to meet the surging demand for beds. An existing three-bedded
nursery was re-located into this area, with space for an additional crib. The vacated nursery was subsequently
renovated and converted into a three-bedded pediatric room. The completion of these renovations permits the
increase of four additional beds, (one crib and three pediatric beds). Therefore, upon approval, the permanent bed
capacity could increase immediately from 44 beds to 54 beds.
Compliance
There are currently no outstanding enforcements against Sunshine Children’s Home and Rehab Center, nor are there
any identified survey deficiencies.
Project Review Analysis
The addition of permanent bed capacity can be made without additional renovation. The completion of the current
project creates sufficient space to add beds, with six temporary beds already operating in the new rooms. The
renovation project has created a more pleasant and functional facility for the children who live there, with the added
benefit of easing the demand for pediatric placements. The unique living arrangement of multiple-bedded rooms
without single bedrooms has been shown to be a beneficial configuration to meet the needs of the children and infants
in the nursing home. Programmatic survey of the nursing home has continuously reinforced the appropriateness of
operating the nursing home without single bedrooms, and the residential environment has been improved by the
renovation project even as the number of beds has increased. DOH nursing staff has also reviewed the infection
control protocol for the nursing home, which relies on leaving the sick child “in place” without relocation to an isolation
room. The protocol was found to be effective, and the minor revisions suggested by DOH staff were put into practice
by Sunshine.
However, Sunshine is in not in compliance with current regulations requiring a minimum of 10% of all beds be located
in single rooms. Since regulations governing the operation of pediatric nursing units have not been promulgated, the
nursing home is surveyed against the conventional nursing home standards contained in 10NYCRR 713-3, including
713-3.4(4). In order to continue with the permanent bed expansion, Sunshine will need to seek a waiver of the single
bed requirement from the Bureau of Architectural Engineering Facility Planning.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Project # 121363-C Exhibit Page 4
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget for the ten additional beds, in 2012 dollars, during the
first and third year, which is summarized below:
Revenues
Year One
$2,411,046
Year Three
$2,411,046
Expenses:
Operating
Capital
Total Expenses
$1,717,725
8,994
$1,726,719
$1,717,725
5,720
$1,723,445
$684,327
$687,601
3,453
94.60%
3,453
94.60%
Net Income
Utilization: (patient days)
Occupancy
Utilization for the ten additional beds will be 100% Medicaid.
Expense and utilization assumptions are based on the historical experience of the facility.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements are estimated at $287,240, which appears reasonable based on two months of third year
expenses. The applicant will finance $143,620 at an interest rate of 6.25% for five years. The remainder, $143,620,
will be provided as equity by the members of the applicant. Presented as BFA Attachment A, is the personal net worth
statement of the members of the applicant, which indicates the availability of sufficient funds for the equity contribution.
The submitted budget projects a net income of $684,327 and $687,601 during the first and third years. Revenues are
based on current reimbursement rates.
Presented as BFA Attachment B, is a financial summary of Sunshine Children’s Home and Rehab Center during the
period 2010 through 2011. As shown on Attachment B, the facility had an average negative working capital position
and average negative net asset position during 2010 through 2011. Also, the facility incurred average net losses of
$207,675 from 2010 through 2011. The applicant had a 2010 loss of $2,689,970, of which reflected a reduction in the
facility’s Medicaid rate based on the Department applying cost ceilings to the pediatric facility. The facility appealed its
Medicaid rate, indicating that pediatric facilities are exempt from the application of cost ceilings and the appeal was
successful in restoring the facility’s Medicaid rate to actual costs. Consequently, the facility received retroactive
Medicaid reimbursement in 2011 for prior periods and is awaiting a revised Medicaid rate for 2011.
Subject to the noted contingency, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 121363-C Exhibit Page 5
Attachments
BFA Attachment A
Personal Net Worth Statement- Members of Sunshine Children’s Home and
Rehab Center
BFA Attachment B
Financial Summary- Sunshine Children’s Home and Rehab Center.
Project # 121363-C Exhibit Page 6
Public Health and Health
Planning Council
Project # 121288-C
Living Resources Certified Home Health Agency, Inc.
County: Albany (Albany)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 20, 2012
Executive Summary
Description
Living Resources Certified Home Health Agency, Inc.
(Living Resources) is a not-for-profit corporation
approved as a special needs certified home health
agency (CHHA) serving Albany, Fulton, Montgomery,
Rensselaer, Schenectady, Saratoga, Schoharie,
Warren, and Washington counties. Living Resources
is requesting approval to convert their existing special
needs CHHA to a general purpose CHHA, and to
expand CHHA services into Columbia County.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. Living Resources
submitted an application in response to the competitive
RFA, and was awarded RFA approval. This CON
application is in response to the RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal # 5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Approval.
Need Summary
The applicant demonstrated an in-depth knowledge of
the health needs of the community, specifically the
medically underserved TBI and OPWDD populations.
Living Resources has been instrumental in modifying
homes to better serve patients with aging, mobility and
Alzheimer conditions. The applicant provided a
comprehensive analysis of demographic data to
establish public need based on 709.1(a) as well as an
analysis of unmet community need.
Program Summary
Living Resources Certified Home Health Agency, Inc.
is currently in compliance with all applicable codes,
rules and regulations.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 7,061,170
6,113,100
$ 948,070
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 121288-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner’s approval of the application, and be providing services in the entire
geographic area approved within one year of the Council’s recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 121288-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval would ensure
access to CHHA services in counties with less than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
The Living Resources Certified Home Health Agency proposal demonstrated the applicant’s organizational capacity to
successfully implement the MRT initiatives and support the goals of the Department in advancing these initiatives.
Living Resources discussed how the proposed general purpose CHHA will work with MLTCPs to serve the home
health care needs of the population and provided details on the role they will play in supporting transitioning of
consumer-directed programs into managed care. The applicant provided detailed information regarding their
community linkages and referral sources and on how these play a vital role in care coordination and service delivery
for MLTCPs.
Project # 121288-C Exhibit Page 3
The applicant demonstrated an in-depth knowledge of the health needs of the community, specifically the medically
underserved TBI and OPWDD populations. Living Resources will bring their knowledge, expertise and experience to
serve at-risk members of the general population through its transition to a general purpose CHHA. Living Resources
thoroughly demonstrated their ability to enhance care coordination and ensure continuity of care for patients currently
receiving home care services. Living Resources has been instrumental in modifying homes to better serve patients
with aging, mobility and Alzheimer conditions. The applicant provided comprehensive analysis of demographic data to
establish public need based on 709.1(a) as well as an analysis of unmet community need. The application provided a
description of the agency’s long standing, extensive continuous quality improvement program and its focus on
improving care processes and outcomes.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Living Resources Certified Home Health Agency, Inc. is an existing not-for-profit corporation which operates a CHHA
approved to serve the special needs population of patients with mental retardation and developmental disabilities in
the counties of Albany, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and
Washington Counties. Pursuant to the recent Request for Applications (RFA) for the establishment of new CHHAs or
the expansion of existing CHHAs into additional counties, the applicant seeks approval to convert their Special Needs
Population CHHA to a general population CHHA, and to add Columbia County to their approved geographic service
area. Living Resources Certified Home Health Agency, Inc. will continue to serve all counties from their existing
offices at 300 Washington Avenue Extension, Albany, New York 12203.
Living Resources Certified Home Health Agency, Inc. will continue to provide the following home health care services:
home health aide; medical social services; medical supplies, equipment, and appliances; nursing; occupational
therapy, physical therapy, and speech language pathology. They are also requesting that nutritional services be
added at this time to their operating certificate as an additional approved service.
Living Resources Certified Home Health Agency, Inc. is currently in compliance with all applicable codes, rules and
regulations.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget for the first and third years, in 2012 dollars, which is
summarized below:
Revenues:
Medicaid Fee- for-service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Commercial Managed Care
Total Revenues
Year One
Year Three
$1,524,605
988,314
456,148
456,149
$76,018
76,019
$3,577,253
$3,005,058
1,952,931
901,364
901,355
150,232
150,230
$7,061,170
Project # 121288-C Exhibit Page 4
Expenses
Net Gain(Loss)
$3,093,564
$6,113,100
$483,689
$948,070
Utilization by payor source for combined programs in the first and third years is as follows:
Payor
Commercial Fee-for-Service
Commercial Managed Care
Medicare Fee-for-service
Medicare Managed Care
Medicaid Fee-for Service
Medicaid Managed Care
Charity Care
Years One and Three
2.45%
2.45%
14.70%
14.70%
31.85%
31.85%
2.00%
Expense and utilization assumptions are based on the existing CHHA Program’s historical experience. Revenues are
reflective of current payment rates as well as the recent implementation of the Medicaid Episodic Payment system.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements, estimated at $1,018,850, which appears reasonable based on two months of third year
expenses and will be provided through the existing operation.
The submitted budget indicates that the applicant will achieve incremental net revenue in the first and third years of
operations of $483,689 and $948,070, respectively. Revenue is based on current payment rates for Certified Home
Health Agencies. The submitted budget appears reasonable.
Presented as BFA Attachment A is the audited financial summary of Living Resources Corporation and Affiliates. This
shows the applicant has maintained a positive working capital position and a positive net asset position and achieved
an average net income of $19,876 for the period 2010 through 2011. The loss in 2011 was due to the facility’s special
needs patients, who require a high intensity of service; and that the Medicaid rate, which applied to almost 100% of
the overall caseload, was far below the actual costs. In order to correct this issue, the facility has submitted this CON
in order to change from a special needs CHHA to a general purpose CHHA, which will expand and diversify its
services and spread the overhead of the agency’s operations.
Based on the preceding, it appears that the applicant has demonstrated the financial capability to proceed in a
financially feasible manner; and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary for Living Resources Corporation and Affiliates 2010-2011.
Project # 121288-C Exhibit Page 5
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Hospice Services – Construction
1.
Number
Applicant/Facility
121405 C
Hospice Buffalo Inc
(Erie County)
Mr. Booth - Interest
Residential Health Care Facility – Construction
Number
Applicant/Facility
1.
121084 C
Pine Haven Home
(Columbia County)
Mr. Fassler - Interest
2.
121183 C
Wayne County Nursing Home
(Wayne County)
Mr. Booth - Interest
Upstate Certified Home Health Agencies - Construction
1.
Number
Applicant/Facility
121199 C
At Home Care, Inc.
(Otsego County)
Mr. Booth - Interest
Exhibit #7
E.P.R.C.
Recommendation
Contingent Approval
Exhibit #8
E.P.R.C.
Recommendation
Contingent Approval
Contingent Approval
Exhibit #9
E.P.R.C.
Recommendation
Contingent Approval
2.
121225 C
Park Ridge at Home – Park
Ridge Nursing Home, Inc.
(Monroe County)
Mr. Booth – Recusal
Mr. Fassler - Interest
Ms. Hines – Recusal
Mr. Robinson – Recusal
Contingent Approval
3.
121274 C
Finger Lakes Visiting Nurse
Service, Inc.
(Ontario County)
Mr. Booth – Recusal
Ms. Hines – Recusal
Mr. Robinson – Recusal
Contingent Approval
4.
122122 C
Visiting Nurse Services in
Westchester, Inc.
(Westchester County)
Ms. Regan - Interest
Contingent Approval
5.
122123 C
Dominican Sisters Family
Health Service, Inc.
(Westchester County)
Ms. Regan - Interest
Contingent Approval
Downstate Certified Home Health Agency - Construction
1.
Number
Applicant/Facility
121203 C
Personal Touch Home Aides of
New York, Inc.
(Kings County)
Mr. Fassler – Interest
Ms. Regan - Interest
Exhibit #10
E.P.R.C.
Recommendation
Contingent Approval
Public Health and Health
Planning Council
Project # 121405-C
Hospice Buffalo, Inc.
County: Erie (Cheektowaga)
Purpose: Construction
Program: Hospice Services
Submitted: May 24, 2012
Executive Summary
Description
Hospice Buffalo, Inc., a not-for-profit corporation, requests
approval for renovations to the clinical building at Hospice
Buffalo’s Mitchell Campus, 225 Como Park Boulevard,
Cheektowaga. This proposal is designed to accomplish
two objectives: create efficiencies and a better work
environment for hospice clinicians, and create a more
home-like and comfortable environment for patients and
their families in need of end of life care.
To accomplish these tasks the renovation project will
include:
•
•
•
•
•
•
•
•
•
More central location and expansion of the Inpatient
Unit nurses station.
Upgrading the bathrooms in 22 patient rooms.
General renovations of all 22 patient rooms leading
to a more comfortable atmosphere.
General upgrading of the Inpatient Unit common
areas.
Upgrading the Clinical Building’s HVAC system so
that each patient room can be individually
temperature controlled.
Adding a distinct patient/ambulance entrance to the
Inpatient Unit.
Reconfiguring and upgrading the building’s
commercial kitchen to make work flow more efficient.
Relocating the chapel to make it more accessible.
General refurbishment of the common areas.
of the construction. Swing beds will be utilized for
additional inpatient need.
The Center for Hospice & Palliative Care, Inc. is the sole
corporate member of Hospice Buffalo, Inc., Home Care
Buffalo, Inc., Life Transitions Center, Inc., Caring Hearts
Home Care, Inc., Palliative Care Institute, Inc., Hospice
Foundation of Western New York, Inc., Saunders
Properties of WNY, Inc. and Gilda’s Club Western New
York, Inc.
Total project costs are estimated at $9,143,586.
DOH Recommendation
Contingent approval.
Need Summary
As this project involves Hospice construction with no
change in capacity, no Need recommendation is required.
Program Summary
Hospice Buffalo, Inc. is currently in compliance with all
applicable codes, rules, and regulations.
Financial Summary
Total project costs will be met via equity of $4,143,586
and a loan of $5,000,000 (20 yrs. @ 2.24%).
Budget:
Revenues:
Expenses:
Gain/(Loss):
$
0
272,334
$ (272,334)
It is anticipated that the Inpatient Unit will be closed for
approximately 9 months. During this time, the 10-bed
hospice house residence in the clinical buildings, which
currently includes two dually-certified beds, will be used
as an inpatient unit.
The applicant has indicated that the losses will be offset
from operations.
These 10 beds, in addition to the newly certified inpatient
beds at the St. John Baptist Hospice Buffalo House, will
provide Hospice Buffalo 18 inpatient beds for the duration
Subject to the noted contingency, it appears that the
applicant has demonstrated the capability to proceed in a
financially feasible manner.
Project # 121405-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of thirty hundredths of one percent of
the total capital value of the project, exclusive of CON fees. [PMU]
2. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP
Drawing Submission Guidelines DSG-01. [AER]
3. Submission of a loan commitment that is acceptable to the Department of Health. [BFA]
Approval conditional upon:
1. The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
2. The applicant shall complete construction by October 1, 2014 in accordance with 10 NYCRR Part 710.2(b)(5) and
710.10(a), if construction is not completed on or before that date, this may constitute abandonment of the approval
and this approval shall be deemed cancelled, withdrawn and annulled without further action by the Commissioner.
[AER]
Council Action Date
October 11, 2012.
Project # 121405-C Exhibit Page 2
Programmatic Analysis
Background
Hospice Buffalo, Inc., a voluntary corporation, currently operates an Article 40 hospice which serves the residents of
Erie County. It is also currently certified to operate a 22-bed hospice inpatient unit and a 10-bed hospice residence
unit (with 2 of these 10 residence beds dually certified for both inpatient care and residence care) in a freestanding
facility located in Cheektowaga, and another 8-bed hospice residence unit (with 2 of these 8 residence beds dually
certified for both inpatient care and residence care) in a freestanding facility located in Buffalo. On December 30,
2011, CON project 112069-C received Public Health and Health Planning Council approval for Hospice Buffalo, Inc.,
to convert the Buffalo facility from an 8-bed hospice residence unit to an 8-bed hospice inpatient unit. The hospice is
currently in contact with the NYSDOH Western Regional Office – Buffalo to complete all necessary steps to finalize
that CON project and receive final NYSDOH approval to begin operating that Buffalo facility as an all inpatient unit.
The current proposal seeks approval to renovate at this time just the 22-bed hospice inpatient unit located in their
facility in Cheektowaga. During construction, which is anticipated to last approximately nine months, the hospice
proposes to temporarily convert the 10 bed residence unit (with 2 dually certified beds) in that same facility in
Cheektowaga, into a temporary 10 bed all inpatient unit. Once all construction renovations are complete, the hospice
plans to revert back to the originally approved and operational configuration of a 22-bed hospice inpatient unit, plus a
10-bed hospice residence unit (with 2 dually certified).
The proposed renovations are designed to create a more home-like and comfortable environment for the patients and
their families, and to create efficiencies and a better work environment for the hospice clinicians as they deliver care
and train students in palliative and end-of life care.
The proposed renovations will include, but are not limited to, the following:
1) Centrally locate and expand the Inpatient Unit’s nurses’ stations.
2) Upgrade the private bathrooms in all 22 hospice inpatient rooms, including adding showers in each bath and
replacing the bathroom doors to make the bathrooms safer and easier for clinical staff to attend to the
patients.
3) Renovate each of the 22 private rooms, including installation of new built-in cabinetry, new lighting, new
windows, and renovation of floors, ceilings, and walls to provide a fresh, more comforting atmosphere.
4) Upgrading the Inpatient Unit’s common areas, including an upgrade of the family kitchen facilities.
5) Upgrading the HVAC system so that each patient’s room may be individually temperature controlled.
6) Adding a distinct patient / ambulance entrance to the Inpatient Unit.
7) Reconfiguring and upgrading the building’s commercial kitchen for more efficient work flow.
8) Relocating the chapel to make it more accessible to patients and families.
9) Renovate all other common areas, including the lobby, the bistro eating area, and the hallways.
Hospice Buffalo, Inc. is currently in compliance with all applicable codes, rules, and regulations.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Total Project Cost and Financing
Total project cost, which is for new construction, renovation, demolition, and the acquisition of moveable equipment, is
estimated at $9,143,586, itemized below:
New Construction
Renovation and Demolition
Site Development
$723,779
5,174,057
135,026
Project # 121405-C Exhibit Page 3
Design Contingency
Construction Contingency
Fixed Equipment
Architect/Engineering Fees
Moveable Equipment
Telecommunications
Financing Costs
Interim Interest Expense
CON Fees
Additional Processing Fee
Total Project Cost
399,475
583,197
520,283
376,500
364,958
210,000
12,500
614,468
2,000
27,344
$9,143,586
Project costs are based on an April 1, 2013 construction start date and an eighteen month construction period.
The applicant’s financing plan appears as follows:
Equity
Bank Loan (2.24% interest rate for a twenty year term)
$4,143,586
5,000,000
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, which are
summarized below:
Revenues
Year One
$0
Year Three
$0
Expenses:
Operating
Capital
Total Expenses
$0
198,170
$198,170
$0
272,334
$272,334
($198,170)
($272,334)
0
0
Excess of Revenues over Expenses
Utilization: (Patient Days)
Capability and Feasibility
The applicant will finance $5,000,000 at an interest rate of 2.24% for a twenty year term from the Hospice Foundation
of Western New York. The remainder, $4,143,586, will be provided as equity via accumulated funds of the Hospice
Foundation of Western New York.
Working capital requirements, which are estimated at $45,389, appear reasonable based on two months of third year
expenses. The working capital will be met via equity from the Hospice Foundation of Western New York. Presented
as BFA Attachment A is the financial summary for Hospice Foundation of Western New York, which indicates the
availability of sufficient funds for the equity contribution for the project cost and the working capital.
The budget indicates an excess of revenues over expenses of ($198,170) and ($272,334) during the first and third
years, respectively. The applicant has indicated that the losses will be offset from operations.
Presented as BFA Attachment B are the 2010 and 2011 certified financial statements of Hospice Buffalo, Inc.
As shown on Attachment B, the facility had an average positive working capital position and an average positive net
asset position from 2010 through 2011. The facility achieved an average excess of revenues over expenses of
$1,304,525 during 2010 and 2011. The facility incurred a loss in 2010 due to the following reasons: wage adjustments
and staffing increases at Hospice Buffalo, Inc. The applicant implemented the following steps to improve operations:
adjusted wages to reflect market rates and reduced staff turnover, leading to decreased investment in training.
Project # 121405-C Exhibit Page 4
Presented as BFA Attachment C are the 2010 and 2011 certified financial statements of The Center for Hospice &
Palliative Care, Inc. As shown on Attachment C, the entity had an average positive working capital position and an
average positive net asset position. Also, the entity achieved an excess of revenues over expenses of $2,515,525
from 2010 through 2011. The entity incurred a loss in 2011 of $453,256. The reasons for the loss in 2011 were the
result of increased competition within the community, leading to increased levels of turnover. The applicant
implemented the following steps to improve operations: the applicant’s sole member, The Center for Hospice/Palliative
Care, appointed a new CFO to head the organization; realigning the case load and increasing clinical staff, and
adjusting wages to reflect market rates. Program investments included developing new products and programs, as
well as growing two existing business lines.
Subject to the noted contingency, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary of Hospice Foundation of Western New York
BFA Attachment B
Financial Summary Hospice Buffalo, Inc.
BFA Attachment C
Financial Summary The Center for Hospice & Palliative Care
Project # 121405-C Exhibit Page 5
Public Health and Health
Planning Council
Project # 121084-C
Pine Haven Home
County: Columbia (Philmont)
Purpose: Construction
Program: Residential Health Care Facility
Submitted: February 16, 2012
Executive Summary
Description
Pine Haven Home is a 120-bed public skilled nursing
facility, located at Route 217, Philmont. The applicant
seeks approval for the construction of a 128-bed
replacement facility, adding 8 net new beds. The
building will be a one-story campus layout comprised
of an ancillary building, which will be flanked by two
residential neighborhoods. Each of the neighborhoods
will be broken down into three households serving as
the home for 64 residents, and will be sharing a
common service core.
The new 128-bed facility will have a combination of
both single and double rooms. In each neighborhood,
two of the three households will be comprised of 2
private and 10 semi-private rooms and the third
household will be comprised of 4 private and 8 semiprivate rooms. The additional 8 beds that are being
requested with this application are to cover the
anticipated nursing home bed need for the county,
which is projected to be eight additional beds by 2016.
Total project costs are estimated at $32,351,635.
DOH Recommendation
Contingent approval.
Need Summary
Pine Haven Home’s certified capacity before and after
completion of this CON is as follows:
Current
120
Change
+8
After Completion
128
by 6.5% from 2008 to 2010. Pine Haven also has the
highest number of Medicaid admissions in Columbia
County for 2010 at 77.5%. The modernization and
modest expansion of the facility will also aid in the
repatration of Columbia County residents who have
sought RHCF care in neighboring Massachusetts.
Program Summary
The proposed replacement Pine Haven Home will
result in a therapeutic and home-like environment for
its occupants. The superior design will be appealing to
prospective residents and will enable the nursing home
to maintain a very high occupancy. Pine Haven Home
is currently in substantial compliance with all applicable
codes, rules and regulations.
Financial Summary
Project costs will be met via $32,351,635 in general
obligation bonds (25 yrs. @ 3%).
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 13,002,634
14,901,351
( $1,898,717)
Subject to the noted contingency, upon continued
receipt of county supplemental funds, it appears that
the facility can maintain operations. The Department is
in receipt of a letter from the Chairman of the Columbia
County Board of Supervisors stating that the county
will continue to fund the operating deficits of the facility
for the foreseeable future.
Pine Haven Home proposes to build a new facility that
will include 8 additional beds, fulfilling the remaining
need. Pine Haven Home has increased its occupancy
Project # 121084-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. The submission of a commitment signed by the applicant indicating that, within two years from the date of
approval, the percentage of all admissions who are Medicaid and Medicare/Medicaid eligible at the time of
admission will be at least 75 percent of the planning area average of all Medicaid and Medicare/Medicaid
admissions, subject to possible adjustment based on factors such as the number of Medicaid patient days, the
facility’s case mix, the length of time before private paying patients became Medicaid eligible, and the financial
impact on the facility due to an increase in Medicaid admissions.
3. Submission of a plan to enhance access to Medicaid residents. At a minimum, the plan should include, but not
necessarily limited to, ways in which the facility will:
a) Reach out to hospital discharge planners to make them aware of the facility’s Medicaid Access
Program;
b) Communicate with local hospital discharge planners on a regular basis regarding bed availability at
the nursing facility;
c) Identify community resources that serve the low-income and frail elderly population who may
eventually use the nursing facility, and inform them about the facility’s Medicaid Access policy; and
d) Submit an annual report for two years to the DOH, which demonstrates substantial progress with the
implementation of the plan. The plan should include but not be limited to:
• Information on activities relating to a-c above; and
• Documentation pertaining to number of referrals and number of Medicaid admissions; and
• Other factors as determined by the applicant to be pertinent.
The DOH reserves the right to require continued reporting beyond the two year period. [RNR]
4. The submission of and programmatic review and approval of final floor plans. [LTC]
5. Submission of the County Bond and Note Resolution that is acceptable to the Department of Health. Included
with the submitted bond and note resolution must be a sources and uses statement and debt amortization
schedule, for both new and refinanced debt. [BFA]
6. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP
Drawing Submission Guidelines DSG-01. [AER]
Approval conditional upon:
1. The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
2. The applicant shall complete construction by October 1, 2015 in accordance with 10 NYCRR Part 710.2(b)(5) and
710.10(a), if construction is not completed on or before that date, this may constitute abandonment of the approval
and this approval shall be deemed cancelled, withdrawn and annulled without further action by the Commissioner.
[AER]
Council Action Date
October 11, 2012.
Project # 121084-C Exhibit Page 2
Need Analysis
Background
Pine Haven Home, a 120 bed public residential health care facility, located at NY Route 217, Philmont, 12565, in
Columbia County seeks approval to build a replacement facility and add 8 net new beds for a total of 128 beds.
Pine Haven Home’s utilization is higher than Columbia County for 2009 and 2010, but was less than the rate for the
county as a whole in 2008 as shown in the table below:
RHCF Occupancy
Pine Haven Home
Columbia County
2008
88.26%
93.10%
2009
94.06%
92.30%
2010
94.94%
91.70%
As shown in the table below, there is currently a need for 8 beds in Columbia County. However, since the county’s
utilization is below 97%, there is a rebuttable presumption that there is no need for additional beds. Pine Haven Home
has provided the following local factors to rebut the presumption of no need.
•
There are currently 29 Columbia County residents receiving care in residential health care facilities located in
Massachusetts. The addition of 8 beds will allow some of these patients to repatriate to Columbia County.
•
Specialized services will be offered in the new facility to repatriate patients who may have left the county in
search of treatment. These services may include Huntington’s disease services, wound care, bariatric
services, and orthopedic rehabilitation. In addition, the facility is collaborating with local health care providers
to have on-site physician specialists.
•
Pine Haven Home acts as a safety net for Columbia County residents. Pine Haven accepts residents that
other facilities may be reluctant to accept, such as those with special care needs and inability to pay.
•
Pine Haven’s rate of Medicaid admissions, 77.5% in 2010, is the highest of any facility in Columbia County.
•
The 65 and older population in Columbia County is 18.7% compared to the statewide average of 13.7%.
•
The 85+ population in Columbia County is 3.1% compared to the statewide average of 1.9%. The 85+
population is the group that will most likely utilize a residential health care facility.
•
There has been an increase of 12.9% of the 85+ population in Columbia County.
•
There is an expectation that residents who own second homes in Columbia County will seek RHCF treatment
for their elderly relatives in the county.
•
The new facility will be constructed using current standards, which will increase the quality of care for
residents and allow for cost efficiencies.
Table 2: RHCF Need – Columbia County
2016 Projected Need
667
Current Beds
648
Beds Under Construction
11
Total Resources
659
Unmet Need
8
Project # 121084-C Exhibit Page 3
Medicaid Access
Regulations indicate that the Medicaid patient admissions standard shall be 75% of the annual percentage of all
Medicaid admissions for the long term care planning area in which the applicant facility is located. Such planning area
percentage shall not include residential health care facilities that have an average length of stay 30 days or fewer. If
there are four or fewer residential health care facilities in the planning area, the applicable standard for a planning area
shall be 75% of the planning area percentage of Medicaid admissions, whichever is less. In calculating such
percentages, the Department will use the most current data which have been received and analyzed by the
Department.
Upon approval, Pine Haven Home will be required to make appropriate adjustments in its admission policies and
practices so that the proportion of its own annual Medicaid patients admissions is at least 75% of the planning area
percentage, whichever is applicable.
Conclusion
The addition of eight beds to Pine Haven and the associated changes in the new facility will promote cost efficiencies
in operation and help improve quality of care. They will also satisfy the need for beds in Columbia County, which has
a high proportion of older people, including those 85 and above. The expansion of the facility and the associated
offering of more specialized services will also aid in the repatriation of Columbia County residents who have sought
care in neighboring Massachusetts. Such repatriation of New Yorkers to facilities and services in New York State is
consistent with the goals of Medicaid Redesign.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Facility Information
Existing
Pine Haven Home
PO Box 785, NY Route 217
Philmont, NY 12565
120
RHCF Capacity
ADHC Program Capacity N/A
Public
Type of Operator
County
Class of Operator
Columbia County
Operator
Facility Name
Address
Proposed
Same
Same
128
N/A
Same
Same
Same
Pine Haven Home is a 120 bed nursing home located in the Town of Philmont, Columbia County. The current building
is situated on a 54-acre parcel and, while generally code compliant, is expensive to operate and functionally obsolete.
The Board of Directors of Columbia County has opted to construct a 128-bed replacement facility, which will include
an additional 8 SNF beds, on the same campus as the existing nursing home building.
Physical Environment
The plan for the new Pine Haven Home can be seen as a virtual textbook of contemporary residential design,
embracing the concepts of resident choice and socialization. Utilizing a single- story layout the plan creates a central
ancillary core connected to a series of arrow points which comprise the residential neighborhoods. Entry into the
nursing home is made at the center of the building, which opens into a “grand lobby” with a concierge desk. An
adjacent hearth room warmed by multiple electric fireplaces offers opportunities for interaction with residents and
visitors.
Administrative offices frame the entry space, with the hearth room ringed by an array of resident services, including
rehabilitation gym and ADL training apartment, activities space, a personal laundry and a beauty parlor. A bistro and
café, arrayed with televisions akin to a sports bar, is located adjacent to the hearth room, providing an additional
Project # 121084-C Exhibit Page 4
venue for socialization with families and friends. The rear area of the ancillary core houses the central kitchen and
food storage area, with a nearby service elevator connecting to the ground floor, which contains the industrial
functions including laundry, receiving dock and mechanical and electrical rooms, and a cluster of conference rooms.
Flanking the central core are twin 64 bed nursing units, with each nursing unit subdivided into three neighborhoods
consisting of two 22 bed and one 20 bed units. The 22 bed sub-units include ten doubles and two singles, and the 20
bed sub-unit on the end includes eight doubles and four singles. Each neighborhood includes a country kitchen with
pantry and dining area, multiple spa bathing areas, and a hearth room and parlor for resident socialization. The
resident rooms feature two configurations of single bedrooms, including a generously-sized “studio” complete with 3
foot by 6 foot shower, and three configurations of double bedrooms. The doubles uniquely locate the toilet rooms
toward the center, creating a divider between the beds forming an angular living area. The corner double is a
particularly appealing design with the toilet room touching the outside corner, resulting in two mini-single bedrooms
with a lounge chair and side table with flat screen television on each side of the window.
The interior ends of each nursing unit include large spa bathing areas with whirlpool tubs, and adjacent multipurpose
rooms. Recreational and activity space is also incorporated into these areas on both sides of the ancillary core,
including an “indoor screened porch” and sunroom, library, private dining room and family lounge.
The design incorporates ample outdoor space throughout the campus, with a covered patio accessible from the parlor
area in each neighborhood. The nursing units are also designed to permit the direct entry of family and friends into
each neighborhood during daytime hours through a vestibule off the patio, with entry controlled from the nurse alcove
in the center of the unit. Patios and terraces are also arrayed between each segment of the building providing
additional outdoor activity space.
Pine Haven Home is currently in substantial compliance with all applicable codes, rules and regulations.
Conclusion
The proposed replacement Pine Haven Home will result in a therapeutic and home-like environment for its occupants.
The superior design will be appealing to prospective residents and will enable the nursing home to maintain a very
high occupancy.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Total Project Cost and Financing
Total project cost for Construction and the acquisition of movable equipment is estimated at $32,351,635, itemized as
follows:
New Construction
Site Development
Temporary Utilities
Design Contingency
Construction Contingency
Fixed Equipment
Architect/Engineering Fees
Construction Manager Fees
Movable Equipment
Financing Fees
Interim Interest Expense
CON Application Fee
CON Processing Fee
Total Project Cost
$17,000,000
5,400,000
230,000
2,263,000
1,131,500
150,000
2,081,960
1,301,250
1,680,000
70,000
865,000
2,000
176,950
$32,351,635
Project # 121084-C Exhibit Page 5
Project cost is based on an April 1, 2014 start date and 18 month construction period.
Based on the mid-point of construction, the Bureau of Architectural and Engineering Facility Planning has determined
that the respective cost per bed exceeds the appropriate bed cost caps by $12,349 per bed. As a result, the allowable
project cost will be limited to $30,762,256 for reimbursement.
$239,000 per bed cap x 128 beds
CON Application Fee
CON Processing Fee
Total Reimbursable Project Cost
$30,592,000
$2,000
$168,256
$30,762,256
Total project financing is as follows:
General obligation bond @ 3% for 25 years
$32,351,635
The Department of Health has determined that reimbursement for interest expense should be limited to 85% of the
allowed reimbursable project cost for reimbursement purposes instead of 75% reimbursement limit, due to the
applicant modernizing the facility in order to provide a safer and more caring environment for the frail, elderly, and hard
to place residents in need of long term care and the facility’s overall financial hardship in treating these individuals.
Operating Budget
The applicant has provided an operating budget, in 2012 dollars, for the first year subsequent to facility replacement.
The budget is summarized as follows:
Per Diem
Total
$221.39
350.02
335.61
6,822,608
1,903,385
3,041,953
1,272,000
(37,312)
Revenue:
Medicaid
Medicare
Private Pay/Other
Intergovernmental Transfer
Bad Debt
Total
$13,002,634
Expenses:
Operating
Capital
Total
$12,509,524
2,391,827
$14,901,351
Excess Revenues/(Expense)
($1,898,717)
The following is noted with respect to the operating budget:
•
Medicare assumes an 11.1% overall reduction to Medicare rate, and private pay and other revenues
assume an enhanced rate of approximately 20% over the previous years rate due to the new facility.
•
Occupancy is projected at 97.00% for the first and third years of operations which is 2% higher than the
current year’s occupancy.
•
Utilization by payor source is projected as follows:
Medicaid
Medicare
Private Pay/Other
68.00%
12.00%
20.00%
Project # 121084-C Exhibit Page 6
Capability And Feasibility
Project Costs of $32,351,635 will be met through general obligation bonds at a 3% interest rate for 25 years.
Working capital requirements are estimated at $2,483,559 based on 2 months of year one expenses.
The facility and Columbia County Board of Supervisors have stated that the applicant will be subsidized by Columbia
County if required. The county’s financial statements, shown as BFA Attachment B, show the ability to fund the
working capital requirements.
Review of BFA Attachment A, financial summary of Pine Haven Home, reveals an average positive working capital
and average positive net asset position for the facility. The facility shows an average net loss of $ 2,569,276, prior to
receiving supplemental income from the county. After receiving county support, the facility has an average positive
net income of $141,497. The overall losses are due to the elimination of the inflation factor in the reimbursement rates
since 2008, lower occupancy due to the obsolete building, as well as the home accepting lower acuity/lower
reimbursement residents.
The issue of feasibility centers on the applicant’s ability to offset expenses with revenues. The submitted budget
indicates that excess expenses of $1,898,717 would be generated in the first year following replacement. The losses
will be offset by Columbia County.
In reviewing the application, the facility is showing a significant reduction in losses in the Year 1 Budget shown above.
Currently, prior to the county adjustment, the facility has an average net loss of $2,569,276 for the period 2008-2011.
The projected net loss as shown above is approximately $670,000 less prior to county adjustments or approximately a
26% reduction. This shows a positive trend and in review of the Year 3 Budget the loss drops another approximately
$30,000 from Year 1. This information shows that the facility is actively reducing its losses and is working towards
breakeven or profitable operations with minimal help from the county.
Staff notes that with the expected 2014 implementation of managed care for nursing home residents, Medicaid
reimbursement is expected to change from a state-wide price with a cost-based capital component payment
methodology to a negotiated reimbursement methodology. Facility payments will be the result of negotiations between
the managed long term care plans and the facility. At this point in time, it cannot be determined what financial impact
this change in reimbursement methodology will have on this project.
The applicant has provided documentation from the Board of Supervisors (Adopted November 9, 2011) supporting
and directing the submission of this Certificate of Need application. The applicant also provided a letter from the
Chairman of the Columbia County Board of Supervisors (dated May 8, 2012) indicating the County’s willingness to
continue financial support for the nursing home. The applicant indicates that this project is critical to the facility,
because a modern structure will better meet the physical and emotional needs of the residents. Also with this
application, the facility is adding 8 certified beds in order to meet the 2016 bed needs for Columbia County, which is a
total of 8 net new beds.
As shown on BFA Attachment B Financial statement for Columbia County, the county had an average positive working
capital position and an average positive net asset position, and generated an average net loss of $65,313 for the
period 2009-2010. The county however, appears to have a current equity position of $27,549,430 for 2010; therefore,
it appears that the county has sufficient resources to continue to offset losses.
Based on the preceding, and subject to the noted contingency, it appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 121084-C Exhibit Page 7
Attachments
BFA Attachment A
Financial Summary 2008-2011 Pine Haven Home
BFA Attachment B
Financial Summary Columbia County 2009-2010
Project # 121084-C Exhibit Page 8
Public Health and Health
Planning Council
Project # 121183-C
Wayne County Nursing Home
County: Wayne (Lyons)
Purpose: Construction
Program: Residential Health Care Facility
Submitted: April 3, 2012
Executive Summary
Description
Wayne County Nursing Home, a 190-bed countyowned residential health care facility (RHCF) located at
1529 Nye Road, Lyons, requests approval to the two
respite beds currently on its operating certificate to
RHCF beds. After approval, the facility will have 192
RHCF beds.
Program Summary
The conversion of two respite care beds to RHCF beds
at Wayne County Nursing Home will permit the full
utilization of space in the building at no cost, while
preserving a resident-friendly environment. Wayne
County Nursing Home is in current compliance with all
codes, rules and regulations.
The two respite beds were a new service that began
with the move to the replacement facility in 2005. The
need for these beds has not developed as anticipated,
while referrals for RHCF care have been steady. With
referrals for RHCF beds remaining constant, often
admissions are denied because of a lack of available
beds, while the respite beds remain empty.
Financial Summary
There are no project costs associated with this
application.
DOH Recommendation
Contingent approval.
Incremental Budget:
Change
2
$ 81,654
69,696
$ 11,958
The applicant has demonstrated the capability to
proceed in a financially feasible manner.
Need Summary
The unmet 2016 RHCF bed need for Wayne County is
86. Occupancy for the Wayne County Nursing Home
was 96.9% in 2008, 96.9% in 2009, and 96.3% in
2010.
Current
190
Revenues:
Expenses:
Gain/(Loss):
After Completion
192
The nursing home currently has a waiting list of 30
patients because the facility is unable to meet a need
for both short-term rehabilitation admissions and
longer term RHCF resident admissions. The
requested addition of two RHCF beds will help
ameliorate this problem.
Project # 121183-C Exhibit Page 1
Recommendations
Health Systems Agency
The Finger Lakes HSA recommends approval of this application.
Office of Health Systems Management
Approval contingent upon:
1. The submission of a commitment signed by the applicant which indicates that, within two years from the date of
the council approval, the percentage of all admissions who are Medicaid and Medicare/Medicaid eligible at the
time of admission will be at least 75 percent of the planning area average of all Medicaid and Medicare/Medicaid
admissions, subject to possible adjustment based on factors such as the number of Medicaid patient days, the
facility’s case mix, the length of time before private paying patients became Medicaid eligible, and the financial
impact on the facility due to an increase in Medicaid admissions. [RNR]
2. Submission of a plan to enhance access to Medicaid residents. At a minimum, the plan should include, but not
necessarily limited to, ways in which the facility will:
(a) Reach out to hospital discharge planners to make them aware of the facility’s Medicaid Access Program;
(b) Communicate with local hospital discharge planners on a regular basis regarding bed availability at the
nursing facility;
(c) Identify community resources that serve the low-income and frail elderly population who may eventually
use the nursing facility, and inform them about the facility’s Medicaid Access policy; and
(d) Submit an annual report for two years to the DOH, which demonstrates substantial progress with the
implement of the plan. The plan should include but not be limited to:
ƒ
ƒ
ƒ
Information on activities relating to a-c above; and
Documentation pertaining to the number of referrals and the number of Medicaid admissions; and
Other factors as determined by the applicant to be pertinent.
The DOH reserves the right to require continued reporting beyond the two-year period. [RNR]
Council Action Date
October 11, 2012.
Project # 121183-C Exhibit Page 2
Need Analysis
Background
Wayne County Nursing Home is a 190-bed public residential health care facility (RHCF) located at 1529 Nye Road,
Lyons, 14489, in Wayne County. It seeks to convert its two short-term respite beds to long-term beds.
Analysis
Occupancy for the Wayne County Nursing Home is slightly higher than the average for all nursing homes in Wayne
County for 2008, 2009, and 2010, as shown in the table below:
RHCF Utilization
Wayne County Nursing Home
Wayne County
2008
96.9%
96.2%
2009
96.9%
96.4
2010
96.3%
95.4%
As indicated below in the table below, the project 2016 RHCF bed need for Wayne County is 635 and the unmet need
is 86.
RHCF Bed Need
Wayne County
2016 Projected Need
635
Current Beds
549
Beds Under Construction
0
Total Resources
549
Unmet Need
86
Although the nursing home’s occupancy level is slightly below the planning optimum of 97 percent, the facility is
unable readily to meet a need for both short-term rehabilitation and long-term RHCF residency, as evinced by a
waiting list of 30 patients for the latter category of admissions. The approval of the additional two RHCF beds through
conversion of the facility’s two respite beds would help ameliorate this problem.
Medicaid Admissions
Regulations require that the Medicaid patient admissions standard shall be 75% of the annual percentage of all
Medicaid admissions for the long term care planning area in which the applicant facility is located. Such planning area
percentage shall not include residential health care facilities that have an average length of stay 30 days or fewer. If
there are four or fewer residential health care facilities in the planning area, the applicable standard for a planning area
shall be 75% of the planning area percentage of Medicaid admissions, whichever is less. In calculating such
percentages, the Department will use the most current data which have been received and analyzed by the
Department.
An applicant will be required to make appropriate adjustments in its admission polices and practices so that the
proportion of its own annual Medicaid patients admissions is at least 75% of the planning area percentage of health
Systems Agency percentage, whichever is applicable.
Wayne County Nursing Home was above the 75 percent planning average for 2009 but was below that in 2008. The
facility reported Medicaid admissions of 7.47 percent and 5.61 percent in 2008 and 2009 respectively. The 75 percent
planning averages for Wayne County for these years were 7.57 percent (2008) and 5.39 percent (2009).
Conclusion
The facility’s two respite beds have been consistently underutilized, from an occupancy rate of 24 percent in 2006, to a
mere three percent in 2009. The conversion of these two beds to RHCF beds would permit more efficient utilization of
the nursing home’s total bed capacity and help reduce the facility’s waiting list of long-term RHCF patients.
Recommendation
From a need perspective, contingent approval is recommended.
Project # 121183-C Exhibit Page 3
Programmatic Analysis
Facility Information
Facility Name
Address
RHCF Capacity
ADHC Program Capacity
Type Of Operator
Class Of Operator
Operator
Existing
Wayne County Nursing Home
1529 Nye Road
Lyons, NY 14489
190 + 2 Respite
0
Public
County
Wayne County Board of
Supervisors
Proposed
Same
Same
192
0
Same
Same
Same
Program Review
Wayne County Nursing Home is a 190 bed nursing home located at 1529 Nye Road, Lyons. In October, 2005 a new
nursing home building opened which included a respite 2 program, replacing an obsolete 1970’s structure. While the
demand for beds in the nursing home has remained strong, currently 96% with an overall occupancy rate of nearly
98% for the past five years, the respite program beds have remained mostly vacant, tailing from a 24% occupancy rate
in 2006 to a miniscule 3% in 2009. In order to alleviate the underutilized occupancy situation, Wayne County has
proposed converting the two respite beds into conventional nursing home beds.
Physical Environment
Wayne County Nursing Home is a two-story structure with each floor containing two 48-bed nursing units in Y-shaped
clusters of 23-25 beds. Each cluster includes a bathing suite, and an open country kitchen dining area adjoins each
cluster. The two respite beds are located in double occupancy bedrooms on the “Canal” wing. The respite beds are
not situated in a discrete bedroom, but are cohorted with a conventional nursing home bed. As a result the bedrooms
are identical to the other double bedrooms in the building, and fully furnished. The “conversion” of these beds to
conventional nursing home beds will result in a decrease in the overall number of single bedrooms from 66 to 64, but
will not change the size of the nursing unit.
No renovations are required to convert the respite rooms to nursing home bedrooms, with the rooms already fully
furnished.
Compliance
Wayne County Nursing Home is in current compliance with all codes, rules and regulations.
Conclusion
The addition of two beds at Wayne County Nursing Home will permit the full utilization of space in the building at no
cost, while preserving a resident-friendly environment.
Recommendation
From a programmatic perspective, approval is recommended.
Project # 121183-C Exhibit Page 4
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years; summarized
below:
Year One
$81,654
Year Three
$81,654
$69,696
0
$69,696
$69,696
0
$69,696
Excess of Revenues over
Expenses
$11,958
$11,958
Utilization: (patient days)
Occupancy (Incremental)
365
50%
365
50%
Revenues
Expenses:
Operating
Capital
Total Expenses
The following is noted with respect to the submitted operating budget:
•
•
Medicaid revenues are based on the current reimbursement rate of the facility.
Utilization is projected to be 100% Medicaid.
Capability and Feasibility
There is no issue of capability, since there is no total project cost associated with this application.
The submitted incremental budget indicates an excess of revenues over expenses of $11,958 during the first and third
years. Revenues are based on the facility’s current reimbursement rates.
Presented as BFA Attachment A are the 2010 and 2011 certified financial statements of Wayne County Nursing
Home. As shown, the facility had an average positive working capital position and an average positive net asset
position from 2010 through 2011. Also, the facility incurred an average operating loss of $1,915,776 from 2010
through 2011. The applicant has indicated that the reason for the losses are as follows: benefit costs are rising, of
which the 2011 rate is at 52%; the county charges the nursing home for the health insurance costs for retirees hired
before March 1977, whose CSEA contract includes health insurance paid by the County; some ancillary services are
contracted to other County departments; and nursing shortages and turnover in staff have led to an increased reliance
on agency nursing and overtime costs.
The applicant is relying on the following steps to improve operations: convert two respite beds to SNF since
occupancy in these beds is lower than expected (25% currently); reviewing the possibility of outsourcing other ancillary
services; increasing revenues for inpatient and outpatient rehabilitation; revamped the purchasing to reduce supply
costs; hired a full time MDS coordinator to ensure proper recording and revenue reimbursement; revisiting policies to
increase occupancy in the rehab beds, thus increasing overall occupancy; taking steps to improve marketing to
become more visible to hospitals in the area, and monthly budget meetings with County administration to monitor
progress. The County has subsidized indirect costs of $200,774 and $244,311 during 2010 and 2011, respectively.
Presented as BFA Attachment B are the April 30, 2012 internal financial statements of Wayne County Nursing Home.
As shown on Attachment B, the facility had a positive working capital position and a positive net asset position through
the period April 30, 2012. Also, the facility incurred an operating loss of $1,025,932 through the period April 30, 2012.
Project # 121183-C Exhibit Page 5
The applicant has demonstrated the capability to proceed in a financially feasible manner, and approval is
recommended
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary- Wayne County Nursing Home
BFA Attachment B
April 30, 2012 Internal Financial Statements of Wayne County Nursing Home
Project # 121183-C Exhibit Page 6
Public Health and Health
Planning Council
Project # 121199-C
At Home Care, Inc.
County: Otsego (Oneonta)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 11, 2012
Executive Summary
Description
At Home Care, Inc., an existing Article 36 not-for-profit
corporation, located at 25 Elm Street in Oneonta,
currently operates a certified home health agency
(CHHA) servicing Chenango, Delaware, Herkimer and
Otsego Counties, requests approval to expand its
CHHA to provide services in Schoharie County.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for application (RFA) to establish new certified
home health agencies, or expand the approved
geographic service areas and/or approved population
of existing CHHAs. At Home Care, Inc. submitted an
application in response to the competitive RFA, and
was awarded RFA Approval. This CON application is
in response to the RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal #5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
Need Summary
The application provided a description of the agency’s
long standing, extensive continuous quality
improvement program with a focus on improving care
processes and outcomes.
Program Summary
At Home Care, Inc. is currently in compliance with all
applicable codes, rules and regulations.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 2,096,367
1,963,278
$ 133,089
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
DOH Recommendation
Approval.
Project # 121199-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner’s approval of the application, and be providing services in the entire
geographic area approved within one year of the Council’s recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 121199-C Exhibit Page 2
Need Analysis
Background
At Home Care, Inc. is an existing not-for-profit corporation approved as a Certified Home Health Agency serving
Delaware, Otsego, Herkimer, and Chenango counties. At Home Care, Inc. is requesting approval to expand the
service area of their Article 36 Certified Home Health Agency (CHHA) into Schoharie County.
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval would ensure
access to CHHA services in counties with fewer than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012 with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
The At Home Care, Inc. proposal demonstrated the applicant’s organizational capacity to successfully implement the
MRT initiatives and support the goals of the Department in advancing these initiatives. The applicant’s plan is to
continue their alignment and integration with the Bassett network as ACO models emerge and medical homes and
MLTCP’s are established. The applicant provided a detailed discussion of the role of their integrated health care
delivery system in the facilitation of cost-effective care and services consistent with MRT initiatives. They further
Project # 121199-C Exhibit Page 3
describe existing integrated and coordinated disease management pathways and programs that would extend to the
proposed service area.
At Home Care provided comprehensive analysis of demographic data to establish public need based on 709.1(a) as
well as on unmet community need. The applicant operates an existing CHHA that has a history of providing
consistently high levels of care. At Home Care emphasized their health information technology, electronic medical
records, and telehealth systems, along with its membership in the Bassett Healthcare Network as means to improve
efficiencies, enhance the continuum of care, control costs and utilization, reduce re-hospitalizations, and enhance
quality.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
At Home Care, Inc. is an existing not-for-profit corporation that operates an Article 36 certified home health agency
with a service area comprising the counties of Delaware, Otsego, Herkimer and Chenango in central New York.
Pursuant to the recent Request for Applications (RFA) for the establishment of new CHHAs or the expansion of
existing CHHAs, At Home Care, Inc. is seeking approval to expand its service area into contiguous Schoharie County.
At Home Care, Inc. proposes to provide the following home healthcare services: home health aide, medical social
services, medical supply, equipment and appliances, nursing, nutritional, occupational therapy, personal care, physical
therapy, respiratory therapy and speech language pathology. They also propose to provide telehealthcare to the
residents of Schoharie County.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, summarized
below:
Year One
Year Three
Revenues:
Commercial
Medicare
Medicaid
Private Pay
Total Revenues:
$30,566
1,474,970
219,640
13,082
$1,738,258
$37,081
1,783,853
259,712
15,721
$2,096,367
Expenses:
$1,700,418
$1,963,278
$37,840
$133,089
Net Income:
Utilization by payor source in the first and third years is as follows:
Commercial Fee-for-Service
Years One and Three
2%
Project # 121199-C Exhibit Page 4
Medicare Fee-for-Service
Medicare Managed Care
Medicaid Managed Care
Private Pay
Charity Care
77%
2%
14%
1%
4%
Expenses and utilization assumptions are based on historical experience of At Home Care’s existing CHHA.
Revenues are reflective of current payment rates as well as the recent implementation of the Medicaid Episodic
Payment System.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements are estimated at $327,213 based on two months of third year expenses and will be
provided through ongoing operations. Presented as BFA Attachment A, is the financial summary of At Home Care,
Inc., which indicates the availability of sufficient funds.
The submitted budget indicates a net income of $37,840 and $133,089 for the first and third years, respectively.
Revenue is based on current payment rates for certified home health agencies. The budget appears reasonable.
As shown of BFA Attachment A, a financial summary of At Home Care, Inc., indicates that the facility has maintained
positive working capital, positive net asset position and generated a net income of $265,918 for 2010 and experienced
a net loss of $153,561 in 2011. The reason for the loss was the cost of the facility’s conversion of their computer
information system to a new provider. Also, all staff required extensive training in the new system, which resulted in
temporary decreased productivity. As of April 30, 2012 the facility has generated a net income of $60,056.
Based on the preceding, it appears that the applicant has demonstrated the capability to proceed in a financially
feasible manner, and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary At Home Care
BFA Attachment B
Internal Financial Summary as of April 30, 2012
Project # 121199-C Exhibit Page 5
Public Health and Health
Planning Council
Project # 121225-C
Park Ridge at Home
County: Monroe (Rochester)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 17, 2012
Executive Summary
Description
Park Ridge Nursing Home, Inc., which operates a 120bed not-for-profit residential health care facility (Park
Ridge at Home) and long-term home health care
program in Monroe County, requests approval for the
expansion of services to include a certified home
health agency (CHHA) to serve Monroe County. Park
Ridge Nursing Home, Inc. is an affiliate of Unity Health
System. Unity Health System is a comprehensive,
integrated health care delivery system located in
Monroe County. The CHHA would provide the
following services: nursing, physical therapy,
occupational therapy, speech pathology, medical
social services, home health aide, homemaker,
housekeeper, personal care services, and nutrition and
respiratory therapy.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. Park Ridge Nursing
Home, Inc. submitted an application in response to the
competitive RFA and was awarded RFA approval.
This CON application is in response to the RFA
approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care, which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal #5) and authorized in the 2011-2012 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Approval.
Need Summary
The applicant provided comprehensive analysis of
demographic data to establish public need based on
709.1(a) and on unmet community need. The applicant
demonstrated experience in meeting the needs of
traditionally underserved populations.
Program Summary
The applicant currently operates a LTHHCP in Monroe
County and has a history of providing consistently high
levels of care.
Financial Summary
There are no project costs associated with this
application.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 20,831,323
19,494,364
$ 1,336,959
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 121225-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this
application within 90 days of receipt of the Commissioner’s approval of the application, and be providing
services in the entire geographic area approved within one year of the Council’s recommendation for
approval. Failure to implement an approved application within the prescribed time shall constitute an
abandonment of the application by the applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 121225-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval would ensure
access to CHHA services in counties with fewer than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
Park Ridge Nursing Home’s proposal described and adequately addressed each of the review criteria used to make
determinations for this competitive review. The proposal demonstrated the applicants’ organizational capacity to
successfully implement the MRT initiatives. Park Ridge Nursing Home is a member of the Unity Health System, which
is an integrated health care system with a strong presence in the county. The applicant described how the health care
system will provide a seamless system of care for patients transitioning from institutional based care to the home
health care setting. Park Ridge describes their experience providing health care to the traditionally medically
underserved and how the CHHA will be well equipped to meet the county’s present and future home health care
needs in an efficient, high quality manner. Unity will partner with MLTCPs that operate in the county and contract with
managed care plans and will use these relationships to facilitate the transition of Medicaid recipients from fee-for-
Project # 121225-C Exhibit Page 3
service to managed care. The applicant demonstrated how the CHHA will promote care coordination and improve
information transfer across the health care continuum as part of the Unity Health System, including Nursing Home
services, Psychiatric and Behavioral Health, and women's health.
The applicant provided comprehensive analysis of demographic data to establish public need based on 709.1(a) and
unmet community need. The applicant demonstrated experience in meeting the needs of traditionally underserved
populations. The applicant currently operates a LTHHCP in Monroe County and has a history of providing consistently
high levels of care. The proposed CHHA will utilize the community relationships established by the LTHHCP for
networking, collaboration and professional affiliations. The applicant demonstrated the potential to produce
efficiencies in the delivery of home care services through a thorough discussion of strategies to reduce hospital and
nursing home admissions and readmissions while improving health care outcomes. Park Ridge intends to establish
the CHHA without additional administrative costs by using the administrative structure from existing home and
community based programs in the Unity Health System. The application provided a description how the agency will
use patient data to implement an ongoing quality assessment and performance improvement program designed to
produce measurable, sustained improvement in health outcomes.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Park Ridge Nursing Home, Inc. is an existing not-for-profit corporation which operates a residential health care facility
and a long term home health care program (LTHHCP), Park Ridge at Home. Park Ridge at Home is currently
authorized to serve patients in Monroe County.
The applicant proposes to establish a new CHHA and serve patients in Monroe County. Park Ridge Nursing Home,
Inc. d/b/a Unity CHHA will serve Monroe County from their existing office located at 1555 Long Pond Road, Rochester,
New York 14626.
Park Ridge Nursing Home, Inc. d/b/a Unity CHHA proposes to provide the following health care services: home health
aide, medical social services, medical supply, equipment and appliances, nursing, nutritional, occupational therapy,
physical therapy, speech language pathology, personal care, homemaker, and housekeeper services.
Park Ridge Nursing Home, Inc. is currently in compliance with all applicable codes, rules and regulations.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, which is
summarized below:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Commercial Managed Care
Year One
$72,318
38,403
1,163,162
2,184,829
20,110
191,900
Project # 121225-C Exhibit Page 4
Year Three
$404,022
214,011
6,484,434
12,029,733
111,982
1,070,739
Other
Private
Total Revenues
56,695
35,903
$3,763,320
316,268
200,134
$20,831,323
4,308,724
19,494,364
$(545,404)
$1,336,959
Expenses
Excess of Revenues over Expenses
Utilization by payor source in the first and third years is as follows:
Year One
1.94%
1.02%
31.13%
55.84%
.53%
5.09%
1.50%
.95%
2.00%
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Commercial Managed Care
Other
Private Pay
Charity Care
Year Three
1.94%
1.02%
31.16%
55.72%
.53%
5.09%
1.50%
1.04%
2.00%
Expense and utilization assumptions are based on the historical experience of other CHHA’s in the geographical area.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements estimated at $3,471,887, appear reasonable based on two months of third year
expenses and will be provided via existing operations of Unity Health System, Inc. and Subsidiaries.
Presented as BFA Attachment A are the 2010 and 2011 certified financial statements of Unity Health System, Inc. and
Subsidiaries, which indicates the availability of sufficient funds to meet the working capital requirement.
The submitted budget indicates that the applicant will have an excess of revenues over expenses of ($545,404) and
$1,336,909 during the first and third years, respectively. Revenues are reflective of current payment rates, as well as
the recent implementation of the Medicaid Episodic Payment System. The submitted budget appears reasonable.
A shown on BFA Attachment A, Unity Health System and Subsidiaries, Inc. had an average positive working capital
position and an average positive net asset position from 2010 through 2011, respectively. Also, the entity achieved an
average operating excess of revenues over expenses of $26,904,000 from 2010 through 2011.
It appears that the applicant has demonstrated the capability to proceed in a financially feasible manner, and approval
is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary for Unity Health System and Subsidiaries, Inc.
Project # 121225-C Exhibit Page 5
Public Health and Health
Planning Council
Project # 121274-C
Finger Lakes Visiting Nurse Service, Inc.
County: Ontario (Geneva)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 19, 2012
Executive Summary
Description
Finger Lakes Visiting Nurse Services, Inc. (FLVNS), an
existing not-for-profit Article 36 certified home health
agency (CHHA) serving Ontario, Wayne and Seneca
counties, requests approval to expand their CHHA into
Yates County. FLVNS also operates a long-term home
health care program approved to serve Seneca,
Wayne and Yates counties, and an Article 40 hospice
approved to serve Ontario and Yates counties.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for application (RFA) to establish new certified
home health agencies, or expand the approved
geographic service areas and/or approved population
of existing CHHAs. Finger Lakes Visiting Nurse
Service, Inc. submitted an application in response to
the competitive RFA, and was awarded RFA Approval.
This CON application is in response to the RFA
approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal #5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Approval.
Need Summary
The FLVNS proposal demonstrated the applicant’s
organizational capacity to successfully implement the
MRT initiatives and support the goals of the
Department in advancing these initiatives. FLVNS
discussed plans for the CHHA to partner with MLTCP's
to transition long term home care patients into
managed care. The applicant provided a
comprehensive analysis of demographic data to
establish public need based on 709.1(a) as well as
unmet community need in Yates County.
Program Summary
Finger Lakes Visiting Nurse Service, Inc. is currently in
compliance with all applicable codes, rules and
regulations.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 814,789
366,220
$ 448,569
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 121274-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner’s approval of the application, and be providing services in the entire
geographic area approved within one year of the Council’s recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 121274-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models, or that approval would ensure
access to CHHA services in counties with less than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
The Finger Lakes Visiting Nurse Services (FLVNS) proposal demonstrated the applicant’s organizational capacity to
successfully implement the MRT initiatives and support the goals of the Department in advancing these initiatives.
FLVNS discussed plans for the CHHA to partner with MLTCP's to transition long term home care patients into
managed care. The applicant provided a comprehensive analysis of demographic data to establish public need based
on 709.1(a) as well as on unmet community need in Yates County. FLVNS CHHA has provided assistance to the only
existing CHHA in the county in meeting the needs of their patients when the existing CHHA has experienced staffing
shortages. FLVNS described their CHHA’s ability to meet the needs of the community through the use of telehealth
services in the county’s rural areas and describes how their telehealth program will enhance access to specialized
services, improve coordination of care and provide primary care providers with early identification of concerns or
Project # 121274-C Exhibit Page 3
issues. The applicant has demonstrated experience in operating a CHHA, LTHHCP and Hospice programs. The
application provided a description of the agency’s longstanding, extensive and continuous quality improvement
program with a focus of improving care processes and outcomes.
Recommendation
From a need perspective, approval is recommended
Programmatic Analysis
Background
Finger Lakes Visiting Nurse Service, Inc. is an existing not-for-profit corporation which operates an Article 36 certified
home health agency authorized to provide services in the counties of Seneca, Wayne and Ontario, a long term home
health care program authorized to provide services in the counties of Seneca, Wayne and Yates and a hospice
approved to serve the counties of Ontario and Yates. . Pursuant to the recent Request for Applications (RFA) for the
establishment of new CHHAs or the expansion of existing CHHAs, Finger Lakes Visiting Nurse Service, Inc. is seeking
approval to expand the service area of the CHHA into Yates County.
Finger Lakes Visiting Nurse Service, Inc. proposes to provide the following home healthcare services: nursing, home
health aide, personal care, physical therapy, occupational therapy, speech language pathology, medical social
services, nutrition and medical supply, equipment and appliances.
Finger Lakes Visiting Nurse Service, Inc. is currently in compliance with all applicable codes, rules and regulations.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budgets
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, summarized
below:
Year One
Year Three
Revenues:
Commercial
Medicare
Medicaid
Private Pay
Total Revenues:
73,554
278,163
329,687
46,717
728,121
82,379
311,536
369,249
51,625
814,789
Expenses:
316,892
366,220
$411,229
$448,569
Net Income:
Utilization by payor source in the first and third years is as follows:
Commercial Fee-for-Service
Medicare Fee-for-Service
Medicare Managed Care
Medicaid Managed Care
Private Pay
Charity Care
Years One and Three
16%
10%
20%
40%
12%
2%
Project # 121274-C Exhibit Page 4
Expenses and utilization assumptions are based on historical experience of Finger Lakes Visiting Nurse Service’s
existing CHHA. Revenues are reflective of current payment rates as well as the recent implementation of the
Medicaid Episodic Payment System.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements are estimated at $61,037 based on two months of third year expenses and will be
provided through the existing operation. Presented as BFA Attachment A, is the financial summary of Finger Lakes
Visiting Nurse Service, Inc., which indicates the availability of sufficient funds.
The submitted budget indicates a net income of $411,229 and $448,569 for the first and third years, respectively.
Revenue is based on current payment rates for certified home health agencies. The budget appears reasonable.
As shown on BFA Attachment A, a financial summary of Finger Lakes Visiting Nurse Service, Inc. indicates that the
facility has maintained positive working capital, positive net asset position and generated a net income of $616,728
and $202,060 for 2010 and 2011, respectively.
Based on the preceding, it appears that the applicant has demonstrated the capability to proceed in a financially
feasible manner, and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary, Finger Lakes Visiting Nurse Service, Inc.
BFA Attachment B
Internal Financial Summary as of July 31, 2012, Finger Lakes Visiting Nurse
Service, Inc.
Project # 121274-C Exhibit Page 5
Public Health and Health
Planning Council
Project # 122122-C
Visiting Nurse Services in Westchester, Inc.
County: Westchester (White Plains)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 18, 2012
Executive Summary
Description
Visiting Nurse Services in Westchester, Inc. is an
existing not-for-profit corporation approved as an
Article 36 certified home health agency (CHHA)
serving Westchester and Putnam Counties. Via this
CON, Visiting Nurse Services in Westchester, Inc.
(VNSW) is requesting approval to expand their CHHA
into the upstate counties of Dutchess and Rockland.
Via CON #121249-C, the Public Health and Health
Planning Council contingently-approved Visiting Nurse
Services in Westchester, Inc. on August 9, 2012 to
serve the downstate county of Bronx.
On December 8, 2011, the Public Health and Planning
Council adopted an amendment to Section 760.5 of
Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. Visiting Nurse Services
in Westchester, Inc. submitted an application in
response to the competitive RFA and was awarded
RFA approval. This CON application is in response to
the RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60 day
episodes of care which will BE adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MAT
proposal #5) and authorized in the 2011-2012 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed service and is part to a
broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Contingent approval.
Need Summary
The applicant provided a comprehensive analysis of
demographic data to establish public need based on
709.1(a) as well as on unmet community need. The
application described how the agency will use patient
data to implement an ongoing quality assessment and
performance improvement program that leads to
measurable and sustained improvement in health
outcomes.
Program Summary
Visiting Nurse Services in Westchester, Inc. is
currently in compliance with all applicable codes, rules
and regulations.
Financial Summary
There are no project costs associated with this
application.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 1,809,196
1,741,574
$
67,622
Subject to the noted contingency, the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
Project # 122122-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation of this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of new incremental budgets to be re-evaluated for financial feasibility for all counties approved for
establishment or expansion to the Department of Health. [BFA]
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner’s approval of the application, and be providing services in the entire
geographic area approved within one year of the Council’s recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 122122-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval would ensure
access to CHHA services in counties with fewer than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
Visiting Nurse Services in Westchester, Inc.’s (VNSW) proposal described and adequately addressed each of the
review criteria used to make determinations for this competitive review. The proposal demonstrated the applicants’
organizational capacity to successfully implement the MRT initiatives and support the goals of the Department in
advancing these initiatives. VNSW has existing contracts with MLTCP's and plans to establish additional relationships
to facilitate the transition of Medicaid beneficiaries from fee-for-service programs to Managed Care. VNSW provided
information regarding their established relationships and linkages with multiple service provider types within the
proposed service area. VNSW demonstrated the potential to produce efficiencies in the delivery of home care services
through education and outreach programs utilizing their collaboration with academic institutions and government
agencies. They also emphasized their commitment to decrease hospitalizations and re-hospitalizations through
Project # 122122-C Exhibit Page 3
disease prevention programs and the use of telehealth. These programs enable patients to better manage their
illness, enjoy a better quality of life and result in significant cost savings from reduced adverse outcomes such as
emergency room visits and re-hospitalization.
The applicant provided a comprehensive analysis of demographic data to establish public need based on 709.1(a) as
well as on unmet community need. The application described how the agency will use patient data to implement an
ongoing quality assessment and performance improvement program that leads to measurable and sustained
improvement in health outcomes.
The applicant also requested approval to serve the following downstate county: Bronx County. A recommendation for
approval for the Downstate county was presented to the Council and approved at the August 9, 2012 meeting.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Visiting Nurse Services in Westchester, Inc. (VNSW) is an existing not-for-profit corporation which operates an Article
36 certified home health agency (CHHA) providing services to the residents of Westchester and Putnam counties.
Pursuant to the recent Request for Applications (RFA) for the establishment of new CHHAs or the expansion of
existing CHHAs, Visiting Nurse Services in Westchester, Inc. is seeking approval to expand its service area into the
downstate county of Bronx and the upstate counties of Dutchess and Rockland. The downstate counties were
assigned CON project number 121249 which was approved by the PHHPC on August 9, 2012. This current CON
seeks approval for the upstate counties of Dutchess and Rockland.
Visiting Nurse Services in Westchester, Inc. proposes to provide the following home health services: nursing, home
health aide, physical therapy, occupational therapy, speech language pathology, medical social services and medical
supply, equipment and appliances.
Visiting Nurse Services in Westchester, Inc. is currently in compliance with all applicable codes, rules and regulations.
The applicant has also requested approval to serve the downstate county of Bronx. A recommendation for approval
for the downstate counties was presented to the Council and approved at the August 9, 2012 meeting.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, summarized
below:
Revenues:
Medicaid Fee-for-Service
Medicare Fee-for-Service
Commercial Fee-for-Service
Private Pay
Other
Total Revenues
Year One
Year
Three
$464,080
690,702
19,738
710
116,724
$1,291,954
$584,957
1,021,037
26,696
1,136
175,370
$1,809,196
Project # 122122-C Exhibit Page 4
Expenses
1,345,069
1,741,574
Excess of Revenues over Expenses
($53,115)
$67,622
Utilization by payor source for the first and third years is as follows:
Year One
55.12%
38.33%
.70%
.02%
3.83%
2.00%
Medicaid Fee-for-Service
Medicare Fee-for-Service
Commercial Fee-for-Service
Private Pay
Other
Charity Care
Year Three
51.53%
42.13%
.59%
.02%
3.73%
2.00%
Expense and utilization assumptions are based on the existing CHHA Program’s historical experience. Revenues are
reflective of current payment rates as well as the recent implementation of the Medicaid Episodic Payment System.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements, estimated at $290,262, appear reasonable based on two months of third year expenses
and will be provided through the existing operation. Presented as BFA Attachment A are the 2011 certified financial
statement of the parent, Westchester Visiting Nurse Services Group, Inc. and subsidiaries, which indicates the
availability of sufficient funds to meet the working capital contribution.
The submitted budget indicates an excess of revenues over expenses of ($53,115) and $67,622 during the first and
third years, respectively.
Revenues are reflective of current payment rates as well as the recent implementation of the Medicaid Episodic
Payment System. The submitted budget appears reasonable.
As shown on Attachment A, the entity had a positive working capital position and a positive net asset position in 2011.
The entity incurred an operating loss of $1,552,490 during 2011. Westchester Visiting Nurse Services Group, Inc. also
includes Westchester Care at Home, a licensed home care agency. The applicant has indicated that the losses were
the result of the losses attributed to Visiting Nurse Services in Westchester, Inc., which will be discussed further in a
subsequent section. The losses were also the result of losses by Westchester Care at Home (WCAH), the licensed
home care agency due to the following: the licensed home care agency was required to refund a total of $649,000 as
part of the Medicaid recoupment/elimination of the trend factor during 2010; and the State of New York Office of the
Medicaid Inspector General (OMIG) conducted an audit of WCAH and found overpayments made to the facility of
$469,341.
Presented as BFA Attachment B is the 2011 certified financial statements of Visiting Nurse Services in Westchester,
Inc. As shown on Attachment B, the facility had a negative working capital position and a positive net asset position in
2011. The facility incurred an operating excess of revenues over expenses of ($1,085,379) in 2011. The applicant
has indicated that the reason for the loss is the facility incurred a one-time and non-recurring severances for former
key management personnel totaling $507,000; incurred approximately $784,000 relating to marketing and promotional
materials, of which $559,000 are one-time non recurring costs related to media advertising. In 2012, the facility has
taken steps to improve operations by maximizing productivity of service delivery staff.
Presented as BFA Attachment C are the May 31, 2012 internal financial statements of Visiting Nurse Services in
Westchester, Inc. As shown on Attachment C, the facility had a negative working capital position and a positive net
asset position through May 31, 2012. The applicant incurred an operating loss of $133,700 through May 31, 2012.
Subject to the noted contingency, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner; and contingent approval is recommended.
Project # 122122-C Exhibit Page 5
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
2011 certified financial statements of Westchester Visiting Nurse Services
Group, Inc.
BFA Attachment B
2011 certified financial statements of Visiting Nurse Services in Westchester,
Inc.
BFA Attachment C
May 31, 2012 internal financial statements of Visiting Nurse Services in
Westchester, Inc.
Project # 122122-C Exhibit Page 6
Public Health and Health
Planning Council
Project # 122123-C
Dominican Sisters Family Health Service, Inc.
County: Westchester (Ossining)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 16, 2012
Executive Summary
Description
Dominican Sisters Family Health Service, Inc.
(DSFHS) is an existing not-for-profit corporation which
operates an Article 36 certified home health agency
(CHHA), long- term home health care program
(LTHHCP) and an AIDS home care program. The
applicant’s CHHA is currently authorized to serve
patients in Westchester, Bronx and Suffolk counties,
and their LTHHCP and AIDS home care program is
currently authorized to serve patients in Bronx, Kings,
New York, Queens, Suffolk and Westchester counties.
Via this CON, the applicant requests approval expand
its CHHA service area into the upstate counties of
Orange, Putnam, and Rockland.
Via CON #121212-C, the Public Health and Health
Planning Council contingently-approved DSFHS on
August 9, 2012 to serve the downstate counties of
Kings, Nassau, New York, Queens, and Richmond.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. DSFHS submitted an
application in response to the competitive RFA, and
was awarded RFA approval. This CON application is
in response to the RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal # 5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Contingent approval.
Need Summary
The applicant provided a comprehensive analysis of
demographic data to establish public need based on
709.1(a) and unmet community need. DSFHS
demonstrated the potential to produce efficiencies in
the delivery of home care services and reduce hospital
and nursing home admissions and readmissions
through specialized disease centered programs.
Program Summary
DSFHS is currently in compliance with all applicable
codes, rules and regulations.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 2,148,291
1,723,615
$ 424,676
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 122123-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of new incremental budgets to be re-evaluated for financial feasibility for all counties approved for
establishment or expansion acceptable to the Department of Health. [BFA]
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner’s approval of the application, and be providing services in the entire
geographic area approved within one year of the Council’s recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 122123-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval will ensure access
to CHHA services in counties with less than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012 with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
Dominican Sisters Family Health Service, Inc.’s proposal described and adequately addressed each of the review
criteria used to make determinations for this competitive review. The proposal demonstrated the applicant’s
organizational capacity to successfully implement the MRT initiatives and provided detailed plans to achieve the goals
of the Department in advancing MRT, including the transition of Medicaid beneficiaries from fee-for-service programs
to MLTCP's.
Dominican Sisters Family Health Service, Inc. provided information regarding their relationships with existing MLTCP's
within the counties they propose to serve. The applicant provided comprehensive analysis of demographic data to
establish public need based on 709.1(a) and unmet community need.
Project # 122123-C Exhibit Page 3
Dominican Sisters Family Health Service, Inc. currently operates a CHHA, LTHHCP and AIDS Home Care Program
and has a history of providing consistently high levels of care. The applicant demonstrated the potential to produce
efficiencies in the delivery of home care services and reduce hospital and nursing home admissions and readmissions
through specialized disease centered programs. The application provided a description of how the agency will use
patient data to implement an ongoing quality assessment and performance improvement program designed to
produce measurable, sustained improvement in health outcomes.
The applicant also requested approval to serve the following downstate counties: Kings, New York, Queens,
Richmond and Nassau Counties. A recommendation for approval for the downstate counties was presented to the
Council and approved at the August 9, 2012 meeting.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Dominican Sisters Family Health Service, Inc. is an existing not-for-profit corporation which operates an Article 36
certified home health agency, long term home health care program and an AIDS home care program. The applicant’s
CHHA currently authorized to serve patients in Westchester, Bronx and Suffolk counties and their LTHHCP and AIDS
home care program is currently authorized to serve patients in Bronx, Kings, New York, Queens, Suffolk and
Westchester counties .
Pursuant to the recent Request for Applications (RFA) for the establishment of new CHHAs or the expansion of
existing CHHAs, the applicant is seeking approval to expand its service area into the downstate counties of Kings,
Nassau, New York, Queens, and Richmond and the upstate counties of Orange, Putnam, and Rockland.
Dominican Sisters Family Health Service, Inc. proposes to provide the following home healthcare services: home
health aide, medical social services, medical supply, equipment and appliances, nursing, occupational therapy,
physical therapy and speech language pathology.
Dominican Sisters Family Health Service, Inc. is currently in compliance with all applicable codes, rules and
regulations.
The applicant has also requested approval to serve the following downstate counties: Kings, Nassau, New York,
Queens, and Richmond. A recommendation for approval for the downstate counties was presented to the Council and
approved at the August 9, 2012 meeting.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget for the first and third years, in 2012 dollars, which is
summarized below:
Revenues:
Medicaid
Medicare
Year One
Year Three
$358,784
495,889
$826,040
1,141,696
Project # 122123-C Exhibit Page 4
Commercial
Total Revenues
78,422
933,096
180,555
2,148,291
Expenses
778,964
1,723,615
Net Gain(Loss)
154,132
424,676
Utilization by payor source for combined programs in the first and third years is as follows:
Payor
Commercial Managed Care
Medicare Fee-for-service
Medicaid Managed Care
Charity Care
Years One and Three
10.00%
54.00%
34.00%
2.00%
Expense and utilization assumptions are based on the existing CHHA Program’s historical experience. Revenues are
reflective of current payment rates as well as the recent implementation of the Medicaid Episodic Payment system.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements, estimated at $287,269, which appears reasonable based on two months of third year
expenses and will be provided through the existing operation.
The submitted budget indicates that the applicant will achieve incremental net revenue in the first and third years of
operations of $154,132 and $424,676, respectively. Revenue is based on current payment rates for Certified Home
Health Agencies. The submitted budget appears reasonable.
Presented as BFA Attachment A is the audited financial summary of Dominican Sisters Family Health Services, Inc.
which shows the applicant has maintained a negative working capital position and a positive net asset position and
achieved an average net loss of $164,330 from operations for the period 2010 through 2011. The loss in 2011 was
$746,500 and it is attributable to a 6% decrease in the Medicare Episodic rates and the 2% decrease in the Medicaid
rates, which both went into effect in 2011. The facility has made adjustments to its operating expenses and has
increased its Medicare case mix in order to maintain a positive operating margin.
BFA Attachment B is the internal 2012 financial summary ending May 31, 2012. The applicant continues to maintain
negative working capital position a positive net asset position and a negative net income position. The applicant
indicates that the reason for the negative net income is due to a retroactive adjustment to the agency’s 2011 Medicaid
rate which was posted in May 2012. The other loss through May 2012 that contributed to negative net income was
due to the acquisition of Elizabeth Seton Pediatric LTHHCP. The loss is due to the facility having a lower than
anticipated census caused by the delays in closing the Elizabeth Seton program and transferring over the patients to
Dominican sisters. Once the program comes back up to full capacity the applicant anticipates that they will again be
operating at positive net income.
Based on the preceeding, it appears that the applicant has demonstrated the financial capability to proceed in a
financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 122123-C Exhibit Page 5
Attachments
BFA Attachment A
Financial Summary for Dominican Sisters Family Health Services, Inc ( 2011
and 2010)
BFA Attachment B
Financial Summary for Dominican Sisters Family Health Services, Inc , May
31, 2012
Project # 122123-C Exhibit Page 6
Public Health and Health
Planning Council
Project # 121203-C
Personal Touch Home Aides of New York, Inc.
County: Kings (Brooklyn)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 12, 2012
Executive Summary
Description
Personal Touch Home Aides of New York, Inc., an
existing Article 36 proprietary corporation, located at
2701 Emmons Avenue in Brooklyn, currently operating
a certified home health agency (CHHA) servicing Kings
County, requests approval to expand its CHHA to
provide services in Bronx, New York, Queens,
Richmond, Nassau and Suffolk Counties. The
applicant will lease additional office space in West
Hempstead and Bronx.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHAs. Personal Touch Aides
of New York, Inc. submitted an application in response
to the competitive RFA, and was awarded RFA
approval. This CON application is in response to the
RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care, which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal #5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
For a conservative approach, revenues were
calculated in which the lower of incremental cost to
episodic payment was projected for year one and year
three, and budgets were sensitized.
DOH Recommendation
Contingent approval.
Need Summary
Personal Touch Home Aides of NY, Inc.’s proposal
clearly describes and adequately addresses each of
the review criteria used to make determinations for this
competitive review.
Program Summary
Personal Touch Home Aides of New York, Inc. is
currently in compliance with all applicable codes, rules
and regulations.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/Loss:
$ 6,272,578
5,902,592
$
369,986
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 121203-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of executed building leases acceptable to the Department of Health. [BFA]
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner's approval of the application, and be providing services in the entire
geographic area approved within one year of the Council's recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner's approval. [CHA]
Council Action Date
October 11, 2012.
Project # 121203-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application will facilitate implementation of Medicaid Redesign Initiatives to
shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long term care
systems, integrated health systems or similar care coordination models or that approval will ensure access to CHHA
services in counties with less than 2 existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012 with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure that
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed and ranked against other applicants for
each county they proposed to serve. If applicants requested Upstate and Downstate counties, they will be presented
to the Public Health and Health Planning Council with other applicants who have requested the same county or
counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
From this review, applicants were ranked in each county proposed against other applicants for that county based on
how well their proposal addressed each of the aforementioned criteria. The top ranked applications were then
selected for recommendation for approval within each county. Ultimately, fourteen of eighty-seven applications were
recommended for approval to expand or establish a new general purpose CHHA in one or more of the eight
Downstate counties.
Personal Touch Home Aides of NY, Inc.’s proposal clearly describes and adequately addresses each of the review
criteria used to make determinations for this competitive review. This proposal demonstrates the applicant has the
organizational capacity to successfully implement the MRT initiatives and supports the goals of the Department in
Project # 121203-C Exhibit Page 3
advancing these initiatives. The applicant demonstrates public need based on 709.1(a) and provides a description of
community need and the health needs of the community supported by data. The applicant has the requisite
knowledge and experience in the provision of home health services and demonstrates the potential to produce
efficiencies in the delivery of home care services. Finally, the application provides a description of how the agency will
use data to implement an ongoing quality assessment and performance improvement program that leads to
measureable and sustained improvement in performance.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Personal Touch Home Aides of New York, Inc. is an existing proprietary corporation which operates a certified home
health agency with approval to serve Kings County.
The applicant proposes to expand the service area of the existing CHHA into Bronx, New York, Queens, Richmond,
Nassau and Suffolk counties. Personal Touch Home Aides of New York, Inc. proposes to serve the residents of these
counties from their existing office located at 2701 Emmons Avenue, Brooklyn, NY 11235 and proposes to open a new
branch offices which will be located at 509 Willis Avenue, Bronx, New York 10455 and 60 Hempstead Avenue, West
Hempstead, NY 11552..
Personal Touch proposes to offer the following health care services: home health aide, medical social services,
medical supply, equipment and appliances, nursing, occupational therapy, physical therapy and speech language
pathology.
Personal Touch Home Aides of New York, Inc. is currently in compliance with all applicable codes, rules and
regulations.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Lease Agreements
The applicant has submitted proposed lease agreements, the terms of which are summarized below:
Landlord:
Tenant:
Premises:
Rental:
Term:
Provisions:
Personal Touch Home Care of LI, Inc.
Personal Touch Homes Aides of New York, Inc.
Approximately 1,000 sq. ft. located at 60 Hempstead Ave., West Hempstead
$20,000/year ($20/sq. ft.)
5 year term with the option to renew for an additional 5 years.
Tenant is responsible for maintenance and utilities
Landlord:
Tenant:
Premises:
Rental:
Term:
Provisions:
Personal Home Care of NY, Inc.
Personal Touch Home Aides of New York, Inc.
Approximately 1,000 sq. ft. located at 509 Willis Ave., Bronx.
$20,000/year ($20/sq. ft.)
5 year term with the option to renew for an additional 5 years
Tenant is responsible for maintenance and utilities.
Project # 121203-C Exhibit Page 4
The applicant has indicated that the leases will be non-arm’s length lease agreements, and letters of opinion from
Licenses Commercial Real Estate Brokers have been submitted indicating rent reasonableness.
Operating Budget
The applicant has submitted an incremental operating budget for the first and third years, in 2012 dollars, which are
summarized below:
Year One
Year Three
Revenues:
Medicaid
Medicare
Commercial
Total Revenue:
$1,889,040
514,443
74,788
$2,478,271
$4,662,013
1,406,146
204,419
$6,272,578
Expenses:
$2,323,457
$5,902,592
$154,814
$369,986
Net Income:
Utilization by payor source in the first and third years is as follows:
Commercial Managed Care
Medicare Fee for Service
Medicaid Managed Care
Charity Care
Years One and Three
2%
15%
81%
2%
Expenses and utilization assumptions are based on existing CHHA Program’s historical experience.
Revenues are reflective of current payment rates as well as the recent implementation of the Medicaid Episodic
Payment system, in which the lower of incremental cost to episodic payment was projected for year one and year
three, for a conservative approach.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements are estimated at $983,765 based on two months of third year expenses and will be
provided through the existing operation. Presented as BFA Attachment A, is the financial summary of Personal Touch
Home aides of New York, Inc., which indicates the availability of sufficient funds in cash and equivalents.
The submitted budget indicates a net income of $154,814 and $369,986 for the first and third years, respectively.
Revenue is based on current payment rates for Certified Home Health Agencies. DOH staff has sensitized the budgets
to reflect the effect of the EPS payments. Presented as BFA Attachment B is the sensitivity analysis. The budget
appears reasonable.
As shown on BFA Attachment A, a financial summary of Personal Touch Home Aides of New York, Inc. indicates that
the facility has experienced negative working capital and negative stockholder’s equity and generated an operating
income of $30,523,000 and $18,969,000 for 2010 and 2011, respectively. As shown on BFA Attachment B, a financial
summary of Personal Touch Home Aides of New York, Inc. as of March 31, 2012 indicates that the facility has
experienced negative working capital and negative stockholder’s equity and generated a net income of $3,053,000.
The applicant has indicated the reason for the negative working capital is due to an increase in Due to Third Party
Payer. The liability is recorded as current, although it is a long term liability, because of GAAP requirements.
The negative stockholder’s equity is due to the applicant establishing an Employee Stock Ownership Plan (ESOP) in
December 2010. The unearned ESOP shares are included as a reduction of stockholder’s equity, as required by
GAAP.
Project # 121203-C Exhibit Page 5
Additionally, Personal Touch utilizes a revolving line of credit of up to $45,000,000 that is secured by its Account
Receivable. Generally Accepted Accounting Principles require that when Account Receivable is utilized to provide
financing, the money borrowed must be included in current liabilities. This is true even though the agreement does not
expire until Deecember 12, 2015. One may note that for an organization of this size ($91 million in total assets and
$376 million in net revenues) personal Touch has relatively little long-term debt of $23 million. Further, the company
has additional capacitiy to borrow funds under its $45 million revolving line of credit, should it be needed, as just
$15.245 million has been utilized ($29.755 million available).
Based on the preceding, it appears that the applicant has demonstrated the capability to proceed in a financially
feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary, Personal Touch Home Aides of New York, Inc.
BFA Attachment B
Financial Summary as of March 31, 2012, Personal Touch Home Aides of
New York, Inc.
BFA Attachment C
Sensitivity Analysis for Episodic Payment System
BFA Attachment D
April 7, 2012 Memorandum to PHHPC Discussing Financial Factors
Project # 121203-C Exhibit Page 6
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 3:
Applications Recommended for Approval with the Following:
™ No PHHPC Member Recusals
™ Establishment and Project Review Committee Dissent, or
™ Contrary Recommendations by HSA
Upstate Certified Home Health Agencies - Construction
1.
Number
Applicant/Facility
121315 C
Home Aide Service of Eastern
New York, Inc.
d/b/a Eddy Visiting Nurse
Service, Inc.
(Rensselaer County)
Ms. Hines – Abstained at
EPRC
Exhibit #11
E.P.R.C.
Recommendation
Approval
Public Health and Health
Planning Council
Project # 121315-C
Home Aide Service of Eastern New York, Inc.
d/b/a Eddy Visiting Nurse Association
County: Rensselaer (Troy)
Purpose: Construction
Program: Certified Home Health Agency
Submitted: April 20, 2012
Executive Summary
Description
Home Aide Service of Eastern New York, Inc., d/b/a
Eddy Visiting Nurse Association, a not-for-profit
corporation approved as an Article 36 certified home
health agency (CHHA) and long-term home health
care program (LTHHCP) serving Albany, Columbia,
Greene Rensselaer, and Saratoga counties, requests
approval to expand their CHHA into Schenectady
County.
On December 8, 2011, the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. Eddy Visiting Nurse
Association submitted an application in response to the
competitive RFA, and was awarded RFA approval.
This CON application is in response to the RFA
approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60 day
episodes, which will be adjusted by patient acuity and
regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal #5) and authorized in the 2011-2012 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Approval.
Need Summary
The applicant provided comprehensive analysis of
demographic data to establish public need based on
709.1(a) as well as on unmet community need. The
data and information presented demonstrated that the
applicant had an in-depth knowledge of the health
needs of the community. The application provided a
description of the agency’s continuous quality
improvement program and its focus on improving care
processes and outcomes.
Program Summary
Home Aide Service of Eastern New York, Inc. d/b/a
Eddy Visiting Nurse Association is currently in
compliance with all applicable codes, rules and
regulations.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 15,993,587
15,868,035
$
125,552
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 121315-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval conditional upon:
1. Pursuant to 10 NYCRR 762.2(l), the applicant shall implement the project that is the subject of this application
within 90 days of receipt of the Commissioner’s approval of the application, and be providing services in the entire
geographic area approved within one year of the Council’s recommendation for approval. Failure to implement an
approved application within the prescribed time shall constitute an abandonment of the application by the
applicant and an expiration of the Commissioner’s approval. [CHA]
Council Action Date
October 11, 2012.
Project # 121315-C Exhibit Page 2
Need Analysis
Background
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models, or that approval would ensure
access to CHHA services in counties with less than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure that
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
The Home Aide Service of Eastern New York, Inc., d/b/a Eddy Visiting Nurse Association proposal demonstrated the
applicant’s organizational capacity to successfully implement the MRT initiatives and support the goals of the
Department in advancing these initiatives. Eddy Visiting Nurse Association is affiliated with St. Peter's Health Partners
(SPHP), which was created through the merger of Northeast Health, St. Peter's Health Care Services and Seton
Health. SPHP offers a comprehensive network of high quality advanced medical care, primary care, rehabilitation and
senior services. Their services and programs include several area Capital District Hospitals, Sunnyview Rehabilitation
Hospital in Schenectady, the Eddy System of continuing care and the Community Hospice. This integrated affiliation
allows Eddy VNA access to a multitude of resources within SPHP and the opportunity to integrate home health care
services across the care continuum.
Project # 121315-C Exhibit Page 3
The applicant described how their expansion will enhance their continuum of care and contribute to the continuity and
coordination of care, and strengthen the delivery system to achieve better care for individuals by offering choice and
accessibility. SPHP ‘s affiliation with Eddy SeniorCare/PACE and partnerships with the CDPHP and VNS Choice
MLTCP’s will facilitate the MRT initiative to shift fee-for-service Medicaid beneficiaries into MLTCP’s within the
proposed service area. Their EMR system and PACE programs currently maintain a physical presence in
Schenectady. Eddy Visiting Nurse Association offers a full range of clinical specialty programs that include chronic
disease management, palliative care, telehealth, IV therapy, HIV/AIDS, cardiopulmonary, diabetes, and
wound/ostomy/continence in the proposed service area. The existing CHHA’s administrative structure will be utilized
for the provision of services within the proposed service area, resulting in minimal additional cost.
The applicant provided comprehensive analysis of demographic data to establish public need based on 709.1(a)
as well as on unmet community need. The data and information presented demonstrated that the applicant had an
in-depth knowledge of the health needs of the community. The application provided a description of the agency’s
continuous quality improvement program and its focus on improving care processes and outcomes.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Home Aide Service of Eastern New York, Inc. dba Eddy Visiting Nurse Association is an existing not-for-profit
corporation which operates an Article 36 certified home health agency and a long term home health care program
currently serving Albany, Rensselaer, Saratoga, Columbia and Greene counties . Pursuant to the recent Request for
Applications (RFA) for the establishment of new CHHAs or the expansion of existing CHHAs, the applicant is seeking
approval to expand the service area of their CHHA into Schenectady County.
The applicant proposes to provide the following home healthcare services: home health aide, medical social services,
medical supply, equipment and appliances, nursing, nutritional, occupational therapy, physical therapy and speech
language pathology.
Home Aide Service of Eastern New York, Inc. dba Eddy Visiting Nurse Association is currently in compliance with all
applicable codes, rules and regulations.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, during the first and third years; which
are summarized below:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Private Pay
Charity Care
Year One
$1,198,024
33,404
221,677
7,169,230
5,531,128
12,306
13,032
Year Three
$1,316,123
18,410
8,099,487
45,821
6,485,619
13,386
14,741
Project # 121315-C Exhibit Page 4
Total Revenues
$14,178,801
$15,993,587
Expenses
14,662,846
15,868,035
Net Gain (Loss)
($484,045)
$125,552
Utilization by payor source during the first and third years is as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Charity Care
Year One
8.54%
.23%
1.55%
46.45%
42.23%
1.00%
Year Three
8.98%
.01%
.01%
48.00%
42.00%
1.00%
Revenues are reflective of current payment rates as well as the recent implementation of the Medicaid Episodic
Payment System. Expense assumptions are based on salaries in the area for CHHA services. Utilization assumptions
are based on the applicant’s discussions with former nurses currently employed by the applicant’s long term home
heath team.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements are estimated at $2,644,673, which appears reasonable based on two months of third
year expenses. Presented as BFA Attachment A is the certified financial statements of Northeast Health, Inc., which
indicates the availability of sufficient funds for the equity contribution to meet the working capital requirements.
The submitted budget indicates that the applicant will achieve an excess of revenues over expenses of ($484,045)
and $125,552 during the first and third years, respectively. Revenues are based on current payment rates as well as
recent implementation of the Medicaid Episodic Payment System. The submitted budget appears reasonable. The first
year indicates a planned loss due to start up costs which appear reasonable and can be absorbed from operations.
Presented as BFA Attachment A are the 2010 and 2011 financial statements. As shown on Attachment A, the entity
had an average positive working capital position and an average positive net asset position. Also, the applicant has
indicated an operating excess of revenues over expenses of $5,338,000 and $12,096,000 in 2010 and 2011
respectively.
The applicant has demonstrated the capability to proceed in a financially feasible manner, and approval is
recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary for Northeast Health, Inc. and Affiliates
Project # 121315-C Exhibit Page 5
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 5:
Applications Recommended for Disapproval by OHSM or
Establishment and Project Review Committee - with or
without Recusals
Residential Health Care Facilities Ventilator Bed– Construction
1.
Number
Applicant/Facility
102376 C
Albany County Nursing Home
(Albany County)
Exhibit #12
E.P.R.C.
Recommendation
Disapproval
Public Health and Health
Planning Council
Project # 102376-C
Albany County Nursing Home
County: Albany (Albany)
Purpose: Construction
Program: Residential Health Care Facility
Submitted: November 15, 2010
Executive Summary
Description
Albany County Nursing Home, a 250-bed countyowned residential health care facility (RHCF), requests
approval to construct a 200-bed replacement facility
and certify a 30-slot adult day health care program
(ADHCP). The 200-bed facility would consist of 180
RHCF beds and 20 ventilator-dependent beds.
Currently, the facility does not consist of any ventilatordependent beds.
This new facility will be constructed on land adjacent to
the existing facility, which has reached the end of its
useful life. The County is proposing that this new
facility will address deficiencies in the existing building,
including a lack of air conditioning, storage space and
sprinkler system.
This project had been deferred by the PHHPC from its
December 2011 and April 2012 agendas.
On April 5, 2012, the Establishment and Project
Review Committee requested that the applicant
reassess the cost of its project in light of the two
percent real property tax cap legislation and submit an
analysis of what the financial impact will be on the
facility given the reimbursement system transition to a
managed care reimbursement methodology. As a
result, the Establishment and Project Review
Committee deferred this application until the applicant
performs the analysis and submits new budgets
demonstrating the capability to operate in a financial
feasible manner in a mandatory managed long term
care environment. This new reimbursement
methodology is to be implemented in 2014. The
applicant has submitted revised budgets, which will be
discussed in a subsequent section.
DOH Recommendation
Disapproval.
Financial Summary
Project costs will be met via General Obligation County
Bonds (30 yrs. @ 4.00%).
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 26,655,018
50,813,787
$ (24,158,769)
The projected operating deficit is proposed to be
funded by Albany County.
Given PHHPC members’ expressed concerns over the
cost and financial feasibility of this project and the
applicant’s insufficient response to those concerns,
disapproval is recommended.
Total project costs are estimated at $70,938,554.
Project # 102376-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Disapproval.
Council Action Date
October 11, 2012.
Project # 102376-C Exhibit Page 2
Financial Analysis
Total Project Cost and Financing
Total project cost, which is for new construction, architect/engineering fees, construction manager fees and the
acquisition of moveable equipment, is estimated at $70,938,554, further itemized as follows:
New Construction
Site Development
Design Contingency
Construction Contingency
Architect/Engineering Fees
Construction Manager Fees
Moveable Equipment
Telecommunications
Financing Costs
Interim Interest Expense
CON Fee
Additional Processing Fee
Total Project Cost
$47,745,047
3,979,205
4,137,408
2,585,649
3,674,383
2,096,687
2,921,658
15,000
925,500
2,468,000
2,000
388,017
$70,938,554
Project costs are based on a January 3, 2013 construction start date and a 18-month construction period.
The costs for this project, excluding the CON fees and the additional processing fees, are broken down as follows:
Nursing Facility
Adult Day Health Care Program
$69,805,032
743,505
Based on a mid-point of construction in 2013, the Bureau of Architectural and Engineering Facility Planning has
determined that the respective costs exceed the construction cap per bed. As a result, the total allowable
reimbursement is limited to $55,805,522.
Reimbursable project cost will be $55,805,522, as shown below:
Nursing Facility Beds - $268,000 x 180
Ventilator Dependent - $268,000 x 1.20% allowance x 20
ADHCP Costs
CON Application Fee
Additional Processing Fee
Total Reimbursable Project Cost
$48,240,000
6,432,000
743,505
2,000
388,017
$55,805,522
The applicant’s financing plan appears as follows:
General Obligation County Bonds (4.00% for thirty years)
$70,938,554
Operating Budget
The applicant has submitted an operating budget for the whole facility, in 2012 dollars, for the third year after the
replacement facility. The budget is summarized below:
Project # 102376-C Exhibit Page 3
Nursing Facility & Ventilator Beds
Medicaid Managed Care (Nursing
Facility)
Medicaid (Ventilator)
Medicare (Nursing Facility)
Medicare (Ventilator)
Private Pay (Nursing Facility)
Private Pay (Ventilator)
Commercial (Nursing Facility)
Other
Total Revenues
Expenses:
Operating
Capital
Total Expenses
Per Diem
$310.34
Total
$14,527,788
537.47
450.01
449.79
449.96
600.61
449.96
3,269,482
4,213,013
252,784
1,404,338
174,178
1,404,338
659,434
$25,905,355
$651.75
70.87
$722.62
$45,199,001
4,914,926
$50,113,927
Excess of Revenues over Expenses
($24,208,572)
Utilization: (patient days)
Nursing Facility Patient Days
Ventilator Dependent
Occupancy Nursing Facility
Occupancy Ventilator Dependent
62,416
6,934
95.00%
94.98%
The following is noted with respect to the submitted RHCF operating budget:
•
•
•
•
The capital component of Medicaid revenues is based on the interest and depreciation reimbursement
methodology, which may be impacted in a yet to be determined manner, by the introduction of a
managed care setting.
The case mix index for the nursing facility is .9400 and the case mix index for the ventilator dependent
beds is 1.55.
The applicant provided an analysis of how the implementation of mandatory Medicaid Managed Long
Term Care will positively impact the facility. The following assumptions were made by the applicant:
rate adjustment for the marketplace (based upon 75% Medicaid occupancy and net 3% increase)
$394,200; incentive payment for specialty behavioral unit $525,600; incentive payment for
alzheimer’s/dementia unit $394,200; CMI change $602,000 and shared savings $192,000.
The legislation authorizing inter-governmental transfer funding currently expires in 2015 and,
therefore, no IGT funding is assumed.
Utilization for the nursing facility beds, broken down by payor source, for the third year after the completion of
the replacement facility is as follows:
Medicaid Managed Care
Medicare Fee-For-Service
Commercial Fee-For-Service
Private Pay
75.00%
15.00%
5.00%
5.00%
Utilization for the ventilator dependent beds, broken down by payor source, for the third year after the
completion of the replacement facility is as follows:
Medicaid Fee-For-Service
Medicare Fee-For-Service
Private Pay
87.71%
8.10%
4.19%
Project # 102376-C Exhibit Page 4
ADHCP
Revenues
Expenses
$749,663
699,860
Excess of Revenues over Expenses
Utilization: (visits)
Cost Per Visit
$49,803
7,020
$99.69
The ADHCP will be 100% Medicaid.
Also, the applicant has projected additional expenses of $7,417,079 for retiree health care costs, which are
included within the budget.
The combined revenues and expenses for the facility for the third year are as follows:
Revenues
Expenses
Excess of Revenues over Expenses
$26,655,018
50,813,787
($24,158,769)
Capability and Feasibility
Project costs of $70,938,554 will be met via General Obligation County Bonds at an interest rate of approximately
4.00% for thirty years.
The submitted budget indicates an operating loss of $24,158,769 during the third year after project completion.
Revenues are based on projected reimbursement methodologies for Medicaid Managed Care and current
reimbursement methodologies for the other payor sources. In regard to the applicant’s submission on their managed
care assumptions, staff notes that the applicant provided a response as to how they will operate under a mandatory
Medicaid Managed Care environment.
The applicant has indicated that incremental expenses will increase by $15,901,681 from the current year (2011) to
the third year after project completion. The applicant has indicated that the increases are primarily in the following
categories:
•
Salaries and wages are increasing by approximately $3,000,000 due to the additional 14.9 FTE’s and salary
increases.
•
Employee Benefits are increasing by approximately $6,000,000 due to the employee benefits for the new
hires, trend factor of 1% for employee benefits and retiree health insurance increases by 10% per year.
•
Additional accrual of approximately $7,400,000 related to the retiree health care.
•
Other direct expenses, which consists of cafeteria and other ancillary expenses, is projected to increase by
approximately $700,000.
•
Interest expense will increase by approximately $2,400,000 due to the proposed financing.
•
Depreciation expense is projected to increase by approximately $1,700,000.
Presented as BFA Attachment A, is a financial summary for Albany County Nursing Home. As shown on Attachment
A, the facility had an average positive working capital position and an average negative net asset position from 2009
through 2011. The facility incurred an operating excess expenses over revenues of $18,597,505 during 2011. To
Project # 102376-C Exhibit Page 5
offset the operating loss, the facility received inter-governmental transfer funds of $6,100,000 and County subsidies of
$8,755,999 during 2011. The applicant has indicated that the reasons for the loss in 2011 are as follows: the cost of
employee benefits and the State Retirement System for employees. As a public facility, Albany County Nursing Home
provides a benefit package that exceeds those found in the private sector. The facility administration and County
policymakers have taken a number of proactive steps to improve revenues to decrease operational deficits. Those
include, but are not limited to: a reduction in staff size of over 100 positions; a reorganization of the therapy
department resulting in a nearly 60% increase in Medicare Part A revenues, and more than 100% increase in
Medicare Part B revenues; reviewing departmental budgets and adjusting them to be more in line with industry
standards; revamping the facility’s purchasing system to ensure better monitoring of costs; implementing regular and
periodic budget reviews with facility Department heads to ensure both adequate staffing levels as well as cost control,
and a reorganization of the facility’s MDS and resident assessment process to promote and facilitate a maximization of
Medicaid revenues. As previously mentioned, the facility incurred a loss of $18,597,505 in 2011. This application
proposes a loss of $24,158,769 during the third year after project completion, which is an incremental loss of
$5,561,364 when compared with the 2011 operations. As a result, it does not appear that this application will improve
the financial performance of the facility.
When this project was deferred by the PHHPC from its December 2011 and April 2012 agendas, PHHPC members
sent a clear message to the applicant that the large projected operating losses was a serious issue. With the new
legislation establishing a two percent cap on real property tax increases and the pending implementation of long term
care mandatory Medicaid managed care, PHHPC members expressed concern that the subject project was not
affordable. At its April 2012 meeting, the PHHPC Establishment and Project Review Committee deferred
recommendation on this project, instructing the applicant to reassess its project given the expressed concerns and
submit a projected budget indicative of a long term care managed care environment.
Public nursing homes are generally the providers that are expected to care for the most difficult to place individuals in
need of residential health care – the providers of last resort. These individuals include people with complex health
care and behavioral issues and those who cannot pay for care and cannot qualify for Medicaid. It is not unusual for
public nursing homes to run operating deficits for these reasons. County operated facilities have the ability to offset
operating deficits through County subsidies and potential tax increases. With documentation of support from the
County governing authority, the Department has traditionally accepted the process and mechanisms of “home rule”
and found such projects to be financially feasible for the purposes of CON application review. The Albany County
Executive and Legislature have provided the Department with letters and board resolutions of support for this project.
The PHHPC members’ expressed concerns about the financial aspects of this Albany County Nursing Home project
and the EPRC’s additional directives to the applicant and the Department require that the Department’s financial
review includes a more critical assessment of this project’s financial factors. In this regard, it seems reasonable to
focus on the cost effectiveness of the subject project as reassessed by the applicant and the following is noted:
•
•
•
•
Project cost of $70,938,554 exceeds reimbursable project cost by 27%. It’s likely that cost efficiencies can be
realized through redesign and value-engineering.
Budgeted revenues are the applicant’s estimates of managed care rates with the implementation of long term
care Medicaid mandatory managed care and are based on Albany County Nursing Home’s managed care rate
experience to date. The resulting revenues are slightly greater than previously presented budgets.
Department staff’s assessment is that the assumed rates are at the high end of what may be considered
reasonable.
Budgeted expenses have not changed from figures presented in December and April and reflect increased
staffing for new proposed programs. While specialty staff may well be needed for the proposed vent bed and
behavioral units, projected staffing levels are questionable given the reduced certified bed count from 250
beds to 200 beds.
The projected operating loss is almost 50% of operating expenses and the projected incremental loss of
$5,561,364, combined with a loss of $6,100,000 in inter-governmental transfers, creates an incremental
budget shortfall that would require an almost two percent increase in the total Albany County operating
budget, assuming no other changes.
With its previous project deferral actions, the PHHPC gave the applicant the opportunity to develop a more costefficient and sustainable nursing home project, not just for the citizens of Albany County, but for the regional health
care system. The applicant’s resulting, revised operating budget and project budget are not substantially improved
Project # 102376-C Exhibit Page 6
from those previously presented to PHHPC. As such, it appears that the applicant has not adequately addressed the
PHHPC’s expressed concerns over financial feasibility in a Medicaid managed care environment and disapproval is
recommended.
Recommendation
From a financial perspective, disapproval is recommended.
Attachments
BFA Attachment A
Financial Summary for Albany County Nursing Home
BFA Attachment B
Comparison of Projected Operating Budget to April PHHPC Exhibit’s Budget
BFA Attachment C
Applicant’s Assessment of the Impact of Mandatory Managed Long Term Care
Project # 102376-C Exhibit Page 7
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
A.
APPLICATIONS FOR CONSTRUCTION OF HEALTH CARE
FACILITIES
CATEGORY 6: Applications for Individual Consideration/Discussion
Residential Health Care Facility– Construction
1.
Number
Applicant/Facility
121075 C
Jewish Home Lifecare,
Manhattan
(New York County)
Mr. Fassler - Interest
Exhibit #13
E.P.R.C.
Recommendation
Contingent Approval
Public Health and Health
Planning Council
Project # 121075-C
Jewish Home Lifecare, Manhattan
County: New York (New York)
Purpose: Construction
Program: Residential Health Care Facility
Submitted: February 8, 2012
Executive Summary
Description
Jewish Home Lifecare, Manhattan (JHL), a 514-bed notfor-profit residential health care facility (RHCF), requests
approval to construct a replacement facility of 414 beds at
a new site on 97th Street, and the permanent
decertification of 100 RHCF beds from the current
complement of 514. The proposed facility will provide an
innovative model of care (The Green House model). The
replacement facility will consist of 264 Long Term Care
beds and 150 sub-acute beds.
The RHCF is a member of the Jewish Home Lifecare
System. The current Manhattan Division is comprised of
five interconnected buildings constructed between 1894
and 1964. The applicant indicates that these outdated
and obsolete structures represent a sprawling institutional
structure that presents significant challenges to the
applicant’s attempts to address operational inefficiencies,
quality of life concerns, barriers to socialization and
independence, and limitations on privacy.
The nursing home will enter into an arms-length land
swap agreement with a developer. JHL would swap its
current 106th Street property for the site on 97th Street.
Total project costs are estimated at $251,855,424.
DOH Recommendation
Contingent approval.
Need Summary
JHL has had 99% occupancy for 2008, 2009, and 2010.
The facility discharges approximately 100 patients per
month and will discharge 100 patients 1 month prior to the
planned opening of the new facility and will not accept
new admissions until the population is stabilized.
Current
514
Change
- 100
After Completion
414
This project will also create system efficiencies by
decertifying 100 beds in a region that currently has a
94.8% occupancy rate for RHCF beds.
Program Summary
The rebuilding of Jewish Home will result in a significantly
enhanced residential environment. The scale of the
nursing home will be reduced, and the program will be
more tailored to meet the needs of the residents. The
programming of eleven floors to function as “urban green
houses” marks the first time this innovative concept of
long term care has been extended to a dense city
environment in New York State. The modern building
design also offers a new approach for fitting larger
nursing homes on smaller sites.
A minor program issue remains concerning the provision
of rehabilitation services to the residents on the green
house floors, to be resolved prior to the submission of
final drawings.
Financial Summary
Project costs will be met via fundraising of $55,685,224;
equity (via land swap) of $35,000,000; and taxable GNMA
Security Loan (FHA insured) of $161,170,200 (30 yrs. @
5.5%).
The developer will purchase the existing nursing home
site for $35,000,000 and will meet the purchase price via
$3,000,000 equity and the remainder of $32,000,000
provided via a loan (5 yrs. @ 7%). The purchaser has
provided a bank letter of interest in regard to the
financing.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 100,864,920
100,052,000
$
812,920
Subject to the noted contingencies, it appears that the
applicant has demonstrated the capability to proceed in a
financially feasible manner.
Project # 121075-C Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Submission of documentation of fundraising to be used as a source of financing that is acceptable to the
Department of Health. [BFA]
3. Submission of a commitment that is acceptable to the Department of Health, for a permanent mortgage from a
recognized lending institution at a prevailing rate of interest within 120 days of receipt from the Department of
Health. Included with the submitted permanent mortgage commitment must be a sources and uses statement and
debt amortization schedule, for both new and refinanced debt. [BFA]
4. Submission of an executed real estate purchase agreement for the land associated with the replacement facility
that is acceptable to the Department of Health. [BFA]
5. Submission of a loan commitment for the purchase of the real estate that is acceptable to the Department of
Health. [BFA]
6. Submission and programmatic review and approval of a plan to provide rehabilitation services to the residents of
the green house floors. [LTC]
7. Submission and programmatic review and approval of the final floor plans. [LTC]
Approval conditional upon:
1. The applicant is required to submit design development drawings, complying with requirements of NCYRR Part
710.4, for review and approval by NYS-DOH bureau of Architecture and Engineering Facility Planning (BAEFP) or
their designated representative. [AER]
2. The applicant is required to submit final construction documents, complying with requirements of NCYRR Part
710.7, to NYS-DOH Bureau of Architecture and Engineering Facility Planning (BAEFP) prior to start of
construction. [AER]
3. A waiver to be granted concurrent with design development approval specific to alternative cooking facilities in
accordance with NFPA 101-2012 18.3.2.5.3 and CMS memorandum S&C-12-21-LSC Dated March 9, 2012.
[AER]
4. The applicant shall complete construction by August 1, 2016 in accordance with NCYRR Part 710.2(b)(5) and Part
710.10(a). If construction is not completed on of before that date, this may constitute abandonment of the
approval and this approval shall be deemed to be cancelled, withdrawn and annulled without further action from
the commissioner. [AER]
Council Action Date
October 11, 2012.
Project # 121075-C Exhibit Page 2
Need Analysis
Background
Jewish Home Lifecare, a 514-bed not for profit residential health care facility (RHCF) located at 120 West 106th
Street, New York, seeks approval to build a 414-bed replacement facility at 125 West 97th Street, New York, and to
decertify 100 RHCF beds.
Analysis
Jewish Home Lifecare’s utilization is higher than New York County’s for 2008, 2009, and 2010, as shown in the table
below:
RHCF Occupancy
Jewish Home Lifecare
New York County
New York City Region
2008
99.0%
96.9%
94.5%
2009
99.0%
96.7%
95.0%
2010
99.1%
96.5%
94.8%
Jewish Home Lifecare operates at 99% occupancy in an area where utilization is at the planning optimum of 97%.
The facility discharges approximately 100 patients per month and will discharge 100 patients 1 month prior to the
planned opening of the new facility and will not accept new admissions until the population is stabilized.
Additionally, Jewish Home Lifecare has 57 physical A and B patients whose placement in other settings will be enough
of a reduction to accommodate the bed reduction that is being requested.
RHCF Bed Need
2016 Projected Need
New York City
51,071
Current Beds
43,343
Beds Under Construction
Total Resources
79
43,422
Unmet Need
7,649
Conclusion
This project will allow Jewish Home Lifecare to build a new facility that meets current trends in residential health care
facility construction and allows for a homelike environment for residents that is also energy efficient. This project will
also create system efficiencies by decertifying 100 beds in a region that currently has a 94.8% occupancy rate for
RHCF beds.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Facility Information
Facility Name
Address
RHCF Capacity
ADHCP Capacity
Existing
Jewish Home Lifecare,
Manhattan
120 West 106th Street
New York, NY 10025
514
60
Proposed
Same
125 West 97th Street
New York, NY 10025
414
* 60
Project # 121075-C Exhibit Page 3
Type Of Operator
Class Of Operator
Operator
Voluntary
Same
Corporation
Same
Jewish Home Lifecare, Manhattan Same
*The location for the 60 slot ADHCP has not been determined at this time.
Program Review
Jewish Home Lifecare, Manhattan (Jewish Home) is proposing to replace and relocate its 514 bed nursing home.
Jewish Home is located on a 2.16 acre site at 120 West 106th Street in Manhattan, and includes five buildings
constructed between 1898 and 1964. Jewish Home intends to sell the current site to a private developer in order to
fund a modern 414 bed replacement facility, to be located at West 97th Street, on an equivalent parcel conveyed by
the developer.
Jewish Home has been engaged in a planning process to transform its portfolio of long term care programs. In
November, 2008 Jewish Home received a rightsizing approval to reduce the size of the nursing home by 108 beds,
and add adult day health care and long term home health care program slots. Subsequently, Jewish Home submitted
a series of CON applications proposing the downsizing and rebuilding of the nursing home, with each encountering
significant planning and zoning issues and community opposition. The current application represents the latest
iteration of the Jewish Home strategic planning process, with the new the location and design of the building an effort
to address the issues which had stalled the earlier projects. The new site is a response to the opposition of
neighborhood groups to the previous site, and the new design creates a sleeker building with a somewhat longer, but
narrower footprint than the current Jewish Home complex. The resulting design makes for smaller-sized residential
floors with reduced nursing units.
The new nursing home proposes to program eleven of its residential floors as “urban Green Houses”, a resident
centered alternative to traditional nursing home care. In the Green House model the houses are staffed with universal
workers, or “Shabazzim” in Green House terminology, all of whom are certified nursing assistants with additional
training in household management, laundry, food preparation and teamwork skills. The Shabazzim work in selfmanaged work teams, with each shabaz rotating through the various household and care functions and assuming
coordinator responsibilities. A clinical support team consisting of nurses, social workers, activities experts, and
therapists provides support to each Green House.
The other five floors of beds will be programmed as short term rehabilitation, with the average residential stay
generally less than three months. Short term rehabilitation, or sub-acute care, is not a recognized bed category under
New York State long term care regulations.
Physical Environment
The proposed building will rise twenty stories from a site located on West 97th Street between Amsterdam and
Columbus Avenues in Manhattan. The replacement nursing home will total 414 beds, with floors 5 thru 8 (short-term
rehab) consisting of 30 beds each, and floors 11 thru 20 (green house) consisting of 24 beds each, arrayed into 12
bed urban green houses. The short-term rehab floors will include 24 single bedrooms and 4 double bedrooms with
room partitions. All of the resident rooms will include a bathroom with a European-type shower and a ceiling-mounted
lift system affording full handicap accessibility. Since the design embraces individual showers in every bedroom, the
need for a central shower or tub room on each floor is eliminated. As an additional amenity, a full whirlpool tub is
available to residents in the spa room located on the second floor, which also offers massage and beauty salon
services.
The short term rehab floors are configured as a traditional rectangular unit with the resident rooms situated on the
outside walls and the interior core containing the elevator bank and staff work area. Four double bedrooms are
located on the corners of the floor, and include partitions which separate the beds, but do not prevent access to
outside light for each of the residents. The remaining 22 beds are all located in single bedrooms. A 30-space dining
area is located on the north side of the building, and a rehabilitation/ADL training room at the opposite end. Twin
lounges are located opposite the dining room and rehab room.
The green house floors have a similar configuration, with 12 single bedrooms running the length of the east and west
sides of the unit. The three passenger elevators open into a lobby, with the floor then divided into north and south
“urban green houses”. Consistent with the Green House model, each nursing unit includes a central Hearth Room
Project # 121075-C Exhibit Page 4
with electric fireplace, which functions as a multi-purpose space for activities and recreation. The central living area
also includes a large dining table where residents can sit and enjoy meals served family style, with staff preparing the
meals in the adjacent kitchen and pantry. Opposite the central living area is a screened porch and a den, which
provide additional activity and socialization space for the residents. The staff work area with medication closet is
located on the other side of the porch, and storage rooms are interspersed in several areas on the unit. Significant
storage is available for all the nursing units in the basement area, accessed by the service elevator in the central
elevator bank.
Due to the unique nature of the design, the nursing home does not have a central rehabilitation suite. Rehabilitation
and ADL training rooms are located on each of the four short term rehab units for use by residents on the floor;
however an equivalent rehabilitation area for the residents of the green house floors is not identified. The applicant
has stated that therapy will take place in the individual resident rooms; however additional information will be required
describing the rehabilitation service for the green house floors.
The lower three floors of the building will contain offices, industrial and service functions, and resident amenities. The
basement area includes staff and nurse lounges, staff lockers and shower rooms, and a staff gym. Food storage,
including walk-in freezers and a separate kosher food storage area, as well as general housekeeping, medical and
equipment storage are also in the basement. The first floor contains the main entrance with reception area, and a
large lobby with an aquarium on one wall. The loading dock and ambulette entrance are also on this floor. The
second floor features activity and recreational space including a library, a bistro, a boutique and a large multipurpose
room, along with the aforementioned “spa” room. Classrooms, geriatric development and clergy offices are also
located on the floor. The third floor is principally composed of offices, including administration and human resources
offices, medical and dental exam rooms, and the pharmacy.
Compliance
Jewish Home Lifecare, Manhattan is currently in substantial compliance with all applicable codes, rules and
regulations.
Conclusion
The rebuilding of Jewish Home will result in a significantly enhanced residential environment. The scale of the nursing
home will be reduced, and the program will be more tailored to meet the needs of the residents. The programming of
eleven floors to function as “urban green houses” marks the first time this innovative concept of long term care has
been extended to a dense city environment in New York State. The modern building design also offers a new
approach for fitting larger nursing homes on smaller sites.
A minor program issue remains concerning the provision of rehabilitation services to the residents on the green house
floors, to be resolved prior to the submission of final drawings.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Real Estate Purchase Agreement
The applicant has submitted real estate purchase agreements for the sale of the existing nursing home property
(executed) and the sale of the property that the replacement facility will be located (draft), which is summarized below:
Existing Nursing Home Site
Date:
Seller:
Purchaser:
Address:
Effective as of July 29, 2011
Collectively, 156 West 106th Street Holding Corp. (JHA) successor by merger to
J.H.A Housing Corporation and 102 West 107th Street Corp. (102W107).
PMV Owner, LLC
JHA is the owner of certain property and improvements known as 111-143 West
105th Street and 156 West 106th Street and 102W107 is the owner of certain
Project # 121075-C Exhibit Page 5
Purchase Price:
Payment of
Purchase Price:
First Closing:
Second Closing:
property and improvements known as 102 West 107th Street, New York.
$35,000,000
Down payment of $3,000,000 to be held in Escrow. The remainder,
$32,000,000, will be delivered to the Escrow Agent at the First Closing.
The conveyance of title to the PMV Property by PMV to JHH or its designee and
the closing, completion and consummation of all other transactions required to
be closed, completed and consummated on the First Closing Date.
The conveyance of title to the JHH Campus by JHA (or such affiliate of JHH then
owning the JHH Campus) to PMV’s designee, and the closing, completion and
consummation of all other transactions required to be closed, completed and
consummated on the Second Closing Date.
At the second Closing, JHA will convey the JHH Campus to PMV’s designee,
subject to the lien of the 106th Street Mortgage and JHH has not, on or before
the Second Closing, moved all of its residents out of the JHH Campus, PMV will
lease the JHH Campus back to JHH upon the terms and conditions set forth in
the 106th Street Lease. The Second Closing Date means the date of the Second
Closing, to be fixed by written notice from JHH to PMV, and which shall occur no
later than one hundred and eighty (180) days after both; JHH receives a
temporary certificate of occupancy for the New Facility and JHH’s existing facility
located on the JHH Property has been vacated; unless adjourned by written
agreement of PMV and JHH or otherwise pursuant to this agreement, but in no
event later than the outside date. The outside date is seven years after applicant
receives Department of Health approval.
The purchaser will finance $32,000,000 via a bank loan at an interest rate of 7% for a five year term. The purchaser
provided a bank letter of interest in regard to the financing.
Proposed Nursing Home Site
Seller:
Purchaser:
Premises:
Purchase Price:
PMV Owner, LLC and PMV Acquisition, LLC
Jewish Home Lifecare Development Corp.
Located in the Borough of Manhattan and as and by the street addresses 107
W.97th Street/784 Columbus Avenue, 120 W.100th Street/792 Columbus Avenue
and 788-790 Columbus Avenue, New York.
$0
Lease Rental Agreement
The applicant has submitted a draft lease rental agreement for the existing site that they will lease in the event the
applicant has not on or before the Second Closing moved all of its residents out of the JHH Campus. This lease will
go into effect seven years after the Department of Health approves this project. The terms of the lease are
summarized below:
Premises:
Landlord:
Tenant:
Expiration Date:
Rental:
The existing site for the nursing home of Jewish Home Lifecare, Manhattan
located at 111-143 West 105th Street and 156 West 106th Street, New York.
PMV Owner, LLC
Jewish Home Lifecare, Manhattan
Shall mean the earlier of July 29, 2021 or one hundred eighty (180) days after
Tenant moves the final residents from the premises or any other earlier date
upon which tenant surrenders the premises to landlord and terminates this lease,
provided the premises is then free of residents.
Interest on the 106th Street Mortgage plus the real estate taxes assessed upon
and payable for the premises.
Project # 121075-C Exhibit Page 6
Total Project Cost and Financing
Total project cost for new construction and the acquisition of moveable equipment, is estimated at $251,855,424,
itemized as follows:
New Construction
Temporary Utilities
Design Contingency
Construction Contingency
Architect/Engineering Fees
Construction Manager Fees
Other Fees (Consultant)
Moveable Equipment
Telecommunications
Financing Costs
Interim Interest Expense
CON Fee
Additional Processing Fee
Total Project Cost
$167,857,702
392,000
16,785,770
8,412,485
11,209,000
3,308,000
3,868,000
9,514,640
3,668,677
14,009,733
11,449,800
2,000
1,377,617
$251,855,424
Project costs are based on a February 1, 2014 construction start date and a thirty month construction period. Based
on a midpoint of construction in 2015, the Bureau of Architectural and Engineering Facility Planning has determined
that the costs exceed the appropriate cost caps by $147,014 per bed. As a result, reimbursable project cost will be
limited to $190,991,617.
Financing for the total project is as follows:
Fundraising
Equity (via land swap)
Taxable GNMA security loan (FHA insured) (5.5% for thirty years)
$ 55,685,224
35,000,000
161,170,200
The applicant has submitted a comparison of tax-exempt financing versus taxable financing and as a result it shows
that taxable financing is less expensive by approximately $20,400,000 on a present value basis. The applicant has
submitted a letter of interest reflecting an interest rate of 5.5% for a Taxable GNMA Security Loan (FHA insured). The
applicant has indicated that the current interest rate for a Taxable GNMA Security Loan (FHA insured) is 3.50% as of
7/2//2012 in a competitive market.
The Department of Health has determined that reimbursement should be allowed 85% of the allowed reimbursable
project cost for reimbursement purposes instead of the 75% reimbursement limit, due to the applicant’s decertification
of 100 beds.
Operating Budget
The applicant has submitted an operating budget for the RHCF, LTHHCP and the ADHCP component, in 2012 dollars,
for the third year subsequent to the construction of the replacement facility, summarized as follows:
RHCF
Revenues:
Medicaid FFS
Medicaid Managed Care
Medicare FFS
Medicare Managed Care
Commercial Managed Care
Private Pay
Total Revenues
Per Diem
Total
$375.31
$375.31
$613.83
$413.00
$500.00
$625.00
$16,314,725
2,506,320
32,299,524
5,390,476
1,832,000
18,821,875
$77,164,920
Project # 121075-C Exhibit Page 7
Expenses:
Direct
Indirect
Non Comparable
Capital
Total Expenses
$254.67
144.54
19.22
115.99
$534.42
Excess of Revenues over Expenses
$38,099,000
21,623,000
2,875,000
17,352,000
$79,948,000
$(2,783,080)
Utilization: (patient days)
Occupancy
149,599
99.00%
The following is noted with respect to the submitted RHCF operating budget:
•
The Medicaid capital component assumes reimbursement on interest ($8,810,173) and depreciation
($5,932,087) associated with the reimbursable project cost. The applicant assumed the reimbursable
project cost. The applicant assumed the reimbursable project cost in their capital component.
•
Budgeted case mix of 1.12 is an increase of .07 from historical experience. The reason for the increase is
the larger proportion of rehabilitative care beds in the new facility, which have a higher case mix intensity
than the RHCF beds.
•
Medicare, Private Pay and other revenues assume current rates of payment.
•
Occupancy is projected at 99.00%, consistent with historical experience. In Year three, the facility will be
at full occupancy.
•
Utilization by payor source is projected as follows:
Medicaid FFS
Medicaid Managed Care
Medicare FFS
Medicare Managed Care
Private Pay
Managed Care
29.06%
4.46%
35.18%
8.72%
20.13%
2.45%
This represents a significant change from historical payor mix that relates to the increased proportion
of rehabilitative beds to residential RHCF beds.
LTHHCP
Revenues
Expenses
Excess of Revenues over Expenses
Visits
Hours
$ 16,545,000
15,299,000
$ 1,246,000
36,555
667,368
Utilization by payor source for the LTHHCP will be as follows:
Medicaid
Medicare
90.71%
9.29%
Project # 121075-C Exhibit Page 8
ADHCP
Revenues
Expenses
Excess of Revenues over Expenses
Visits
$ 5,733,000
4,805,000
$ 928,000
23,022
Other Revenues (Contributions)
$1,422,000
The combined projected revenues and expenses for Jewish Home Lifecare, Manhattan for the third year subsequent
to the replacement facility are as follows:
Revenues
$100,864,920
Expenses
100,052,000
Excess of Revenues over Expenses $
812,920
Capability and Feasibility
Project costs of $251,855,424 will be met as follows: Fundraising of $55,685,224; Equity (via land swap) $35,000,000
and a Taxable GNMA security loan (FHA insured) for $161,170,200 at an interest rate of 5.5% for thirty years.
The applicant provided a letter of interest for the loan at an interest rate of 5.5% for thirty years. As of this date, the
applicant has received fundraising pledges of $22,508,413, of which $9,298,289 in cash has been received. As a
contingency of approval, the applicant must provide documentation of receipt of fundraising proceeds.
The submitted budget indicates an excess of revenues over expenses of $812,920 during the third year subsequent to
the construction of the replacement facility. Following is a comparison of historical (2011) and projected revenues and
expenses.
2011 Operating Revenues
2011 Operating Expenses
2011 Operating Excess of Revenues over Expenses
$106,556,279
104,417,875
$ 2,138,404
Incremental Income
Incremental Expense
Net Incremental Income
$(5,691,359)
$(4,365,875)
$(1,325,484)
Projected Excess of Revenues
$812,920
Incremental income includes the increase in revenues associated with the revised payor mix and adjustments in
revenue due to new bed configuration. The applicant has projected that the non-operating revenue will decrease by
$4,795,000 due to the following factors: transfer of fixed assets to and from the following related organizations were a
one-time item that are not planned to occur in the future; adjustment for pension is a year end adjustment that
depends upon discount rates at that time; change in beneficial interest in related organizations represent the capital
campaign that will cease when the project is operational, and transfer from related organizations and interest income
are unpredictable and therefore, not projected. Also, the applicant projected reduction in revenues associated with
LTHHCP and ADHCP due to the impact of managed care. Incremental expenses include interest and depreciation
related to the replacement facility and staffing adjustments associated with the new bed configuration. Budgeted net
income appears reasonable.
As shown on BFA Attachment A, Jewish Home and Lifecare, Manhattan had an average negative working capital
position and an average positive net asset position. The applicant has indicated that the reason for the negative
working capital position is that the facility did not receive payment for the 2002 rebased rate until 2011. The applicant
achieved an average operating excess of revenues over expenses of $2,821,960 during the period shown. Also, the
applicant achieved an average change in net assets of $2,886,075 during the period shown. The applicant incurred a
change in net assets of ($4,043,930) in 2011, due to adjustments to pension liability funded status of ($8,434,432).
Project # 121075-C Exhibit Page 9
Subject to the noted contingencies, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary for Jewish Home Lifecare, Manhattan
Project # 121075-C Exhibit Page 10
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
B
.
APPLICATIONS FOR ESTABLISHMENT AND CONSTRUCTION OF
HEALTH CARE FACILITIES
CATEGORY 1:
Applications Recommended for Approval – No Issues or
Recusals, Abstentions/Interests
CON Applications
Ambulatory Surgery Centers – Establish/Construct
Number
Applicant/Facility
1.
121104 B
AMSC, LLC d/b/a All Surg
(Bronx County)
2.
121403 B
Union Square SC, LLC
(New York County)
Exhibit #14
E.P.R.C.
Recommendation
Contingent Approval
Contingent Approval
Diagnostic and Treatment Center – Establish/Construct
Exhibit #15
Number
Applicant/Facility
E.P.R.C.
Recommendation
Approval
1.
121354 E
Hillside Polymedic Diagnostic
and Treatment Center
(Queens County)
2.
121355 E
A Merryland Operating, LLC
d/b/a Mermaid Health Center
(Kings County)
Contingent Approval
3.
122001 E
Beacon Christian Community
Health Center
(Richmond County)
Approval
Residential Health Care Facilities – Establish
1.
Number
Applicant/Facility
121481 E
Haym Solomon Home for the
Aged
(Kings County)
Certificate of Incorporation
Betty’s Be Brave Foundation, Inc.
HOME HEALTH AGENCY LICENSURES
1.
E.P.R.C.
Recommendation
Contingent Approval
Exhibit #17
Applicant
1.
Exhibit 16
Number
Applicant/Facility
2169 L
Greene County Public Health
Nursing Service
(Greene County)
E.P.R.C.
Recommendation
Approval
Exhibit #18
E.P.R.C.
Recommendation
Contingent Approval
Public Health and Health
Planning Council
Project # 121104-B
AMSC, LLC
d/b/a All-Surg
County: Bronx (Bronx)
Purpose: Establishment and Construction
Program: Ambulatory Surgery Center
Submitted: February 28, 2012
Executive Summary
Description
AMSC, LLC d/b/a All-Surg, an existing limited liability
company, requests approval to establish and construct an
Article 28 diagnostic and treatment center (D&TC) that will
be certified as a multi-specialty freestanding ambulatory
surgery center (FASC). The proposed FASC will lease
space on the third floor and basement level of a three-story
building located at 951 Brook Avenue, Bronx. The facility will
include four operating rooms, along with requisite support
areas.
The applicant states they will take steps to become a
provider in the Bronx Accountable Healthcare Network and
become a member of Accountable Care Organizations that
form to provide services to Bronx residents.
AMSC, LLC states that they are committed to seeking
certification from one of following: Joint Commission on
Accreditation of Healthcare Organization (JCAHO),
Accreditation Association for Ambulatory Health Care
(AAAHC) or the American Association for Accreditation of
Ambulatory Surgery Facilities (AAAASF) within two years of
becoming operational.
The proposed members of AMSC, LLC d/b/a All-Surg and
their ownership interest are as follows:
Proposed Members
Abdo Balikcioglu, M.D.
Billy Ford, M.D.
Robert Slingsby
Joshua Schwartz
hospitals regarding the impact of the proposed ASC in
the service area, objections were received from Lincoln
Medical & Mental Health Center. The Department does not
find the comments submitted sufficient to warrant reversal or
modification of the recommendation for contingent approval.
Total project costs are estimated at $1,112,412.
DOH Recommendation
Contingent approval, with an expiration of the operating
certificate five years from the date of its issuance, should the
operator not comply with the conditions of approval granted
this CON.
Need Summary
AMSC, LLC proposes to provide the orthopedic, podiatric,
general, urology, gynecology, and gastroenterology surgery
services as well as pain management. It is projected that
there will be 9,033 visits in the first year and 9,583 in year 3.
Program Summary
Based on the information reviewed, staff found nothing that
would reflect adversely upon the applicant’s character and
competence or standing in the community.
Financial Summary
Project costs will be met with $111,242 in member’s
investment and a $1,001,170 capital equipment lease with
AccuLease, carrying payment terms of five years at a 7.82%
interest rate.
Interest
40%
10%
25%
25%
The applicant states that Robert Slingsby is a member of
RJZM, LLC d/b/a All-Med & Rehabilitation of New
York, an Article 28 D&TC that was established under CON
#982540-B as the operator of a multi-specialty FASC in the
Bronx with an extension clinic site in Queens.
In response to the Department’s inquiry to local
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 4,755,439
4,159,362
$ 596,077
Subject to the noted contingencies, the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
Project # 121104-B Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval with an expiration of the operating certificate five years from the date of its issuance is
recommended contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Submission of a signed agreement with an outside independent entity satisfactory to the Department to provide
annual reports to the DOH beginning in the second year of operation. Said reports shall include:
•
•
•
•
•
•
Data showing actual utilization including procedures;
Data showing breakdown of visits by payor source;
Data showing number of patients who need follow-up care in a hospital within seven days after
ambulatory surgery;
Data showing number of emergency transfers to a hospital;
Data showing percentage of charity care provided, and
Number of nosocomial infections recorded during the year in question. [RNR]
3. Submission of an executed transfer and affiliation agreement, acceptable to the Department, with a local acute
care hospital. [HSP]
4. Submission of an executed equipment lease that is acceptable to the Department. [BFA]
5. Submission of a working capital loan commitment that is acceptable to the Department. [BFA]
6. The Articles of Organization must include a provision describing how the LLC will be managed and stating that
neither the management structure nor the provision setting forth such structure may be deleted, modified or
amended without the prior approval of the Department. [CSL]
7. The Articles of Organization must further provide that, notwithstanding anything in the Articles of Organization or
the Operating Agreement to the contrary, transfers, assignments or other dispositions of membership interests or
voting rights must be effectuated in accordance with Public Health Law Section 2801-a(4)(b). [CSL]
Approval conditional upon:
1. The submission of a CON or other licensing extension application required by the Department prior to expiration
date of the operating certificate issued pursuant to this CON, seeking extension of the operating certificate of the
ambulatory surgery center. [PMU]
2. The staff of the facility must be separate and distinct from staff of other entities. [HSP]
3. The signage must clearly denote the facility is separate and distinct from other adjacent entities. [HSP]
4. The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
5. The clinical space must be used exclusively for the approved purpose. [HSP]
Council Action Date
October 11, 2012.
Project # 121104-B Exhibit Page 2
Need Analysis
Background
AMSC, LLC (d/b/a All-Surg) seeks to establish and construct an Article 28 diagnostic and treatment center to be
certified as a multi-specialty freestanding ambulatory surgery center (FASC) with four (4) operating rooms. It will be
located at 951 Brook Avenue, Bronx, 10451, in Bronx County.
Analysis
AMSC, LLC will serve Bronx County.
The procedures that are proposed for AMSC, LLC are currently being performed in office based settings or other
ambulatory surgery centers.
There are currently two free standing multi specialty ambulatory surgery centers and one multi specialty ambulatory
surgery center extension clinic in Bronx County (HFIS).
Montefiore Medical Center, which is located 4.4 miles and 17 minutes driving time from the proposed ambulatory
surgery center, will provide back-up support services for AMSC, LLC.
The proposed ambulatory surgery center is located in a health professional shortage area (HPSA) for the following
services, as shown:
Primary Care Services: Morrisania
Mental Health Services: Homeless-West Central Bronx
Dental Health Services: Southwest Bronx-Medicaid
The Morrisania service area is also designated as a medically underserved population/area.
The applicant has provided an organizational mission statement and a statement that the proposed financial/referral
structure has been assessed in light of anti-kickback and self-referral laws with consultation of the legal counsel.
These statements are acceptable to the Department.
Conclusion
The proposed ambulatory surgery center will provide patients with a variety of surgical services and will
have a total 9,033 visits in the first year and 9,583 in year 3.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Project Proposal
Establish a diagnostic and treatment center that will also be federally certified as an ambulatory surgery center.
Proposed Operator
Operator Type
Doing Business As
Site Address
Surgical Specialties
Operating Rooms
AMSC, LLC
Limited Liability Corporation
All-Surg
951 Brook Avenue
(Third Floor and Basement)
Bronx, NY 10451
Orthopedic Surgery, Podiatric Surgery, General Surgery,
Urology, Gynecology, Gastroenterology, and Pain Management
4
Project # 121104-B Exhibit Page 3
Procedure Rooms
Hours of Operation
Staffing (1st Year / 3rd Year)
Medical Director(s)
Emergency, In-Patient and
Backup Support Services
Agreement and Distance
On-call service
0
Monday through Friday from 6:00 am to 6:00 pm (Extended as
necessary to accommodate patient needs).
26.5 FTEs / 28.5 FTEs
Abdo Balikcioglu, MD
Expected to be provided by Montefiore Medical Center 4.4
Miles and 17 minutes driving time away.
Access to the facility’s on-call physician during hours when the
facility is closed.
Character and Competence
The members of the LLC are:
Name
Abdo Balikcioglu, MD
Billy Ford, MD
Robert Slingsby
Joshua Schwartz
Interest
40%
10%
25%
25%
Dr. Abdo Balikcioglu is a gastroenterologist in private practice.
Dr. Billy Ford is an anesthesiologist in private practice.
Robert Slingsby is the Chief Operating Officer of RJZM, LLC which operates All-Med and Rehabilitation of New York,
an existing Article 28 Diagnostic and Treatment Center.
Joshua Schwartz is a Vice President at All-Med and Rehabilitation of New York.
Staff from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses
held, formal education, training in pertinent health and/or related areas, employment history, a record of legal actions,
and a disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health.
Included in the review were the results of any incident and/or complaint investigations, independent professional
reviews, and/or comprehensive/focused inspections. The review found that any citations were properly corrected with
appropriate remedial action.
Integration with Community Resources
A sliding fee scale will be in place for those without insurance, and provisions will be made for those who cannot afford
services.
The Facility will be aligning with an existing D&TC (All-Med and Rehabilitaion of New York), with two (2) sites in the
Bronx, to ensure continuity of care and access to primary care
The operating budget for this project projects that 51% of its visits are expected to be for individuals covered by
Medicaid. The applicant is also committed to the development of a formal outreach program directed to members of
the local community, including local physicians.
Project # 121104-B Exhibit Page 4
The facility commits to becoming a network provider in the provider-led health homes designated by NYSDOH for
Bronx County and the surrounding counties and will consider joining any Accountable Care Organization (ACO) that is
formed in (or for providers in) Bronx county.
The facility plans to implement an EMR system.
The facility will investigate the potential of joining a RHIO, given the importance placed on linkages with RHIOs by
NYSDOH.
Compliance with Applicable Codes, Rules and Regulations
The medical staff will ensure that procedures performed at the facility conform to generally accepted standards of
practice and that privileges granted are within the physician's scope of practice and/or expertise. The facility’s
admissions policy will include anti-discrimination regarding age, race, creed, color, national origin, marital status, sex,
sexual orientation, religion, disability, or source of payment. All procedures will be performed in accordance with all
applicable federal and state codes, rules and regulations, including standards for credentialing, anesthesiology
services, nursing, patient admission and discharge, a medical records system, emergency care, quality assurance and
data requirements. The Center intends to review the list acceptable procedures annually and as needed to determine
the appropriateness of adding new procedures consistent with individual physician expertise.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Lease Rental Agreement
The applicant has submitted an executed lease for the proposed site, the terms of which are summarized below:
Dated:
Premises:
Landlord:
Lessee:
Term:
Provisions:
January 9, 2012
12,000 gross square feet located at 951 Brook Avenue, Bronx, New York
MBX Acquisition Holdings, LLC
AMSC, LLC d/b/a All-Surg
10 years at $516,000 ($43.00 sq. ft.) plus a 4% increase each year after the first year.
Renewal option one 10-year term
Utilities, Taxes, Maintenance and Insurance
The applicant states that the lease is a non-arm’s length arrangement as the following individuals are both members of
the landlord (MBX Acquisition Holdings, LLC) and the applicant (AMSC, LLC): Abdo Balikcioglu, M.D., Robert
Slingsby, and Joshua Schwartz. Realtor letters have been provided attesting to the rental rate being of fair market
value.
According to the applicant, the home of the proposed site was purchased by MBX Acquisition Holdings, LLC (landlord)
in December 2010 for $1,300,000, and it is estimated that renovating the entire 26,000 square foot structure will cost
the landlord slightly over $5,000,000.
Total Project Costs And Financing
Total project cost for the acquisition of moveable equipment is estimated at $1,112,412, itemized as follows:
Other Fees
Movable Equipment
CON Application Fee
CON Processing Fee
Total Project Cost
$24,000
1,080,338
2,000
6,074
$1,112,412
Project costs are based on a September 1, 2012 start date with a six month construction period.
Project # 121104-B Exhibit Page 5
The applicant’s financing plan appears as follows:
Cash Equity (Applicant)
Equipment lease (5-year term, 7.82%)
Total
$111,242
1,001,170
$1,112,412
A letter of interest for leasing moveable equipment has been provided by AccuLease.
Operating Budget
The applicant has submitted the first and third years operating budgets, in 2012 dollars, as summarized below:
Revenues
Expenses:
Operating
Capital
Total Expenses
Net Income or (Loss)
Utilization: (procedures)
Cost Per Procedure
Year One
$4,482,457
Year Three
$4,755,439
$3,219,609
741,239
$3,960,848
$3,407,566
751,796
$4,159,362
$521,609
$596,077
9,033
$438.49
9,583
$434.04
Utilization by payor source for the first and third years is anticipated as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Commercial Fee-for-Service
Commercial Manage Care
Private Pay
Charity
13.12%
37.66%
19.48%
14.93%
10.39%
2.21%
2.21%
Utilization and expense assumptions were based on the applicant’s experience in operating an article 28 FASC, along
with input from the proposed participating physicians. The applicant has submitted eleven physician’s referral letters
in support of the utilization projections, and has calculated the breakeven point to be approximately 88% of first and
third year budgeted procedures.
The FASC will offer the following services: Orthopedic Surgery, Podiatric Surgery, General Surgery, Urology,
Gynecology, Gastroenterology, and Pain Management.
Capability and Feasibility
The total project cost of $1,112,412 will be satisfied by the proposed members contributing $111,242 from their
personal resources and entering into a capital equipment lease with AccuLease for $1,001,170 at the above stated
terms.
Working capital requirements are estimated at $693,228, which appears reasonable based on two months of third year
expenses. Half of the working capital or $346,614 will be contributed by the members with the remaining $346,614
being borrowed from TD Bank for five years at a 4% fixed rate of interest. Presented as BFA Attachment A is the
member’s statement of personal net worth, which indicates the ability to meet both the equity and working capital
requirements. Presented as BFA Attachment B is AMSC, LLC d/b/a All-Surg pro-forma balance sheet that shows
operations will start off with $457,856 in positive equity.
AMSC, LLC projects an operating excess of $521,609 and $596,077 in the first and third years, respectively.
Revenues are based on current and projected federal and state governmental reimbursement methodologies, while
commercial payers are based on estimates. The budget appears reasonable.
Project # 121104-B Exhibit Page 6
It appears that the applicant has demonstrated the capability to proceed in a financially feasible manner, and
contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Personal Net Worth Statement for the Proposed Member of AMSC, LLC d/b/a
All-Surg
BFA Attachment B
Pro-forma Balance Sheet of AMSC, LLC d/b/a All-Surg
Supplemental Information
Outreach
Below are presented summaries of responses by hospitals to letters from the Department asking for information on the
impact of the proposed ambulatory surgery center (ASC) in their service areas. There follows a summary of the
applicant’s response to DOH’s request for information on the proposed facility’s volume of surgical cases, the sources
of those cases, and on how staff will be recruited and retained by the ASC.
Facility:
Bronx-Lebanon Hospital Center
Concourse Division
1650 Grand Concourse
Bronx, New York 10457
No response.
Facility:
St. Barnabas Hospital
4422 Third Avenue
Bronx, New York 10457
No response.
Facility:
Lincoln Medical & Mental Health Center
234 East 149th Street
Bronx, New York 10451
Current
OR Use
82%
1
Surgery Cases
Ambulatory
Inpatient
10,147
Not
Provided
1
Ambulatory Cases by
Applicant Physician
Reserved OR Time
for Applicant Physician
None
None
Utilization for eight OR’s. Facility also operates three GI and two GU procedure rooms.
Project # 121104-B Exhibit Page 7
Lincoln Medical and Mental Health Center opposes the application. The hospital predicts that the proposed
ASC would have negative ramifications on Lincoln and could jeopardize its financial stability. The hospital
states that in 2011 it generated $4.6 million from 1,296 ambulatory surgical procedures from Zip code 10451,
where Lincoln stands and where the proposed ASC would be located. The hospital states that the location of
an ASC in such close proximity makes it likely that Lincoln would lose surgical referrals from community
physicians. These and other losses within its catchment area could reduce the revenues from ambulatory
surgery that help the hospital to support more than 600,000 outpatient and emergency room visits. Lincoln’s
ambulatory surgery payor mix is $40.5% Medicaid HMO, 20.5% self-pay and 8.7% Medicaid.
The hospital acknowledges that none of the physicians slated to practice at the proposed ASC currently
perform surgery at Lincoln.
Supplemental Information from Applicant
•
Need and Sources of Cases
The source of cases will be those currently being performed in the offices of the 11 physicians who have committed to
perform cases at the proposed ASC. The applicant also states that the proposed facility will be aligned with All-Med &
Rehab of New York (All-Med), an affiliated existing diagnostic and treatment center with two sites in the Bronx and one
site in Queens. This association will help ensure continuity of care and access to primary care for All-Surg’s patients
and will help facilitate access to surgical procedures by All-Med’s clientele. The applicant also believes that recognition
of the higher quality of services at certified facilities will cause patients and insurers to prefer the services of the
proposed ASC as opposed to office-based practices.
•
Office-Based Cases
All of the projected procedures for the proposed ASC are currently performed in an office-based setting. The applicant
states that cases that are more appropriately performed in a general hospital setting will continue to be performed at
the area hospitals where the applicant physicians are credentialed.
•
Staff Recruitment and Retention
The applicant states that initial recruitment will be of selected staff currently employed by the member physicians in
their private practices, particularly the nursing and technical staff. Staff will also be recruited through accredited
schools, newspaper advertisements, training programs, local recruiters and, if needed, job fairs. Competitive salaries
and benefits are expected to aid in the recruitment and retention of skilled employees, as are a positive work
environment and flexible working hours. The applicant also expects that nurses and technicians currently employed
by hospitals who choose to augment their income will be able to find supplemental employment at the proposed ASC
because of the flexible work schedule, without cutting back on or abandoning their hospital employment.
OHSM Comment
Although one hospital in the area of the proposed ASC expressed opposition to the application, the fact that none of
the physicians who intend to operate at the facility currently operate at the hospital renders the hospital’s prediction of
lost cases and revenues speculative and provides no basis for reversal or modification of the recommendation for
contingent approval of the proposed ASC based on public need, financial feasibility and operator character and
competence.
Project # 121104-B Exhibit Page 8
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish and construct an Article 28 D&TC that will be certified as a multi-specialty freestanding
ambulatory surgery center, and with the contingencies, if any, as set forth below and providing
that each applicant fulfills the contingencies and conditions, if any, specified with reference to
the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121104 B
AMSC, LLC d/b/a All Surg
APPROVAL CONTINGENT UPON:
Approval with an expiration of the operating certificate five years from the date of its
issuance is recommended contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New
York State Department of Health. Public Health Law Section 2802.7 states that all
construction applications requiring review by the Public Health and Health Planning Council
shall pay an additional fee of fifty-five hundredths of one percent of the total capital value of
the project, exclusive of CON fees. [PMU]
2. Submission of a signed agreement with an outside independent entity satisfactory to the
Department to provide annual reports to the DOH beginning in the second year of operation.
Said reports shall include:
•
•
•
•
•
•
Data showing actual utilization including procedures;
Data showing breakdown of visits by payor source;
Data showing number of patients who need follow-up care in a hospital within seven
days after ambulatory surgery;
Data showing number of emergency transfers to a hospital;
Data showing percentage of charity care provided, and
Number of nosocomial infections recorded during the year in question. [RNR]
3. Submission of an executed transfer and affiliation agreement, acceptable to the Department,
with a local acute care hospital. [HSP]
4. Submission of an executed equipment lease that is acceptable to the Department. [BFA]
5. Submission of a working capital loan commitment that is acceptable to the Department.
[BFA]
6. The Articles of Organization must include a provision describing how the LLC will be
managed and stating that neither the management structure nor the provision setting forth
such structure may be deleted, modified or amended without the prior approval of the
Department. [CSL]
7. The Articles of Organization must further provide that, notwithstanding anything in the
Articles of Organization or the Operating Agreement to the contrary, transfers, assignments
or other dispositions of membership interests or voting rights must be effectuated in
accordance with Public Health Law Section 2801-a(4)(b). [CSL]
APPROVAL CONDITIONAL UPON:
1. The submission of a CON or other licensing extension application required by the
Department prior to expiration date of the operating certificate issued pursuant to this CON,
seeking extension of the operating certificate of the ambulatory surgery center. [PMU]
2. The staff of the facility must be separate and distinct from staff of other entities. [HSP]
3. The signage must clearly denote the facility is separate and distinct from other adjacent
entities. [HSP]
4. The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
5. The clinical space must be used exclusively for the approved purpose. [HSP]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121403-B
Union Square SC, LLC
County: New York (New York)
Purpose: Establishment and Construction
Program: Ambulatory Surgery Center
Submitted: May 23, 2012
Executive Summary
Description
Union Square SC, LLC., a to-be-formed limited liability
company, requests approval to establish and construct a
single-specialty freestanding ambulatory surgery center
(FASC) specializing in orthopedic procedures. The FASC
will be located in leased space at 27 West 20th Street,
New York, on the first and second floors of the building.
The applicant proposes to provide orthopedic surgery
using four operating rooms.
This application will consolidate several private medical
practices and Beth Israel Medical Center (BIMC)
physicians. Upon approval, the applicant will change its
name to Union Square Surgery Center, LLC. The
proposed members are as follows:
Beth Israel Ambulatory Care Services Corp.
Metro Bloom, LLC
Steven Arsht, MD
Steven Beldner, MD
Catherine Compito, MD
Jonathan Gordon, MD
Christopher Hubbard, MD
Jerry Lubliner, MD
Peter McCann, MD
Debra Parisi, MD
Kevin Plancher, MD
Debra Polatsch, MD
Vladimir Shur, MD
Max Tyorkin, MD
Robert Ziets, MD
67.500%
10.000%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
The applicant will enter into a development agreement
and an administrative services agreement with Metro
Bloom, LLC, a healthcare consultant with ambulatory
surgery experience in New Jersey and Florida, which is
wholly-owned by Henry Bloom.
Beth Israel Ambulatory Care Services Corporation is a
not-for-profit and is an affiliate of BIMC. BIMC and its
parent support this project, but will not take an active role
in the operation of the FASC.
No responses were received to the Department’s inquiry
to local hospitals regarding the impact of the proposed
ASC in the service area.
Total project costs are estimated at $7,086,144.
DOH Recommendation
Contingent approval, with an expiration of the operating
certificate five years from the date of its issuance, should
the operator not comply with the conditions of approval
granted this CON.
Need Summary
The majority of the cases will be a result of the transfer of
excess volume from BIMC. The first year volume of
5,484 procedures is based on the majority of cases that
are currently performed at BIMC. The applicant projects
a third-year utilization of 5,818 procedures. Performing
these cases in the FASC will free up needed space in the
hospital’s operating room, where inpatient surgical cases
have increased by 13.6% from 12,487 in 2008 to 14,189
in 2010.
Program Summary
Staff found nothing that would reflect adversely upon the
applicant’s character and competence or standing in the
community.
Financial Summary
Total project costs will be met via equity of $708,614 and
a bank loan of $6,377,530 (7 yrs. @ 5.25%).
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 10,049,135
6,834,505
$ 3,214,630
Subject to the noted contingencies, it appears that the
applicant has demonstrated the capability to proceed in a
financially feasible manner.
Project # 121403-B Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval with an expiration of the operating certificate five years from the date of its issuance is recommended
contingent upon:
1.
2.
Submission of a check for the amount enumerated in the approval letter, payable to the New York State Department of Health.
Public Health Law Section 2802.7 states that all construction applications requiring review by the Public Health and Health
Planning Council shall pay an additional fee of fifty-five hundredths of one percent of the total capital value of the project,
exclusive of CON fees. [PMU]
Submission of a signed agreement with an outside independent entity satisfactory to the Department of Health beginning in the
second year of operation. These reports shalll include:
•
•
•
•
•
•
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Data showing actual utilization including procedures;
Data showing breakdown of visits by payor source;
Data showing number of patients who needed follow-up care in a hospital within seven days after ambulatory surgery;
Data showing number of emergency transfers to a hospital;
Data showing percentage of charity care provided; and
Number of nosocomial infections recorded during the year in question. [RNR]
Submission by the governing body of the ambulatory surgery center of an Organizational Mission Statement which identifies, at
a minimum, the populations and communities to be served by the center, including underserved populations (such as racial
and ethnic minorities, women and handicapped persons) and the center’s commitment to meet the health care needs of the
community, including the provision of services to those in need regardless of ability to pay. The statement shall also include
commitment to the development of policies and procedures to assure that charity care is available to those who cannot afford
to pay. [RNR]
Submission of a statement from the applicant, acceptable to the Department, that the proposed financial/referral structure has
been assessed in light of anti-kickback and self-referral laws, with consultation of the legal counsel, and it is concluded that
proceeding with the proposal is acceptable. [RNR]
Submission of a statement, acceptable to the Department, that the applicant will consider creating or entering into an
integrated system of care that will reduce the fragmentation of the delivery system, provide coordinated care for patients, and
reduce inappropriate utilization of services. The applicant will agree to submit a report to the Department beginning in the
second year of operation and each year thereafter detailing efforts and results. [RNR]
Submission of a bank loan commitment that is acceptable to the Department. [BFA]
Submission of a photocopy of an executed lease rental agreement that is acceptable to the Department. [BFA, CSL]
Submission of a working capital loan commitment that is acceptable to the Department. [BFA]
Submission of a photocopy of the executed Articles of Organization of Union Square SC, L.L.C., acceptable to the Department.
[CSL]
Submission of a photocopy of the executed Operating Agreement of Union Square SC, L.L.C., acceptable to the Department.
[CSL]
Submission of a photocopy of the executed Articles of Organization of Metro-Bloom LLC, acceptable to the Department. [CSL]
Submission of a photocopy of the executed Operating Agreement of Metro-Bloom LLC, acceptable to the Department. [CSL]
The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP Drawing
Submission Guidelines DSG-01. [AER]
Approval conditional upon:
1.
2.
3.
4.
5.
6.
The staff of the facility must be separate and distinct from staff of other entities. [HSP]
The signage must clearly denote the facility is separate and distinct from other adjacent entities. [HSP]
The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
The clinical space must be used exclusively for the approved purpose. [HSP]
The submission of Final Construction Documents, signed and sealed by the project architect, as described in BAEFP Drawing
Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
The applicant shall complete construction by June 30, 2015. In accordance with 10 NYCRR Part 710.2(b)(5) and 710.10(a), if
construction is not completed on or before that date, this may constitute abandonment of the approval and this approval shall
be deemed cancelled, withdrawn and annulled without further action by the Commissioner. [AER]
Project # 121403-B Exhibit Page 2
7. The submission of a CON or other licensing extension application required by the Department prior to
expiration date of the operating certificate issued pursuant to this CON, seeking extension of the operating
certificate of the ambulatory surgery center. [PMU]
Council Action Date
October 11, 2012.
Need Analysis
Background
Union Square SC, LLC requests approval to establish and construct a single-specialty freestanding ambulatory
surgery center (FASC) at 27 West 20th Street, New York, in New York County.
Currently, New York County has 12 FASCs. The types of ambulatory surgery service and number of cases performed
at the centers are listed below:
AS Type
Gastroenterology
Multi Specialty
Gastroenterology
Multi Specialty
Multi Specialty
Multi Specialty
Endoscopy
Gastroenterology
Ophthalmology
Multi Specialty
Ophthalmology
Multi Specialty
Total
Existing Ambulatory Surgery Centers: New York County
Name
Carnegie Hill Endo, LLC
Center for Specialty Care Inc
East Side Endoscopy
Fifth Avenue Surgery Center
Gramercy Park Digestive Disease Center
Gramercy Surgery Center, Inc
Kips Bay Endoscopy Center, LLC
Manhattan Endoscopy Center, LLC
Mid Manhattan Surgi-Center
Midtown Surgery Center
Retinal Ambulatory Surgery Center of New York Inc
SurgiCare of Manhattan, LLC
2010
N/A
4,679
6,326
916
7,494
1,868
9,179
N/A
4,011
N/A
924
1,671
37,068
2011
N/A
4,757
9,059
1,494
8,215
1,876
9,504
617
3,661
2,867
1,857
3,350
47,257
Source: SPARCS 2010 – 2011.
The first-year volume of 5,484 procedures is based on the majority of cases that are currently performed at Beth Israel
Medical Center. The applicant projects a third-year utilization of 5,818 procedures. Performing these cases in the
ambulatory surgery center will free up needed space in the hospital’s operating room, where inpatient surgical cases
have increased by 13.6 percent, from 12,487 in 2008 to 14,189 in 2010.
The applicant states that the members of Union Square SC, LLC are committed to serving all persons in need of its
specialty care without regard to race, sex, age, religion, creed, sexual orientation, ability to pay, source of payment or
other personal characteristics.
Recommendation
From a need perspective, contingent approval is recommended.
Project # 121403-B Exhibit Page 3
Programmatic Analysis
Establish a diagnostic and treatment center that will also be federally certified as a single-specialty ambulatory surgery
center.
Proposed Operator
Site Address
Surgical Specialties
Operating Rooms
Hours of Operation
Staffing (1st Year / 3rd Year)
Medical Director(s)
Emergency, In-Patient and
Backup Support Services
On-call service
Union Square SC, LLC
Upon approval will change name to Union Square Surgery
Center, LLC
27 West 20th Street, New York
Orthopedics
4
Monday through Friday from 7:00 am to 6:00 pm (Extended as
necessary to accommodate patient needs).
24.5 FTEs / 28 FTEs
Peter McCann
Beth Israel Medical Center
1.1 miles / 5 minutes
Access to the facility’s on-call physician during hours when the
facility is closed.
Character and Competence
The members of the LLC are:
Class A Members
Steven J. Arsht, MD
Steven Beldner, MD
Catherine A. Compito, MD
Jonathan C. Gordon, MD
Christopher E. Hubbard, MD
Jerry A. Lubliner, MD
Peter D. McCann, MD
Debra M. Parisi, MD
Kevin D. Plancher, MD
Daniel B. Polatsch, MD
Vladimir B. Shur, MD
Max Tyorkin, MD
Robert J. Ziets, MD
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
1.731%
Class B Members
Metro-Bloom, LLC
-- Henry Bloom (100%)
10.000%
Class C Members
Beth Israel Ambulatory Care Services Corp
67.500%
The 13 Class A members are all practicing surgeons with admitting privileges to Beth Israel Medical Center. The
Class B member is wholly owned by Henry Bloom. Mr. Bloom has extensive experience providing administrative and
consulting services to ambulatory surgery centers nationwide. The Class C member, Beth Israel Ambulatory Care
Services Corp. (BIACSC), is a not-for-profit corporation which is an affiliate of Beth Israel Medical Center (BIMC) and
whose board members are officers of BIMC. BIACSC is the operator and/or member of multiple ambulatory surgery
centers in New York State.
Project # 121403-B Exhibit Page 4
Staff from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses
held, formal education, training in pertinent health and/or related areas, employment history, a record of legal actions,
and a disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Dr. Gordon disclosed three pending malpractice cases. Dr. Hubbard disclosed one settled malpractice case. Dr. Ziets
disclosed two settled and one pending malpractice cases.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health.
Included in the review were the results of any incident and/or complaint investigations, independent professional
reviews, and/or comprehensive/focused inspections. The review found that any citations were properly corrected with
appropriate remedial action.
In 2005 Beth Israel Medical Center entered into a Corporate Integrity Agreement related to cost report overpayments.
The Agreement remains in effect.
Integration with Community Resources
The center has committed to serving all persons in need of its specialty care without regard to race, sex, age, religion,
creed, sexual orientation, ability to pay, source of payment or other personal characteristics.
The center commits to becoming a network provider in the provider-led health homes designated by the Department
for New York County and its surrounding counties and will consider joining any Accountable Care Organization that is
formed for providers in New York County. Additionally, the center intends to implement an electronic medical record
system that qualifies under the Meaningful Use provisions of the HITECH Act and will consider joining a regional
health information organization or qualified health information exchange.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Lease Rental Agreement
The applicant has submitted a draft lease rental agreement for the site that they will occupy, which is summarized
below:
Premises:
Lessor:
Lessee:
Term:
Rental:
Provisions:
12,000 square feet located at 27 West 20th Street, New York, New York
Dezer Properties, Inc.
Union Square SC, LLC
Fifteen years (15)
$702,000 per annum ($58.50 per sq. ft.) plus a 3% increase compounded annually.
The lessee shall be responsible for utilities.
The applicant has submitted an affidavit indicating that the lease agreement will be an arm’s length lease
arrangement. The applicant has submitted three real estate letters attesting to the reasonableness of the per square
foot rental.
Project # 121403-B Exhibit Page 5
Development Services Agreement
The applicant has submitted an executed development services agreement which they will enter before they open the
facility, which is summarized below:
Date:
Facility:
Contractor:
Term:
Services Provided:
Compensation:
February 28, 2012
Union Square SC, LLC
Metro Bloom, LLC
Metro Bloom, LLC shall begin providing Development Services on the
commencement date and shall continue providing such Development
Services until the Center perform its first surgical procedure at the Center.
During the term, Metro Bloom, LLC shall be responsible for a 3 phase
Development Process. The Contractor will provide the following services:
Assist the company with respect to the development and review of pro forma
statements of operations and strategic planning; assist the company with site
location in order to determine the best location of the Center; assist the
Company with respect to the Company’s efforts to obtain financing for the
Center; interview and advise the Company with respect to the selection of an
architect; shall schedule and attend regular meetings with the architect, the
Company and a steering group of physicians; review the architect’s drawings
and specifications as they are being prepared; assist in the preparation of a
budget for the Center; indentify and arrange for the purchase of any and all
instrumentation and equipment required for the Center; shall monitor and
review all changes to the Center or the Budget with the Company and the
architect and assist in negotiating said changes; shall recommend for
purchase or lease by the Company, any and all furniture, fixtures, equipment
and supplies as may be required in order to operate the Center; shall
recommend for approval and hire by the Company and all staff as shall be
required in connection with the development of the Center; shall assist and
recommend the selection and implementation of the Company’s computer
system and Metro will assist in the preparation of financial projections for the
Company, which shall include revenue forecasts based on current
reimbursement methodologies and staffing and supply expense estimates.
In consideration of the Development Services to be performed by Metro, the
Company shall compensate Metro for three phases of services, for maximum
aggregate payments of one hundred fifty thousand dollars ($150,000).
Administrative Services Agreement
The applicant has submitted an executed administrative services agreement, which is summarized below:
Facility:
Contractor:
Term:
Compensation:
Services Provided:
Union Square Surgery Center
Metro Bloom, LLC
Three years and the agreement shall be extended for an
additional two years.
The administrative services fee will be $96,000 annually for the
term of the agreement.
The Consultant shall provide the following services: Responsible
for consulting with the Client relative to the Client’s furniture,
fixtures and equipment; work closely with Administrator to
arrange for appropriate maintenance of equipment; subject to the
Client’s approval, the Contractor shall recruit a full time on-site
administrator; shall recruit and recommend for hire by Client and
all clerical and professional personnel that will be required in
order to operate the Center; assist the Client to establish unified
office policies and procedures, which such policies and
procedures shall be approved by the Client; work with the
Project # 121403-B Exhibit Page 6
accountants to develop and establish bookkeeping and
accounting protocols; consultant shall maintain, monitor and
reconcile all bank accounts; assist the Client to establish and
monitor Quality Assurance/Utilization Review programs for the
Client; negotiate contracts with various hospitals, insurance
companies and managed care companies; perform a quarterly
on-site review of the Client to assist Client in meeting regulatory
and accreditation standards and shall establish and operational
budget on an annual basis subject to the review and approval of
the Board.
The Consultant will not have the following responsibilities:
•
•
•
•
authority to hire or fire the administrator or other key management employees;
maintenance and control of the books and records;
authority over the disposition of assets and the incurring of liabilities on behalf of the facility, and
the adoption and enforcement of policies regarding to the operation of the facility.
Total Project Cost and Financing
Total project cost, which is for renovations and the acquisition of moveable equipment, is estimated at $7,086,144,
itemized below:
Renovation and Demolition
Design Contingency
Construction Contingency
Architect/Engineering Fees
Construction Manager Fees
Other Fees (Consultant)
Moveable Equipment
Telecommunications
Financing Costs
Interim Interest Expense
CON Fee
Additional Processing Fee
Total Project Cost
$3,392,376
339,237
339,237
332,800
40,000
369,000
1,771,000
182,000
127,551
152,193
2,000
38,750
$7,086,144
Project costs are based on a February 1, 2012 construction start date and a five month construction period.
The applicant’s financing plan appears as follows:
Equity
Bank Loan (5.25% interest rate for a seven year term)
$ 708,614
$6,377,530
Operating Budget
The applicant has submitted an operating budget, in 2012 dollars, for the first and third years; summarized below:
Revenues
Year One
$9,472,274
Year Three
$10,049,135
Expenses:
Operating
Capital
$4,750,474
1,661,307
$ 5,214,291
1,620,214
Project # 121403-B Exhibit Page 7
Total Expenses
$6,411,781
$ 6,834,505
Net Income
$3,060,493
$ 3,214,630
5,484
$1,169.18
5,818
$1,174.72
Utilization: (Procedures)
Cost Per Procedure
Utilization by payor source during the first and third years is shown below:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Commercial Fee-for-Service
Commercial Managed Care
Charity Care
Years One and Three
0.87%
11.03%
10.01%
38.36%
34.71%
5.02%
Utilization projections are based on the experience of the participating surgeons and their estimate of the number of
cases they would bring to the Center. Expense assumptions are based on the experience of the participating
physicians, as well as the projections and experience of other freestanding ambulatory surgery centers in New York
State.
Capability and Feasibility
The applicant will finance $6,377,530 at an interest rate of 5.25% for a seven year term; the applicant has provided a
letter of interest. The remainder, $708,614, will be provided as equity from the proposed members’ personal resources
and via Beth Israel Ambulatory Care Services Corporation’s operations.
Working capital requirement is estimated at $1,139,084, which is equivalent to two months of third year expenses.
The applicant will finance $569,542 at an interest rate of 4.50% for a term of five years. The remainder, $569,542, will
be provided from the proposed members’ personal resources and via Beth Israel Ambulatory Care Services
Corporation’s operations. Presented as BFA Attachment A and B are the personal net worth statements for the
proposed members of Union Square SC, LLC, and the 2010 and 2011 certified financial statements of Beth Israel
Ambulatory Care Services Corporation, which indicates the availability of sufficient funds for the equity contribution.
Presented as BFA Attachment C, is the pro-forma balance sheet of Union Square SC, LLC as of the first day of
operation, which indicates a positive net asset position of $1,278,156 as of the first day of operation.
The submitted budget indicates a projected net income of $3,060,493 and $3,214,630 during the first and third years,
respectively. Revenues are based on current reimbursement methodologies for ambulatory surgery services.
Subject to the noted contingencies, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 121403-B Exhibit Page 8
Attachments
BFA Attachment A
Personal Net Worth Statement
BFA Attachment B
2010 and 2011 certified financial statements of Beth Israel Ambulatory Care
Services Corporation
BFA Attachment C
Pro-forma Balance Sheet
BHFP Attachment
Map
Supplemental Information
Outreach
Below are presented summaries of responses by hospitals to letters from the Department asking for information on the
impact of the proposed ambulatory surgery center (ASC) in their service areas. There follows a summary of the
applicant’s response to DOH’s request for information on the proposed facility’s volume of surgical cases, the sources
of those cases, and on how staff will be recruited and retained by the ASC.
Facility:
NYU Langone Medical Center
550 First Avenue Avenue
New York, New York 10016
No response.
Facility:
Hospital for Joint Diseases
301 East 17th Street
New York, New York 10003
No response.
Facility:
Bellevue Hospital Center
First Avenue at 27th Street
New York, New York 10016
No response.
Supplemental Information from Applicant
•
Need and Sources of Cases
The utilization projected for the proposed ASC is base on the current caseload of the 13 member physicians who have
committed to perform cases at the facility. The majority of the cases (98%) at the proposed ASC are currently being
performed at Beth Israel Medical Center’s (BIMC) Philips Ambulatory Care Center, with the remaining procedures
performed in the physicians’ private offices or other freestanding (non-hospital based) ambulatory surgery centers.
Project # 121403-B Exhibit Page 9
The proposed application has been developed with the cooperation and support of BIMC. The applicant also cites the
continuous growth of ambulatory surgery in New York County, and in New York State, as a source of cases and
further expects that the higher quality of surgery in ASCs will cause patients and insurers to prefer the services of an
ASC, as opposed to an office-based practice.
•
Staff Recruitment and Retnetion
The applicant states that initial recruitment will be of selected staff currently employed by the member physicians in
their private practices, particularly the nursing and technical staff. Staff will also be recruited through accredited
schools, newspaper advertisements, training programs, local recruiters and, if needed, job fairs. Competitive salaries
and benefits are expected to aid in the recruitment and retention of skilled employees, as are a positive work
environment and flexible working hours. The applicant also expects that nurses and technicians currently employed
by hospitals who choose to augment their income will be able to find supplemental employment at the proposed ASC
because of the flexible work schedule, without cutting back on or abandoning their hospital employment.
•
Office-Based Cases
As noted previously, the majority of the projected cases (98%) are currently being performed at BIMC’s Philips
Ambulatory Care Center, which is related to the Beth Israel Ambulatory Care Services Corporation, one of the owners
of the proposed ASC, with the remaining cases coming from the physicians’ private offices or other non-hospital based
ASCs. The applicant states that none of the projected procedures will migrate to the proposed ASC from any hospital
or other ASC.
OHSM Comment
The absence of any comments in opposition to this application from hospitals in the proposed service area provides no
basis for reversal or modification of the recommendation for five-year limited life approval of the proposed ASC based
on public need, financial feasibility and operator character and competence.
Project # 121403-B Exhibit Page 10
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish and construct a single-specialty freestanding ambulatory surgery center specializing in
orthopedic procedures, and with the contingencies, if any, as set forth below and providing that
each applicant fulfills the contingencies and conditions, if any, specified with reference to the
application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121403 B
Union Square SC, LLC
APPROVAL CONTINGENT UPON:
Approval with an expiration of the operating certificate five years from the date of its
issuance is recommended contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New
York State Department of Health. Public Health Law Section 2802.7 states that all
construction applications requiring review by the Public Health and Health Planning Council
shall pay an additional fee of fifty-five hundredths of one percent of the total capital value of
the project, exclusive of CON fees. [PMU]
2. Submission of a signed agreement with an outside independent entity satisfactory to the
Department of Health beginning in the second year of operation. These reports shalll
include:
•
•
•
•
•
•
Data showing actual utilization including procedures;
Data showing breakdown of visits by payor source;
Data showing number of patients who needed follow-up care in a hospital within
seven days after ambulatory surgery;
Data showing number of emergency transfers to a hospital;
Data showing percentage of charity care provided; and
Number of nosocomial infections recorded during the year in question. [RNR]
3. Submission by the governing body of the ambulatory surgery center of an Organizational
Mission Statement which identifies, at a minimum, the populations and communities to be
served by the center, including underserved populations (such as racial and ethnic
minorities, women and handicapped persons) and the center’s commitment to meet the
health care needs of the community, including the provision of services to those in need
regardless of ability to pay. The statement shall also include commitment to the
development of policies and procedures to assure that charity care is available to those who
cannot afford to pay. [RNR]
4. Submission of a statement from the applicant, acceptable to the Department, that the
proposed financial/referral structure has been assessed in light of anti-kickback and selfreferral laws, with consultation of the legal counsel, and it is concluded that proceeding with
the proposal is acceptable. [RNR]
5. Submission of a statement, acceptable to the Department, that the applicant will consider
creating or entering into an integrated system of care that will reduce the fragmentation of
the delivery system, provide coordinated care for patients, and reduce inappropriate
utilization of services. The applicant will agree to submit a report to the Department
beginning in the second year of operation and each year thereafter detailing efforts and
results. [RNR]
6. Submission of a bank loan commitment that is acceptable to the Department. [BFA]
7. Submission of a photocopy of an executed lease rental agreement that is acceptable to the
Department. [BFA, CSL]
8. Submission of a working capital loan commitment that is acceptable to the Department.
[BFA]
9. Submission of a photocopy of the executed Articles of Organization of Union Square SC,
L.L.C., acceptable to the Department. [CSL]
10. Submission of a photocopy of the executed Operating Agreement of Union Square SC,
L.L.C., acceptable to the Department. [CSL]
11. Submission of a photocopy of the executed Articles of Organization of Metro-Bloom LLC,
acceptable to the Department. [CSL]
12. Submission of a photocopy of the executed Operating Agreement of Metro-Bloom LLC,
acceptable to the Department. [CSL]
13. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as
described in BAEFP Drawing Submission Guidelines DSG-01. [AER]
APPROVAL CONDITIONAL UPON:
1. The staff of the facility must be separate and distinct from staff of other entities. [HSP]
2. The signage must clearly denote the facility is separate and distinct from other adjacent
entities. [HSP]
3. The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
4. The clinical space must be used exclusively for the approved purpose. [HSP]
5. The submission of Final Construction Documents, signed and sealed by the project
architect, as described in BAEFP Drawing Submission Guidelines DSG-01, prior to the
applicant’s start of construction. [AER]
6. The applicant shall complete construction by June 30, 2015. In accordance with 10 NYCRR
Part 710.2(b)(5) and 710.10(a), if construction is not completed on or before that date, this
may constitute abandonment of the approval and this approval shall be deemed cancelled,
withdrawn and annulled without further action by the Commissioner. [AER]
7. The submission of a CON or other licensing extension application required by the
Department prior to expiration date of the operating certificate issued pursuant to this CON,
seeking extension of the operating certificate of the ambulatory surgery center. [PMU]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121354-E
Hillside Polymedic Diagnostic and Treatment Center, Inc.
County: Queens (Jamaica)
Purpose: Establishment
Program: Diagnostic and Treatment Center
Submitted: April 27, 2012
Executive Summary
Description
Hillside Polymedic Diagnostic and Treatment Center,
Inc. (Hillside Polymedic), a proprietary corporation,
requests permanent life approval to operate an Article
28 diagnostic and treatment center (D&TC) providing
primary care and specialty services at 187-30 Hillside
Avenue, Jamaica. Under CON #052016-B, Hillside
Polymedic was approved by the Public Health Council
in November 2005 for a limited life of five years. The
sole shareholder of Hillside Polymedic is Bridget
Chime.
Financial Summary
There are no project costs associated with this
application.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 1,988,412
1,852,887
$
135,525
The applicant has demonstrated the capability to
proceed in a financially feasible manner.
DOH Recommendation
Approval.
Need Summary
Hillside Polymedic Diagnostic and Treatment Center,
Inc. (Hillside Polymedic) served 3,127 patients in 2011,
for a total of 13,333 visits since becoming operational
in 2007. Nearly 71% of the visits accounted for
primary care services, including: internal medicine
(26.9%), obstetrics and gynecology (16.9%), pediatrics
(15.8%), and family medicine (11.0%). The remaining
29% of the visits were podiatry (12.9%), dental (4.9%),
and other (12.1%).
It is projected that visits will increase from 13,133 to
17,333 in the first year of permanent life operation and
19,533 by year 3.
Program Summary
Based on the information reviewed, staff found nothing
that would reflect adversely upon the applicant’s
character and competence or standing in the
community.
Project # 121354-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval.
Council Action Date
October 11, 2012.
Project # 121354-E Exhibit Page 2
Need Analysis
Background
Hillside Polymedic Diagnostic and Treatment Center, Inc. (Hillside Polymedic), located at 187-30 Hillside Avenue,
Jamaica, 11432 in Queens County, seeks permanent life. Hillside was previously approved for a 5-year limited life
through CON #052016-B. The applicant has met the following contingency on CON #052016-B:
Submission of an agreement with an outside independent entity, satisfactory to the Department, to provide annual
reports to the department beginning in the second year of operation).
Analysis
The service area includes ten zip codes in Queens County as follows:
11432, 11423, 11412, 11434, 11433, 11429, 11427, 11428, 11413, and 11435.
The prevention quality indicators (PQIs) are rates of admissions to the hospital for conditions for which good outpatient
care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or
more severe disease.
The PQIs for zip code 11432, the location of Hillside, are significantly poor compared with those of the State (Source:
NYSDOH). The rates for the ten service area zip codes are also unfavorable for most of the PQI conditions.
PQIs: # of admissions per
100,000 adult population
All PQIs
Zip Code 11432
2,130
Ten Service Area
Zip Codes
2,014
NYS
1,563
All Acute
646
520
526
All Circulatory
662
697
456
All Diabetes
398
406
224
All Respiratory
421
391
357
The number of projected visits is as follows:
Current Year
First Year
Third Year
13,133
17,333
19,533
These projections are based on moderate growth and the addition of the provider staff. Based on the NYSDOH data,
the population of Queens County is expected to grow 9.5 percent from 2010-2020. The elderly population (65 years
and over) will grow approximately 27 percent.
Conclusion
According to the annual reports compiled by the outside independent entity engaged to review the facility’s services
and operations Hillside Polymedic has provided primary care and related services to residents of their service area
under the terms of the limited life approval put into effect on April 27, 2007.
Recommendation
From a need perspective, approval is recommended.
Project # 121354-E Exhibit Page 3
Programmatic Analysis
Program Proposal
Seek Permanent Life approval for a diagnostic and treatment center which has been operating for five years. There
will be no changes to the facility’s services as a result of this project.
Character and Competence
The sole member of the LLC is Bridget Chime.
Staff from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses
held, formal education, training in pertinent health and/or related areas, employment history, a record of legal actions,
and a disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health.
Included in the review were the results of any incident and/or complaint investigations, independent professional
reviews, and/or comprehensive/focused inspections. The review found that any citations were properly corrected with
appropriate remedial action.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Lease Rental Agreement
The applicant has submitted an executed lease rental agreement for the site, which is summarized below:
Premises:
Lessor:
Lessee:
Term:
Rental:
Provisions:
8,466 square feet located at 187-30 Hillside Avenue, Jamaica, New York
Chudi Chime
Hillside Polymedic Diagnostic and Treatment Center
10 years
$240,000 annually ($28.35 per sq. ft.)
The lessee shall be responsible for maintenance, insurance and utilities.
Operating Budget
The applicant has submitted operating budgets for the current year (2010) and years one and three in 2012 dollars,
summarized below:
Revenues
Total Operating Expenses
Net Income
Utilization: (visits)
Cost Per Visit
Current Year
$1,207,433
Year One
$1,761,862
Year Three
$1,988,412
1,475,359
1,663,358
1,852,887
$(267,926)
$98,504
$135,525
11,007
17,333
19,533
$134.03
$95.96
$94.85
Project # 121354-E Exhibit Page 4
Utilization by payor source for the current year and year’s one and three is as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Commercial Fee-for-Service
Commercial Managed Care
Private Pay
Current year (2010)
5.90%
41.52%
2.71%
.28%
6.49%
30.88%
12.22%
Year One
9.53%
42.22%
3.17%
3.17%
5.62%
31.28%
5.01%
Year Three
9.53%
42.22%
3.17%
3.17%
5.59%
31.28%
5.04%
Below, as a comparison, is the projected year one and year three utilization by payor source from the original limited
life application CON #052016-B.
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare
Commercial Fee-for-Service
Commercial Managed Care
Self Pay
Year One
15%
20%
5%
8%
47%
5%
Year Three
15%
20%
5%
8%
47%
5%
Expense and utilization assumptions are based on the historical experience of Hillside Polymedic Diagnostic and
Treatment Center.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirement is estimated at $308,815, which is equivalent to two months of incremental third year
expenses. The sole shareholder will provide equity to meet the working capital requirement. Presented as BFA
Attachment A is the net worth statement of the sole shareholder, which indicates the availability of sufficient funds for
the equity contribution.
The submitted budget indicates a net income of $98,504 and $135,525 during the first and third years after the
permanent life. Revenues are based on current reimbursement rates. The improvement in operations from historical
to projected is the result of an increase in visits. The increase in visits is the result of provider staff now stabilized, and
plans are in place to increase the number of physicians FTE’s (from 4.2 currently to 5.0 in year 3) and to add a full
time nurse practitioner immediately. The facility anticipates that all provider staff will be able to operate more efficiently
as a result of these changes.
Presented as BFA Attachment B are the 2010 and 2011 compiled financial statements of Hillside Polymedic
Diagnostic and Treatment Center. As shown on Attachment B, the facility had an average negative working capital
position and an average negative net asset position. Also, the facility incurred an average net loss of $251,682 from
2010 through 2011. The applicant has indicated that the reason for the losses are as follows: much lower patient
volume than anticipated, medical staff provider turnover, more rapid movement to Medicaid Managed Care, high fixed
costs for space that can accommodate more patient activity than exists, and insufficient payment rates from Medicaid
Managed Care plans (much lower than fee for service). The applicant is adding ambulatory surgery, family planning,
nutrition, psychological services and medical social services to improve operations. The turnover in medical staff has
subsided and is currently stable, which will help maintain and expand the existing patient base and ease the
administrative resources required to enroll providers with managed care plans. Also, the lease for space has been
renegotiated, which reduces operating expenses by $120,000 annually. Patient visit volume has also been steadily
increasing over the past few years.
Project # 121354-E Exhibit Page 5
Presented as BFA Attachment C are the April 30, 2012 internal financial statements of Hillside Polymedic Diagnostic
and Treatment Center. As shown on Attachment C, the facility had a negative working capital position and a negative
net asset position. Also, the facility achieved a net income of $30,347 through April 30, 2012.
The applicant has demonstrated the capability to proceed in a financially feasible manner; and approval is
recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Personal Net Worth Statement
BFA Attachment B
2010 and 2011 compiled financial statements of Hillside Polymedic
Diagnostic and Treatment Center
BFA Attachment C
April 30, 2012 internal financial statements of Hillside Polymedic Diagnostic
and Treatment Center
Project # 121354-E Exhibit Page 6
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
certify indefinite life to operate an Article 28 diagnostic and treatment center providing primary
care and specialty services at 187-30 Hillside Avenue, Jamaica, and with the contingencies, if
any, as set forth below and providing that each applicant fulfills the contingencies and
conditions, if any, specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121354 E
Hillside Polymedic Diagnostic and
Treatment Center
APPROVAL CONTINGENT UPON:
N/A
APPROVAL CONDITIONAL UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121355-E
A Merryland Operating, LLC
d/b/a Mermaid Health Center
County: Kings (Brooklyn)
Purpose: Establishment
Program: Diagnostic and Treatment Center
Submitted: April 27, 2012
Executive Summary
Description
A Merryland Operating, LLC d/b/a Mermaid Health
Center requests approval to be established as the new
operator of Mermaid Health Center, an existing,
proprietary diagnostic and treatment center (D&TC)
located at 1704-1706 Mermaid Avenue, Brooklyn, via
asset purchase agreement with the current operator –
Mermaid Management, Inc. Ownership of the
operation before and after the requested change is as
follows:
Current
Mermaid Management, Inc.
MEMBERS:
-- Armen Gambarian
-- Arkady Starovoyt
-- Maria Starovoyt
Proposed
A Merryland Operating, LLC
MEMBER:
-- Lidiya Leshchinsky
Interest
Program Summary
Based on the information reviewed, staff found nothing
that would reflect adversely upon the applicant’s
character and competence or standing in the
community.
Financial Summary
Total asset purchase price of $100,000 will be met with
a $ 90,000 personal loan at an interest rate of 3% for
five years and $10,000 of member’s equity.
Budget:
45.5%
45.5%
9.0%
Revenues:
Expenses:
Gain/(Loss):
$ 1,123,832
1,029,592
$
94,240
Subject to the noted contingency, the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
Interest
100%
Upon approval the center will continue to provide
nutritional services, optometry, pediatrics, podiatry,
primary medical care, physical therapy and well child
care.
DOH Recommendation
Contingent approval.
Need Summary
There will be no change in services as a result of this
transaction. It is projected that there will be 6,850
visits in year one and 11,600 in year 3.
Project # 121355-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a statement from the applicant, acceptable to the Department of Health, documenting commitment
to serve patients regardless of their ability to pay or the source of payment and the amount of charity care. [RNR]
2. Submission of an executed transfer and affiliation agreement, acceptable to the Department, with a local acute
care hospital. [HSP]
3. Submission of a photocopy of an executed Lease Agreement of A Merryland Operating, LLC, acceptable to the
Department. [BFA, CSL]
4. The completion of Schedules 1A and 3B, acceptable to the Department. [CSL]
5. Submission of a photocopy of the executed Articles of Organization of A Merryland Operating, LLC, acceptable to
the Department. [CSL]
6. Submission of a photocopy of an executed Operating Agreement of A Merryland Operating, LLC, acceptable to
the Department. [CSL]
7. Submission of a photocopy of an executed Certificate of Amendment or Certificate of Dissolution of Mermaid
Management, Inc., acceptable to the Department. [CSL]
8. Submission of a photocopy of an executed Certificate of Discontinuance of an Assumed Name of Mermaid
Management, Inc., acceptable to the Department. [CSL]
Approval conditional upon:
1.
2.
3.
4.
The staff of the facility must be separate and distinct from staff of other entities. [HSP]
The signage must clearly denote the facility is separate and distinct from other adjacent entities. [HSP]
The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
The clinical space must be used exclusively for the approved purpose. [HSP]
Council Action Date
October 11, 2012.
Project # 121355-E Exhibit Page 2
Need Analysis
Background
Mermaid Health Center, Inc. (Mermaid) seeks approval for an Asset Purchase Agreement with A Maryland Operating,
LLC to acquire the operating interests of Mermaid.
Analysis
The primary service area of Mermaid is located in zip codes 11224, 11223, 11229, and 11235.
The number of projected visits is as follows:
Current Year:
First Year:
Third Year:
3,036
6,850
11,600
Mermaid Health Center provides the following services:
Nutritional O/P
Primary Medical Care O/P
Optometry O/P
Physical Therapy O/P
Pediatric O/P
Well Child care O/P
Podiatry O/P
Lutheran Medical Center will provide backup and transfer services for Mermaid. Lutheran is located six (6) miles from
Mermaid, with travel time of approximately 15 minutes.
Conclusion
Mermaid Health Center is an existing D&TC that provides comprehensive primary care services to the community. The
proposed change of ownership will preserve this resource for the community.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Program Proposal
Establish a new operator of an existing diagnostic and treatment center.
Proposed Operator
Doing Business As
Site Address
Services
A Merryland Operating, LLC
Mermaid Health Center
Staffing (1st Year / 3rd Year)
Medical Director(s)
Emergency, In-Patient and Backup
Support Services Agreement and
Distance
Nutrition
Optometry
Pediatrics
Physical Therapy
Podiatry
Well Child
Primary Care
10.3 FTEs / 10.7 FTEs
Asha Mittal
Lutheran Medical Center
6 miles, 15 minutes travel time
Project # 121355-E Exhibit Page 3
Character and Competence
The sole member of the LLC is Lidiya Leshchinsky. Ms. Leshchinsky is the owner operator of Anfex, Inc., a durable
medical equipment supplier. She has also been employed by Mermaid Health Center as the CEO since February 15,
2012.
Staff from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses
held, formal education, training in pertinent health and/or related areas, employment history, a record of legal actions,
and a disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health.
Included in the review were the results of any incident and/or complaint investigations, independent professional
reviews, and/or comprehensive/focused inspections. The review found that any citations were properly corrected with
appropriate remedial action.
Compliance with Applicable Codes, Rules and Regulations
The medical staff will ensure that procedures performed at the facility conform to generally accepted standards of
practice and that privileges granted are within the physician's scope of practice and/or expertise. The facility’s
admissions policy will include anti-discrimination regarding age, race, creed, color, national origin, marital status, sex,
sexual orientation, religion, disability, or source of payment. All procedures will be performed in accordance with all
applicable federal and state codes, rules and regulations, including standards for credentialing, anesthesiology
services, nursing, patient admission and discharge, a medical records system, emergency care, quality assurance and
data requirements.
Conclusion
Based on the information reviewed, staff found nothing that would reflect adversely upon the applicant’s character and
competence or standing in the community.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Asset Purchase Agreement
The applicant has submitted an executed asset purchase agreement, the terms of which are summarized below:
Date:
Seller:
Buyer:
Assets Transferred:
Excluded Assets:
February 10, 2012
Mermaid Management, Inc., d/b/a Mermaid Health Center
A Merryland Operating, LLC
All seller’s right, title and interest in equipment, furniture, furnishings and
supplies; seller’s good will and business; copies of client lists and patient files;
rights to provider agreements and supplier/vendor agreements; all tangible
assets owned by Seller and principally used in the business of Clinic; leases of
personal property; contract and contract rights; Seller’s cash, cash equivalents,
security or performance deposits and notes receivable; all accounts receivable
for services rendered from and including the effective date; any trade names
used by seller; any claims, refunds, rights, actions and litigation by Seller, and
the proceeds thereof.
The clinic’s financial records, canceled checks and bank statements; the clinic’s
books and records, tax records and tax returns, accounting records and general
ledger or other books of account; insurance policies and prepaid premiums, and
Project # 121355-E Exhibit Page 4
Assumed Liabilities:
Purchase Price:
Payment:
other prepaid expenses and seller's federal tax identification number.
Buyer shall assume all liabilities and obligations of the clinic based upon
operation of the clinic arising on or after the effective date.
$100,000
Paid in full at the closing.
The applicant has provided an original affidavit, which is acceptable to the Department, in which the applicant agrees,
notwithstanding any agreement, arrangement or understanding between the applicant and the transferor to the
contrary, to be liable and responsible for any Medicaid overpayments made to the facility and/or surcharges,
assessments or fees due from the transferor pursuant to Article 28 of the Public Health Law, with respect to the period
of time prior to the applicant acquiring its interest, without releasing the transferor of its liabilities and responsibilities.
Lease Assignment Agreement
The applicant has submitted a proposed lease assignment agreement, the terms of which are summarized below:
Date:
Landlord:
Assignor:
Assignee:
Premises:
Rental
Term:
Provisions:
January 22, 2010
1709 Surf Avenue Associates, LLC
Mermaid Management, Inc.
A Merryland Operating, LLC
Approximately 4,000 sq. ft. on the ground floor of the building located at 17041706 Mermaid Avenue, Brooklyn
$84,000 per year, increasing 5% yearly
5 year term with the option to renew for an additional five years.
The Assignee shall be responsible for taxes, utilities, insurance and maintenance.
The applicant has indicated that the lease will be an arm’s length agreement, and letters of opinion from Licensed
Commercial Real Estate Brokers have been submitted indicating rent reasonableness.
Operating Budget
The applicant has submitted an operating budget, in 2012 dollars, for the first year subsequent to the change in
operator, summarized below:
Year One
$1,123,832
Revenues:
Expenses:
Operating
Capital
Total Expenses:
$836,108
193,484
$1,029,592
Net Income:
$94,240
Utilization(visits)
Cost per visit
10,341
$99.56
Utilization by payor source for the first year is as follows:
Commercial
Medicare Fee-for-Service
Medicare Managed Care
Medicaid Fee-for-Service
Medicaid Managed Care
Private Pay
Charity Care
Year One
0.6%
16.0%
0.4%
18.0%
61.0%
2.0%
2.0%
Project # 121355-E Exhibit Page 5
Expenses and utilization are based on the historical experience of Mermaid Health Center.
Capability and Feasibility
The purchase price of $100,000 will be provided by $10,000 member’s equity and a $90,000 personal loan from Yury
Leshchinsky, husband of applicant, at an interest rate of 3% for five years, for which a commitment letter has been
provided and DOH staff has confirmed sufficient funds available. Presented as BFA Attachment A is the net worth
statement of the proposed member showing sufficient funds.
Working capital contributions are estimated at $171,599, based on two months of first year expenses, and will be
provided by member’s equity. Presented as BFA Attachment B, is the pro-forma balance sheet of A Merryland
Operating, LLC as of the first day of operation, which indicates positive member’s equity position of $150,000.
The submitted budget indicates a net income of $94,240 for the first year subsequent to change in ownership.
Revenue is based on Mermaid Health Center’s experience in the operation of its diagnostic and treatment center and
on current reimbursement rates. The budget appears reasonable.
Presented as BFA Attachment C, a financial summary of Mermaid Operating Co., LLC, indicates that the facility
experienced negative working capital and member’s equity for 2009 and 2010 and generated a net income of $52,312
in 2009 and experienced a net loss of $211,447 in 2010. The applicant has stated the reason for the losses is from the
loss of its medical director, who was responsible for generating a substantial portion of the center’s business,
discontinuance of some of the services that were provided, and difficulty in enrolling physicians into the appropriate
health plans. To improve operations, the applicant has already hired a new medical director and plans to improve
community outreach and marketing efforts, restore discontinued services and add additional services in the future.
Based on the preceding, and subject to the noted contingency, it appears that the applicant has demonstrated the
capability to proceed in financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Personal Net Worth Statement
BFA Attachment B
Pro-forma Balance Sheet
BFA Attachment C
Financial Summary, Mermaid Operating Co., LLC.
Project # 121355-E Exhibit Page 6
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish A Merryland Operating, LLC d/b/a Mermaid Health Center as the new operator of
Mermaid Health Center, and with the contingencies, if any, as set forth below and providing that
each applicant fulfills the contingencies and conditions, if any, specified with reference to the
application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121355 E
A Merryland Operating, LLC d/b/a Mermaid
Health Center
APPROVAL CONTINGENT UPON:
1. Submission of a statement from the applicant, acceptable to the Department of Health,
documenting commitment to serve patients regardless of their ability to pay or the source of
payment and the amount of charity care. [RNR]
2. Submission of an executed transfer and affiliation agreement, acceptable to the Department,
with a local acute care hospital. [HSP]
3. Submission of a photocopy of an executed Lease Agreement of A Merryland Operating,
LLC, acceptable to the Department. [BFA, CSL]
4. The completion of Schedules 1A and 3B, acceptable to the Department. [CSL]
5. Submission of a photocopy of the executed Articles of Organization of A Merryland
Operating, LLC, acceptable to the Department. [CSL]
6. Submission of a photocopy of an executed Operating Agreement of A Merryland Operating,
LLC, acceptable to the Department. [CSL]
7. Submission of a photocopy of an executed Certificate of Amendment or Certificate of
Dissolution of Mermaid Management, Inc., acceptable to the Department. [CSL]
8. Submission of a photocopy of an executed Certificate of Discontinuance of an Assumed
Name of Mermaid Management, Inc., acceptable to the Department. [CSL]
APPROVAL CONDITIONAL UPON:
1. The staff of the facility must be separate and distinct from staff of other entities. [HSP]
2. The signage must clearly denote the facility is separate and distinct from other adjacent
entities. [HSP]
3. The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
4. The clinical space must be used exclusively for the approved purpose. [HSP]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 122001-E
Beacon Christian Community Health Center
County: Richmond (Staten Island)
Purpose: Establishment
Program: Diagnostic and Treatment Center
Submitted: July 2, 2012
Executive Summary
Description
Beacon Christian Community Health Center, Inc.
(BCCHC), an existing not-for-profit Article 28
diagnostic and treatment center (D&TC) and Federally
Qualified Health Center (FQHC) located at 2079 Forest
Avenue, Staten Island, requests permanent life
approval. BCCHC received Public Health Council
approval for five-year limited life on November 19,
2004, via CON #041107-B, and began operations on
August 11, 2006.
Financial Summary
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
DOH Recommendation
Approval.
Need Summary
After beginning operations in August 2006, BCCHC
was unable to meet the projected number of 9,100
visits in the first year of operation when there were
3,250 actual visits. However, it surpassed the
projected number of 12,829 visits in the third year with
14,246 actual visits.
The number of proposed visits is as follows:
Current Year:
First Year:
Third Year:
13,272
14,000
18,000
Beacon Christian Community Health Center has met
all terms of the limited life that it was granted in August
2006 and has become a Federally Qualified Health
Center.
Program Summary
Based on the information reviewed, staff found nothing
that would reflect adversely upon the applicant’s
character and competence or standing in the
community.
Project # 122001-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval.
Council Action Date
October 11, 2012.
Project # 122001-E Exhibit Page 2
Need Analysis
Background
Beacon Christian Community Health Center (BCCHC), an existing Article 28 Diagnostic and Treatment Center (D &
TC) and Federally Qualified Health Center (FQHC), requests approval for permanent life. BCCHC was granted a fiveyear limited life through CON 041107. BCCHC is located at 2079 Forest Avenue, Staten Island, 10303, in Richmond
County.
Beacon Christian Community Health Center’s service area includes zip codes 10302 and 10314.
During the limited life of five years, BCCHC met the following five conditions set forth in the approval:
•
•
•
•
•
•
Submitted all required annual reports beginning in the 2nd year of the operation.
From 2008 to 2011, 75 percent of the visits at BCCHC were from patients in its service area, zip codes 10302,
10303, and 10314 during each year from 2008 to 2011.
By Year 3 of the operation, Medicaid represented 58.4 percent of 8,321 patient visits, and private pay patients
who paid according to a sliding fee scale represented 16 percent of 2,284 patient visits. These third year
Medicaid visits and private pay visits exceeded the projections at 39.1 percent for Medicaid and 10 percent for
private pay.
BCCHC instituted programs to diagnose, screen, and treat its patients for asthma, diabetes, lead poisoning,
and breast, cervical and colorectal cancer.
BCCHC developed a strong working relationship with Staten Island University Hospital, which routinely refers
its discharged Emergency Department patients who do not have a regular primary care provider for follow-up
treatment.
BCCHC promoted continuity of care by decreasing unnecessary visits, increasing available procedures,
providing better coordination of referrals to specialists, trying to involve patients in their ongoing health care
management, and more.
BCCHC is located in a health professional shortage area (HPSA) for primary care services and is also located in a
medically underserved area/population (MUA/P).
The prevention quality indicators (PQIs) for zip code 10303 where BCCHC is located are significantly poor compared
with those of the State.
PQIs: # of admissions per 100,000 adult population
Zip Code 10303
2,377
602
636
401
702
401
All PQIs
All Acute
All Circulatory
All Diabetes
All Respiratory
Asthma
NYS
1,563
526
456
224
357
176
Source: NYSDOH
Beacon Christian Community Health Center has met all terms of the limited life that it was granted in August 2006 and
has become a Federally Qualified Health Center.
Recommendation
From a need perspective, approval is recommended.
Project # 122001-E Exhibit Page 3
Programmatic Analysis
Background
Grant permanent life for Beacon Christian Community Health Center, a diagnostic and treatment center operating at
2079 Forest Avenue, Staten Island.
Character and Competence
The board of directors include:
Name
Victor Anjorin
Sushila Balakrishnan
Ledia Kaci
Debra McCaw
Margaret Rozalski
Marco Silva
Staff from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses
held, formal education, training in pertinent health and/or related areas, employment history, a record of legal actions,
and a disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health.
Included in the review were the results of any incident and/or complaint investigations and/or comprehensive/focused
inspections. The review found that any citations were properly corrected with appropriate remedial action.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted actual financial operating results for 2011 and a projected operating budget, in 2012
dollars, for the first and third years of operations. The budget is summarized below:
Revenue:
Expenses:
Operating
Capital
Total Expenses
Net Income
Utilization (visits)
Cost per visit
Current Year 2011
$2,853,312
Year One (2013)
$3,005,737
Year Three (2015)
$3,620,677
2,226,717
293,312
$2,520,029
2,603,536
307,751
$2,911,287
3,222,506
323,138
$3,545,644
$333,283
$ 94,450
$ 75,033
13,272
$189.87
14,000
$207.94
18,000
$196.98
Cost per visit increases by $18 in year one, and moderates somewhat in year three due to the following: The applicant
indicates that they have held to minimal staffing levels since commencing operations in order to maintain financial
Project # 122001-E Exhibit Page 4
feasibility. The increasing demand for additional services (visits) requires that the applicant increase staffing, to a
more preferable level in order to meet both clinical and business operational needs.
Below, are the projected year one and three utilizations from the original limited life application # 041107, along with
actual results.
Utilization (visits)
Projected
Actual
Year One (2007)
9,100
3,250
Year Three (2009)
12,829
14,246
* The actual budgeted number of visits for this primary care practice was initially 9,100 and 12,829 visits year one and three, respectively, when the
limited life was originally approved. The applicant did not meet year one projections; however it exceeded the number of projected visits for year
three by 1,417.
Utilization by payor source during the first and third years is itemized as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare
Commercial
Private Pay
Current Year
10%
54%
5%
15%
16%
Years One and Three
10%
54%
5%
15%
16%
Expense and utilization assumptions are based on the experience of the Center, the geographic area, and the impact
of Medicaid Managed Care.
Below, as a comparison is the projected year one and three utilization by payor source from the original limited life
application # 041107.
Medicaid FFS
Medicaid M C
Medicare FFS
Medicare M C
Commercial FFS
Commercial M C
Other
Year One (2007)
13.15%
27.18%
17.23%
1.72%
11.00%
22.72%
7.00%
Year Three (2009)
7.33%
31.80%
15.64%
3.47%
6.00%
25.73%
10.03%
Capability and Feasibility
There is no project cost associated with this application.
The issue of feasibility is centered on the applicant’s ability to offset ongoing expenses with revenues and maintain a
viable operating entity. The submitted budget of the operator indicates a breakeven budget for year one and three.
The budget appears reasonable.
Presented as BFA Attachment A is the financial summary of Beacon Christian Community Health Center, Inc. 2010
and 2011 certified financial statements. The Center had an average positive working capital position of $949,911 and
an average positive net asset position of $2,132,343 during the period shown.
The surgery center achieved and an operating excess of revenues over expenses of $1,075,859 during 2010 and
$316,027 during 2011, respectively.
Presented as BFA Attachment B are January 1 through April 30, 2012 un-audited income statement, which indicate an
excess of revenues over expense of $103,939 for the period shown.
It appears that the applicant has demonstrated the capability to proceed in a financially feasible manner, and approval
is recommended.
Project # 122001-E Exhibit Page 5
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Financial Summary (Certified) – Beacon Christian Community Health Center,
Inc. 2010 and 2011
BFA Attachment B
Financial Summary (un-audited) – Beacon Christian Community Health
Center, Inc. January 1 through April 30, 2012.
Project # 122001-E Exhibit Page 6
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
certify indefinite life for an Article 28 diagnostic and treatment center and federally qualified
health center located at 2079 Forest Avenue, Staten Island, and with the contingencies, if any,
as set forth below and providing that each applicant fulfills the contingencies and conditions, if
any, specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
122001 E
Beacon Christian Community Health Center
APPROVAL CONTINGENT UPON:
N/A
APPROVAL CONDITIONAL UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121481-E
Haym Solomon Home for the Aged
County: Kings (Brooklyn)
Purpose: Establishment
Program: Residential Health Care Facility
Submitted: June 29, 2012
Executive Summary
Description
Haym Solomon Home for the Aged, LLC, an existing
20-bed residential health care facility (RHCF) located
at 2340 Cropsey Avenue, Brooklyn, requests approval
for a change in the facility’s membership and
ownership. The total aggregate percentage interests
that will be transferred if this application is approved
are 54% of the LLC’s percentage interests
Need Summary
As this project involves only a change in the ownership
interests, no Need recommendation is required.
This application proposes the addition of two (2) new
members to the LLC who will own a total of 27% of the
LLC’s percentage interests. Additionally, four existing
members are increasing their percentage interest by
4% each. Two members who own a total of 54% of
the percentage interests of the LLC, have decided to
reduce their membership interest to a combined 27%
of the LLC. The current and the proposed ownership
of Haym Solomon Home for the Aged, LLC is as
follows:
No changes in the program or physical environment
are proposed in this application.
Olga Lipschitz
Estate if Adolf Wieder
Tzipporah Paneth
Pearl Kahan
Samuel Lipschitz
Howard Liptschitz
Elliot Lipschitz
Anna Paneth
Leah Werner
Morton Paneth
Current
21%
10%
12%
6%
6%
6%
6%
33%
0%
0%
Proposed
5%
10%
12%
10%
10%
10%
10%
22%
10%
1%
Status
Decreasing
No Change
No Change
Increasing
Increasing
Increasing
Increasing
Decreasing
New Member
New Member
Program Summary
No negative information has been received concerning
the character and competence of the above applicants
identified as new members.
Financial Summary
There is no monetary consideration for this application.
Also, there are no project costs associated with this
application. The change in membership will have no
impact on the day-to-day business. Subject to the
noted contingency, it appears that the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
The two new proposed members also have ownership
interests in Sheepshead Nursing and Rehabilitation
Center, LLC.
DOH Recommendation
Contingent approval.
Project # 121481-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of an executed transfer agreement that is acceptable to the Department of Health. [BFA]
Council Action Date
October 11, 2012.
Project # 121481-E Exhibit Page 2
Programmatic Analysis
Facility Information
Facility Name
Address
RHCF Capacity
ADHC Program Capacity
Type of Operator
Class of Operator
Operator
Existing
Haym Solomon Home for the Aged
Proposed
Same
2340 Cropsey Avenue
Brooklyn, NY. 11214
240
N/A
LLC
Proprietary
Same
Same
N/A
LLC
Proprietary
Haym Solomon Home for the Aged,
LLC
Same
Members:
Anna Paneth …………………33%
Olga Lipschitz………………...21%
Estate of Adolf Wieder…....…10%
Tzipporah Paneth.………...…12%
Pearl Kahan..…………..…...…6%
Samuel Lipschitz..………....… 6%
Howard Lipschitz…………...…6%
Elliot Lipschitz…….………...…6%
Members:
Anna Paneth ……………...…..22%
Tzipporah Paneth.………...…..12%
Estate of Adolf Wieder….........10%
Pearl Kahan..…………..……...10%
Samuel Lipschitz..……..…......10%
Howard Lipschitz…………….. 10%
Elliot Lipschitz…….………......10%
Olga Lipschitz………...……...…5%
New Members
Leah Werner.……....……….…10%
Morton Paneth……….…..……..1%
Character and Competence
•
FACILITIES REVIEWED:
Residential Health Care Facilities
Newark Health and Extended Care Facility (Newark, New Jersey)
Sheepshead Nursing and Rehabilitation Center
•
09/2002 to 05/2012
09/2002 to 05/2012
INDIVIDUAL BACKGROUND REVIEW:
Leah Werner holds a New York State Nursing Home Administrator’s License, license number 04699, for which he is
currently registered and in good standing. He also holds a New Jersey Nursing Home Administrator’s License, license
number 1669, for which he is currently registered and in good standing. He is employed as an assistant administrator
at Haym Solomon Home for the aged. He has disclosed ownership interest in the following residential health care
facilities:
Newark Health and Extended Care Facility
Sheepshead Nursing and Rehabilitation Center
01/1985 to 04/2012
05/1987 to 04/2012
Morton Paneth is the CFO of Newark Health and Extended Care Facility, a nursing home located in Newark, New
Jersey. He discloses ownership interest in the following residential health care facilities:
Project # 121481-E Exhibit Page 3
Newark Health and Extended Care Facility
Sheepshead Nursing and Rehabilitation Center
01/1985 to 05/2012
05/1987 to 05/2012
Character and Competence – Analysis:
No negative information has been received concerning the character and competence of the above applicants
identified as new members.
A review of operations for the Newark Health and Extended Care Facility in Newark, New Jersey and Sheepshead
Nursing and Rehabilitation Center for the periods identified above, results in a conclusion of substantially consistent
high level of care, since there were no enforcements.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Background
The applicant has submitted a draft transfer agreement indicating the transfer is gifted for the change in ownership of
Haym Solomon Home for the Aged, LLC, the terms of which are summarized below:
Purpose:
Transferor:
The total transfer of 27% of the ownership of
Haym Solomon Home for the Aged
Anna Paneth
Interest
Transferred
11%
Transferee:
Leah Werner
Morton Paneth
10%
1%
Transferor:
Olga Lipschitz
16%
Transferee:
Samuel Lipshitz
Howard Lipschitz
Elliot Lipschitz
Pearl Kahn
4%
4%
4%
4%
Capability and Feasibility
There is no project cost associated or purchase price with this application.
There are no significant issues of feasibility associated with this application since there is no change in the facility
operations. Presented as BFA Attachment A, is a financial summary of Haym Salomon Home for the Aged, LLC. As
shown on Attachment A, the facility had an average positive working capital position and an average positive net asset
position from 2009 through 2011. Also, the facility has achieved an average operating income of $1,751,244 from
2009 through 2011.
Presented as BFA Attachment B, is the financial summary of Sheepshead Nursing & Rehabilitation Center, LLC.
As shown on Attachment B, the facility had an average positive working capital position and an average positive net
asset position from 2009 through 2011. Also, the facility achieved an average operating income of $1,224,384 from
2009 through 2011.
Subject to the noted contingency, the applicant has demonstrated the capability to proceed in a financially feasible
manner, and approval is recommended.
Project # 121481-E Exhibit Page 4
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary, Haym Salomon Home for the Aged, LLC
BFA Attachment B
Financial Summary
Project # 121481-E Exhibit Page 5
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application for
a change in the facility’s membership and ownership, and with the contingencies, if any, as set
forth below and providing that each applicant fulfills the contingencies and conditions, if any,
specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121481 E
Haym Solomon Home for the Aged
APPROVAL CONTINGENT UPON:
1. Submission of an executed transfer agreement that is acceptable to the Department of
Health. [BFA]
APPROVAL CONDITIONAL UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
New York State Department Of Health
Memorandum
TO:
Public Health and lilthknning Council
FROM:
James F. I%fl*rYeneritounseI
DVI’E:
August 14.2012
SUBJECT:
Proposed Certificate of Incorporation of Bettvs Be Brave
Foundation, Inc.
Betty’s Be Brave Foundation, Inc. (hereinafler referred to as the “Foundation”)
requests Public Hcalth and Health Planning Council approval of its proposed Certificate of
Incorporation in accordance with Public Health Law *2801 -a (I) and (6), and Not-for-Profit
Corporation Law §404 (0).
The Foundation seeks to raise funds for the research and cure of pancreatic cancer
at the Roswell Park Alliance Foundation, and to provide scholarship funds for a graduate of
Cohoes High School who is planning to enter the medical field. The Foundation seeks to raise
funds for these purposes by holding golf tournaments, dinnei-s, walk/run events and coin drops at
local banks. The Foundation states in support of approval that there is no organizational
relationship between the Foundation and Roswcll Park Alliance Foundation. In addition, there
appears to he no entities which control or are controlled by the Foundation.
Attached are copies of the proposed Certificate of Incorporation, proposed
Bvlawsa letter From Roswell Park Alliance Foundation acknowledging that it will accept funds
raised by the Foundation, and a statement from the Foundation setting forth a generalized
description of fundraising activities: names addresses, occupations and affiliations of the
Foundation’s initial Board of Directors: that no relationship exists between the Foundation and
Roswell Park Alliance Foundation: and that no entities control or are controlled by the
Foundation.
The Certificate of Incorporation is in legally acceptable form.
Attachments
New ‘York State I )eparlmeTu el Slate
)R-ision
(‘orponilions. Stale Records and I ndonti ( ommercial (‘i,de
)ne Commerce I’Iaia, ‘19 Washtngion Ave Albany, NY 12231
wwdosstateityns
CERTIFICATE OF INCORPORATION
OF
I3ETTY’S BE BRAVE FOUNDATION, INC.
Ilnscrt ( ‘orporation Name)
tinder Section 402 oldie Not—For—Profit Corporation La4
FIRST: The name of the corporation is:
BETTY’S BE BRAVE FOUNDATION, INC.
SECOND: The corporation is a corporation as defined in subparagraph (a)(5) of Section 102
(Definitions) of the Not-lbr-Profit Corporation Law.
TI-I I RD—Part A: The purpose or purposes [or which the corporation is ihrrned arc as follows:
11115 CORIN)RA’lION IS I3EIN(i FORME[) FOR CI IARITABI.E PURPOSES:
SPECIEICAII.Y 10 RAISE MONIES IN ORDER 10 PROVIDE FL NDING FOR [I-IL
RESEARCH AND CURE OF PANCREATIC CANCER AT fl-IF ROS WELL PARK
Al I IAN( I I OIiNDA I ION 13U1 [Al 0 NI W YORK ANI) 10 PROVIDI 5(1101 ARS1JIP
I UNDS I OR \ (RADU\Il 01 (01101 S [HUH 5(11001 P1 ANNINU 101 Nil R 1111
Ni El) I CAL F] F 1.1).
Nothing contained in the Certificate of Incorporation shall authorize the corporation to
establish, operate or maintain a hospital, a home care services agency. a hospice. a health
maintenance organization, or a comprehensive health services plan, as provided lbr by Articles
28, 36.40 and 44, respectively, of the Public 1-Iealth Law, to provide hospital service or health
related service, to establish, operate or maintain art adult care facility, as provided fbr by Article
7 of the Social Services Law, or to solicit any funds, contributions or grants. from any source,
for the establishment or operation of any adult care facility.
0051511-f-I Ret 02/11)
Page I of 4
FOURTH: The corporation shall be a Type
B
corporation pursuant to Section 201 oithe
Not-for-Profit Corporation La%%. (p:ease oxen r;t’7Thj3,r D. us Jpproprrte
FIFTH:
The office of the corporation is to be Located in the County of
ALBANY
State of New York.
SIXTH: The names and addresses of the
initial directors of the corporation area minimum of three
are required y:
KIMBERLY CESTARO
ANTHONY CESTARO
SHELLEY CESTARO
MICHAEL CESTARO
14 DIANE COURT. COHOES, NY
14 DIANE COURT, COHOES, NY
14 DIANE COURT, COHOES, NY
14 DIANE COURT, COHOES, NY
12047
12047
12047
12047
SEVENTH:
The Secretary of State is designated as agent of the corporation upon whom
process against it may be served. The address which the Secretary of State shall mail a copy of
any process accepted on behalf of the corporation is:
14 DIANE COURT, COHOES, NY 12047
EIGHTH:
(Corporations seeking tax exempt status may include language required by the Internal
Revenue Service in this paragraph. See instructions, paragraph eighth.)
(Stare and Federal exemption Iangvage for 1)pe B and C corporations seeking tar exemption):
Notwithstasding any other provisions of these articles, the corporation is organized exclusivety for one or more of the
purposes as specified in *50l(cX3) of the Internal Revenue Code of 1954 (the “IRC”), and shall not carry on any
activities not permitted tebe carried on by a corporation exempt from Federal income tax under IRC *50l(cX3) or
corresponding provisions of any subsequent Federal tax laws.
No past of the net earnings of the corporation shall inure to the benefit of any member, trustee, director, officer of the
corporation, or any private individual (except that reasonable compensation may be paid for services rendered to or for
the corporation), and no member, trustee, officer of the corporation or any private individual shall be entitled to share
in the distribution of any of the corporation assets on dissolution of the corporation.
No substantial part of the activities of the corporation shall be carrying on propaganda, or otherwise attempting to
influence legislation (except as otherwise provided by [P.C §501(h)). and the corporation shall not participate in, or
intervene in (including the publication or distrib4stion of statements), any political campaign on behalf of (or in
opposition to) any candidate for public office.
In the event of dissolution, all of the remaining assct,and property of the Corporation shall, after neccssasy expenses
thereof be disthbuted to another organization exetñpc uñçr IRC §301(cX3). or corresponding provisions of any
subsequent Federal tax laws, cc to the Federal government, or state or local government for a public purpose, subject
to the approval of a Justice of the Supreme Court of the State of New York.
The incorporator or incorporators must szgn the Cerujicate of Incorporation and ttpe or print his her
name and aadress
KIMBERLY CESTARO
iJtj orpr:nt name of incorporator)
(tire)
--—V
14 DIANE COURT, COHOES, NY 12047
4-1idreiis)
ANTHONY CESTARO
St
or print name (u:ncorporazorl
.1
Signaturei
14 DIANE COURT, COHOES, NY
12047
‘
lddrcssj
iTtpe
Or
(Q
X
SHELLEY CESTARO
pr:n( name of 1ncOrçratorJ
14 DIANE COURT, COHOES, NY
d
(Signature,
12047
(4 ddrrssj
MICHAEL CESTAPO
X
(Type or print name of
incorporator)
14 DIANE COURT,
COHOES,
(Signature)
NY
12&47
(Address)
(IRIJrl(:\ IE Ol- NcoEpR;\
[ION
)f:
(
BETTYS BE BRAVE FOUNDA
TION INC
ih,vrtLnrt,,rijuu
i
tider Section
-1i12 ol
the Nt-t;sr-I’rt’nt Corporation I
EDWARD J GROGAN
riled in:
P 0 BOX 394
——
CLIFTON PARK, NY 12065
1
ii
.
0
5
ic
ilIjii
1 l-- I Ins
Inpic turn p pr itt-U Fi he Nc
‘irk \tc I)cprtcitl
cerlIi:ate iiiit-trfMitn
us torn is designed i’siti
sI\- tile lIrilill
1 ‘nile I)iiuutt
iii
( irpifli
4%
liii hhte
tile rcjurcrnctts ptsrsuni in
Pr,iii I rpirn I
lie Stair—
he I
sit
ulI iterJ’i in’ liter him
itch ciniphe stli tie applicable
lIe hi sun recieds Ii its
lain prisMs.
cal doimcni tic prepared lcr he
glee nt-in -lime’ the I )t
ii pm-dc legaL iccilinhin
Sort dies
g Ii IN iii tee.
its certliebe mu-i he uhintued
ith
111am lee nisle pa’ tile ti lIe
l)cpritrcnt tl
-or
I )i IS u—c
tints
BY-LAWS OF BETTY’S BE BRAVE FOtJNI)ATION, INC.
ARTICLE I NAME, LOCATION AND MEMBERSHiP.
The name of the Corporation is
Hefty’s Be Brave Foundation, Inc.. hereinafter referred to as “Foundation”. The principal office of the
Foundation shall be located in the City of Cohoes, County of Albany and State of New York. located at
14 Diane Court, Cohoes, New York 12047. The Foundation shall consist of members who are devoted to
the elirninarion or cure of pancreatic cancer. The Foundation shall, from time to time, prescribe the form
and manor in which application may be made for membership.
-
No member shall have any right, title or interest in any of the property or assets, including any earnings or
investment income, of this Foundation nor shall any of such property or assets be distributed to an\
member on its dissolution or winding up
No member of this Foundation shall be personally liable for any of its debts, liabilities or obligations, nor
shall any member be subject to any assessment.
At any meeting of members. every member shall be entitled to vote in person, or by prox>
All proxies shall be in writing and shall he tiled with the Secretary prior to the meeting at which the sank
are to be used. Such proxies shall onl he valid for such meeting or subsequent adjourned meetin2
thereof A notation of such proxy shall he made in the minutes of the meeting.
ARTICLE II MEETINGS OF MEMBERS.
An annual meeting of niemher
shall be held on the first Monday in the month of May in each year beginning with the year 2012.
Meetings shall beheld at 14 Diane Court, Cohoes, New York 12047 or at such other place or places as the
Hoard of Directors may designate from time to time by resolution. Appropriate for consideration at such
meetings is the election of directors and such other Foundation business as they come before the meeting.
—
ARTICLE III SPECIAL MEETINGS.
may he called by the President.
—
Special meetings of members
ARTICLE IV OUORUMS.
The presence in person or by
proxy of 50% of the members shall constitute a quorum at all meetings of the members.
—
ARTICLE V MAJORITY VOTE.
All actions shall be taken by
vote of the majority of members at a meeting at which a quorum shall be present or represented by proxy.
ARTICLE VI— ORDER OF BUSINESS AT MEETINGS.
The order of business at all
meetings of the members shall follow Robert’s Rules of Order and shall be as follows:
a. Roll Call
b. ProofofNotice of Meetinr
c. Reading of Minutes of Preceding Meeting
d. Reports of Officers
e. Election Of members of the Board of Directors (when so required)
I Unfinished Business
g. New Business
ARTiCLE VII DIRECTORS.
directors of this Corporation shall be four.
The
ARTICLE VIII
Corporatior.
This must be members of the
—
—
QUALIFICATIONS OF DIRECTORS.
authorized
number
of
ARTICLE IX TERM OF OFFICE.
The Directors named in the
Certificate of Incorporation as the first Board of Directors shall hold office
until the annual meeting when
an election of Directors shall be held. Thereafter. the term of office
of each Director shall be five (5)
vear
—
ARTICLE X VACANCIES.
Vacancies of the Board ol
Directors caused by any reason shall be filled by a vole of the majority
of the remaining Directors at a
regular or special meeting of the Board of Directors, held for that purpose. promp
tly after the occurrence
of any such vacancy.
—
ARTICLE XI RESIGNATION.
A member of the Board of
Directors may resign at any time by giving written notice to the Board
or to the President. unless specified
in the letter of resignation. the resignation shall take effect immediately upon
receipt thereof by the Board
and acceptance of the resignation shall not be necessary to make it effective.
—
ARTICLE XII COMPENSATION.
compensation or salary fhr their services as Directors.
—
Directors shall not receive any
ARTICLE XIII REGULAR MEETINGS.
Regular meetings of the Board
ol Directors shall he held at least twice a year at such place and at
such time that is convenient to the
Directors as may be designated from time to time by resolution of the
Board of Directors.
—
ARTICLE XIV POWERS.
[he powers of this Foundatiou
shall be exercised and its properties controlled and its affairs conducted
by the Board of Directors, which
may however, delegate performance of any duty or the exercise of any powers
to such officers and agents
as the Board may from time to time by resolution designate.
—
ARTICLE XV
-
OFFICERS.
DESIGNATION OF OFFICERS
The officers of the Corporation shall be President. Vice.President. Secreta
ry and the Ireasurer.
[he Board of Directors may elect or appoint such other officers as it shall
deem desirable. Such officers
to have the authority to perform the duties prescribed from time to time
by the Board of Directors. Any
two or more offices may be held by the same person, except the office
of President and Secretary.
ARTICLE XVI- ELECTIONS AND TERMS OF OFFICE.
The officers of this Foundation
shall be elected annually by the Board of Directors at the regular
annual meeting of the Board of
Directors. Each officer shall hold office until his or her successor
shall have been duly elected and shall
have been qualified.
ARTICLE XVII REMOVAL.
Any officer elected or appointed
by the Board of Directors may be removed by the Board of Directors
whenever in its judgment the
interest of the Foundation would be best served.
—
ARTICLE XVIII VACANCIES.
The vacanc of any office
whether due to death, resignation, removal, disqualification or otherwise. may he filled by the Board
of
Directors ftr the unexpired portion of the term.
—
ARTICLE XIX PRESII)ENT.
The President shall he the chiel
executive officer of the Foundation and shall exercise general supervision and control over all activities
of
the Foundation.
ARTICLE XX VICE-PRESIDENT.
The Vice-President shall be
capable of performing all the duties of the President. ihe Vice-President shall also perform such
other
duties that shall from time to time be imposed upon him by the Board of Directors or the President.
—
ARTICLE XXI SECRETARY.
The Secretary shall cause
notices of all meetings to be served as prescribed by these By-Laws. shall record the votes,
keep the
minutes of all meetings, shal be in charge of the seal, if any, and the corporate records of the Foundation
and shall perform such other duties as are assigned to him or her by the President or the Board
of
Directors.
—
ARTICLE XXII TREASURER.
The Treasurer shaH have the
custody of all money and securities of the Foundation and shall keep or cause to be kept regular hooks
and record
—
ARTICLE XXIII COMPENSATION OF OFFICERS.
No officer shall receive any
compensation from the association for acting in his or her capacity as an officer, however, any officer
ma be reimbursed for his or her actual reasonable expenses incurred in the performance of duties
as an
officer
ARTICLE XXIV CONTRACTS.
The Board of Directors may by
resolution duly adopted authorize any officer or officers, agent or agents of the Foundation to enter
into
an contract or to execute and deliver any instrument in the name of and in behalf of the Foundation.
—
ARTICLE XXV GiFTS AND CONTRIBUTIONS.
The Board of Directors may (a)
accept on behalf of the Foundation any contribution, gill, bequest or devise of any type of property
fbr the
charitable purposes of the Foundation and on such terms as the Board of Directors shall approve
(b) all
such funds or property in the name of the Foundation (c) collect and receive the income from such
funds
for property (d) devote the principal or income from such donations to the Roswell Park
Alliance
Foundation and/or to the scholarship hind at Cohoes High School.
—
ARTICLE XXVI DEPOSITS.
All funds of the Foundation
shall be deposited from time to time to the credit of the Foundation in such banks, trust companies
or
other depositories as the Board of Directors may select
—
ARTICLE XXVII —AMENDMENT.
The
By-Laws
of
this
Foundation may be amended, repealed or added to or new By-Laws may be adopted
by the vote or
written assent of a majority of the members entitled to vote at a meeting duly called for
the purpose
according to the certificate.
I
tfl
t 4
URE
Janiary, 2012
Betty s Be Brave Foundation
Anthony Cestero Jr.
14 Diane Ct.
Cohoes, NY 12047
Dear Mr Cestero:
The Roswdll Park A!Hance Fouridaton s very pleased to be selected to
receive donations from Betly’s Be Brave Foundation to heb pancreatfc
cancer research.
The Roswdll Park Alliance Foundation is a riot-for profit corporation
orapized to so{tc, receive and administer furds for the benefit of Roswo
Park Cricer institute, Buffao, New Yotk, for uw in sclentffic and medical
research, for the delivery of medical core to indvduas suffering from
canr;er and for charitable actiyftjt,s related thereto
Sincerely,
ZZvD
1airny Lightoap
Director of Finance & Operations
Roswefl Park Afliance Foundation
m
ROSWLLL
PARK
Rb; & ts’irnn Suc’:t k3uf,eTO New VorL 4!C)J
‘nc ‘no, rnformr,,;s r ;vwttTean4 ,t.C’’
Mt
Generalized description of the flindraising activities to be undertaken by the foundation
Oltrournr’zents
Dinners
5K Walk / Run
Corn dray at local banks
List of the foUowin information regarding the foundation’s initial Board of Directors
Name & address
Oceupatic’n
Ernpover name & address
Past & prenr afflhaüons with other charitable or nor-profit organizations
President
—
Kinsberlv Ce.siaro
Sasdent I Parry planner
Chuck F Cheese
Ladiam Farms, LathamNi
Secretary She/icy Cestaro
—
SecrerarF
Sczrnarnan Hospiuil
Tray, WY
rice Pres;dent .4;;tho’ty Ceslaro Jr
Ret,red
AThaiiv Co SherffDep;.
A/han;’ NY
Treczcw-er
Michael Cestart.
Delivery driver
Awards by Walsh s
233 Oncsr1o St. Co/toes, NY
—
None of the above officers have any affiliations with other charitable or nori-projIt orlginatios
Identification of the organizational relationship between the ibundation and the Article 28
beneficiary
.* reltionsh;p
List of any entities which control or are controlled by the foundation & the nature of such
relationships.
Be Brave Memorial Scholarship. A $500 Yearly schclarshlp to a grciduatiot; senior
verissing a career in the inedicaljieli
1
‘2I2
23:23
1
.
bh4.
33734[4
ED WA RD J. GROGAPd Ill
ATTORNEYAND COUNSELOR ATL4W
P.c 20X394
CLIFTON P.41K, iVY 12065
TELEPHONE (518) 664-9200
&MAIL: egroga*nycap.rr.com
FAX (518) 664-1201
Via Facsimile
(518)473.20l9
August 1,2012
Sandra M Jensen
Senior Attorney
New York Department of Health
Coming Tower Rin 2484
Empire Stale Plaza
Albany, NY 12237
-
RE:
Certificate of Incorporation for Betty’s Be Brave Foundation, Inc.
Dear Ms. Jensen:
One of the purposes of the foundation is to provide scholarship funds for a graduate of Cohoes
High
School planning to enter the medical field. The scholarship is not a separate entity under
the control of
the corporatIon. It is the intent of the incorporators to provide fUnds based on the recommenda
non of
Cohoes High School.
Please advise if there is anything further you need.
Very tn)4JYyours.
Edward J. Grogan
EJ 0:1 g
Cc:
Anthony Cestaro
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, on this 11th day
of October, 2012, approves the filing of the Certificate of Incorporation of Betty’s Be Brave
Foundation, Inc., dated as attached.
Division of Home & Community Based Services
Character and Competence Staff Review
Name of Agency:
Address:
County:
Structure:
Application Number:
Greene County Public Health Nursing Service
Catskill
Greene
Public
2169-L
Description of Project:
Greene County Public Health Nursing Service, a government subdivision, requests approval to
obtain licensure as a home care services agency under Article 36 of the Public Health Law.
The applicant currently operates a certified home health agency (CHHA) and a diagnostic and
treatment center. Greene County Public Health Nursing Service intends to close its CHHA and
surrender its operating certificate to the New York State Department of Health. Greene County
Public Health Nursing Service is requesting approval to become licensed as a licensed home
care services agency to enable the county to provide essential public health nursing services.
The applicant proposes to serve the residents of Greene County from an office located at:
rd
411 Main Street, 3 Floor, Suite #300, Catskill, New York 12414.
The applicant proposes to provide the following health care service:
Nursing
The information provided by the Division of Home and Community Based Services has indicated
that the certified home health care agency (CHHA) reviewed have provided sufficient supervision
to prevent harm to the health, safety and welfare of patients and to prevent recurrent code
violations.
The information provided by the Division of Certification and Surveillance has determined that the
Article 28 diagnostic and treatment center reviewed has exercised sufficient supervisory
responsibility to protect the health, safety and welfare of patients and to prevent recurrent code
violations.
Since the applicant is a public entity, it is not subject to a character and competence review.
Contingency
Submission of any and all information requested by the Division of Legal Affairs, in a form and
manner acceptable to the Department.
Recommendation: Contingent Approval
Date:
August 10, 2012
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3605 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the staff of the New York State Department of Health and the
Establishment and Project Review Committee of the Council, and after due deliberation, hereby
approves the following applications for licensure, and with the contingencies, if any, as set forth
below and providing that each applicant fulfills the contingencies and conditions, if any,
specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
2169 L
FACILITY:
Greene County Public Health Nursing Service
(Greene County)
1991 L
International Home Care Services of NY, LLC
(Bronx, Queens, Kings, Richmond, Nassau and New
York Counties)
1943 L
Omega Care & Health Inc. d/b/a Right at Home
(Nassau and Suffolk Counties)
2166 L
Tioga County Health Department
(Tioga County)
1999 L
Gotham Per Diem, Inc.
(Bronx, Richmond, Kings, Westchester, New York and
Queens Counties)
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
B
.
APPLICATIONS FOR ESTABLISHMENT AND CONSTRUCTION OF
HEALTH CARE FACILITIES
CATEGORY 2:
Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Without Dissent by HSA
™ Without Dissent by Establishment and Project Review Committee
CON Applications
Acute Care Services – Establish/Construct
1.
Number
Applicant/Facility
122004 E
Fletcher Allen
Partners/Community Providers,
Inc.
(Clinton County)
Mr. Booth – Interest
Dr. Rugge – Abstaining/Interest
Residential Health Care Facility – Establish
Number
Applicant/Facility
1.
092058 B
HBL SNF, LLC d/b/a The
Rehabilitation and Care
Institute at White Plains
(Westchester County)
Mr. Fassler – Recusal
Mr. Fensterman – Recusal
2.
121427 E
JOPAL Sayville, LLC d/b/a
Petite Fleur Nursing Facility
(Suffolk County)
Mr. Fensterman - Recusal
Exhibit #19
E.P.R.C.
Recommendation
Contingent Approval
Exhibit #20
E.P.R.C.
Recommendation
Contingent Approval
Contingent Approval
3.
121407 E
150 Riverside OP, LLC d/b/a
The Riverside
(New York County)
Mr. Fensterman - Recusal
Certified Home Health Agencies – Establish
Number
Applicant/Facility
1.
112306 E
Hospitals Home Health Care
Inc
(Oswego County)
Mr. Booth - Interest
2.
121358 E
Catholic Health Care System
d/b/a Archcare
(Kings County)
Dr. Bhat – Recusal
Mr. Fassler - Recusal
Upstate Certified Home Health Agencies - Construction
Contingent Approval
Exhibit #21
E.P.R.C.
Recommendation
Contingent Approval
Contingent Approval
Exhibit #22
Number
Applicant/Facility
E.P.R.C.
Recommendation
Contingent Approval
1.
121318 E
Northern Lights Home Health
Care
(St. Lawrence County)
Mr. Booth – Interest
2.
122120 E
CenterLight Certified Home
Health Agency
(Kings)
Mr. Fassler – Recusal
Contingent Approval
3.
122121 E
Jewish Home Lifecare,
Community Services
(New York County)
Mr. Fassler – Interest
Ms. Regan - Interest
Contingent Approval
Certificate of Amendment of the Certificate of Incorporation
Applicant
1.
North Shore University Hospital Stern Family Center
for Extended Care and Rehabilitation
Mr. Fensterman – Recusal
Mr. Kraut – Recusal
HOME HEALTH AGENCY LICENSURES
Exhibit #23
E.P.R.C.
Recommendation
Approval
Exhibit #24
Number
Applicant/Facility
E.P.R.C.
Recommendation
Contingent Approval
1.
1991 L
International Home Care
Services of NY, LLC
(Bronx, Queens, Kings,
Richmond, Nassau and New
York Counties)
Ms. Regan – Interest
2.
1943 L
Omega Care & Health Inc.
d/b/a Right at Home
(Nassau and Suffolk Counties)
Ms. Regan – Interest
Contingent Approval
3.
2166 L
Tioga County Health
Department
(Tioga County)
Mr. Booth – Interest
Contingent Approval
4.
1999 L
Gotham Per Diem, Inc.
(Bronx, Richmond, Kings,
Westchester, New York and
Queens Counties)
Ms. Regan - Interest
Contingent Approval
Public Health and Health
Planning Council
Project # 122004-E
Fletcher Allen Partners/Community Providers, Inc.
County: Clinton (Plattsburgh)
Purpose: Establishment
Program: Acute Care Services
Submitted: July 2, 2012
Executive Summary
Description
Fletcher Allen Partners, Inc., (FAP) an existing Vermont
not-for-profit corporation, is seeking approval to be
established as the active parent and sole member of
Community Providers, Inc. (CPI) and to be established as
the active parent of CPI’s subsidiary hospitals, Champlain
Valley Physicians Hospital Medical Center (CVPHMC)
and Elizabethtown Community Hospital (ECH). Also, CPI
is seeking approval to become an active parent of
CVPHMC and ECH.
CPI, an existing New York not-for-profit corporation, is the
sole member of CVPHMC and ECH:
•
•
CVPHMC is a 333-bed acute care hospital located at
75 Beekman Street, Plattsburgh, in Clinton County;
and
ECH is a 15-bed Critical Access Hospital located at
75 Park Street, Elizabethtown, in Essex County.
CPI was organized in 1984 to develop and coordinate a
community and regionally-focused health system in
upstate New York to provide cost effective care.
FAP was organized in October 2011, to be the active
parent of Fletcher Allen Health Care, Inc. (Fletcher Allen)
and Central Vermont Medical Center, Inc. (CVMC).
Fletcher Allen is a not-for-profit corporation that functions
as the academic medical center affiliated with the
University of Vermont and its College of Medicine, based
in Burlington, Vermont, providing integrated health care
services as an acute care, teaching hospital with 562
licensed beds and a multi-specialty physician practice.
CVMC is a not-for-profit corporation that provides health
care services as an acute care, community hospital with
122 licensed beds, a 153-bed RHCF and a multi-specialty
physician practice located in Berlin, Vermont.
Fletcher Allen and CVMC. FAP and CPI will have the
ability to exercise active powers over the hospitals and
gain oversight with respect to the entities day-to-day
operations, set forth in the executed affiliation agreement
between all parties. FAP will consist of a Board of twentyseven that includes thirteen Fletcher Allen appointees, six
CPI appointees, five CVMC appointees, and the
Presidents of the Medical Staffs of CVMC, Fletcher Allen
and CVPHMC. This new corporate arrangement will
increase efficiency and improve care coordination in the
region.
DOH Recommendation
Contingent Approval.
Need Summary
The purpose of this application is to establish a
coordinated, highly integrated, four hospital care system
under common control of Fletcher Allen Partners, Inc.,
with the objectives of improving quality, increasing access
and lowering the costs of health care in the communities
served by the system in Vermont and upstate New York.
There will be no change in the daily operations of each
health care facility.
Program Summary
Based on the information reviewed, staff found nothing
that would reflect adversely upon the applicant’s
character and competence or standing in the community.
Financial Summary
There are no project costs or incremental revenue or
expenses associated with this application.
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Upon approval CPI, CVPHMC and ECH will become
members of FAP’s health system and affiliate with
Project # 122004-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval, contingent upon:
1. Submission of a photocopy of the executed Certificate of Amendment to the Articles of Incorporation of Fletcher
Allen Partners, Inc., acceptable to the Department. [CSL]
2. Submission of a photocopy of the adopted Amended and Restated Bylaws of Fletcher Allen Partners, Inc.,
acceptable to the Department. [CSL]
3. Submission of a photocopy of the executed Restated Certificate of Incorporation of Community Providers, Inc.,
acceptable to the Department. [CSL]
4. Submission of a photocopy of the adopted Amended and Restated Bylaws of Community Providers, Inc.,
acceptable to the Department. [CSL]
5. Submission of a photocopy of the executed Certificate of Amendment of the Certificate of Incorporation of
Champlain Valley Physicians Hospital Medical Center, acceptable to the Department. [CSL]
6. Submission of a photocopy of the adopted Amended and Restated Bylaws of Champlain Valley Physicians Hospital
Medical Center, acceptable to the Department. [CSL]
7. Submission of a photocopy of the executed Certificate of Amendment of the Certificate of Incorporation of Elizabeth
Community Hospital, acceptable to the Department. [CSL]
8. Submission of a photocopy of the adopted Amended and Restated Bylaws of Elizabeth Community Hospital,
acceptable to the Department. [CSL]
Council Action Date
October 11, 2012.
Project # 122004-E Exhibit Page 2
Need Analysis
Background
This project seeks to establish Fletcher Allen Partners, Inc. (FAP) as the active parent of Community Providers, Inc.
(CPI) and to establish FAP and CPI as the active parents of Champlain Valley Physicians Hospital Medical Center
(CVPHMC) and Elizabethtown Community Hospital (ECH). Upon project completion, the certified beds and services at
the two hospitals will remain the same.
Fletcher Allen Partners (FAP), a Vermont not-for-profit corporation, is currently the active parent of Fletcher Allen
Health Care in Burlington, Vermont and Central Vermont Medical Center in Berlin, Vermont. Community Providers,
Inc. (CPI), a New York not-for-profit corporation, is currently the sole member of Champlain Valley Physicians Hospital
Medical Center (CVPH) and Elizabethtown Community Hospital (ECH).
In addition to its corporate affiliation with CVPH through Fletcher Allen Partners, Fletcher Allen has contractual
affiliations with Alice Hyde Medical Center in Malone, Canton-Potsdam Hospital in Potsdam, and Inter-Lakes Health in
Ticonderoga. These affiliations provide a mechanism for regional planning on issues of common concern for each
hospital, while allowing them to each maintain independence.
CPI’s primary purpose is to develop and coordinate a community and regionally focused health care system that
provides appropriate, cost-effective care.
CVPH is the only hospital in Clinton County and is licensed to operate 333 hospital beds and 54 residential health care
facility beds. CVPH offers a variety of services at its main site and at 11 hospital extension clinics, including a mobile
health screening van. CVPH is certified as an Area Trauma Center and a Level 1 Perinatal Center.
ECH is a Critical Access Hospital in Essex County. The hospital is licensed to operate 15 Special Use beds and offers
a range of services at its main site and at three (3) hospital extension clinics.
There are no costs associated with this project. Following completion of the project, CVPH and ECH will remain
separate not-for-profit corporations licensed under Article 28 of the New York Public Health Law and will retain
separate operating certificates. There will be no change in authorized services or the number or type of beds as a
result of the proposed change in governance structure.
Analysis
Table 1 shows the distribution of beds by services category for CVPH, CVPH Skilled Nursing Facility, and ECH.
Table 1:
Distribution of Certified Beds by Service Category
Champlain Valley
Bed
Physicians Hospital
Category
Medical Center
Coronary Care
7
Intensive Care
14
Maternity
21
Medical /Surgical
227
Pediatric
10
Psychiatric
34
Transitional Care
20
Special Use
RHCF
Total
333
Champlain Valley
Physicians Hospital
Medical Center SNF
Elizabethtown
Community
Hospital
15
54
54
15
Source: Health Facilities Information System August 2012
CVPH SNF occupancy rates for 2008, 2009, and 2010 were 98.3 percent, 98.9 percent and 99.0 percent, respectively.
Project # 122004-E Exhibit Page 3
Table 2 shows utilization for CVPH and ECH for 2009, 2010, and 2011.
Table 2:
Distribution of Hospital Utilization Statistics
Service Category
CVPH Medical Center
Total inpatient discharges
Emergency Department
Ambulatory Surgery
Elizabethtown Community Hospital
Total inpatient discharges
Emergency Department
Ambulatory Surgery
2009
2010
2011
11,645
47,774
11,597
46,939
8,468
10,120
44,232
8,903
470
5,004
378
4,814
282
323
5,053
292
Source: SPARCS 2009 – 2011*
* SPARCS Reporting for 2011 is incomplete.
Conclusion
Approval of this application will give FAP and CPI the ability to exercise active powers over the two hospitals and to
gain oversight of day-to-day operations, while increasing regional health planning and the opportunity for continued
collaboration to meet community needs.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Program Proposal
Establish Community Providers, Inc. (CPI) as the active parent of Champlain Valley Physicians Hospital Medical
Center, Champlain Valley Physicians Hospital SNF, and Elizabethtown Community Hospital. Establish Fletcher Allen
Partners (FAP) as the active parent of CPI and the hospitals and nursing home.
Character and Competence
All current and proposed board members for CPI and FAP are subject to a character and competence review. Staff
from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses held,
formal education, training in pertinent health and/or related areas, employment history, a record of legal actions, and a
disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health
and reports from other state regulatory agencies if applicable. The review found that any citations were properly
corrected with appropriate remedial action.
The following disclosures, pertaining to Fletcher Allen Health Care within the last ten years, were made:
•
In 2003 Fletcher Allen settled with Vermont and federal law enforcement authorities regarding an
investigation into false statements made by executives of Fletcher Allen about the capital costs of a
construction project. The settlement included Fletcher Allen acknowledging certain false statements and
paying $1 million.
Project # 122004-E Exhibit Page 4
•
In November 2011 Fletcher Allen and the NYS Office of Medicaid (OMIG) Inspector General entered into
a Stipulation of Settlement in regard to an audit report by OMIG with respect to billings for ambulatory
surgery services. The stipulation required Fletcher Allen to pay $510,973 with no admission of liability.
Conclusion
Based on the information reviewed, staff found nothing that would reflect adversely upon the applicant’s character and
competence or standing in the community.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budgets
The applicant has indicated there are no incremental operating expenses or revenues associated with this project
since patient care services will not be affected or interrupted.
Capability and Feasibility
There are no project costs or incremental revenue or expenses associated with this application. As shown on BFA
Attachment B, a financial summary of CVPHMC, ECH, CVMC and Fletcher Allen, each hospital has maintained
positive working capital, positive net assets and experienced positive net income for 2011. As of June 30, 2012, all
four hospitals have maintained positive working capital and net assets. ECH, CVMC and Fletcher Allen have
experienced positive net income, while CVPHMC generated a net loss of $1,129,797. CVPHMC has indicated the
loss was due to vacancies in physician specialties, including General Surgery, Emergency Room and Plastic Surgery.
There has been a drop in surgical volumes and a corresponding drop in case mix. Locums were hired to fill many
physician vacancies and absences and this came at a much higher cost. The hospital is actively recruiting and one
general surgeon will be returning from maternity leave, which will provide some relief. Most ER positions have been
filled along with one surgeon. The affiliation with FAP will allow CVPHMC to reduce costs and continue further
necessary Physician recruitment.
Based on the preceding, it appears the applicant has demonstrated the capability to proceed in a financially feasible
manner, and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA Attachment A
Organizational Chart
BFA Attachment B
Financial Summaries- Fletcher Allen Partners Inc.
Project # 122004-E Exhibit Page 5
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish Fletcher Allen Partners, Inc. (FAP) as the active parent of Community Providers, Inc.
(CPI) and establish FAP and CPI as the active parents of Champlain Valley Physicians Medical
Center and Elizabethtown Community Hospital, and with the contingencies, if any, as set forth
below and providing that each applicant fulfills the contingencies and conditions, if any,
specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
122004 E
Fletcher Allen Partner/Community
Providers, Inc.
APPROVAL CONTINGENT UPON:
1. Submission of a photocopy of the executed Certificate of Amendment to the Articles of
Incorporation of Fletcher Allen Partners, Inc., acceptable to the Department. [CSL]
2. Submission of a photocopy of the adopted Amended and Restated Bylaws of Fletcher Allen
Partners, Inc., acceptable to the Department. [CSL]
3. Submission of a photocopy of the executed Restated Certificate of Incorporation of
Community Providers, Inc., acceptable to the Department. [CSL]
4. Submission of a photocopy of the adopted Amended and Restated Bylaws of Community
Providers, Inc., acceptable to the Department. [CSL]
5. Submission of a photocopy of the executed Certificate of Amendment of the Certificate of
Incorporation of Champlain Valley Physicians Hospital Medical Center, acceptable to the
Department. [CSL]
6. Submission of a photocopy of the adopted Amended and Restated Bylaws of Champlain
Valley Physicians Hospital Medical Center, acceptable to the Department. [CSL]
7. Submission of a photocopy of the executed Certificate of Amendment of the Certificate of
Incorporation of Elizabeth Community Hospital, acceptable to the Department. [CSL]
8. Submission of a photocopy of the adopted Amended and Restated Bylaws of Elizabeth
Community Hospital, acceptable to the Department. [CSL]
APPROVAL CONDITIONAL UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 092058-B
HBL SNF, LLC
d/b/a The Rehabilitation and Care Institute at White Plains
County: Westchester (White Plains)
Purpose: Establishment and Construction
Program: Residential Health Care Facility
Submitted: August 31, 2009
Executive Summary
Description
HBL SNF, LLC, a proposed limited liability company,
requests approval to establish and construct a new 160bed residential health care facility (RHCF) at 116-120
Church Street, White Plains, to be known as The
Rehabilitation and Care Institute at White Plains. The
160-bed complement is comprised of 70 contingently
approved beds from Hebrew Hospital Home of
Westchester, Inc., 18 contingently approved beds from
Bethel Nursing Home Company, Inc. and 72 RHCF beds
to be acquired from Taylor Care Center (which has been
acknowledged by the Department of Health). Contingently
approved Project 011102 Bethel Nursing Home
Company, Inc. is deemed withdrawn with PHHPC
contingent approval of this project. Hebrew Hospital of
Westchester, Inc.’s Project 021033 has already been
withdrawn in concert with this project.
The proposed members of HBL SNF, LLC will be
Westchester Health Care Properties I, LLC (51%),
Hebrew Hospital Home of Westchester, Inc. (39%) and
Bethel Nursing Home Company, Inc. (10%).
Westchester Health Care Properties I, LLC is comprised
of Lizer Jozefovic (50%) and Mark Neuman (50%), who
are established operators of the following RHCFs in New
York State: Skyview Rehabilitation and Health Care
Center, a 192-bed proprietary RHCF in Croton on the
Hudson; Waterview Hills Rehabilitation and Nursing
Center, a 130-bed proprietary RHCF in Purdys; Salem
Hills Rehabilitation & Nursing Center, a 126-bed
proprietary RHCF in Purdys; and Park Manor Acquisition
II, LLC d/b/a Middletown Park Rehabilitation & Health
Care Center, a 230-bed proprietary RHCF in Middletown.
Total project costs are estimated at $56,631,759.
DOH Recommendation
Contingent approval.
Need Summary
The facility will be built in the White Plains area, which is
shown to have a higher than normal minority population
and has a high poverty population compared to the
surrounding areas. This increased demand to treat the
local Medicaid eligible population will be met by HBL
SNF.
Eighty-eight of the applicant’s proposed 160 beds have
undergone the CON review process and were
contingently approved, but have not become operational.
Program Summary
As currently advanced, the design of the nursing home is
generally code compliant. However, refinements in the
final design could promote greater efficiencies and
improve the resident environment. In addition, final
design should demonstrate sufficient office and storage
space in the nursing home, including resident personal
storage.
Financial Summary
Project costs will be financed via land value of
$4,528,333, equity of $9,863,426, and a HUD mortgage
of $42,240,000 (30 yrs. @ 5.5%).
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 21,115,663
20,168,415
$
947,248
Subject to the noted contingencies, the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
Project # 092058-B Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New York State
Department of Health. Public Health Law Section 2802.7 states that all construction applications requiring review
by the Public Health and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent
of the total capital value of the project, exclusive of CON fees. [PMU]
2. Withdrawal of Project 011102 Bethel Nursing Home Company, Inc.[PMU]
3. Submission of an affidavit signed by the applicant affirming that the facility will be accepting “hard to place
patients” which include but are not limited to undocumented patients or charity care patients, patients with
behavioral issues, and any other patients that hospitals are having a difficult time placing. [RNR]
4. Submission of a commitment signed by the applicant which indicates that, within two years from the date of
PHHPC approval, the percentage of all admissions who are Medicaid and Medicare/Medicaid eligible at the time
of admission will be at least 75 percent of the planning area average of all Medicaid and Medicare/Medicaid
admissions, subject to possible adjustment based on factors such as the number of Medicaid patient days, the
facility’s case mix, the length of time before private paying patients became Medicaid eligible, and the financial
impact on the facility due to an increase in Medicaid admissions. [RNR]
5. Submission of a plan to enhance access to Medicaid residents. At a minimum, the plan should include, but not
necessarily limited to, ways in which the facility will:
a) Reach out to hospital discharge planners to make them aware of the facility’s Medicaid Access Program;
b) Communicate with local hospital discharge planners on a regular basis regarding bed availability at the
nursing facility;
c) Identify community resources that serve the low-income and frail elderly population who may eventually
use the nursing facility, and inform them about the facility’s Medicaid Access policy; and
d) Submit an annual report for two years to the Department, which demonstrates substantial progress with
the implement of the plan. The plan should include but not be limited to:
ƒ
ƒ
ƒ
ƒ
Information on activities relating to a-c above;
Documentation pertaining to the number of referrals and the number of Medicaid admissions;
Other factors as determined by the applicant to be pertinent; and
Documents showing which patients were accepted from hospital waiting lists and which are still on
the waiting lists. [RNR]
The DOH reserves the right to require continued reporting beyond the two year period.
6. Submission and acceptable programmatic review of a new name which is more descriptive of a nursing home.
[LTC]
7. Submission and programmatic review and approval of the final floor plans, including layouts showing the
placement of furniture, equipment and storage for all types of resident rooms. [LTC]
8. Submission of a commitment that is acceptable to the Department, for a permanent mortgage from a recognized
lending institution at a prevailing rate of interest. Included with the submitted permanent mortgage commitment
must be a sources and uses statement and debt amortization schedule, for both new and refinanced debt. [BFA]
9. Submission of an executed working capital loan agreement that is acceptable to the Department. [BFA]
10. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP
Drawing Submission Guidelines DSG-01. [AER]
11. Submission of a photocopy of an executed operating lease agreement between White Plains Healthcare
Properties I, LLC and the applicant, which is acceptable to the Department. [BFA, CSL]
12. Submission of a photocopy of the Articles of Organization of HBL SNF, LLC, which is acceptable to the
Department. [CSL]
Project # 092058-B Exhibit Page 2
13. Submission of a photocopy of a Certificate of Amendment of the Articles of Organization of HBL SNF, LLC which
is acceptable to the Department. [CSL]
14. Submission of a photocopy of an executed Operating Agreement of HBL SNF, LLC, which is acceptable to the
Department. [CSL]
15. Submission of a photocopy of the bylaws of Hebrew Hospital Home of Westchester and Bethel Nursing Home
Company. [CSL]
16. Submission of a list providing the name of each member, membership interest, and percentage ownership interest
in Westchester Health Care Properties I, LLC. [CSL]
17. Submission of a list of all managers of Westchester Health Care Properties I, LLC. [CSL]
18. Submission of a photocopy of the Articles of Organization and any amendments thereto, and the Operating
Agreement of Westchester Health Care Properties I, LLC, which is acceptable to the Department. [CSL]
19. Submission of a photocopy of a Development Agreement between HBL SNF, LLC and White Plains Healthcare
Properties I, LLC, which is acceptable to the Department. [CSL]
Approval conditional upon:
1. The submission of Final Construction Documents, signed and sealed by the project architect, as described in
BAEFP Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
2. The applicant shall complete construction by April 1, 2015 in accordance with 10 NYCRR Part 710.2(b)(5) and
710.10(a), if construction is not completed on or before that date, this may constitute abandonment of the approval
and this approval shall be deemed cancelled, withdrawn and annulled without further action by the Commissioner.
[AER]
3. Annual reporting of the number of admissions of “hard to place” patients and of any and all hospital waiting lists for
such patients in Westchester County. [RNR]
Council Action Date
October 11, 2012.
Project # 092058-B Exhibit Page 3
Need Analysis
Background
Westchester Health Care Properties Inc. is a proposed residential health care facility to be established at 116 – 120
Church Street White Plains, 10601, in Westchester County. The facility plans to establish a 160-bed RHCF via
purchase of 72 RHCF beds from Ruth Taylor Care, 70 RHCF beds from Hebrew Home, and 18 beds from Bethel
Nursing Home, for a total of 160.
Analysis
Westchester County Bed Need
2016 Projected Need
6,716
Current Beds
6,556
Beds Contingently Approved
18
Total Resources
6574
Unmet Need
142
Included in the current bed count is the bed complement for the Home for the Aged Blind which has 199 beds but
ceased operations four years ago. The operating certificate has not yet been surrendered. All 199 beds are not in
use, thus creating a need for 341 beds. The 18 beds indicated above as “Beds Contingently Approved ” are the
contingently approved beds for Bethel Nursing Home that are now part of this application. Utilization in Westchester
County for 2008, 2009, and 2010 was 93.17%, 93.32%, and 92.85%, respectively.
Notwithstanding that there is an indication of need in a planning area for additional residential health care facility beds
as determined in accordance with Subdivisions (d) or (e) of 10 NYCRR 709.3, there shall be a rebuttable presumption
that there is no need for any additional residential health care facility beds in such planning area if the overall
occupancy rate for existing residential health care facility beds in such planning area is less than 97% based on the
most recently available data. It shall be the responsibility of the applicant in such instances to demonstrate that there
is a need for additional RHCF beds despite the less than 97% occupancy rate in the applicant’s planning area utilizing
the factors set forth in Subdivision (h) of 10 NYCRR 709.3.
The applicant addressed the above regulation to the Department’s satisfaction in view of the following factors:
•
The new facility will accept “difficult to place patients”, who are patients classified by local hospital as follows:
• Patients who exhibit psychiatric behaviors but also have primary medical diagnosis.
• Patients who are undocumented.
• Patients with a history of substance abuse but have a primary medical diagnosis.
• Patients with a history of developmental and/or physical disabilities but have a primary medical
diagnosis.
• Patients who have no means of financial support and require charity care.
• Short term restorative patients who require seven days per week physical therapy and/or occupation
therapy services.
•
Nathan Miller, a 65 bed nursing facility located in White Plains, closed in 2011, creating a local community
need in the area.
•
King Street Nursing Home, a facility located within the service area of the proposed facility, has been well
below the 75% Medicaid Access standard, posing an increased need for a facility that accepts Medicaid
patients.
•
Additionally, there has been an increase of 28.7% in the over 85 population in Westchester County, causing a
need for additional nursing home resources in the coming years.
HBL SNF, LLC will be required to provide access to Medicaid patients per the Medicaid Access regulation.
•
Project # 092058-B Exhibit Page 4
Access
Regulations indicate that the Medicaid patient admissions standard shall be 75% of the annual percentage of all
Medicaid admissions for the long term care planning area in which the applicant facility is located. Such planning area
percentage shall not include residential health care facilities that have an average length of stay 30 days or fewer. If
there are four or fewer residential health care facilities in the planning area, the applicable standard for a planning area
shall be 75% of the planning area percentage of Medicaid admissions, whichever is less. In calculating such
percentages, the Department will use the most current data which have been received and analyzed by the
Department.
An applicant will be required to make appropriate adjustments in its admission polices and practices so that the
proportion of its own annual Medicaid patients admissions is at least 75% of the planning area percentage of health
Systems Agency percentage, whichever is applicable.
Conclusion
The applicant will provide services for an increasing elderly population and patients that are not accepted by other
facilities because of their special needs. The applicant has demonstrated the existence of sufficient local factors to
show a need for this facility.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Facility Information
Facility Name
Address
RHCF Capacity
ADHCP Capacity
Operator Type
Operator Class
Existing
N/A
N/A
N/A
N/A
N/A
N/A
Proposed
The Rehabilitation and Care Institute at White Plains
116-120 Church Street
White Plains, NY. 10601
160
N/A
LLC
Proprietary
Project # 092058-B Exhibit Page 5
Operator
Existing
N/A
Proposed
HBL SNF, LLC
Members
Westchester Health Care Properties I, LLC……………………….....51%
Hebrew Hospital Home of Westchester, Inc………………………….39%
Bethel Nursing Home Company, Inc…………………………….…….10%
Westchester Health
Hebrew Hospital Home
Bethel Nursing
Home
Care Properties I, LLC
of Westchester, Inc.
Company, Inc.
(Proprietary)
(Voluntary)
(Voluntary)
Members:
Mark Neuman…..…50%
Lizer Jozefovik……50%
Board of Directors:
Bertram Gelfand
Michael Gelfand
Charles Goldberger
Arnold Goldstein
Donna Jakubovitz
Michael Laub
Marvin Lifson
Alan Pearce
Edward Schecter
Leon Silverman
David Spector
George Strauch
Board of Directors:
John Carrington
Robert Elliott
James Holden, Jr.
Catherine PelczerWissner
Andrew Samalin
John Watkins Jr.
Character and Competence Review
•
FACILITIES REVIEWED:
Residential Health Care Facilities
Sky View Rehabilitation and Health Care Center
Salem Hills Rehabilitation and Health Care Center
Waterview Hills Rehabilitation and Health Care Center
Middletown Park Rehabilitation and HealthCare Center
Long Island Care Center
Brooklyn United Methodist Church Home
The Bethel Nursing Home Company
Bethel Nursing and Rehabilitation Center
Hebrew Hospital Home of Westchester
Westchester Meadows
10/2003 to present
10/2005 to present
10/2005 to present
04/2010 to present
01/1992 to present
09/2002 to present
09/2002 to present
09/2002 to present
09/2002 to present
09/2002 to present
Out-of-State Residential Health Care Facilities
Chapin Hill Nursing and Rehabilitation Center (NJ)
West Broward Care Center (FL)
Lackawanna Health & Rehab Center (PA)
01/2010 to present
01/2010 to present
11/2011 to present
New York State Hospitals
New York Methodist Hospital
09/2002 to present
Adult Care Facility / Enriched Housing Program
Fieldstone at Westchester Meadows
09/2002 to present
Licensed Home Care Services Agency
HHH Home Care, Inc.
09/2002 to present
Project # 092058-B Exhibit Page 6
•
INDIVIDUAL BACKGROUND REVIEW:
Westchester Health Care Properties, Inc.
Mark Neuman is the controller of the Long Island Care Center. He has disclosed ownership interest in the following
residential health care facilities:
Long Island Care Center
Sky View Rehabilitation and Health Care Center
Salem Hills Rehabilitation and Health Care Center
Waterview Hills Rehabilitation and Health Care Center
Middletown Park Rehabilitation and Health Care Center
Chapin Hill Nursing and Rehabilitation Center (Red Bank, NJ)
West Broward Care Center (Plantation, FL)
Lackawanna Health and Rehab Center (Lackawanna, PA)
01/1992 to present
10/2003 to present
10/2005 to present
10/2005 to present
04/2010 to present
01/2010 to present
01/2010 to present
11/2011 to present
Lizer Jozefovic holds a NYS Nursing Home Administrator License which is currently involuntary inactive. He has
disclosed ownership interest in the following residential health care facilities:
Sky View Rehabilitation and Health Care Center
Salem Hills Rehabilitation and Health Care Center
Waterview Hills Rehabilitation and Health Care Center
Middletown Park Rehabilitation and Health Care Center
Chapin Hill Nursing and Rehabilitation Center (Red Bank, NJ)
West Broward Care Center (Plantation, FL)
Lackawanna Health and Rehab Center (Lackawanna, PA)
10/2000 to present
10/2005 to present
10/2005 to present
10/2010 to present
01/2010 to present
01/2010 to present
11/2011 to present
Board of Directors - Hebrew Hospital Home of Westchester, Inc.
Hon. Bertram Gelfand is a retired NYS licensed attorney and is in good standing. He serves on the Board of
Directors for the Hebrew Hospital Home of Westchester.
Michael Gelfand is a New York, New Jersey, Connecticut, and Massachusetts licensed architect and is in good
standing. He is on the Board of Directors for the Hebrew Hospital Home of Westchester.
Charles Goldberger is a NYS licensed attorney and is in good standing. He is the vice-president for the Board of
Directors for Hebrew Hospital Home of Westchester.
Arnold Goldstein is the chairman to Samson Management, a real-estate management company. He is the chairman
of the Board of Directors for Hebrew Hospital Home of Westchester. Mr. Goldstein also discloses that he is a Director,
Secretary, and Treasurer for HHH Home Care, Inc., a licensed home care services agency (LHCSA) from 09/2002 to
present. Mr. Goldstein also discloses that he is the chairman of the Board of Directors of Westchester Meadows /
Hebrew Hospital Senior Housing, a continuing care retirement community (CCRC), from 09/2002 to present.
Donna Jakubovitz is vice president of Joremi Enterprises, a real estate management company. She is on the Board
of Directors for Hebrew Hospital Home of Westchester.
Michael Laub is the owner of Michael Laub LLC, a real estate management company. He is the president of the
Board of Directors for Hebrew Hospital Home of Westchester.
Marvin Lifson is an inactive NYS licensed Professional Engineer. He has been retired for over 10 years. Mr. Lifson
serves on the Board of Directors for the Hebrew Hospital Home of Westchester.
Alan Pearce is a NYS licensed attorney and is in good standing. He discloses that he is a member of the Board of
Directors, Secretary, and Treasurer for the Hebrew Hospital Home of Westchester. Mr. Pearce also discloses that he
Project # 092058-B Exhibit Page 7
is the president of the Board of Directors of HHH Home Care, Inc., a licensed home care services agency (LHCSA)
from 09/2002 to present.
Mr. Pearce also discloses that he is a member of the Board of Directors, Secretary, and Treasurer of Westchester
Meadows / Hebrew Hospital Senior Housing, a CCRC, from 09/2002 to present.
Rabbi Edward Schecter has been employed by the Temple Beth Shalom for over 10 years. He is a board member of
the Hebrew Hospital Home of Westchester.
Leon Silverman is a New York and Connecticut licensed real estate broker, with license in good standing. He is the
chairman to Silverman Realty Group, Inc., a real estate brokerage firm. He serves on the Board of Directors for the
Hebrew Hospital Home of Westchester.
David Spector is a retired New York licensed associate broker, with license in good standing. He serves on the
Board of Directors for the Hebrew Hospital Home of Westchester.
George Strauch is a NYS licensed attorney and is in good standing. He is on the Board of Directors for the Hebrew
Hospital Home of Westchester.
Board of Directors - Bethel Nursing Home Company, Inc.
Rev. Dr. John Carrington is retired, formerly employed as Executive Director/CEO of the United Methodist City
Society. He is on the Board of Directors for the Bethel Nursing Home Company. Dr. Carrington also discloses that he
is a trustee for Brooklyn United Methodist Church Home, from 1968 to present. He also discloses that he is a trustee
for New York Methodist Hospital, 1968 to present.
Robert Elliott is a self-employed consultant for community and economic development. He serves as vice-chairman
of the Board of Directors for the Bethel Nursing Home Company.
James Holden Jr. is a NYS licensed attorney and is in good standing. He is the chairman of the Board of Directors
for the Bethel Nursing Home Company.
Catherine Pelczar-Wissner, M.D. is a licensed medical doctor, in good standing and consulting physician for
Industrial Medicine Associates. She is on the Board of Directors for the Bethel Nursing Home Company.
Andrew Samalin is a certified financial planner as well as a registered investment advisor with licenses in good
standing. He is a board member and treasurer for the Bethel Nursing Home Company.
John Watkins Jr. is a NYS licensed attorney and is in good standing. He is the secretary for the Board of Directors
for the Bethel Nursing Home Company. He also discloses that he is a member of the Board of Directors of Bethel
Nursing and Rehabilitation Center, from 01/1993 to present.
Character and Competence – Analysis:
No negative information has been received concerning the character and competence of the above applicants.
A review of operations for the Middletown Park Rehabilitation and Health Care Center, Salem Hills Rehabilitation and
Health Care Center, Waterview Rehabilitation and Health Care Center, Long Island Care Center, Hebrew Hospital
Home of Westchester, and Westchester Meadows for the periods identified above results in a conclusion of
substantially consistent high level of care since there were no enforcements.
A review of the Sky View Rehabilitation and Health Care Center for the period identified above reveals the following:
•
The facility was fined $2,000 pursuant to a Stipulation and Order for surveillance findings on August 24, 2005.
Deficiencies were found under 10 NYCRR 415.11(2)(i-iii): Resident Assessment and Care Planning:
Comprehensive Care Plans and 10 NYCRR 415.12 – Quality of Care.
Project # 092058-B Exhibit Page 8
A review of operations for Sky View Rehabilitation and Health Care Center for the period identified above results in a
conclusion of substantially consistent high level of care, since there were no repeat enforcements.
A review of the Bethel Nursing Home Company for the period identified above reveals the following:
•
The facility was fined $4,000 pursuant to a Stipulation and Order for surveillance findings on June 18, 2003.
Deficiencies were found under 10 NYCRR 415.12(j): Quality of Care – Hydration.
•
The facility was fined $12,000 pursuant to a Stipulation and Order for surveillance findings on December 17,
2010. Deficiencies were found under 10 NYCRR 415.11(c)(2)(i-iii): Right to Participant Planning – Care
Revise CP; and 10 NYCRR 415.12(h)(1)(2): Quality of Care – Accident Hazard and Supervision.
A review of operations for the Bethel Nursing Home Company for the period identified above results in a conclusion of
substantially consistent high level of care since there were no repeat enforcements.
A review of the Bethel Nursing and Rehabilitation Center for the period identified above reveals the following:
•
•
The facility was fined $10,000 pursuant to a Stipulation and Order for surveillance findings on May 19, 2003.
Deficiencies were found under 10 NYCRR 415.12: Quality of Care; 10 NYCRR 415.12(j): Quality of Care –
Hydration; 10 NYCRR 415.15(b)(1)(i)(ii): Medical Services – Physician Services; 10 NYCRR 415.26:
Organization and Administration; 10 NYCRR 415.26(b)(3): Organization and Administration – Governing
Body; and 10 NYCRR 415.15(a): Medical Services – Medical Director.
The facility was fined $2,000 pursuant to a Stipulation and Order for surveillance findings on August 30, 2006
and January 30, 2007. Deficiencies were found under 10 NYCRR 415.12(h)(2): Quality of Care – Accidents;
and 10 NYCRR 415.12(c)(1)&(2): Quality of Care – Pressure Sores.
A review of operations for Bethel Nursing and Rehabilitation Center for the period identified above results in a
conclusion of substantially consistent high level of care, since there were no repeat enforcements.
A review of the Brooklyn United Methodist Church Home for the period identified above reveals the following:
•
The facility was fined $22,000 pursuant to a Stipulation and Order for surveillance findings on March 8, 2012.
Deficiencies were found under 10 NYCRR 415.12: Quality of Care - Highest Practicable Potential; 10 NYCRR
415.12(l)(1): Quality of Care - Significant Medication Errors; and 10 NYCRR 415.27(a-c): Quality Assessment
and Assurance.
A review of operations for the Brooklyn United Methodist Church Home for the period identified above results in a
conclusion of substantially consistent high level of care since there were no repeat enforcements.
A review of the New York Methodist Hospital for the period identified above reveals the following:
•
The facility was fined $6,000 pursuant to a Stipulation and Order in April 2007 for a “Delay and Recognition”
incident relating to the death of an infant suffering from a hernia.
A review of operations for the New York Methodist Hospital for the period identified above results in a conclusion of
substantially consistent high level of care since there were no repeat enforcements.
A review of operations for HHH Home Care, Inc. for the periods identified above results in a conclusion of substantially
consistent high level of care since there were no enforcements.
A review of operations for Fieldstone at Westchester Meadows for the periods identified above results in a conclusion
of substantially consistent high level of care since there were no enforcements.
Project # 092058-B Exhibit Page 9
A review of information provided by the New Jersey Department of Health for the Chapin Hill Nursing and
Rehabilitation Center located in Red Bank, New Jersey for the period identified above results in a conclusion of
substantially consistent high level of care since there were no enforcements.
A review of information provided by the Florida Department of Health for the West Broward Care Center located in
Plantation, Florida for the period identified above results in a conclusion of substantially consistent high level of care
since there were no enforcements.
A review of information provided by the Pennsylvania Department of Health for the Lackawanna Health and Rehab
Center located in Lackawanna, Pennsylvania for the period identified above results in a conclusion of substantially
consistent high level of care since there were no repeat enforcements.
Character and Competence – Conclusion:
The Establishment Review of HBL SNF, LLC is acceptable. However the name “The Rehabilitation and Care Institute
at White Plains” is not descriptive of a nursing home. As a contingency of approval, a modified facility name will be
required.
Project Review
•
PROGRAM REVIEW:
HBL SNF, LLC proposes to construct a new 160 bed skilled nursing facility (SNF) to be known as The Rehabilitation
and Care Institute at White Plains (HBL). The nursing home will consist of five floors with the nursing units distributed
on the four upper floors. The nursing units will range in size from 36 to 42 beds, and will be programmed for different
sub-groups. The second floor will be constructed as a short term rehabilitation unit of 36 beds, complete with
dedicated rehabilitation gym serving the nursing unit. The third floor will be designed as a conventional 40 bed unit,
identified in the narrative as serving a “sub-acute step down” population. The fourth and fifth floors will be the largest
nursing units with 42 beds, with the fourth floor programmed to serve a dementia population and the fifth floor
programmed as a conventional geriatric floor.
•
PHYSICAL ENVIRONMENT:
HBL intends to construct a 99,694 square foot building at Baker Avenue and Church Street in downtown White Plains.
The building will occupy a rectangular site and consist of five floors, with basement and mechanical penthouse. The
nursing units are located on the second through the fifth floors, and arrayed in an “L” configuration. The nursing home
will include 13% single bedrooms, and the double bedrooms will utilize a standard toe to toe layout to guarantee
adequate light for both residents. Recreational space, as well as dining and rehabilitation, is generally located to the
inside of the building.
Entrance into the nursing home will be made from the first level, which is on grade, from either the vehicle drop-off or
parking garage which occupies half of the ground level. The lobby and waiting area are flanked by the admissions
parlor and offices. The main elevator bank is located in the center of the floor, opposite the central dining rooms, and
adjacent to an activity and multipurpose room. A terrace leads out from the main dining room to provide outdoor
space for the residents.
The second floor is intended to serve residents requiring short term rehabilitation, and includes a dedicated
rehabilitation gym to serve the floor. The nursing unit contains 36 beds divided into 13 doubles and 10 singles. The
central nurses station and tub and shower room are located on either side of the elevator bank, in the middle of the
nursing unit. Behind the elevators is the on-floor dining room, with the rehabilitation gym/ ADL training room and
rooftop gardens in back of the dining area. Access into the rehabilitation gym, and the overall configuration of the
area, has been the subject of several discussions. The current plan places a corridor around the perimeter of the 26
space dining room, which also divides the dining room from the adjacent activities room. Additional activities and
recreation space is provided in a generously sized lounge in the corner of the unit.
The third floor layout is similar to the second floor, containing 40 beds divided into 17 doubles and 6 singles. An
exterior patio, located on top of the second floor gym, is accessed from the on-floor dining area, with the perimeter
corridor connecting it to the elevator bank.
Project # 092058-B Exhibit Page 10
The fourth and fifth floor layouts are identical, with each nursing unit containing 42 beds divided into 20 doubles and 2
singles. The design of these floors is similar to the third floor nursing unit, with two doubles replacing singles in the
lower nursing unit. An additional shower room and dressing area is fitted into space housing a single bedroom on the
third floor. Also, In lieu of the gardens areas which are only available to the residents of the lower floors, residents of
the fourth and fifth floors are given use of a deck area accessed from the interior activities area. Additional detail
regarding the fencing and rails to be installed to ensure the safety of residents using the decks, and the protocols
regarding their use in inclement weather, will be required at the final plan review stage.
Residents of the three upper floors will travel to the basement area for rehabilitation services, in a gym of greatly
reduced size in comparison to the short term rehab gym. The barber and beauty salon has also been located in the
basement area, as well as staff dining room and lounge, and employee lockers.
Project Review – Analysis:
Constrained by its downtown site, the design of HBL attempts to maximize the size of the nursing units and retain
sufficient resident services. The inclusion of covered parking on the ground floor limits the availability of common
space for resident amenities and socialization, and creates circulation issues on the upper floors. Resident services,
including the beauty parlor and rehabilitation area, are located in the basement, due to the limited floor area of the
ground level, which inhibit their appeal and therapeutic value to the residents. The use of off-site parking, or the
relocation of the parking garage to the undersized basement area, would permit additional resident amenities to be
located on the ground floor, and improve accessibility to recreation and socialization space.
A re-consideration of the design of the nursing units, perhaps creating “U” or irregular-shaped nursing units, would
provide increased square footage on the floors and ease potential congestion. While the program decisions to create
a self-contained short term rehab unit on the second floor drives the current design of the nursing home, especially the
upper floor nursing units, the second floor would also benefit from a re-design. The placement of the dedicated rehab
gym and dining area away from the center of the nursing unit creates accessibility issues, which are mirrored on the
upper floors. The suggested design change would allow the dining room to move to a more central or corner location
reducing traffic on the unit. Similarly, the dedicated rehab gym could be situated adjacent to the resident bedrooms,
creating a more integrated program. The upper floors would similarly benefit from the design change with the ability to
offer more single bedrooms, without detracting from storage or service functions. The additional square footage could
also foster a more homelike environment, for example preparing meals on the floor and serving them family style, with
the central dining room offering a more social dining experience.
As currently advanced, the design of the nursing home is generally code compliant. However, refinements in the final
design could promote greater efficiencies and improve the resident environment. In addition, final design should
demonstrate sufficient office and storage space in the nursing home, including resident personal storage.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Development Agreement
On March 30, 2012, HBL SNF, LLC (operator/Tenant) and White Plains Healthcare Properties I, LLC(Developer) were
subject to a draft Development Agreement, whereas Tenant has requested the Developer to design and construct a
160 Bed Skilled Nursing Facility at 116-120 Church Street in White Plains. Presented as BFA Attachment C is the
organizational chart of White Plains Properties I, LLC, which has no relationship to the tenant.
Lease Agreement
Facility occupancy is subject to a draft lease agreement, the terms of which are summarized as follows:
Lessor:
Lessee:
Term:
White Plains Healthcare Properties I, LLC
HBL SNF, LLC
30 year term
Project # 092058-B Exhibit Page 11
Rental:
Other:
Equal to debt service on Mortgage of $239,834 per month ($2,878,008 annually) plus
$1,440,000 per year based on a return of cash equity to the project’s investors
Lessee pays insurance, maintenance and utilities
White Plains Healthcare Properties I, LLC, landlord and developer, is comprised of CCC Equities, LLC (80%), and
Project Equity Consulting (20%). Presented as BFA Attachment C is the organizational Chart for Landlord and
Operator.
Total Project Cost and Financing
Total cost to build and construct the proposed 160 bed facility is projected to be $56,631,759, itemized as follows:
Land Acquisition
New Construction
Design Contingency
Construction Contingency
Architect/Engineering Fees
Construction Manager Fees
Other Fees(Consultant)
Movable Equipment
Financing Costs
Interim Interest Expense
CON Application Fee
CON Processing Fee
Total Project Cost
$
4,528,333
37,282,722
1,864,136
1,864,136
2,982,618
745,654
750,000
1,480,000
2,112,000
2,710,400
2,000
309,760
$56,631,759
Project cost is based on a construction start date of August 1, 2013, with a twenty month completion period. Project
cost per bed, exclusive of CON fees, is $352,000 per bed and is within the geographic per bed limitation for
Westchester County.
Financing for the project is anticipated as follows:
Land Value
Cash
HUD Mortgage (5.5% over 30 year term)
Total Funds
$4,528,333
9,863,426
42,240,000
$56,631,759
The land value is based on the actual Bargain and Sale Deed and registered with Westchester County. The land was
sold to White Plains Healthcare Properties I, LLC on September 3, 2010.
CCC Equities will be providing the $9,863,426 cash requirement for total project costs. Presented as BFA Attachment
B is the net worth statement for CCC Equities, which shows sufficient funds available.
Operating Budget
Following is a summary of the submitted operating budget for the RHCF, presented in 2012 dollars, for the first and
third years subsequent to facility being built:
RHCF
Revenues:
Medicaid
Medicare
Private Pay/Other
Total Revenues
First Year Total
Third Year Total
$8,887,323
4,019,580
2,411,748
$15,318,651
$9,985,353
7,326,280
3,804,030
$21,115,663
Project # 092058-B Exhibit Page 12
Expenses:
Operating
Capital
Total Expenses
$11,952,795
4,621,877
$16,574,672
$15,537,460
4,630,955
$20,168,415
Net Income(Loss)
$(1,256,021)
$
Utilization:(patient days)
Occupancy
947,248
44,662
56,356
76.48%
96.50%
The following is noted with respect to the submitted RHCF operating budget:
•
•
•
The capital component of the Medicaid rate is based on the interest, amortization and return on equity
reimbursement methodology.
Medicare and private pay revenues are based on current payment rates.
Overall utilization for year one and year three is projected at 76.48% and 96.5% respectively, while
utilization by payor source is expected as follows:
Payor
Medicaid
Medicare
Private Pay
Charity Care
•
First Year
73.0%
15.0%
11.5%
0.5%
Third Year
65.0%
20.0%
14.5%
0.5%
Year One utilization is based on a start up year and is not at full capacity.
Capability and Feasibility
Total project costs will be met through $4,528,333 in land value, $9,863,426 from equity, and $42,240,000 from a HUD
mortgage at stated terms. A letter of interest from Red Mortgage Capital, LLC has been submitted by the applicant.
Equity will be provided through CCC Equities, LLC, which BFA Attachment B shows CCC Equities, LLC has sufficient
funds.
Working capital requirements for the RHCF are estimated at $3,361,402 based on two months of third year expenses.
Financing will be provided as 50% owner’s equity of $1,680,701 and 50% bank loan of $1,680,701. BFA Attachment
A shows that HBL SNF, LLC has sufficient equity. A letter of interest has been submitted by Capital One Bank for a
term of five years at 7% interest. Presented as BFA Attachment F is the Pro-forma Balance Sheet for HBL SNF, LLC
as of the first day of operations with member’s equity of $1,680,701.
The submitted budget indicates a net loss of $1,256,021 in the first year and a net profit of $947,248 in the third year.
Projected income includes the applicant’s estimated impact of the Statewide Pricing Reimbursement methodology to
RHCF Medicaid rates. The operating expenses and the projected case mix level of acuity are based on the historical
experiences of member owned and similar bed complement RHCFs in Westchester County; Sky View Nursing and
Rehabilitation Center and Hebrew Hospital Home of Westchester, Inc. The budget appears reasonable.
The applicant hired a firm to research the demand for nursing home services in Westchester County and create a
demand analysis. The analysis indicates that national utilization rates were applied to the estimated population for
each age group in Westchester County. The analysis supports an increase in nursing home utilization for people ages
65 and older, of which the majority of the residents are in the 85 and older age group. While the projected bed need is
higher than the Department of Health’s unmet bed need of 142, the study more than supports demand for these
incremental RHCF beds. The new facility will accept “difficult to place patients,” who are patients classified by local
hospitals as follows: patients who exhibit psychiatric behaviors but also have primarily medical diagnosis; patients who
are undocumented; patients with a history of developmental and/or physical disabilities but have a primary medical
diagnosis; patients who have no means of financial support and require charity care and short term restorative patients
who require seven days per week physical therapy and/or occupational therapy services.
Project # 092058-B Exhibit Page 13
Staff notes that the individual owners, Mark Neuman and Lizer Jozefovic, have had history of achieving high
occupancy in the nursing homes that they operate. They acquired Park Manor Rehab & Health Center on March 6,
2010, renaming it Middletown Park Rehabilitation and Health Care Center (BFA Attachment J), and achieved
occupancy of 96.60% and 96.70% during 2010 and 2011, respectively. From 2007 through 2009, Park Manor Rehab
& Health Center had occupancy of 89.73% (2007); 88.70% (2008) and 86.94% (2009). In regard to the filling up of the
new beds, the applicant anticipates one 40 bed unit be brought on line at a time, over a period of 4-6 months. This fill
up is reflective in the applicant’s first year projected occupancy of 76.48%.
Staff notes that with the expected 2014 implementation of managed care for nursing home residents, Medicaid
reimbursement is expected to change from a state-wide price with a cost-based capital component payment
methodology to a negotiated reimbursement methodology. Facility payments will be the result of negotiations between
the managed long term care plans and the facility. At this point in time, it cannot be determined what financial impact
this change in reimbursement methodology will have on this project.
As shown on BFA Attachment D, Hebrew Hospital Home of Westchester, Inc. has experienced negative working
capital in 2009 and 2011 and maintained positive net equity in 2009-2011 and an average loss from operations of
$1,081,710 over the 2009-2011 periods. The losses experienced in 2009-2011 are due to the current revenue stream
not being sufficient to support current operations; therefore, management has decided to cut operating expenses in
order to at least bring the RHCF to a break-even point by reducing nursing costs without interruption of patient care,
renegotiation of outside contracts, reduction of employee benefit funds by increased employee participation,
renegotiation of union contracts, and reduction of administrative staffing.
As shown on BFA Attachment E, The Bethel Nursing Home Company, Inc. has experienced negative working capital
and net equity, and an average loss from operations of $358,517 over the 2009-2010 periods. In 2011, The Bethel
Nursing Home Company, Inc. maintained a net profit from operations of $210,749. The losses experienced in 20092010 were eliminated in 2011, since management has taken steps to reduce their operating costs, such as closing
their kitchen and having meals brought in through their sister RHCF, Bethel Nursing and Rehabilitation Center,
retaining contracted services for Physical Therapy and other rehabilitative services, and the increase in Medicare days
and rates. Administration has also reduced staffing based on the reduction in occupancy.
As shown on BFA Attachment G, Sky View Rehabilitation and Health Center has experienced negative working capital
and maintained positive net equity and an average net income from operations of $896,813 over the 2009-2011
periods.
The negative working capital is due to an interest rate swap agreement entered into to protect the RHCF from
increased interest rates.
As shown on BFA Attachment H, Waterview Hills Rehabilitation and Nursing Center has maintained positive working
capital and net equity on average net income from operations of $624,161 over the 2009-2011 periods.
As shown on BFA Attachment I, Salem Hills Rehabilitation and Nursing Center has maintained positive working capital
and net equity on average net income from operations of $442,350 over the 2009-2011 periods.
As shown on BFA Attachment J, Middletown Park Rehabilitation and Health Care Center has maintained positive
working capital and net equity on net income from operations of $759,300 over the 2010-2011period.
Based on the preceding and subject to the noted contingencies, it appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Net Worth Statement for Westchester Health Care Properties I, LLC
Project # 092058-B Exhibit Page 14
BFA Attachment B
Net Worth Statement for CCC Equities, LLC
BFA Attachment C
Organizational Chart for Proposed Landlord and Operator of HBL SNF, LLC
BFA Attachment D
Financial Summary for Hebrew Hospital Home of Westchester, Inc.
BFA Attachment E
Financial Summary for Bethel Nursing Home Company, Inc.
BFA Attachment F
Pro-forma Balance Sheet
BFA Attachment G
Financial Summary for Sky View Rehabilitation & Health Care Center, LLC
BFA Attachment H
Financial Summary for Waterview Hills Rehabilitation & Nursing Center
BFA Attachment I
Financial Summary for Salem Hills Rehabilitation & Nursing Center
BFA Attachment J
Financial Summary for Middletown Park rehabilitation & Health Care Center
DHFP Attachment
Map
Project # 092058-B Exhibit Page 15
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish and construct a new 160-bed residential health care facility at 116-120 Church Street,
White Plains, and with the contingencies, if any, as set forth below and providing that each
applicant fulfills the contingencies and conditions, if any, specified with reference to the
application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
092058 B
HBL SNF, LLC d/b/a The Rehabilitation and
Care Institute at White Plains
APPROVAL CONTINGENT UPON:
1. Submission of a check for the amount enumerated in the approval letter, payable to the New
York State Department of Health. Public Health Law Section 2802.7 states that all
construction applications requiring review by the Public Health and Health Planning Council
shall pay an additional fee of fifty-five hundredths of one percent of the total capital value of
the project, exclusive of CON fees. [PMU]
2. Withdrawal of Project 011102 Bethel Nursing Home Company, Inc.[PMU]
3. Submission of an affidavit signed by the applicant affirming that the facility will be accepting
“hard to place patients” which include but are not limited to undocumented patients or
charity care patients, patients with behavioral issues, and any other patients that hospitals
are having a difficult time placing. [RNR]
4. Submission of a commitment signed by the applicant which indicates that, within two years
from the date of PHHPC approval, the percentage of all admissions who are Medicaid and
Medicare/Medicaid eligible at the time of admission will be at least 75 percent of the
planning area average of all Medicaid and Medicare/Medicaid admissions, subject to
possible adjustment based on factors such as the number of Medicaid patient days, the
facility’s case mix, the length of time before private paying patients became Medicaid
eligible, and the financial impact on the facility due to an increase in Medicaid admissions.
[RNR]
5. Submission of a plan to enhance access to Medicaid residents. At a minimum, the plan
should include, but not necessarily limited to, ways in which the facility will:
a) Reach out to hospital discharge planners to make them aware of the facility’s
Medicaid Access Program;
b) Communicate with local hospital discharge planners on a regular basis regarding
bed availability at the nursing facility;
c) Identify community resources that serve the low-income and frail elderly population
who may eventually use the nursing facility, and inform them about the facility’s
Medicaid Access policy; and
d) Submit an annual report for two years to the Department, which demonstrates
substantial progress with the implement of the plan. The plan should include but not
be limited to:
ƒ
ƒ
ƒ
ƒ
Information on activities relating to a-c above;
Documentation pertaining to the number of referrals and the number of
Medicaid admissions;
Other factors as determined by the applicant to be pertinent; and
Documents showing which patients were accepted from hospital waiting lists
and which are still on the waiting lists. [RNR]
The DOH reserves the right to require continued reporting beyond the two year period.
6. Submission and acceptable programmatic review of a new name which is more descriptive
of a nursing home. [LTC]
7. Submission and programmatic review and approval of the final floor plans, including layouts
showing the placement of furniture, equipment and storage for all types of resident rooms.
[LTC]
8. Submission of a commitment that is acceptable to the Department, for a permanent
mortgage from a recognized lending institution at a prevailing rate of interest. Included with
the submitted permanent mortgage commitment must be a sources and uses statement and
debt amortization schedule, for both new and refinanced debt. [BFA]
9. Submission of an executed working capital loan agreement that is acceptable to the
Department. [BFA]
10. The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as
described in BAEFP Drawing Submission Guidelines DSG-01. [AER]
11. Submission of a photocopy of an executed operating lease agreement between White
Plains Healthcare Properties I, LLC and the applicant, which is acceptable to the
Department. [BFA, CSL]
12. Submission of a photocopy of the Articles of Organization of HBL SNF, LLC, which is
acceptable to the Department. [CSL]
13. Submission of a photocopy of a Certificate of Amendment of the Articles of Organization of
HBL SNF, LLC which is acceptable to the Department. [CSL]
14. Submission of a photocopy of an executed Operating Agreement of HBL SNF, LLC, which is
acceptable to the Department. [CSL]
15. Submission of a photocopy of the bylaws of Hebrew Hospital Home of Westchester and
Bethel Nursing Home Company. [CSL]
16. Submission of a list providing the name of each member, membership interest, and
percentage ownership interest in Westchester Health Care Properties I, LLC. [CSL]
17. Submission of a list of all managers of Westchester Health Care Properties I, LLC. [CSL]
18. Submission of a photocopy of the Articles of Organization and any amendments thereto,
and the Operating Agreement of Westchester Health Care Properties I, LLC, which is
acceptable to the Department. [CSL]
19. Submission of a photocopy of a Development Agreement between HBL SNF, LLC and
White Plains Healthcare Properties I, LLC, which is acceptable to the Department. [CSL]
APPROVAL CONDITIONAL UPON:
1. The submission of Final Construction Documents, signed and sealed by the project
architect, as described in BAEFP Drawing Submission Guidelines DSG-01, prior to the
applicant’s start of construction. [AER]
2. The applicant shall complete construction by April 1, 2015 in accordance with 10 NYCRR
Part 710.2(b)(5) and 710.10(a), if construction is not completed on or before that date, this
may constitute abandonment of the approval and this approval shall be deemed cancelled,
withdrawn and annulled without further action by the Commissioner. [AER]
3. Annual reporting of the number of admissions of “hard to place” patients and of any and all
hospital waiting lists for such patients in Westchester County. [RNR]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121427-E
JOPAL Sayville, LLC
d/b/a Petite Fleur Nursing Facility
County: Suffolk (Sayville)
Purpose: Establishment
Program: Residential Health Care Facility
Submitted: June 7, 2012
Executive Summary
Description
JOPAL Sayville, LLC, requests approval to be
established as the new operator of Petite Fleur Nursing
Home, an existing 180-bed proprietary residential
health care facility (RHCF) located at 300 Broadway
Avenue, Sayville. The proposed change in ownership
of the operation and the real estate is as follows:
Operation
Current Owner
Petite Fleur Nursing Home
MEMBERS:
-- Theresa M Santmann
-- Theresa A Santmann
-- John Santmann
(52.00%)
(35.00%)
(13.00%)
(33.33%)
(33.34%)
(33.33%)
Real Property
Current Owner
Petite Fleur Nursing Home
MEMBERS:
-- Theresa M Santmann
-- Theresa A Santmann
-- John Santmann
DOH Recommendation
Contingent approval.
Need Summary
Petite Fleur Nursing Home occupancy for 2008 through
2010 was 96.3%, 97.4% and 96.0%, respectively. The
facility was significantly above the 75% regional planning
average for Medicaid admissions in 2009 and 2010.
Program Summary
No negative information has been received concerning
the character and competence of the above applicants.
Proposed Owner
JOPAL Sayville, LLC
MEMBERS:
-- Joseph Carillo II
-- Pasquale DeBenedictis
-- Alex Solovey
The acquisition of the operating interests by JOPAL
Sayville, LLC is for $11,750,000, and the realty
interests by Petite Fleur Acquisition, LLC for
$11,750,000.
(52.00%)
(35.00%)
(13.00%)
No changes in the program or physical environment
are proposed in this application.
Financial Summary
The purchase price will be met via equity of
$2,500,000 from the proposed members and a bank
loan of $21,000,000 for the operation and the real
estate (30 yrs. @ 2.75%).
Budget:
Proposed Owner
Petite Fleur Acquisition, LLC
MEMBERS:
-- Joseph Carillo II
-- Pasquale DeBenedictis
-- Alex Solovey
(33.33%)
(33.34%)
(33.33%)
Revenues:
Expenses:
Gain/(Loss):
$ 18,516,900
18,348,029
$
168,871
Subject to the noted contingencies, it appears that the
applicant has demonstrated the capability to proceed
in a financially feasible manner.
Project # 121427-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. The submission of a commitment signed by the applicant which indicates that, within two years from the date of the
council approval, the percentage of all admissions who are Medicaid and Medicare/Medicaid eligible at the time of
admission will be at least 75 percent of the planning area average of all Medicaid and Medicare/Medicaid admissions,
subject to possible adjustment based on factors such as the number of Medicaid patient days, the facility's case mix,
the length of time before private paying patients became Medicaid eligible, and the financial impact on the facility due to
an increase in Medicaid admissions. The Department reserves the right to require continued reporting beyond the two
year period. [RNR]
2. Submission of a working capital loan commitment that is acceptable to the Department of Health. [BFA]
3. Submission of a loan commitment for the operating portion that is acceptable to the Department. [BFA]
4. Submission of a loan commitment for the real estate portion that is acceptable to the Department. [BFA]
5. Submission of a photocopy of a fully executed asset purchase agreement between Jopal Sayville, LLC and Petite
Fleur Nursing Home that is acceptable to the Department. [BFA, CSL]
6. Submission of a photocopy of the fully executed real estate purchase agreement between Petite Fleur Acquisition,
LLC and Petite Fleur Nursing Home that is acceptable to the Department. [BFA, CSL]
7. Submission of a photocopy of the fully executed lease between Petite Fleur Acquisition, LLC and Jopal Sayville,
LLC that is acceptable to the Department. [BFA, CSL]
8. Submission of a photocopy of the signed and dated Certificate of Assumed Name of Jopal Sayville, LLC,
indicating its intent to do business as Petite Fleur Nursing Facility, acceptable to the Department. [CSL]
9. Submission of a photocopy of the signed and dated Operating Agreement of Jopal Sayville, acceptable to the
Department. [CSL]
10. Submission of a photocopy of the filed Articles of Organization of Jopal Sayville, acceptable to the Department.
[CSL]
11. Submission of a photocopy of the signed and dated Certificate of Amendment of the Articles of Organization of
Jopal Sayville, LLC acceptable to the Department. [CSL]
Council Action Date
October 11, 2012.
Project # 121427-E Exhibit Page 2
Need Analysis
Background
JOPAL Sayville, LLC has entered into an Asset and Real Estate Purchase Agreement with Petite Fleur Nursing Home,
a 180-bed proprietary residential health care facility (RHCF) located at 300 Broadway Avenue, Sayville, 11782, in
Suffolk County. The facility is seeking approval to acquire Petite Fleur Nursing Home and to change the name to
JOPAL Sayville.
Petite Fleur Nursing Home’s occupancy of 97.4% in 2009 exceeded the planning optimum of 97%. Occupancy for 2008
and 2010 was slightly lower at 96.3% and 96%, respectively. Petite Fleur Nursing Home exceeded the Long Island and
Suffolk County planning area utilization for all years in question, as indicated in the table below.
RHCF Occupancy
Petite Fleur Nursing Home
Suffolk County
Long Island Region
2008
96.3%
94.8%
95.0%
2009
97.4%
95.4%
94.8%
2010
96.0%
94.3%
93.4%
The 2016 Projected Bed Need for the Long Island Region is 1,353. The region’s occupancy must exceed 97% for
there to be a presumption of need.
RHCF Bed Need
2016 Projected need
Current Beds
Beds under Construction
Total Resources
Unmet Need
Long Island
16,962
16,000
- 391
15609
1353
Access
Regulations indicate that the Medicaid patient admissions standard shall be 75% of the annual percentage
of all Medicaid admissions for the long term care planning area in which the applicant facility is located.
Such planning area percentage shall not include residential health care facilities that have an average
length of stay 30 days or fewer. If there are four or fewer residential health care facilities in the planning area,
the applicable standard for a planning area shall be 75% of the planning area percentage of Medicaid
admissions, whichever is less. In calculating such percentages, the Department will use the most current
data which have been received and analyzed by the Department.
An applicant will be required to make appropriate adjustments in its admission policies and practices so that the proportion
of its own annual Medicaid patients admissions is at least 75% of the planning area percentage of health Systems Agency
percentage, whichever is applicable.
Petite Fleur Nursing Home exceeded the 75 percent planning average for 2009 and 2010 with reported Medicaid
admissions of 49.03 percent in 2009 and 30.42 percent in 2010. The 75 percent planning averages for Suffolk for 2009 and
2010 were 17.32 percent and 8.95 percent, respectively.
Recommendation
From a need perspective, contingent approval is recommended.
Project # 121427-E Exhibit Page 3
Programmatic Analysis
Facility Information
Existing
Petite Fleur Nursing Home
Proposed
Same
Same
RHCF Capacity
ADHC Program Capacity
Type of Operator
Class of Operator
300 Broadway Avenue
Sayville, NY. 11782
180
N/A
Partnership
Proprietary
Same
N/A
LLC
Proprietary
Operator
Petite Fleur Nursing Home
JOPAL Sayville, LLC
Facility Name
Address
Members:
Thomas M Santmann
Theresa A Santmann
John Santmann
Members:
52% Pasquale DeBenedictis 33.34%
35% Joseph Carillo II
33.33%
13% Alexander Solovey
33.33%
Character and Competence
•
FACILITIES REVIEWED:
Residential Health Care Facilities
Barnwell Nursing and Rehabilitation Center
East Neck Nursing and Rehabilitation Center
Mills Pond Nursing and Rehabilitation Center
Carillon Nursing and Rehabilitation Center
•
11/2003 to present
02/2005 to present
10/2010 to present
01/1999 to present
INDIVIDUAL BACKGROUND REVIEW:
Pasquale DeBenedictis is a certified public accountant (CPA] with license in good standing. He has disclosed
ownership interest in the following residential health care facilities:
Barnwell Nursing and Rehabilitation Center
East Neck Nursing and Rehabilitation Center
Mills Pond Nursing and Rehabilitation Center
11/2003 to present
02/2005 to present
10/2010 to present
Alexander Solovey is a New York State licensed physical therapist, in good standing. He discloses ownership
interest in the following residential health care facilities:
Barnwell Nursing and Rehabilitation Center
East Neck Nursing and Rehabilitation Center
Mills Pond Nursing and Rehabilitation Center
11/2003 to present
02/2005 to present
10/2010 to present
Joseph Carillo II holds a New York State Nursing Home Administrator’s License, for which he is currently registered
and in good standing. He has disclosed ownership interest in the following residential health care facilities:
Carillon Nursing and Rehabilitation Center
Barnwell Nursing and Rehabilitation Center
East Neck Nursing and Rehabilitation Center
Mills Pond Nursing and Rehabilitation Center
Project # 121427-E Exhibit Page 4
01/1999 to present
10/2006 to present
02/2006 to present
10/2010 to present
Character and Competence – Analysis:
No negative information has been received concerning the character and competence of the above applicants.
A review of operations for the Barnwell Nursing and Rehabilitation Center, East Neck Nursing and Rehabilitation
Center, Mills Pond Nursing & Rehabilitation Center, and Carillon Nursing & Rehabilitation Center for the periods
identified above, results in a conclusion of substantially consistent high level of care since there were no
enforcements.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Asset Purchase Agreement
The change in operational ownership will be effectuated in accordance with a draft asset purchase agreement, the
terms of which are summarized below:
Date:
Seller:
Buyer:
Assets Transferred:
Excluded Assets:
Assumed Liabilities:
Purchase Price:
Payment of
Purchase Price:
June 2012
Petite Fleur Nursing Home
JOPAL Sayville, LLC
The nursing home, including the right to use the name “Petite Fleur Nursing
Home” and any and all other trade names, inventory and supplies, the Account
Receivable of the Nursing Home; all leasehold improvements and equipment to
the extent assignable, all licenses and permits; prepaid expenses with regard to
the Assets; trust funds belonging to the residents and held by the nursing home;
and any all pre-payments for room and service charges.
The land located at the address commonly known as 380 Broadway Avenue,
Sayville, New York together with all buildings and improvements, easements,
private roads and streets and fixtures and plumbing, heating, electrical, sewage
and HVAC systems; and any an all cash and cash equivalents, HUD or bank
reserves, bank accounts and other deposits and stocks and bonds; any and all
instruments, prepaid assets and deposits; the operating certificate issued to the
Seller by DOH of which is required to operate the nursing home; other than the
Operating Records, and any all tax and financial accounting records of the
Seller, minute books and other corporate records of the Seller, the Seller’s
corporate seal; the insurance policies and any pending claims; all personal
property owned or used by Theresa A Santmann in her office of the nursing
home; books and records related to the organization, maintenance and
existence of the Seller and any rights and interests of the Seller in or to the
Excluded Accounts or the Written Off Accounts.
All liabilities of the Seller arising from or relating to Assets, the operations or
business of the Nursing Home on or after the Closing Date; those commitments,
contracts, leases and agreements outstanding in respect of the Assets and the
operation of the Nursing Home, including, but not limited to the Nursing Home’s
Medicare and Medicaid Provider Agreements; the Accounts Payable that are
outstanding as of the Closing Date; any and all obligations of the Seller pursuant
to the collective bargaining agreement and any and all obligations of the Seller to
contribute to the 1199 SEIU United Healthcare Workers East and 1199 SEIU
Healthcare Employees Pension Funds.
$11,750,000 plus the assumption of the Assumed Liabilities.
$600,000 by a payment made to the order of the Escrow Agent, payable upon
execution of this Agreement. The balance of the purchase price shall be paid by
the Buyer to the Seller at the Closing.
Project # 121427-E Exhibit Page 5
The operational purchase price will be met as follows:
Bank Loan (2.75% interest rate for a 30 year term)
Equity
$9,250,000
2,500,000
The applicant submitted an affidavit, which is acceptable to the Department, in which the applicant agrees,
notwithstanding any agreement, arrangement or understanding between the applicant and the transferor to the
contrary, to be liable and responsible for any Medicaid overpayments made to the facility and/or surcharges,
assessments or fees due from the transferor pursuant to Article 28 of the Public Health Law with respect to the period
of time prior to the applicant acquiring its interest, without releasing the transferor of its liability and responsibility.
Currently, the facility does not have any outstanding liabilities.
Real Estate Purchase Agreement
The applicant has submitted a draft real estate purchase agreement for the nursing home site, summarized below:
Premises:
Seller:
Purchaser:
Purchase Price:
Payment of Purchase Price:
The site located at 300 Broadway Avenue, Sayville, New York where
Petite Fleur Nursing Home is located.
Petite Fleur Nursing Home
Petite Fleur Acquisition, LLC
$11,750,000
Payable at Closing
The real estate purchase price will be payable as follows:
Bank Loan (2.75% for a 30 year term)
$11,750,000
Lease Rental Agreement
The applicant has submitted a draft lease for the site that they will occupy after the change in ownership; which is
summarized below:
Lessor:
Lessee:
Term:
Rental:
Provisions:
Petite Fleur Acquisition, LLC
JOPAL Sayville, LLC
45 years
The annual rental payment is $1,401,309.80.
The lessee shall be responsible for utilities, maintenance and real estate taxes.
The facility is encumbered by a mortgage, with an original principal of $13,089,973, payable over 35 years and 6
months. The mortgage balance of July 1, 2012 will be approximately $11,368,117. The mortgage will mature in 2033.
Currently, Medicaid capital reimbursement is based on interest, amortization, and return on and return of equity
methodology. After the change in ownership, reimbursement will be based on return of and return on equity
reimbursement methodology.
Operating Budget
The applicant has submitted an operating budget, in 2012 dollars, for the first year subsequent to the change in
operator, summarized as follows:
Revenues:
Medicaid FFS
Medicare FFS
Commercial
Private Pay
Other
Total Revenues
Per Diem
Total
$245.03
582.54
358.06
390.35
$12,249,600
4,624,800
44,400
1,549,700
48,400
$18,516,900
Project # 121427-E Exhibit Page 6
Expenses:
Operating
Capital
Total Expenses
$262.91
32.90
$295.81
$16,307,334
2,040,695
$18,348,029
Net Income
$168,871
Utilization: (patient days)
Occupancy
62,026
94.40%
The following is noted with respect to the submitted RHCF operating budget:
o
Medicaid capital reimbursement will be based on return of and return on equity reimbursement
methodology after the change in ownership.
o
Budgeted case mix of 1.0580 is consistent with the facility’s experience.
o
Medicare, Private Pay and other revenues assume current payment rates.
o
Occupancy is projected at 94.40% during the first year subsequent to the change in operator. Projected
occupancy is consistent with historical experience.
o
Utilization, broken down by payor source, during the first year subsequent to the change in operator, is as
follows:
Medicaid FFS
Medicare FFS
Commercial
Private Pay
80.60%
12.80%
.20%
6.40%
Capability And Feasibility
The purchase price for the realty interests is $11,750,000 and the purchase price for the operational interests is
$11,750,000. The purchase price for these interests will be met as follows: Equity of $2,500,000 from the proposed
members and a bank financing of $21,000,000 for the operation and the real estate portion at an interest rate of 2.75%
for a 30 year term.
Working capital requirement is estimated at $3,058,004, which appears reasonable based on two months of first year
expenses subsequent to the change in operator. The applicant will finance $1,500,000 via a bank loan at an interest
rate of 5% for a five year term. The remainder, $1,558,004, will be provided via equity from the members personal
resources. Presented as BFA Attachment A are the personal net worth statements of the proposed members of
JOPAL Sayville, LLC, which indicates the availability of sufficient funds to meet the working capital requirement and
the equity towards the operation and the real estate purchase.
Presented as BFA Attachment C, is the pro-forma balance sheet of the operating entity, JOPAL Sayville, LLC,
indicating a positive $58,004 equity position as of the first day of operation subsequent to the change in operator.
Presented as BFA Attachment D, is the pro-forma balance sheet of the real estate entity, Petite Fleur Acquisition, LLC,
which indicates a $0 equity position as of the first day subsequent to the change in operator.
The submitted budget indicates a net income of $168,871 during the first year subsequent to the change in operator.
Following is a comparison of historical and projected revenue and expense:
2011 Historical Income
2011 Historical Expense
2011 Historical Net Income
Incremental Income
$19,879,145
17,598,183
$ 2,280,962
($1,362,245)
Project # 121427-E Exhibit Page 7
Incremental Expense
Incremental Net Income
749,846
($2,112,091)
Projected Net Income
$
168,871
Incremental income is the result of the decrease of Medicaid revenues by approximately $2,900,000 because of the
one-time retro-active adjustments in 2011. Also, incremental income will increase due to Medicare utilization
increasing by 2.06%. Incremental expenses include acquisition of capital expenses and lease rental payments.
Presented as BFA Attachment B, is the financial summary of Petite Fleur Nursing Home during the period 2009
through 2011. As shown on Attachment B, the facility had an average positive working capital position and an
average negative net asset position. The average negative net asset position is the result of 2010 losses. The facility
incurred a loss of $292,228 in 2010 due to two factors: Medicaid rates had not been approved by the CMS for
payment by NYSDOH; and, excessive overtime pay for nursing staff. Cost saving initiatives included a reduction in
facility contribution to employee health insurance premiums; and restrictions on overtime. The facility achieved an
average net income of $759,781 during the period 2009 through 2011 due to a positive Medicaid retroactive rate
adjustment resulting in a net income of $2,280,962 in 2011.
Presented as BFA Attachment E, is the financial summary of Carillon Nursing Home and Rehabilitation Center during
the period 2009 through 2011. As shown on Attachment E, the facility had an average positive working capital
position and an average positive net asset position. Also, the facility achieved an average net income of $691,492.
Presented as BFA Attachment F, is the financial summary of East Neck Nursing and Rehabilitation Center during the
period 2009 through 2011. As shown on Attachment F, the facility had an average positive working capital position
and an average positive net position. Also, the facility achieved an average net income of $875,938 from 2009
through 2011.
Presented as BFA Attachment G, is the financial summary of Mills Pond Nursing and Rehabilitation during the period
2009 through 2011. As shown on Attachment G, the facility had an average positive working capital and an average
positive net asset position.
Also, the facility achieved an average net income of $669,044 from 2010 through 2011.
Presented as BFA Attachment H, is the financial summary of Barnwell Nursing and Rehabilitation Center during the
period 2009 through 2011. As shown on Attachment H, the facility had an average negative working capital position
and an average positive net asset position during the period 2009 through 2011. Also, the facility achieved an
average net income of $357,644 during the period 2009 through 2011.
Subject to the noted contingencies, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Personal Net Worth Statement for Proposed Members
BFA Attachment B
Financial Summary
BFA Attachment C
Pro Forma Balance Sheet (Operation)
BFA Attachment D
Pro Forma Balance Sheet (Real Estate)
BFA Attachment E
Financial Summary Carillon Nursing Home and Rehabilitation
Project # 121427-E Exhibit Page 8
BFA Attachment F
Financial Summary East Neck Nursing Home and Rehabilitation Center
BFA Attachment G
Financial Summary Mills Pond Nursing and Rehabilitation
BFA Attachment H
Financial Summary Barnwell Nursing and Rehabilitation Center
BFA Attachment I
Establishment Checklist
Project # 121427-E Exhibit Page 9
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish JOPAL Sayville, LLC as the new operator of Petite Flour Nursing Facility, and with the
contingencies, if any, as set forth below and providing that each applicant fulfills the
contingencies and conditions, if any, specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121427 E
JOPAL Sayville, LLC d/b/a Petite Fleur Nursing
Facility
APPROVAL CONTINGENT UPON:
1. The submission of a commitment signed by the applicant which indicates that, within two years
from the date of the council approval, the percentage of all admissions who are Medicaid and
Medicare/Medicaid eligible at the time of admission will be at least 75 percent of the planning
area average of all Medicaid and Medicare/Medicaid admissions, subject to possible adjustment
based on factors such as the number of Medicaid patient days, the facility's case mix, the length
of time before private paying patients became Medicaid eligible, and the financial impact on the
facility due to an increase in Medicaid admissions. The Department reserves the right to require
continued reporting beyond the two year period. [RNR]
2. Submission of a working capital loan commitment that is acceptable to the Department of
Health. [BFA]
3. Submission of a loan commitment for the operating portion that is acceptable to the
Department. [BFA]
4. Submission of a loan commitment for the real estate portion that is acceptable to the
Department. [BFA]
5. Submission of a photocopy of a fully executed asset purchase agreement between Jopal
Sayville, LLC and Petite Fleur Nursing Home that is acceptable to the Department. [BFA,
CSL]
6. Submission of a photocopy of the fully executed real estate purchase agreement between
Petite Fleur Acquisition, LLC and Petite Fleur Nursing Home that is acceptable to the
Department. [BFA, CSL]
7. Submission of a photocopy of the fully executed lease between Petite Fleur Acquisition, LLC
and Jopal Sayville, LLC that is acceptable to the Department. [BFA, CSL]
8. Submission of a photocopy of the signed and dated Certificate of Assumed Name of Jopal
Sayville, LLC, indicating its intent to do business as Petite Fleur Nursing Facility, acceptable
to the Department. [CSL]
9. Submission of a photocopy of the signed and dated Operating Agreement of Jopal Sayville,
acceptable to the Department. [CSL]
10. Submission of a photocopy of the filed Articles of Organization of Jopal Sayville, acceptable
to the Department. [CSL]
11. Submission of a photocopy of the signed and dated Certificate of Amendment of the Articles
of Organization of Jopal Sayville, LLC acceptable to the Department. [CSL]
APPROVAL CONDITIONAL UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121407-E
150 Riverside OP, LLC
d/b/a The Riverside
County: New York (New York)
Purpose: Establishment
Program: Residential Health Care Facility
Submitted: May 29, 2012
Executive Summary
Description
150 Riverside OP, LLC d/b/a The Riverside, is seeking
approval to become the new operator of Kateri
Residence, an existing 520-bed, not-for-profit residential
health care facility (RHCF) located at 150 Riverside Drive,
in Manhattan. Catholic Health Care System is currently
the sole member of Kateri Residence. 150 Riverside OP,
LLC’s ownership is as follows:
Proposed Operator
150 RSD Ventures LLC (59%)
Membership and Interest
- Shanon Penson (100.00%)
150 Riverside Management
Group, LLC (21%)
- Sharon Einhorn (45.24%)
Devorah Friedman (45.24%)
Yossie Zucker
(9.52%)
DJ River OP, LLC (19%)
- Jay Eisenstadt
Helene Scharf
AS River OP, LLC (1%)
Ann Schon
(50.00%)
(50.00%)
The realty is being purchased by 150 Riverside, LLC,
which is owned by the following:
150 Riverside, LLC
150 RSD Property Ventures LLC
(59%)
Membership and Interest
- Andrew Penson (100.00%)
150 Riverside MN Property LLC
(21%)
- Mark Friedman
Neal Einhorn
Yossie Zucker
(45.24%)
(45.24%)
(9.52%)
DJ River Prop, LLC (19%)
- Jay Eisenstadt
David Scharf
(50.00%)
(50.00%)
DOH Recommendation
Contingent approval.
Need Summary
Kateri Residence’s occupancy exceeded the 97%
planning optimum from 2008 to 2010, with rates of 98.1%,
97.9%, and 98.3%, respectively. The facility also
reported Medicaid admissions of 24.5%and 16.7% in
2008 and 2009, respectively, both above the 75%
planning averages for New York County during those
years.
Program Summary
No negative information has been received concerning
the character and competence of the above applicants
identified as new members.
Financial Summary
The purchase price for the operating assets is
$14,000,000 and the real property is $66,000,000, totaling
$80,000,000 plus a maximum cost of $1,350,000 for the
sprinkler system based on invoice. The sprinkler system
will be funded through equity. The purchase price will be
paid by $16,000,000 in cash
and a $64,000,000 mortgage at 5.26% over a 10-year
term with a 30 year amortization.
There are no project costs associated with this proposal.
Budget:
Ann Schon (1%)
No changes in the program or physical environment are
proposed in this application.
Revenues:
Expenses:
Gain/(Loss):
$ 64,143,494
61,287,873
$ 2,855,621
Subject to the noted contingencies, it appears that the
applicant has demonstrated the capability to proceed in a
financially feasible manner.
Project # 121407-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
The submission of a commitment signed by the applicant which indicates that, within two years from the date of the council
approval, the percentage of all admissions who are Medicaid and Medicare/Medicaid eligible at the time of admission will be at
least 75 percent of the planning area average of all Medicaid and Medicare/Medicaid admissions, subject to possible
adjustment based on factors such as the number of Medicaid patient days, the facility’s case mix, the length of time before
private paying patients became Medicaid eligible, and the financial impact on the facility due to an increase in Medicaid
admissions. The DOH reserves the right to require continued reporting beyond the two year period. [RNR]
Submission of a loan commitment for working capital that is acceptable to the Department of Health. [BFA]
Submission of an executed building lease agreement that is acceptable to the Department of Health. [BFA]
Submission of a commitment acceptable to the Department of Health, for a permanent mortgage from a recognized lending
institution at a prevailing rate of interest within 120 days of receipt from the Office of Health Systems Management, Bureau of
Architectural and Engineering Facility Planning of approval of final plans and specifications and before the start of construction.
Included in the submitted permanent mortgage commitment must be a sources and uses statement and debt amortization
schedule, for both new and refinanced debt. [BFA]
Confirmation regarding the name of the facility. [CSL]
Submission of a photocopy of an executed Certificate of Assumed Name for 150 Riverside Op., LLC acceptable to the
Department. [CSL]
Submission of a photocopy of an executed proposed Certificate of Amendment to the Certificate of Formation of 150 Riverside
Op., LLC acceptable to the Department. [CSL]
Submission of a photocopy of an executed Application of Authority of 150 Riverside Op., LLC acceptable to the Department.
[CSL]
Submission of a photocopy of the executed Operating Agreement of 150 Riverside Op., LLC acceptable to the Department.
[CSL]
Submission of a photocopy of an executed proposed Certificate of Amendment to the Certificate of Formation of 150 RSD
Ventures, LLC, acceptable to the Department. [CSL]
Submission of a photocopy of an executed proposed Certificate of Amendment to the Certificate of Formation of DJ River Op.,
LLC, acceptable to the Department. [CSL]
Submission of a photocopy of an executed Application of Authority of DJ River Op., LLC, acceptable to the Department. [CSL]
Submission of a photocopy of an executed proposed Certificate of Amendment to the Articles of Incorporation of 150 Riverside
Management Group, LLC, acceptable to the Department. [CSL]
Submission of a photocopy of the executed Limited Liability Company Agreement of AS River Op., LLC, acceptable to the
Department. [CSL]
Submission of a photocopy of the executed Limited Liability Company Agreement of DJ River Op., LLC, acceptable to the
Department. [CSL]
Submission of a photocopy of the executed Limited Liability Company Agreement of 150 Riverside Management Group, LLC,
acceptable to the Department. [CSL]
nd
Submission of a list providing the name, membership interest and percentage ownership interest in the 2 Level member and
indirect ownership percentage in the Article 28 LLC.
Submission of photocopies of Exhibits A and C to the Purchase and Sale agreement.
Submission of a photocopy of an executed Certificate of Amendment or Certificate of Dissolution of Kateri Residence, Inc.,
acceptable to the Department. [CSL]
Submission of a photocopy of the executed Lease Agreement of 150 Riverside Op., LLC acceptable to the Department. [CSL]
Approval conditional upon:
1.
The transaction provides payment to the Seller for long term care real estate and operations. The Seller has represented and
confirmed to the Department that a majority of the sale proceeds will be reinvested into the development of a PACE program
and other long term care programs that add capacity in the region. This sale and project approval are conditioned upon the
Seller adhering to those commitments. [BFA]
Council Action Date
October 11, 2012.
Project # 121407-E Exhibit Page 2
Need Analysis
Background
Kateri Residence, a 520 bed voluntary not-for-profit facility located at 150 Riverside Drive, 10024, in New York County
seeks approval to enter into an asset purchase and sale agreement with 150 Riverside OP. LLC d\b\a The Riverside
(The Center).
Kateri Residence exceeded the planning optimum of 97% for 2008, 2009, and 2010. In addition Kateri exceeded New
York County and the NYC Region utilization for all years in question.
RHCF Occupancy
Kateri Residence New York
New York County
NYC Region
2008
98.1%
96.9%
94.5%
RHCF Bed Need
2016 Projected Need
Current Beds
Beds Under Construction
Total Resources
Unmet Need
2009
97.9%
96.7%
95.0%
2010
98.3%
96.5%
94.8%
New York City
51,071
43,343
79
43,422
7,649
Regulations indicate that the Medicaid patient admissions standard shall be 75% of the annual percentage of all
Medicaid admissions for the long term care planning area in which the applicant facility is located. Such planning area
percentage shall not include residential health care facilities that have an average length of stay 30 days or fewer. If
there are four or fewer residential health care facilities in the planning area, the applicable standard for a planning area
shall be 75% of the planning area percentage of Medicaid admissions, whichever is less. In calculating such
percentages, the Department will use the most current data which have been received and analyzed by the
Department.
An applicant will be required to make appropriate adjustments in its admission polices and practices so that the
proportion of its own annual Medicaid patients admissions is at least 75% of the planning area percentage of health
Systems Agency percentage, whichever is applicable.
Kateri Residence was above the 75 percent planning average for 2008 and 2009. The facility reported Medicaid
admissions of 24.5 percent and 16.7 percent in 2008 and 2009, respectively. The 75 percent planning averages for
New York County were 21.9 percent in 2008 and 11.7 percent 2009.
Kateri Residence has exceeded the planning optimum for occupancy and the Medicaid Access admissions standard.
Recommendation
From a need perspective, contingent approval is recommended.
Project # 121407-E Exhibit Page 3
Programmatic Analysis
Facility Information
Existing
Proposed
Facility Name
Kateri Residence
The Riverside
Address
150 Riverside Drive
Same
RHCF Capacity
ADHC Program Capacity
520
N/A
Same
N/A
Type of Operator
Class of Operator
Corporation
Voluntary not-for-profit
LLC
Proprietary
Operator
Kateri Residence
150 Riverside Op. LLC
2nd Level LLCs
150 RSD Ventures LLC
150 Riverside Management
Group LLC
DJ River Op LLC
AS River Op LLC
59.00%
21.00%
19.00%
1.00%
___________________________
MEMBERS:
150 RSD Ventures LLC
Shannon Penson
150 Riverside Management
Group LLC*
Sharon Einhorn
Devorah Friedman
Yossie Zucker
DJ River Op LLC
Jay Eisenstadt
Helene Scharf
100.00%
45.24%*
45.24%*
9.52%
50.00%
50.00%
AS River Op LLC
Ann Schon
100.00%
* Managing member
Character and Competence
•
FACILITIES REVIEWED:
Residential Health Care Facilities
Bellhaven Center for Rehabilitation and Nursing Care
Project # 121407-E Exhibit Page 4
03/2010 to present
•
Dumont Center for Rehabilitation and Nursing Care
New Vanderbilt Rehabilitation and Care Center
Sans Souci Rehabilitation and Nursing Center
08/2010 to present
01/2010 to present
10/2009 to present
Out-of-State Residential Health Care Facilities
Forbes Center for Rehabilitation and Healthcare
10/2011 to present
INDIVIDUAL BACKGROUND REVIEW:
Shannon Penson has been a homemaker and has not been employed for the past 10 years. She discloses no
ownership interest in health facilities.
Sharon Einhorn discloses employment history for the last 10 years. She has disclosed ownership interest in the
following residential health care facilities:
Bellhaven Center for Rehabilitation and Nursing Center
Dumont Center for Rehabilitation and Nursing Care
03/2010 to present
08/2010 to present
Devorah Friedman is NYS licensed speech language pathologist, license number 017276 and is in good standing.
She has disclosed ownership interest in the following residential health care facilities:
Bellhaven Center for Rehabilitation and Nursing Center
Dumont Center for Rehabilitation and Nursing Care
Sans Souci Rehabilitation and Nursing Center
03/2010 to present
08/2010 to present
10/2009 to present
Yossie Zucker is a certified public accountant (CPA), license number 094870-1 and is in good standing. He discloses
no ownership interest in health facilities.
Jay Eisenstadt is the president and partner of Esplanade Capital LLC, a real estate investment firm. He discloses
ownership interest in the following out-of-state residential health care facility:
Forbes Center for Rehabilitation and Healthcare
10/2011 to present
Helene Scharf is a NYS licensed speech language pathologist, license number 012601 and is in good standing. She
discloses no ownership interest in health facilities.
Ann Schon is a bookkeeper at the New Vanderbilt Rehabilitation and Care Center. She discloses ownership interest
in the following residential health care facility:
New Vanderbilt Rehabilitation and Care Center
01/2010 to present
Character and Competence – Analysis:
No negative information has been received concerning the character and competence of the above applicants
identified as new members.
A review of Bellhaven Center for Rehabilitation and Nursing Care, Dumont Center for Rehabilitation and Nursing Care,
and the New Vanderbilt Rehabilitation and Care Center reveals that a substantially consistent high level of care has
been provided since there were no enforcements for the time period reviewed.
A review of operations for San Souci Nursing Home for the period reveals the following:
•
The facility was fined $10,000 pursuant to a Stipulation and Order for surveillance findings on February 11,
2011. Deficiencies were found under 10 NYCRR 415.12(j): Quality of Care – Hydration.
A review of operations for the Sans Souci Rehabilitation and Nursing Center for the period results in a conclusion of
substantially consistent high level of care since there were no repeat enforcements.
Project # 121407-E Exhibit Page 5
A review of information provided by the Pennsylvania Department of Health for the Forbes Center for Rehabilitation
and Healthcare located in Pittsburgh, Pennsylvania for the period identified above results in a conclusion of
substantially consistent high level of care since there were no enforcements.
No changes in the program or physical environment are proposed in this application.
Recommendation
From a programmatic perspective, approva is recommended.
Financial Analysis
Asset Purchase and Sale Agreement
The change in ownership and real property will be effectuated in accordance with an executed asset purchase and
sale agreement, the terms of which are summarized below:
Date:
Seller:
Purchaser of Operating Assets:
Buyer of Real Property Assets:
Purchased Assets:
Excluded Assets:
Purchase Price:
Payment of Purchase Price:
March 27, 2012
Kateri Residence
150 Riverside OP, LLC
150 Riverside, LLC
The real estate and all assets used in operation of the facility.
Facilities; equipment; supplies and inventory; prepaid expenses;
documents and records; assignable leases, contracts, licenses and
permits; telephone numbers, fax numbers and all logos; resident trust
funds; deposits; accounts and notes receivable; cash, deposits and
cash equivalents;
Any security, vendor, utility or other deposits with any Governmental
Entity; any refunds, debtor claims, third-party retroactive adjustments
and related documents prior to closing, and personal property of
residents.
$14,000,000 for the operating interest and $66,000,000 for the real
property interest totaling $80,000,000 plus the cost of the new
sprinkler system up to a maximum amount of $1,350,000.
A total deposit of $5,000,000 paid to the trustee to be held in escrow
with the remaining $75,000,000 to be paid at closing. The sprinkler
system will be paid prior to 5 days of closing based on invoice.
Lease Agreement
Facility occupancy is subject to a draft lease agreement, the terms of which are summarized as follows:
Premises:
Lessor:
Lessee:
Terms:
Rental:
Provisions:
An 520 bed RHCF located at 150 Riverside Drive, New York
150 Riverside, LLC
150 Riverside OP, LLC
10 years commencing on the execution of the lease
$5,129,090 per year ($427,424 per month)
Lessee is responsible for taxes, insurance, utilities and maintenance
The lease arrangement is a non-arm’s length agreement. The applicant has submitted an affidavit attesting to the
relationship between the Landlord and operating entity.
The applicant is entering into a ten year lease to allow the operator to decide whether to continue operating the facility
at this site or to propose a new location, since the existing facility will be beyond its useful life and relocation maybe
inevitable if the costs of operating a nursing home in New York County become financially prohibitive.
Project # 121407-E Exhibit Page 6
Operating Budget
Following is a summary of the submitted operating budget for the RHCF, presented in 2012 dollars, for the first year
subsequent to change in ownership:
Revenues:
Medicaid
Medicare
Private Pay
$41,069,550
17,781,019
5,292,925
Total Revenues
$64,143,494
Expenses:
Operating
Capital
$54,792,101
6,495,772
Total Expenses
$61,287,873
Net Income
$2,855,621
Utilization: (patient days)
Occupancy
187,464
98.77%
The following is noted with respect to the submitted RHCF operating budget:
•
The capital component of the Medicaid rate is based on historical cost.
•
Expenses include lease rental.
•
Medicaid revenues include assessment revenues.
•
Medicaid rates are based on actual 2011 rates with no trend to 2012.
•
Overall utilization is projected at 98.77%, while utilization by payor source is expected as follows:
Medicaid
Medicare
Private Pay
•
79.44%
15.81%
4.75%
Breakeven occupancy is projected at 94.37%.
Capability and Feasibility
The purchase price of $14,000,000 for the operations will be financed by the proposed members’ equity. The
purchase price of the real property will be financed by a loan from Capital One Bank of $64,000,000 at an interest rate
of 5.26% for 10 years, with a 30 year amortization, with the remaining $2,000,000 from the members of 150 Riverside,
LLC equity. Presented as BFA Attachment B, is the net worth statement of proposed members, which shows
sufficient equity. A letter of interest has been submitted by Capital One bank.
The members of 150 Riverside LLC have submitted an affidavit stating that they will fund the balloon payment, should
acceptable financing not be available at the time the loan comes due after the 10 year period. Presented as BFA
Attachment E, is the interest and amortization schedule for the ten year term.
Working capital requirements are estimated at $10,214,646, based on two months of the first year expenses, which
$5,107,323 will be satisfied from the proposed member’s equity and the remaining $5,107,323 will be satisfied through
a loan from Capital One Bank at 5.26% over 5 years. A letter of interest has been supplied by the bank. An affidavit
from Shanon Penson, an applicant member, states that she is willing to contribute resources disproportionate to her
Project # 121407-E Exhibit Page 7
ownership percentages to cover necessary equity contributions. Presented as BFA Attachment B, is the Net Worth of
proposed members, which shows sufficient equity.
The submitted budget indicates that a net income of $2,855,621 would be maintained during the first year following
change in ownership. Presented as BFA Attachment C is the pro-forma balance sheet of 150 Riverside OP, LLC d/b/a
The Riverside, which indicates positive members’ equity of $19,107,323 as of the first day of operations.
The budget appears reasonable.
Staff notes that with the expected 2014 implementation of managed care for nursing home residents, Medicaid
reimbursement is expected to change from a state-wide price with a cost-based capital component payment
methodology to a negotiated reimbursement methodology. Facility payments will be the result of negotiations between
the managed long term care plans and the facility. At this point in time, it cannot be determined what financial impact
this change in reimbursement methodology will have on this project.
As shown on BFA Attachment D, the facility maintained positive working capital, net assets and a net income from
operations in 2010-2011 and as of May 31, 2012.
BFA Attachments F-I, Financial Summaries of affiliated RHCFs shows all four facilities have experienced negative
working capital and maintained positive equity and net income from operations for the periods shown. The reason for
negative working capital is due to the recording of the category due to third party payors as a current liability.
Based on the preceding, and subject to the noted contingencies, it appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Organizational Chart of proposed entities
BFA Attachment B
Net Worth of Proposed Members
BFA Attachment C
Pro-forma Balance Sheet,
BFA Attachment D
Financial Summary, Kateri residence
BFA Attachment E
Interest and Amortization Schedule
BFA Attachment F
Financial Summary, New Vanderbilt Rehabilitation & Care Center, Inc.
BFA Attachment G
Financial Summary, Sans Souci Rehabilitation & Care Center
BFA Attachment H
Financial Summary, Dumont Center for rehabilitation & Care
BFA Attachment I
Financial Summary, Bellhaven Center for Rehabilitation & Nursing Care
BHFP Attachment
Map
Project # 121407-E Exhibit Page 8
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 2801-a of the Public Health Law, on this 11th day of October, 2012,
having considered any advice offered by the Regional Health Systems Agency, the staff of the
New York State Department of Health, and the Establishment and Project Review Committee of
this Council and after due deliberation, hereby proposes to approve the following application to
establish 150 Riverside OP, LLC d/b/a The Riverside as the new operator of Kateri Residence,
and with the contingencies, if any, as set forth below and providing that each applicant fulfills
the contingencies and conditions, if any, specified with reference to the application, and be it
further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that any approval of this application is not to be construed as in any
manner releasing or relieving any transferor (of any interest in the facility that is the subject of
the application) of responsibility and liability for any Medicaid (Medicaid Assistance Program -Title XIX of the Social Security Act) or other State fund overpayments made to the facility
covering the period during which any such transferor was an operator of the facility, regardless
of whether the applicant or any other entity or individual is also responsible and liable for such
overpayments, and the State of New York shall continue to hold any such transferor responsible
and liable for any such overpayments, and be it further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
FACILITY/APPLICANT:
121407 E
150 Riverside OP, LLC d/b/a The Riverside
APPROVAL CONTINGENT UPON:
1. The submission of a commitment signed by the applicant which indicates that, within two
years from the date of the council approval, the percentage of all admissions who are
Medicaid and Medicare/Medicaid eligible at the time of admission will be at least 75 percent
of the planning area average of all Medicaid and Medicare/Medicaid admissions, subject to
possible adjustment based on factors such as the number of Medicaid patient days, the
facility’s case mix, the length of time before private paying patients became Medicaid
eligible, and the financial impact on the facility due to an increase in Medicaid admissions.
The DOH reserves the right to require continued reporting beyond the two year period.
[RNR]
2. Submission of a loan commitment for working capital that is acceptable to the Department of
Health. [BFA]
3. Submission of an executed building lease agreement that is acceptable to the Department
of Health. [BFA]
4. Submission of a commitment acceptable to the Department of Health, for a permanent
mortgage from a recognized lending institution at a prevailing rate of interest within 120 days
of receipt from the Office of Health Systems Management, Bureau of Architectural and
Engineering Facility Planning of approval of final plans and specifications and before the
start of construction. Included in the submitted permanent mortgage commitment must be a
sources and uses statement and debt amortization schedule, for both new and refinanced
debt. [BFA]
5. Confirmation regarding the name of the facility. [CSL]
6. Submission of a photocopy of an executed Certificate of Assumed Name for 150 Riverside
Op., LLC acceptable to the Department. [CSL]
7. Submission of a photocopy of an executed proposed Certificate of Amendment to the
Certificate of Formation of 150 Riverside Op., LLC acceptable to the Department. [CSL]
8. Submission of a photocopy of an executed Application of Authority of 150 Riverside Op.,
LLC acceptable to the Department. [CSL]
9. Submission of a photocopy of the executed Operating Agreement of 150 Riverside Op., LLC
acceptable to the Department. [CSL]
10. Submission of a photocopy of an executed proposed Certificate of Amendment to the
Certificate of Formation of 150 RSD Ventures, LLC, acceptable to the Department. [CSL]
11. Submission of a photocopy of an executed proposed Certificate of Amendment to the
Certificate of Formation of DJ River Op., LLC, acceptable to the Department. [CSL]
12. Submission of a photocopy of an executed Application of Authority of DJ River Op., LLC,
acceptable to the Department. [CSL]
13. Submission of a photocopy of an executed proposed Certificate of Amendment to the
Articles of Incorporation of 150 Riverside Management Group, LLC, acceptable to the
Department. [CSL]
14. Submission of a photocopy of the executed Limited Liability Company Agreement of AS
River Op., LLC, acceptable to the Department. [CSL]
15. Submission of a photocopy of the executed Limited Liability Company Agreement of DJ
River Op., LLC, acceptable to the Department. [CSL]
16. Submission of a photocopy of the executed Limited Liability Company Agreement of 150
Riverside Management Group, LLC, acceptable to the Department. [CSL]
17. Submission of a list providing the name, membership interest and percentage ownership
interest in the 2nd Level member and indirect ownership percentage in the Article 28 LLC.
18. Submission of photocopies of Exhibits A and C to the Purchase and Sale agreement.
19. Submission of a photocopy of an executed Certificate of Amendment or Certificate of
Dissolution of Kateri Residence, Inc., acceptable to the Department. [CSL]
20. Submission of a photocopy of the executed Lease Agreement of 150 Riverside Op., LLC
acceptable to the Department. [CSL]
APPROVAL CONDITIONAL UPON:
1. The transaction provides payment to the Seller for long term care real estate and
operations. The Seller has represented and confirmed to the Department that a majority of
the sale proceeds will be reinvested into the development of a PACE program and other
long term care programs that add capacity in the region. This sale and project approval are
conditioned upon the Seller adhering to those commitments. [BFA]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 112306-E
Hospitals Home Health Care, Inc.
County: Oswego (Fulton)
Purpose: Establishment
Program: Certified Home Health Agency
Submitted: November 22, 2011
Executive Summary
Description
This proposal seeks to de-establish Albert Lindley Lee
Memorial Hospital (A.L. Lee) as a member corporation
of Hospitals Home Health Care, Inc., a not-for-profit
Article 36 certified home health agency (CHHA),
leaving Oswego Health, Inc. as the sole remaining
corporate member of Hospitals Home Health Care, Inc.
(HHHC). This proposal also seeks PHHPC approval to
file with the NYS Department of State a Certificate of
Amendment to the Certificate of Incorporation to
change the legal corporate name of Hospitals Home
Health Care, Inc., to Oswego Health Home Care, Inc.
The applicant will continue to lease 2,400 square feet
of space located at 113 Schuyler Street, Fulton for
administrative offices and storage.
In 1991, A.L. Lee and Oswego Hospital became the
sole members of HHHC, each possessing 50%
membership. In 2009, A.L. Lee filed for bankruptcy
and ceased all licensed health care operations.
Through an arrangement approved by the Department
of Health, A.L. Lee’s facilities were transferred to
Oswego Hospital in 2010. As part of that transaction,
A.L. Lee agreed to withdraw as a member of HHHC,
subject to approval of the Department of Health. In the
interim, A.L. Lee executed a voting agreement with
Oswego Hospital, giving them authority to vote A.L.
Lee’s membership interests in HHHC. Oswego
Hospital has obtained financial support from the
Department of Health through a HEAL-NY grant to
develop an extension clinic at the site of the former
A.L. Memorial Hospital buildings to ensure the
continuation of healthcare needs for the residents of
Oswego County and surrounding communities.
Oswego Health, Inc., a not-for-profit corporation, was
established in 1997 to further promote and support the
charitable purposes of several entities including
Oswego Hospital and Seneca Hill Manor, Inc. Oswego
Health, Inc. serves as the sole member of each of
these entities.
DOH Recommendation
Contingent approval.
Program Summary
A review of all personal qualifying information indicates
there is nothing in the background of the board
members of Hospitals Home Health Care, Inc., and
Oswego Health, Inc., to adversely effect their positions
on the boards. The applicant has the appropriate
character and competence under Article 36 of the
Public Health Law.
Financial Summary
There are no project costs associated with this
application.
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 112306-E Exhibit Page 1
Recommendations
Health Systems Agency
The Central New York HSA recommends approval of this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission to the NYS Department of Health of a NYS Department of State filed, stamped, receipted, statesealed, and dated copy of the Certificate of Amendment to the Certificate of Incorporation for Hospitals Home
Health Care, Inc., to officially change its name to Oswego Health Home Care, Inc. [LTC]
Council Action Date
October 11, 2012.
Project # 112306-E Exhibit Page 2
Programmatic Analysis
Background
The current proposal seeks to de-establish Albert Lindley Lee Memorial Hospital as a member corporation of Hospitals
Home Health Care, Inc., and to convert the remaining member of Hospitals Home Health Care, Inc., from Oswego
Hospital to the hospital’s member corporation Oswego Health, Inc. Accordingly, Oswego Health, Inc. would be the
sole corporate member of Hospitals Home Health Care, Inc., and would also remain the sole corporate member of
Oswego Hospital. This proposal also seeks PHHPC approval to file a Certificate of Amendment to the Certificate of
Incorporation with the NYS Department of State to change the legal corporate name of Hospitals Home Health Care,
Inc., to Oswego Health Home Care, Inc.
In addition to becoming the sole member corporation of Hospitals Home Health Care, Inc. (proposed Oswego Health
Home Care, Inc.), Oswego Health, Inc. is the member sole corporation of Oswego Hospital, an Article 28 acute care
hospital, which also formerly operated Home Aide Service for Oswego County, an Article 36 LHCSA that closed
August 1, 2011. Oswego Health, Inc. is also the member corporation of Seneca Hill Manor, an Article 28 nursing
home; and Springside at Seneca Hill, an independent retirement community. All of the above facilities in the Oswego
Health, Inc. corporate structure are listed as affiliations for each board member named below.
The governing bodies of both Hospitals Home Health Care, Inc. (proposed Oswego Health Home Care, Inc.), and
Oswego Health, Inc., consist of the following board members:
Thomas Schneider (Chairperson)
President and CEO, Pathfinder Bank
Chris Burritt (Vice-Chairperson)
Owner, Burritt Motors (Auto Dealership)
John FitzGibbons (Treasurer)
Owner, FitzGibbons Agency (Insurance) and
FitzGibbons Real Estate (Real Estate)
Mary McGowan, Esq. (Secretary)
Attorney, Reynolds and McGowan, PLLC (Law
Firm)
Adjunct Professor, SUNY Oswego
Barbara J. Bateman
Senior VP, Alliance Bank
Pamela Caraccioli
Business Manager, Caraccioli and Associates,
PLLC (Law Firm)
Adjunct Professor, SUNY Oswego
William Clark
Owner, The Great Outdoors (Recreational Vehicle
Sales)
Additional Affiliations: Albert Lindley Lee Memorial
Hospital, including Phoenix Primary Care Center
D&TC, and Hannibal Primary Care Center D&TC
Peter K. Cullinan
Emergency Plant Instructor, Manager, Specialist,
and Human Performance Manager, Entergy
Nuclear Northeast (Nuclear Energy Plant)
Allison Duggan, MD
Self-Employed Physician and General Surgeon
VP Medical Affairs, Oswego Hospital
Adam C. Gagas
Principal, Breakwall Asset Management, LLC
(Investment Advisors)
Principal, Gagas Realty, Inc. (Commercial Real
Estate)
William Galloway
Real Estate Broker, Century 21 Galloway Realty
(Real Estate)
Ann C. Gilpin
President and CEO, Oswego Health, Inc.
Additional Affiliation: Jones Memorial Hospital,
Wellsville, NY
Bernie Henderson
Retired
Ellen Holst, RN
Health and Nutrition Administrator, Oswego
County
Opportunities, Inc. (Community Action agency)
Project # 112306-E Exhibit Page 3
Additional Affiliations: Oswego County
Department of Health (CHHA, LTHHCP, Hospice,
D&TC)
Paul Kurtzman
Executive Director, Oswego Industries, Inc.
(Community Rehabilitation Services)
David Vickery
Vice President, Leon Vickery, Inc. (Insurance
Agency)
Renato Mandanas, MD
Self-Employed Physician
Owner, Renato Mandanas, MD, PLLC, d/b/a
Primecare Medical Practice
Director, Pulmonary Function and Respiratory
Therapy Departments, Oswego Hospital
VP Medical Affairs and Sole Shareholder, Ontario
Medical Practice, PC
Joseph E. Mather, MD
Physician, Oswego County OB/GYN, PC
Patricia Mears
Corporate Secretary, Ernest Mears, DDS, PC
(Dental Practice)
Yvonne Petrella
Dean of Extended Learning, SUNY Oswego
Ricky D. Shaw, CPA
Partner, Green and Seifter CPAs, PLLC (CPA
Firm)
Mark Slayton, CPA
Director of Finance, Oswego College Foundation,
SUNY Oswego
James Tschudy
Pastor, Congregational United Church of Christ
Chaplain, St. Luke Residential Health Care
Facility
Adjunct Professor, SUNY Oswego
Linda Tyrell
Owner, Harbor Towne Gifts (Retail Gift Shop)
The applicant has confirmed that the proposed financial/referral structure has been assessed in light of anti-kickback
and self-referral laws, with the consultation of legal counsel, and it is concluded that proceeding with the proposal is
appropriate.
A search of all of the above named board members, employers, and affiliations revealed no matches on either the
Medicaid Disqualified Provider List or the Office of the Inspector General’s Provider Exclusion List.
The Office of the Professions of the NYS Education Department, NYSDOH Office of Professional Medical Conduct,
NYSDOH Physician Profile, and NYS Department of State Occupational Licensing indicate no issues with the
licensure of the health professionals and other licensed professionals associated with this application. In addition, the
attorney has submitted a Certificate of Good Standing.
The Division of Hospital Certification and Surveillance reviewed the compliance history of all affiliated hospitals, and
diagnostic and treatment centers, for the time period 2002 to 2012, or for the time periods specified as the affiliations,
whichever applied. It has been determined that the hospitals, and diagnostic and treatment centers, have provided a
substantially consistent high level of care.
The Division of Residential Services reviewed the compliance history of the affiliated nursing home for the time period
2002 to 2012. An enforcement action was taken against Seneca Hill Manor in 2002 based on an August, 2001 survey
citing violations in Resident Assessment and Care Planning: Comprehensive Care Plans. The action was resolved
with a $1000 civil penalty. It has been determined that the affiliated nursing home has provided a substantially
consistent high level of care.
The Division of Home and Community Based Services reviewed the compliance history of all affiliated certified home
health agencies, long term home health care programs, licensed home care service agencies, and hospices for the
time period 2002 to 2012, or for the time periods specified as the affiliations, whichever applied. An enforcement
action was taken against Hospitals Home Health Care, Inc. in 2003 based on a May, 2002 survey, citing violations in
Project # 112306-E Exhibit Page 4
Policies and Procedures of Service Delivery; Patient Assessment and Plan of Care; and Governing Authority. The
action was resolved with a $2500 civil penalty, $1250 of which was suspended. It has been determined that the
certified home health agencies, long term home health care programs, licensed home care service agencies, and
hospices have exercised sufficient supervisory responsibility to protect the health, safety, and welfare of patients and
to prevent the recurrence of code violations. When code violations did occur, it was determined that the operators
investigated the circumstances surrounding the violation, and took steps appropriate to the gravity of the violation that
a reasonably prudent operator would take to promptly correct and prevent the recurrence of the violation.
A review of all personal qualifying information indicates there is nothing in the background of the board members of
Hospitals Home Health Care, Inc., and Oswego Health, Inc., to adversely effect their positions on the boards. The
applicant has the appropriate character and competence under Article 36 of the Public Health Law.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Operating Budgets
The applicant has indicated there are no incremental operating expenses or revenues associated with this project
since patient care services will not be affected or interrupted.
Capability And Feasibility
There are no project costs associated with this application.
Presented as BFA Attachment B, a financial summary of Hospitals Home Health Care, Inc. indicates that the facility
has maintained positive working capital, a positive net asset position, and experienced a net loss of $76,274 and
$543,274 for 2010 and 2011 respectively. This represents 2.3% and 20% of the gross operating revenues
respectively. The applicant has stated that the losses were due to the loss of several RN case managers through May
of 2010, causing a decrease in admissions and the closure of Lee Memorial, causing recruitment of staff to become
difficult. In July 2011, HHHC formed a steering committee and developed a Turnaround Action Plan, which has taken
the following steps to improve operations:
•
•
•
•
Target admissions of 115 were met in August 2011.
As of September 15, 2011, all four vacant case manager positions were filled.
Revenue was maximized by increasing case manager work load.
Operating expenses were reduced by $23,000 a month.
Presented as BFA Attachment C, a financial summary of Oswego Health, Inc. and Affiliates indicates that the
corporation has maintained positive working capital, a positive net asset position and experienced a net loss from
operations of $5,431,132 and $3,350,045 for 2010 and 2011 respectively, which represents an average of 4% of gross
operating revenues. The applicant has indicated that the loss from operations was due to Oswego Hospital, the
largest component in the Oswego Health, Inc.’s consolidated statements, getting a significant reduction in their
Medicaid rate, the loss of physicians, a major renovation project to the facility and the implementation of a new
information system. The Hospital has been able to reduce costs and recruit new physicians, causing the loss from
operations to be decreased to $15,571, which represents 0.03% of gross operating revenues, as of May 31, 2012.
Based on the preceding, it appears that the applicant has demonstrated the capability to proceed in a financially
feasible manner, and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Project # 112306-E Exhibit Page 5
Attachments
BFA Attachment A
Organizational Chart, post approval
BFA Attachment B
Financial Summary, Hospitals Home Health Care, Inc. (2011 and 2010)
BFA Attachment C
Financial Summary, Oswego Health, Inc. and Affiliates (2010 and 2009)
BFA Attachment D
Internal Financial Summary as of February 29, 2012, Hospitals Home Health
Care.
BFA Attachment E
Internal Financial Summary as of May 31, 2012, Oswego Health Inc. and
Affiliates
Project # 112306-E Exhibit Page 6
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3606 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the Regional Health Systems Agency, the staff of the New
York State Department of Health, and the Establishment and Project Review Committee of this
Council, and after due deliberation, hereby approves the following application to de-establish
Albert Lindley Lee Memorial as a member of Hospitals Home Health Care, Inc., and with the
contingencies, if any, as set forth below and providing that each applicant fulfills the
contingencies and conditions, if any, specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER
APPLICANT/FACILITY
112306 E
Hospitals Home Health Care, Inc.
APPROVAL CONTINGENT UPON:
1. Submission to the NYS Department of Health of a NYS Department of State filed, stamped,
receipted, state-sealed, and dated copy of the Certificate of Amendment to the Certificate of
Incorporation for Hospitals Home Health Care, Inc., to officially change its name to Oswego
Health Home Care, Inc. [LTC]
APPROVAL CONDITIONED UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies (4
copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121358-E
Catholic Health Care System
d/b/a Archcare
County: Kings (Brooklyn)
Purpose: Establishment
Program: Certified Home Health Agency
Submitted: May 1, 2012
Executive Summary
Description
Catholic Health Care System (CHCS) d/b/a Archcare,
an existing not-for-profit corporation, requests approval
to become the sole corporate member of Empire State
Home Care Services (Empire), and Visiting Nurse
Association of Brooklyn, Inc. (VNA of Brooklyn), both
located at 15 Metrotech Center, 10th floor, Brooklyn.
Each operates an Article 36 certified home health
agency (CHHA) and long-term home health care
program (LTHHCP).
Empire provides CHHA services in the following six
counties: Bronx, Kings, New York, Queens, Richmond
and Westchester, and provides LTHHCP services in
New York County with a program capacity of 200.
VNA of Brooklyn provides CHHA services in Kings
County, and LTHHCP services in Kings and Queens
Counties with program capacity of 750. Visiting Nurse
Regional Health Care System will no longer be the
non-member parent of the two CHHAs.
There is no acquisition cost or purchase agreement
involved in the transition of Catholic Health Care
System as the sole corporate member. The sole
corporate member arrangement is expected to:
•
•
•
•
promote the sharing of clinical best practices and
joint training opportunities;
integrate and centralize administrative functions;
produce cost savings and efficiencies through
group purchasing;
improve staff recruitment and retention;
and enhance the System’s marketing presence.
There will be no change in lease arrangements nor any
programmatic changes.
DOH Recommendation
Contingent approval.
Need Summary
As this project involves only a change in the ownership
of a CHHA, no Need recommendation is required.
Program Summary
A review of all personal qualifying information indicates
there is nothing in the background of the board
members of Providence Health Services, Catholic
Health Care System, d/b/a Archcare, Visiting Nurse
Association of Brooklyn, Inc., and Empire State Home
Care Services, Inc., to adversely effect their positions
on the boards. The applicant has the appropriate
character and competence under Article 36 of the
Public Health Law.
Financial Summary
There are no project costs associated with this project
and there will be no change in the daily operations.
It appears that the applicant has demonstrated the
capability to proceed in a financially feasible manner.
Project # 121358-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of completed, signed, and notarized Schedule 2As and Schedule 2Cs for Cardinal Timothy Dolan and
Bishop Robert Brucato. [LTC]
2. Submission of Certificates of Good Standing for the following attorneys: Monsignor Gregory A. Mustaciuolo,
Francis J. Serbaroli, John T. Dunlap, Rory Kelleher, and Kathryn K. Rooney. [LTC]
3. Submission of a photocopy of the executed Certificate of Incorporation of Empire State Home Care Services, Inc.,
and any amendments thereto, acceptable to the Department. [CSL]
4. Submission of a photocopy of the adopted Amended and Restated Bylaws of Empire State Home Care Services,
Inc., acceptable to the Department. [CSL]
5. Submission of a photocopy of the executed Certificate of Incorporation of Visiting Nurse Association of Brooklyn,
Inc., and any amendments thereto, acceptable to the Department. [CSL]
6. Submission of a photocopy of the adopted Amended and Restated Bylaws of Visiting Nurse Association of
Brooklyn, Inc., acceptable to the Department. [CSL]
Council Action Date
October 11, 2012.
Project # 121358-E Exhibit Page 2
Programmatic Analysis
Background
Empire State Home Care Services, Inc., is a not-for-profit Article 36 certified home health agency (CHHA) serving
Bronx, Kings, New York, Queens, Richmond, and Westchester Counties, and long term home health care program
(LTHHCP) serving New York County. Visiting Nurse Association of Brooklyn, Inc., is a not-for-profit Article 36 certified
home health agency (CHHA) serving Kings County, and long term home health care program (LTHHCP) serving Kings
and Queens Counties. The current non-member parent corporation of both is Visiting Nurse Regional Health Care
System, a not-for-profit corporation.
The current proposal seeks to de-establish Visiting Nurse Regional Health Care System as the non-member parent
corporation, and to establish Catholic Health Care System, d/b/a Archcare, a not-for-profit corporation, as the active
sole member (parent) corporation of both Empire State Home Care Services, Inc. CHHA and LTHHCP, and Visiting
Nurse Association of Brooklyn, Inc. CHHA and LTHHCP. The sole member (parent) corporation of Catholic Health
Care System, d/b/a Archcare, is Providence Health Services, a not-for-profit corporation.
In addition to becoming the sole member corporation of Empire State Home Care Services, Inc. CHHA and LTHHCP,
and Visiting Nurse Association of Brooklyn, Inc. CHHA and LTHHCP, Catholic Health Care System, d/b/a Archcare is
also the member corporation of the following health care corporations:
•
•
•
•
•
•
•
•
•
•
Calvary Hospital, Inc. - including Calvary Hospital (Hospital), Calvary Hospital Home Health Agency
(CHHA), and Calvary Hospital Home Health Agency and Hospice Care (Hospice),
Carmel Richmond Healthcare and Rehabilitation Center (RHCF),
Ferncliff Nursing Home (RHCF),
Kateri Residence (RHCF),
Mary Manning Walsh Nursing Home (RHCF),
St. Vincent DePaul Residence (RHCF),
St. Teresa’s Nursing and Rehabilitation Center (RHCF),
Terence Cardinal Cooke Health Care Center (RHCF),
CMLTC, Inc., d/b/a Archcare Senior Life (PACE Program and proposed Managed Long Term Care Plan), and
CSNP, LLC, d/b/a Archcare Advantage (Medicare Advantage Special Needs Plan)
All of the above health care facilities and providers in the Catholic Health Care System, d/b/a Archcare corporate
structure are listed as affiliations for each board member named below.
The governing body of the ultimate member (parent) corporation, Providence Health Services, consists of the following
board members:
Cardinal Timothy Dolan
(disclosure pending – see contingency)
Bishop Robert Brucato
(disclosure pending – see contingency)
Bishop Dennis J. Sullivan
Vicar General, Archdiocese of New York
(Religious Organization)
Monsignor Gregory A. Mustaciuolo, Esq.
Chancellor, Archdiocese of New York (Religious
Organization)
The governing bodies of the member (parent) corporation, Catholic Health Care System, d/b/a Archcare, and of
Empire State Home Care Services, Inc. CHHA and LTHHCP, and Visiting Nurse Association of Brooklyn, Inc. CHHA
and LTHHCP, all consist of the same individual board members as follows:
Francis J. Serbaroli, Esq. (Chairperson)
Partner, Greenberg Traurig, LLP (Law Firm)
Karl P. Adler, MD (Vice-Chairperson / Secretary)
CEO, New York Medical College (Medical School)
Project # 121358-E Exhibit Page 3
Additional Affiliations: St. Vincent’s Hospital, St.
Clare’s / St. Vincent’s Midtown Hospital, Our Lady
of Mercy Hospital, St. Agnes Hospital, Benedictine
Hospital, St. Francis Hospital, Center for
Comprehensive Health Practice (D&TC)
Thomas M. O’Brien (Vice-Chairperson)
Self Employed Banking Consultant
Bishop Dennis J. Sullivan
(disclosed above)
Monsignor Gregory A. Mustaciuolo, Esq.
(disclosed above)
Manfred Altstadt, CPA
Retired COO, Mutual of America (Insurance
Corp)
Joseph P. Anderson
Retired CEO, Schaller Anderson, Inc. (Health
Care Management / Administrative Services)
Monsignor William Belford
Diocesan Administrator / Parish Priest,
Archdiocese of New York (Religious Organization)
John T. Dunlap, Esq.
Partner, Dunnington, Bartholow, and Miller, LLP
(Law Firm)
Monsignor Charles J. Fahey, LMSW
Retired Professor, Fordham University (Higher
Education)
Additional Affiliations: Village Center for Care,
d/b/a VillageCare (RHCF, CHHA, and LTHHCP),
Isabella Geriatric Center, Inc. (RHCF and
LTHHCP)
Thomas J. Fahey, MD
Retired Senior VP, Memorial Sloan Kettering
Cancer Center (Cancer Health Care), Retired
Associate Dean, Cornell University Medical
College (Medical College)
Eric P. Feldmann, Real Estate Broker
CEO / Executive Director, Sisters of Charity
Housing Development Corporation (Affordable
Housing)
Rory Kelleher, Esq.
Senior Counsel, Sidley Austin, LLP (Law Firm)
Scott La Rue, Registered Dietician / Nutritionist
CEO / President, Catholic Health Care System,
d/b/a Archcare (NFP Health Care System)
John Marinelli
Managing Director, Arc Partners, Inc. (Consulting
Firm)
Kathryn K. Rooney, Esq.
Retired Intern / Counsel to Senator Marchi, NYS
Senate (State Government Legislature)
Additional Affiliations: Richmond University
Medical Center (Hospital), Homemakers of Staten
Island, Inc., d/b/a Safe Harbor Healthcare Services
(LHCSA)
The applicant has confirmed that the proposed financial/referral structure has been assessed in light of anti-kickback
and self-referral laws, and with the consultation of legal counsel, it is concluded that proceeding with the proposal is
appropriate.
A search of all of the above named board members, employers, and affiliations revealed no matches on either the
Medicaid Disqualified Provider List or the Office of the Inspector General’s Provider Exclusion List.
Project # 121358-E Exhibit Page 4
The NYS Education Department’s Office of the Professions, NYSDOH Office of Professional Medical Conduct,
NYSDOH Physician Profile, NYS Department of State Occupational Licensing, and NYS Unified Court System all
indicate no issues with the licensure of the health professionals and other licensed professionals associated with this
application. Submissions of Certificates of Good Standing by the attorneys listed above are pending (see
contingency).
The Division of Hospital Certification and Surveillance reviewed the compliance history of all affiliated hospitals, and
diagnostic and treatment center, for the time period 2002 to 2012, or for the time periods specified as the affiliations,
whichever applied.
An enforcement action was taken against St. Vincent’s Hospital in 2006 citing violations in medical resident working
hours regulations. This action was resolved with a $6,000 civil penalty. An additional enforcement action was taken
against St. Vincent’s Hospital in 2007 citing violations in medical resident working hours regulations. This action was
resolved with a $25,000 civil penalty. An additional enforcement action was taken against St. Vincent’s Hospital in
2007 citing the elopement of two psychiatric patients, one of which committed suicide. This action was resolved with a
$6,000 civil penalty. An additional enforcement action was taken against St. Vincent’s Hospital in 2008 citing violations
in medical resident working hours regulations. This action was resolved with a $12,000 civil penalty.
It has been determined that the hospitals, and diagnostic and treatment center, have provided a substantially
consistent high level of care.
The Division of Residential Services reviewed the compliance history of the affiliated nursing homes for the time period
2002 to 2012, or for the time periods specified as the affiliations, whichever applied.
An enforcement action was taken against Kateri Residence in 2009 based on a March, 2008 survey citing violations in
Quality of Care; and Quality of Care: Accidents. The action was resolved with a $4000 civil penalty.
An enforcement action was taken against Mary Manning Walsh Nursing Home in 2005 based on May 2002, and
September 2003, surveys citing violations in Quality of Care; and Quality of Care: Medication Errors. The action was
resolved with a $3000 civil penalty.
An enforcement action was taken against St. Teresa’s Nursing Home in in 2004 based on an August, 2003 survey
citing violations in Quality of Care: Accidents. The action was resolved with a $2000 civil penalty.
An enforcement action was taken against Terence Cardinal Cooke Health Care Center in 2004 based on a November,
2002 survey citing violations in Quality of Care. The action was resolved with a $1000 civil penalty. An additional
enforcement action was taken against Terence Cardinal Cooke Health Care Center in 2005 based on an April, 2005
survey citing violations in Resident Assessment and Care Planning: Comprehensive Care Plans; Quality of Care:
Accidents; Organization and Administration: Governing Body; and Organization and Administration: Nurse Aide
Certification and Training. The action was resolved with a $4000 civil penalty. An additional enforcement action was
taken against Terence Cardinal Cooke Health Care Center in 2007 based on a February, 2007 survey citing violations
in Quality of Care: Accidents; and Organization and Administration. The action was resolved with a $3000 civil
penalty. An additional enforcement action was taken against Terence Cardinal Cooke Health Care Center in 2009
based on a March, 2008 survey citing violations in Quality of Care: Accidents; Organization and Administration; and
Organization and Administration: Governing Body. The action was resolved with a $6000 civil penalty. An additional
enforcement action was taken against Terence Cardinal Cooke Health Care Center in 2011 based on an April, 2010
survey citing violations in Quality of Care: Highest Practicable Potential. The action was resolved with a $2000 civil
penalty.
An enforcement action was taken against Village Center for Care, d/b/a VillageCare Rehabilitation and Nursing
Center, in 2004 based on an April, 2003 survey citing violations in Quality of Care: Accidents. The action was
resolved with a $2000 civil penalty. An additional enforcement action was taken against Village Center for Care, d/b/a
VillageCare Rehabilitation and Nursing Center, in 2009 based on an April, 2008 survey citing violations in Quality of
Care. The action was resolved with a $2000 civil penalty.
It has been determined that the affiliated nursing homes have provided a substantially consistent high level of care.
Project # 121358-E Exhibit Page 5
The Division of Home and Community Based Services reviewed the compliance history of all affiliated certified home
health agencies, long term home health care programs, licensed home care service agencies, and hospices for the
time period 2002 to 2012, or for the time periods specified as the affiliations, whichever applied.
An enforcement action was taken against Village Center for Care, d/b/a VillageCare Long Term Home Health Care
Program in 2005 based on April 2005 and June 2005 surveys, citing violations in Policies and Procedures of Service
Delivery; Patient Care; and Governing Authority. This action was resolved with a $3000 civil penalty, $1500 of which
was suspended.
An enforcement action was taken against Village Center for Care, d/b/a VillageCare Certified Home Health Agency in
2005 based on an August 2005 survey, citing violations in Policies and Procedures of Service Delivery; and Governing
Authority. This action was resolved with a $4000 civil penalty.
It has been determined that the certified home health agencies, long term home health care programs, licensed home
care service agencies, and hospices have exercised sufficient supervisory responsibility to protect the health, safety,
and welfare of patients and to prevent the recurrence of code violations. When code violations did occur, it was
determined that the operators investigated the circumstances surrounding the violation, and took steps appropriate to
the gravity of the violation that a reasonably prudent operator would take to promptly correct and prevent the
recurrence of the violation.
The Division of Managed Long Term Care reviewed the compliance history of the affiliated Medicare Advantage
Special Needs Plan, and PACE Program, for the time period 2002 to 2012, or for the time periods specified as the
affiliations, whichever applied. It has been determined that both plans have provided a substantially consistent high
level of care.
A review of all personal qualifying information indicates there is nothing in the background of the board members of
Providence Health Services, Catholic Health Care System, d/b/a Archcare, Visiting Nurse Association of Brooklyn,
Inc., and Empire State Home Care Services, Inc., to adversely effect their positions on the boards. The applicant has
the appropriate character and competence under Article 36 of the Public Health Law.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Capability and Feasibility
There are no significant issues of capability or feasibility associated with this application. There will be no change in
the daily operations of each health care facility, although each facility is expected to experience cost benefits from the
sole corporate member designation.
Presented as BFA Attachment B is the pro-forma balance sheet of Catholic Health Care System as sole Member,
which shows on the first day of operation of VNA and Empire there will be an allocation of investment assets of
$16,856,975 and $7,384,727, respectively, to both CHHAs, therefore maintaining positive working capital.
Presented as BFA Attachment C is the financial summary of the Visiting Nurse Regional Health Care System, Inc.,
which has maintained positive net asset positions and generated excess revenues in 2011, and also through March
31, 2012. The applicant indicates that Visiting Nurse Regional Health Care System, Inc. allocates a significant
proportion of their liquid investment assets as long term assets, which are available and should be taken into
consideration in reviewing for positive working capital for 2011, as well as through March 31, 2012.
Presented as BFA Attachments D is the financial summary of the Catholic Health Care System, Inc., which has
maintained positive working capital, net asset positions, and experienced a net loss from operations in the years
shown for 2011, and also through March 31 2012. The net losses from operations are due to the start-up of its PACE
program, a dual-eligible Managed Long Term Care Plan. The applicant indicates that the losses will be eliminated
once the program is fully operational and generates revenue to cover its operating expenses.
Project # 121358-E Exhibit Page 6
Based on the preceding, it appears that the applicant has demonstrated the capability to proceed in a financially
feasible manner, and approval is recommended.
Recommendation
From a financial perspective, approval is recommended.
Attachments
BFA-Attachment A
Organizational Chart
BFA-Attachment B
Pro-forma Balance Sheet
BFA-Attachment C
Financial Summaries for Visiting Nurse Regional Health Care System,
Inc., 2011 and March 31, 2012 internal
BFA-Attachment D
Financial Summary for Catholic Health Care System 2011 and March
31, 2012 internal
Project # 121358-E Exhibit Page 7
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3606 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the Regional Health Systems Agency, the staff of the New
York State Department of Health, and the Establishment and Project Review Committee of this
Council, and after due deliberation, hereby approves the following application to establish
Catholic Health Care System d/b/a Archcare, to become the sole corporate member of Empire
State Home Care Services and Visiting Nurse Association of Brooklyn, Inc., and with the
contingencies, if any, as set forth below and providing that each applicant fulfills the
contingencies and conditions, if any, specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER
APPLICANT/FACILITY
121358 E
Catholic Health Care System d/b/a Archcare
APPROVAL CONTINGENT UPON:
1. Submission of completed, signed, and notarized Schedule 2As and Schedule 2Cs for
Cardinal Timothy Dolan and Bishop Robert Brucato. [LTC]
2. Submission of Certificates of Good Standing for the following attorneys: Monsignor Gregory
A. Mustaciuolo, Francis J. Serbaroli, John T. Dunlap, Rory Kelleher, and Kathryn K. Rooney.
[LTC]
3. Submission of a photocopy of the executed Certificate of Incorporation of Empire State
Home Care Services, Inc., and any amendments thereto, acceptable to the Department.
[CSL]
4. Submission of a photocopy of the adopted Amended and Restated Bylaws of Empire State
Home Care Services, Inc., acceptable to the Department. [CSL]
5. Submission of a photocopy of the executed Certificate of Incorporation of Visiting Nurse
Association of Brooklyn, Inc., and any amendments thereto, acceptable to the Department.
[CSL]
6. Submission of a photocopy of the adopted Amended and Restated Bylaws of Visiting Nurse
Association of Brooklyn, Inc., acceptable to the Department. [CSL]
APPROVAL CONDITIONED UPON:
N/A
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 121318-E
Northern Lights Health Care Partnership, Inc.
d/b/a Northern Lights Home Health Care
County: St. Lawrence (Canton)
Purpose: Establishment
Program: Certified Home Health Agency
Submitted: April 20, 2012
Executive Summary
Description
Northern Lights Health Care Partnership, Inc., d/b/a
Northern Lights Home Health Care, a proposed Article
36 not-for-profit corporation, requests approval to
establish a new certified home health agency (CHHA)
to serve St. Lawrence County. The members of
Northern Lights Health Care Partnership, Inc., consist
of four health care organizations from St. Lawrence
County: Claxton-Hepburn Medical Center,
Ogdensburg; United Helpers Management Company,
Inc., Ogdensburg; Canton-Potsdam Hospital, Potsdam;
and Hospice and Palliative Care of St Lawrence
Valley, Inc., Potsdam. Each of the four proposed
members will have a 25% interest in the applicant.
On December 8, 2011 the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. Northern Lights Health
Care Partnership, Inc., submitted an application in
response to the competitive RFA, and was awarded
RFA approval. This CON application is in response to
the RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal # 5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Contingent approval.
Need Summary
The applicant provided comprehensive analysis of
demographic data to establish public need based on
709.1(a) as well as unmet community need. The
information presented demonstrated the applicants in
depth knowledge of the health needs of the
community.
Program Summary
The applicant has the appropriate character and
competence under Article 36 of the Public Health Law.
Financial Summary
There are no project costs associated with this
proposal.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 2,013,400
1,684,870
$
328,530
Subject to the noted contingencies, the applicant has
demonstrated the capability to proceed in a financially
feasible manner.
Project # 121318-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of an executed building lease that is acceptable to the Department of Health. [BFA]
2. Submission of a photocopy of the executed Management and Administrative Services Agreement between the
applicant and United Helpers Canton Nursing Home, Inc. acceptable to the Department. [BFA, CSL]
3. Submission of a photocopy of the signed and dated Certificate of Incorporation of Northern Lights Health Care
Partnership, Inc., acceptable to the Department. [CSL]
4. Submission of evidence of adoption of the bylaws of Northern Lights Health Care Partnership, Inc. acceptable to
the Department. [CSL]
Approval conditional upon:
1. Pursuant to 10 NYCRR 760.8, the applicant shall be providing services in the entire geographic area approved by
the Council within one year of the Council’s approval. The failure, neglect or refusal of an applicant for the
establishment of a new certified home health agency to commence operation of the certified home health agency
within one year of issuance of the Council’s approval or contingent approval of the application shall constitute an
abandonment of the application by the applicant, with any such approval to be deemed cancelled and withdrawn
without further action by the Council. [CHA]
Council Action Date
October 11, 2012.
Project # 121318-E Exhibit Page 2
Need Analysis
Background
Northern Lights Home Health Care Partnership, Inc. d/b/a Northern Lights Home Health Care is requesting approval to
establish a new Article 36 Certified Home Health Agency (CHHA) to serve St. Lawrence County.
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval would ensure
access to CHHA services in counties with fewer than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
The Northern Lights Home Health Care Partnership, Inc. d/b/a Northern Lights Home Health Care’s (NLHCP) proposal
demonstrated the applicants’ capacity to successfully implement the MRT initiatives and support the goals of the
Department in advancing these initiatives. The proposed CHHA is a collaboration of four health care organizations:
Canton-Potsdam Hospital, Hospice of St. Lawrence Valley, Inc., United Helpers Management Company, Inc., and
Claxton-Hepburn Medical Center. The applicant described their experience providing services to Medicare and
Medicaid beneficiaries and the advantages the establishment of the proposed CHHA will have in aligning their
Project # 121318-E Exhibit Page 3
operations with MRT Initiatives. The applicant described strategies to transition Medicaid beneficiaries from traditional
fee-for-service to MLTCPs. The proposed CHHA will assure continuity of care for patients by providing case
management to patients of all four NLHCP collaborating organizations.
NLHCP discussed the challenges posed by St. Lawrence County’s size and geographically dispersed population. By
combining resources NLHCP providers will have the necessary capacity to meet home health care needs of residents
countywide. NLHCP provided details of their existing linkages and referral sources within the county and described
their experience as providers of health care to Medicare and Medicaid beneficiaries. The collaborations offer an
existing network of relationships that will support and enhance the effectiveness of home health care delivery by the
proposed CHHA.
The applicant provided comprehensive analysis of demographic data to establish public need based on 709.1(a) as
well as unmet community need. The information presented demonstrated the applicants in depth knowledge of the
health needs of the community. They also described the in and out-migration for specific services and surmised that
St. Lawrence county residents rely more heavily on their local health care system for primary and recovery care than
they do for complex medical and surgical cases. The applicant also showed that county residents who travel outside of
the region for advanced procedures were unable to return to the region for home health care due to lack of capacity
among home health care providers.
One of the collaborating organizations currently cross-trains CNA's and HHA's who can work both in home care and in
residential services. Strategic placement of staff will reduce staff travel time, maximizing productivity and containing
costs and ensure county wide coverage. The applicant also discussed Health Information Technology used by the
partnership members as well as plans for a technology subcommittee to review current resources and develop
protocols for the CHHA. Their proposal demonstrated how they will improve care coordination, reduce inadequate care
transitions and build access to efficient/effective community-based systems of care.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Northern Lights Home Health Care Partnership, Inc. d/b/a Northern Lights Home Health Care is a proposed not-forprofit corporation requesting approval to become established as a CHHA under Article 36 of the Public Health Law,
with approval to serve St. Lawrence. The proposed CHHA is collaboration by four St. Lawrence health care
organizations: Canton-Potsdam Hospital, Hospice of St. Lawrence Valley, Inc., United Helpers Management
Company, Inc., and Claxton-Hepburn Medical Center.
The applicant proposes to operate the CHHA from an office located at 205 State Street Road, Canton, New York
13617. The applicant proposes to provide the following health care services:
Nursing
Physical Therapy
Speech Language Pathology
Nutrition
Audiology
Respiratory Therapy
Housekeeper
Home Health Aide
Occupational Therapy
Medical Social Services
Medical Supplies, Equipment, and Appliances
Personal Care
Homemaker
The Board of Directors of Northern Lights Home Health Care Partnership, Inc. d/b/a Northern Lights Home Health
Care will be as follows:
Brian D. Gardam – Chairperson
Executive Director, Hospice of Palliative Care of
Steve E. Knight – Vice Chairperson
Chief Executive Officer – United Helpers
Project # 121318-E Exhibit Page 4
St. Lawrence Valley
Affiliations:
• Canton-Potsdam Hospital (2011-present)
• Canton Enriched Housing (2006-present)
• Planned Parenthood of Northern NY
(2006-2008)
Management Company
David B. Acker, Esq. – Treasurer
President, Chief Executive Officer, CantonPotsdam Hospital
Affiliations:
• Warren State Hospital, Pennsylvania
(2002-2003)
Jennie H. Flanagan, RN – Secretary
Director of Compliance/Accreditation, ClaxtonHepburn Medical Center
Margaret E. Madden – Director
Provost and Vice President of Academic Affairs
and Professor of Psychology, State University of
New York at Potsdam
Affiliations:
• Canton-Potsdam Hospital (2004-present)
Rev. Thomas T. Patterson – Director
Retired
Affiliations:
• Hospice of St. Lawrence Valley
(2003-present)
• Claxton-Hepburn Medical Center
(1978-present)
Maureen L. Missert – Director
Substitute Teacher, Ogdensburg City School
District
Affiliations:
• Claxton-Hepburn Medical Center (2003present)
Martha K. MacArthur
Retired
Affiliations:
• United Helpers Nursing Home
(2009-present)
• United Helpers Canton Nursing Home
(2009-present)
• United Helpers Residence (2009-present)
• United Helpers Care, Inc. (2009-present)
Northern Lights Home Health Care Partnership, Inc. d/b/a Northern Lights Home Health Care will have four corporate
members:, Canton-Potsdam Hospital, Hospice of St. Lawrence Valley, Inc., United Helpers Management Company,
Inc., and Claxton-Hepburn Medical Center.
The Board of Directors of Canton-Potsdam Hospital is as follows:
Margaret E. Madden – Chairperson
(Previously Disclosed)
Judy C. Chitten – Vice Chairperson
Retired
Affiliations:
• Canton-Potsdam Hospital Foundation
John E. Dewar, MD – 2nd Vice Chairperson
Detox Unit Director, Canton-Potsdam Hospital
Kathryn L. Mullaney – Treasurer
Vice President of Finance, St. Lawrence
University
Judy A. Chase – Secretary
Dental Hygienist, Smile Associates
Ronald E. Berry
Retired
Project # 121318-E Exhibit Page 5
Paul A. Cole – Director
Supervisory/Public Health, United State
Department of Agriculture
Mark J. Cornett – Director
General Manager, NexID Biometrics, LLC
Brian P. Gardam – Director
(Previously Disclosed)
Michael P. Griffin – Director
Director of News and Digital Content Services,
Clarkson University
Mary Anne Healey, RN – Director
RN Office Manager, Healey Medical Practice
Affiliations:
• Caregivers (2003-present)
John A. Kaplan – Director
Chief of Police, SUNY Potsdam
Laurie B. Maki, RN – Director
Public Health Educator, St. Lawrence County
Public Health Department
Paul B. McGrath – Director
Professor, Clarkson University
David C. Patterson – Director
Owner/President, Wight & Patterson, Inc.
Duane M. Pelkey – Director
Team Leader, Community Bank
June M. Peoples – Director
Membership Director, North Country Public
Radio
Penelope A. Rattan, NHA – Director
Retired
James C. Theodore – Director
Senior Vice President, Financial Advisor,
Portfolio Management Director, Financial
Planning Specialist, Morgan Stanley Smith
Barney
Spencer F. Thew – Director
Director Construction Engineering Management,
Clarkson University
Michael J Tulloch, MD – Director
Part-time Physician, Sun Mount
Physician, Self Employed
The Board of Directors of Hospice of St. Lawrence Valley, Inc. is as follows:
Rev. Thomas T. Patterson – President
(Previously Disclosed)
David E. Hornung – Vice President
University Professor, St. Lawrence University
Ronald C. Romano – Treasurer
Retired
Normadine Kennedy – Secretary
Margaret K. Bass – Director
Professor, St. Lawrence University
Tara M. Freeman
University Photographer, St. Lawrence University
Edward I. Gordon, DVM – Director
Veterinarian, Potsdam Humane Society
Affiliations:
• United Helpers Nursing Home (2002present)
• United Helpers Canton Nursing Home
(2002-present)
• United Helpers Residence, Inc. (2002present)
• United Helpers Care, Inc. (2002-present)
Chad W. Green – Director
President-Owner/Licensed Manager, Donaldson
Funeral Home, Inc.
Project # 121318-E Exhibit Page 6
•
Leap (2007-present)
Linda S. Griffin – Director
Retired
Affiliations:
• Planned Parenthood of North Country
New York
Helen W. Hutchinson – Director
Retired
Marlinda L. LaValley – Director
Vice President for Administrative Services,
Corporate Compliance Officer, Canton- Potsdam
Hospital
Robin McClellan III – Director
Adjunct Instructor, SUNY Canton
Consulting, Self-employed
Francis H. McLaughlin – Director
Professor, State University of New York
James E. Morrison – Director
Director of Finance, United Helpers Management
Company
David H. Moulton – Director
Branch Manager, NBT Bank
June F. O’Neill – Director
Employer Outreach Manager, Office of NYS
Comptroller
Elaine A. Scott – Director
Administrative Assistant, Canton-Potsdam
Hospital
The Board of Directors of United Helpers Management, Inc. is as follows:
Martha K. MacArthur – President
Retired
Affiliations:
• United Helpers Nursing Home (2009present)
• United Helpers Canton Nursing Home
(2009-present)
• United Helpers Residence, Inc. (2009present)
• United Helpers Care, Inc. (2009-present)
Wayne N. Ladouceur – 1st Vice President
Owner/Producer/Director,
Video Images Productions
Affiliations:
• United Helpers Nursing Home (2009present)
• United Helpers Canton Nursing Home
(2009-present)
• United Helpers Residence, Inc. (2009present)
• United Helpers Care, Inc. (2009-present)
Nancy Rehse – 2nd Vice President
Retired
Affiliations:
• United Helpers Nursing Home (2011present)
• United Helpers Canton Nursing Home
(2011-present)
• United Helpers Residence, Inc. (2011present)
• United Helpers Care, Inc. (2011-present)
Francine Naccarato – Secretary/Treasurer
Retired
Affiliations:
• United Helpers Nursing Home (2011present)
• United Helpers Canton Nursing Home
(2011-present)
• United Helpers Residence, Inc. (2011present)
• United Helpers Care, Inc. (2011-present)
Ronald L. Bovay – Director
Owner, Richville Furniture
William Bradley
Retired
Project # 121318-E Exhibit Page 7
Affiliations:
• United Helpers Nursing Home (2009present)
• United Helpers Canton Nursing Home
(2009-present)
• United Helpers Residence, Inc. (2009present)
• United Helpers Care, Inc. (2009-present)
Affiliations:
• United Helpers Nursing Home (2002present)
• United Helpers Canton Nursing Home
(2002-present)
• United Helpers Residence, Inc. (2002present)
• United Helpers Care, Inc. (2002-present)
Cheryl M. Cruickshank, RN – Director
Retired
Affiliations:
• United Helpers Nursing Home (2005present)
• United Helpers Canton Nursing Home
(2005-present)
• United Helpers Residence, Inc. (2005present)
• United Helpers Care, Inc. (2005-present)
Edward I. Gordon, DVM – Director
(Previously Disclosed)
Patricia A. Lewis – Director
Retired
Affiliations:
• United Helpers Nursing Home (2009present)
• United Helpers Canton Nursing Home
(2009-present)
• United Helpers Residence, Inc. (2009present)
• United Helpers Care, Inc. (2009-present)
James Michaelson – Director
Retired
Affiliations:
• United Helpers Nursing Home (2003present)
• United Helpers Canton Nursing Home
(2003-present)
• United Helpers Residence, Inc. (2003present)
• United Helpers Care, Inc. (2003-present)
Norton W. Taylor, Licensed Pharmacist –
Director
Retired
Affiliations:
• United Helpers Nursing Home (2009present)
• United Helpers Canton Nursing Home
(2009-present)
• United Helpers Residence, Inc. (2009present)
• United Helpers Care, Inc. (2009-present)
The Board of Directors of Claxton-Hepburn Medical Center is as follows:
Maureen L. Missert – Chairperson
(Previously Disclosed)
Joseph E. Tracy – Vice President
Retired
Philip A. Cosmo – Secretary
City Comptroller, City of Ogdensburg
Chet A. Truskowski – Treasurer
Commercial Manager,
Citizen Telephone Company
Christopher F. Brandy, MD – Director
Clive B. Chambers – Director
Project # 121318-E Exhibit Page 8
Surgeon, Self-employed
Retired
Tracy L. Lafair, MD – Director
Physician, Self-employed
Macreena A. Doyle – Director
Coordinator of New Services,
St. Lawrence University
Linda L. Fay, RN – Director
Retired
Bryan J. Felitto – Director
Retired
Mary E. LaComb – Director
Volunteer, Frederic Remington Art Museum
Sister Mary Teresa LaBrake – Director
Pastoral Associate, St. Mary’s Cathedral
Ted L. Lawrence – Director
Retired
Sister Mary E. Looby – Director
Pastoral Associate, Malone Catholic Parishes
Rev. Thomas T. Patterson – Director
(Previously Disclosed)
Lawrence F. Sears – Director
Retired
Michael Seidman, MD – Director
Physician, Self-employed
Russell B. Strait – Director
Owner, Harrison A. Rogers Agency
James S. Thew – Director
Principal, Thew Associates PE-LS, PLLC
A search of the individuals named above revealed no matches on either the NYS OMIG Medicaid Disqualified Provider
List, or the US DHHS Office of the Inspector General Exclusion List.
The Office of the Professions of the State Education Department, the New York State Physician Profile and the Office
of Professional Medical Conduct, where appropriate, indicate no issues with the licensure of the health professionals
associated with this application.
The State Bar of Montana verifies the active attorney registration associated with this application.
The Supreme Court of Pennsylvania verifies the active attorney registration associated with this application.
The Bureau of Professional Credentialing has indicated that Penelope Rattan NHA license #02639 holds a NHA
license issued on January 1, 1975 and it currently inactive. It is in good standing and the Board of Examiners of
Nursing Home Administrators has never taken disciplinary action against this individual or his license.
The applicant has confirmed that the proposed financial/referral structure has been assessed in light of anti-kickback
and self-referral laws, with the consultation of legal counsel, and it is concluded that proceeding with the proposal is
appropriate.
A 10-year review of the operations of the following facilities was performed as part of this review:
•
•
•
•
•
•
•
•
•
•
•
Canton-Potsdam Hospital
Canton Enriched Housing
Claxton-Hepburn Medical Center
Hospice of St. Lawrence Valley, Inc.
United Helpers Nursing Home
United Helpers Canton Nursing Home
United Helpers Residence
United Helpers Care, Inc.
Leap (2007-present)
Caregivers (2003-present)
Warren State Hospital, Pennsylvania (2002-2003)
Project # 121318-E Exhibit Page 9
The Division of Certification and Surveillance has indicated that the hospitals reviewed have exercised sufficient
supervisory responsibility to protect the health, safety and welfare of patients and to prevent recurrent code violations.
The Bureau of Quality Assurance and Surveillance for Nursing Homes has indicated the following:
United Helpers Canton Nursing Home, Inc. was fined one thousand dollars ($1,000) pursuant to a stipulation and
order dated March 28, 2007 for surveillance findings of September 27, 2006. Deficiencies were found under 10
NYCRR 415.12(i)(1) Quality of Care: Nutrition.
The information provided by the Bureau of Quality Assurance and Surveillance for Nursing Homes has indicated that
the nursing homes reviewed has provided sufficient supervision to prevent harm to the health, safety and welfare of
residents and to prevent recurrent code violations. When code violations have occurred, it was determined that the
operators investigated the circumstances surrounding the violation and took steps appropriate to the gravity of the
violation which a reasonably prudent operator would take to promptly correct and prevent the recurrence of the
violations.
The information provided by the Division of Home and Community Based Services has indicated that the licensed
home care services agencies and long term home health care programs have provided sufficient supervision to
prevent harm to the health, safety and welfare of patients and to prevent recurrent code violations.
The information provided by the Division of Quality Improvement, Bureau of Program Certification has indicated that
the OPWDD facilities have provided sufficient supervision to prevent harm to the health, safety and welfare of patients
and to prevent recurrent code violations.
The information provided by the Bureau of Community and Hospital Operations in Pennsylvania has indicated that
Warren State Hospital has provided sufficient supervision to prevent harm to the health, safety and welfare of patients
and to prevent recurrent code violations.
A review of all personal qualifying information indicates there is nothing in the background of the principals listed
above to adversely effect their positions in the proposed organizational structure. The applicant has the appropriate
character and competence under Article 36 of the Public Health Law.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Total Project Cost and Financing
There are no project costs associated with this application.
Management and Administrative Services Agreement
The applicant has submitted a draft management and administrative services agreement; the terms are summarized
below:
Facility:
Contractor:
Services Provided:
Northern Lights Home Health Care Partnership, Inc., d/b/a Northern Lights Home
Health Care
United Helpers Canton Nursing Home, Inc., d/b/a Canton Home Health Care
Quality Improvement Program; Patients’ Rights and Incident Reporting:
Assist with maintenance and implementation and complying with the applicable
state and federal laws and regulations.
Financial:
Accounting services, including preparation of financial statements; assist in
developing annual budgets; assist in the preparation and submission of bills to
payors, accounts receivable and accounts payable management; process of
Project # 121318-E Exhibit Page 10
payrolls; negotiation of 3rd party payor participation agreements; and billing review.
Patient Referral, Admission and Discharge; Patient Assessment and Plan of Care;
and Service Delivery:
Assist with maintenance and implementation of policies and procedures and
complying with the applicable regulations.
Recruitment of Additional Staff and Training; Providing Physician Clearance, and
Medicaid/Medicare Provider and Employee Exclusion Checks; Completion of
Consumer Assessment of Healthcare Providers and System Reports and Surveys;
assist with Clinical Records and Complaint Procedures.
3 year – may be renewed only if authorized by the DOH as required by 10 NYCRR
763.11 and upon the mutual written consent of the Parties.
Total Annual Fee $307,683 (1/12 to be paid monthly or $25,640.25)
Term:
Fee:
The administrative services provider is affiliated with United Helpers Management Company, Inc., a member of the
applicant.
Lease Rental Agreement
The applicant has submitted a letter of interest to lease the proposed site, the terms of which are summarized below:
Premises:
Landlord :
Lessee:
Term:
Provisions:
242 gross square feet located at 205 State Street Road, Canton, NY
United Helpers Canton Nursing Home, Inc., d/b/a Maplewood Health Care and
Rehabilitation Center
Northern Lights Health Care Partnership, Inc., d/b/a Northern Lights Home Health Care
1 year at $2,424 per year ($10.02 per sq. f.t) Automatic renewals of one year in length
Insurance and Maintenance
The lease is a non-arm’s length arrangement as the landlord is affiliated United Helpers Management Company, Inc.,
a member of the applicant.
Operating Budget
The applicant has submitted the first and third year incremental operating budgets, in 2012 dollars, as summarized
below:
First Year
Third Year
Description:
Medicaid
Medicare
Commercial
Total Revenues
$375,367
686,208
104,503
$1,166,078
$544,937
1,274,384
194,079
$2,013,400
Total Expenses
Net Income or (Loss)
$1,088,147
$77,931
$1,684,870
$328,530
Utilization by payor source for the first & third year is anticipated as follows:
Medicaid Manage Care
Medicare Fee-for-Service
Commercial Manage Care
Charity Care
34%
54%
10%
2%
Expense projections were based on industry norms adjusted for the projected case load and case mix. Also, the
projected expenses were consistent with the experience from existing upstate NY CHHAs. Patient utilization
projections are based on the need analysis, as well as applicant members’ historical CHHA referral data.
Project # 121318-E Exhibit Page 11
The Medicaid average episode payment is expected to be $4,019 based upon the North County Wage Index Factor of
.95561 and an average case mix of .738765. As a conservative measure Medicaid revenues were based upon the
lower of projected cost at $2,629 per episode in the first year and $2,055 per episode in the third year. Medicare
revenues were based upon regional episodic payments of $3,025 per episode.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements are estimated at $280,812, which appear reasonable based on two months of third year
expenses. Presented as BFA Attachment A through D are the proposed members’ 2010 and 2011 certified financial
summaries which indicates the availability of sufficient resources for the project.
The budget projects an operating surplus of $77,931 and $328,530 in the first and third years, respectively.
Revenues are based upon the following: episodic payment methodology was utilized in developing Medicare
revenues; Medicaid revenues were based upon the episodic payment methodology and then as a conservative
measure adjusted lower to reflect projected cost; and commercial payors were based on regional historical rates. The
budget appears reasonable.
A review of BFA Attachments A through D shows the following: Attachment A, Claxton-Hepburn Medical Center has a
positive average working capital position of $16,748,692 and generated an average excess revenues over expenses
of $1,923,705; Attachment B, United Helpers Management Company, Inc. has a positive average working capital
position of $219,250 and generated a small average loss of $27,365, and when you consider the positive results for
the seven months ending July 2012 of $79,259 the average loss turns into a positive surplus of $8,176; Attachment C,
Canton-Potsdam Hospital has a positive average working capital position of $7,140,820 and generated average
excess revenues over expenses of $1,307,364; Attachment D, Hospice and Palliative Care of St. Lawrence Valley,
Inc., generated average excess revenues over expenses of $409,356 and based on the July 31, 2012 internal
financial statements the working capital was $2,446,420.
It appears that the applicant has demonstrated the capability to proceed in a financially feasible manner, and
contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Financial Summary for 2010 and 2011, Claxton-Hepburn Medical Center
BFA Attachment B
Financial Summary for 2010 and 2011, United Helpers Management Company,
Inc.
BFA Attachment C
Financial Summary for 2010 and 2011, Canton-Potsdam Hospital
BFA Attachment D
Financial Summary for 2010 and 2011, Hospice and Palliative Care of St.
Lawrence Valley, Inc.
BFA Attachment E
Organizational Chart
Project # 121318-E Exhibit Page 12
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3606 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the Regional Health Systems Agency, the staff of the New
York State Department of Health, and the Establishment and Project Review Committee of this
Council, and after due deliberation, hereby approves the following application to establish a new
certified home health agency in St. Lawrence County, and with the contingencies, if any, as set
forth below and providing that each applicant fulfills the contingencies and conditions, if any,
specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER
APPLICANT/FACILITY
121318 E
Northern Lights Health Care Partnership,
Inc. d/b/a Northern Lights Home Health Care
APPROVAL CONTINGENT UPON:
1. Submission of an executed building lease that is acceptable to the Department of Health.
[BFA]
2. Submission of a photocopy of the executed Management and Administrative Services
Agreement between the applicant and United Helpers Canton Nursing Home, Inc.
acceptable to the Department. [BFA, CSL]
3. Submission of a photocopy of the signed and dated Certificate of Incorporation of Northern
Lights Health Care Partnership, Inc., acceptable to the Department. [CSL]
4. Submission of evidence of adoption of the bylaws of Northern Lights Health Care
Partnership, Inc. acceptable to the Department. [CSL]
APPROVAL CONDITIONED UPON:
1. Pursuant to 10 NYCRR 760.8, the applicant shall be providing services in the entire
geographic area approved by the Council within one year of the Council’s approval. The
failure, neglect or refusal of an applicant for the establishment of a new certified home
health agency to commence operation of the certified home health agency within one year
of issuance of the Council’s approval or contingent approval of the application shall
constitute an abandonment of the application by the applicant, with any such approval to be
deemed cancelled and withdrawn without further action by the Council. [CHA]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 122120-E
CenterLight Certified Home Health Agency
County: Kings (Brooklyn)
Purpose: Establishment
Program: Certified Home Health Agency
Submitted: April 20, 2012
Executive Summary
Description
CenterLight Health System (CenterLight, formerly
known as Beth Abraham Family of Health Services) is
an existing not-for profit nonsectarian, multi-service
continuing and managed care provider. Centerlight
presently operates four nursing facilities, a myriad of
community based programs, a licensed home care
agency and senior housing and is requesting
permission to establish CenterLight Certified Home
Health Agency, a new not- for-profit certified home
health agency (CHHA) to operate in Rockland County.
Via CON #121309-E, the Public Health and Health
Planning Council contingently-approved CenterLight
on August 9, 2012 to serve the downstate counties of
Bronx, Kings, New York, Queens, Richmond, Nassau,
Suffolk, and Westchester.
On December 8, 2011 the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. CenterLight Health
System submitted an application in response to the
competitive RFA, and was awarded RFA approval.
This CON application is in response to RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal # 5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Contingent approval.
Need Summary
The applicant demonstrated public need based on
709.1(a) and provided a description of community
need and the health needs of the community
supported by data including a gap analysis.
Program Summary
The applicant has the appropriate character and
competence under Article 36 of the Public Health Law.
Financial Summary
There are no project costs associated with this
application.
Incremental Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 313,150
269,545
$ 43,605
Subject to the noted contingency, it appears that the
applicant has demonstrated the capability to proceed
in a financially feasible manner.
Project # 122120-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of new incremental budgets to be re-evaluated for financial feasibility for all counties approved for
establishment or expansion acceptable to the Department of Health. [BFA]
2. Submission of a photocopy of the signed and dated Certificate of Incorporation of Centerlight Certified Home
Health Agency, acceptable to the Department. [CSL]
Approval conditional upon:
1. Pursuant to 10 NYCRR 760.8, the applicant shall be providing services in the entire geographic area approved by
the Council within one year of the Council’s approval. The failure, neglect or refusal of an applicant for the
establishment of a new certified home health agency to commence operation of the certified home health agency
within one year of issuance of the Council’s approval or contingent approval of the application shall constitute an
abandonment of the application by the applicant, with any such approval to be deemed cancelled and withdrawn
without further action by the Council. [LTC]
Council Action Date
October 11, 2012.
Project # 122120-E Exhibit Page 2
Need Analysis
Background
Center Light Certified Home Health Agency, Inc. seeks to establish a Certified Home Health Agency (CHHA) to serve
the downstate counties of Bronx, Kings, New York, Queens, Richmond, Nassau, Suffolk, and Westchester, and the
upstate county of Rockland. The downstate counties were assigned CON project number 121309-E which was
approved by PHHPC on August 9, 2012. This current CON project number 122120-E seeks approval for the upstate
county of Rockland.
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models or that approval would ensure
access to CHHA services in counties with fewer than two existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012 with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
Centerlight Certified Home Health Agency’s proposal described and adequately addressed each of the review criteria
used to make determinations for this competitive review. The proposal demonstrated the applicant’s organizational
capacity to successfully implement the MRT initiatives and support the goals of the Department in advancing these
Project # 122120-E Exhibit Page 3
initiatives. The applicant discussed in detail how they will improve efficiencies, decrease fragmentation and provide
greater care coordination through the establishment of the proposed CHHA. The applicant currently operates a PACE
program, MLTCP, Nursing Home and LHCSA each with a history of providing consistently high levels of care. The
addition of a CHHA will provide the foundation for an integrated health care system. The applicant provided extensive
information regarding their existing relationships and linkages with all service provider types within the counties they
propose to serve.
The applicant demonstrated public need based on 709.1(a) and provided a description of community need and the
health needs of the community supported by data, including a gap analysis. The applicant has the requisite knowledge
and experience in the provision of home health services and demonstrated the capacity to produce efficiencies in the
delivery of home care services through their use of health information technology and focus on the reduction of
hospitalizations.
The applicant also requested approval to serve the following downstate counties: Bronx, Kings, Queens, New York,
Richmond, Westchester, Nassau, and Suffolk Counties. A recommendation for approval for the downstate counties
was presented to the Council and approved at the August 9, 2012 meeting.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
CenterLight Certified Home Health Agency is a proposed not-for-profit corporation requesting approval to become
established as a CHHA under Article 36 of the Public Health Law, with approval to serve the upstate county of
Rockland. The sole member corporation of the proposed CenterLight Certified Home Health Agency is CenterLight
Health System, Inc., an existing not-for-profit corporation. CenterLight Health System, Inc., is also the member
corporation of:
•
•
•
•
•
•
Center for Nursing and Rehabilitation, Inc. (RHCF and LTHHCP),
Beth Abraham Health Services (RHCF and LTHHCP),
Margaret Tietz Nursing and Rehabilitation Center (RHCF), which was the member corporation of MTC
Senior Housing, Inc. (now closed),
Schnurmacher Center for Nursing and Rehabilitation (RHCF),
Best Choice Home Health Care, Inc. (LHCSA), and
CenterLight Healthcare (MLTCP, PACE, and an approved but not yet operational Medicaid Advantage
Plus Plan), which is the member corporation of Comprehensive Care Management, Inc. (CCM)
Diagnostic and Treatment Center (D&TC - 11 locations).
CenterLight Health System, Inc.is also a member of the following:
•
•
•
•
•
•
•
•
Institute for Music and Neurological Function (providing stroke/neurological treatment therapies),
CNR Health Care Network, Inc. (now closed), which was the member corporation of Prospect Home
Care, Inc. (LHCSA) and Prospect Home Attendant Services, Inc., which both closed in 2009,
CNR Housing Development Fund,
MVP Housing (HUD senior independent living),
Park Housing (HUD senior independent living),
Beth Abraham Housing (HUD senior independent living),
TBM Housing (HUD senior independent living), and
Beth Abraham/CNR Foundation, Inc.
Project # 122120-E Exhibit Page 4
The applicant proposes to operate the CHHA from an office located at 596 Prospect Place, Brooklyn, New York
11230. The applicant proposes to provide the following health care services:
Nursing
Home Health Aide
Physical Therapy
Occupational Therapy
Speech Language Pathology
Audiology
Nutrition
Homemaker
Medical Supplies, Equipment, and Appliances
Personal Care
Respiratory Therapy
Medical Social Services
Housekeeper
The Board of Directors of CenterLight Certified Home Health Agency will be as follows:
Michael R. Potack, Chairperson
CEO, Unitex Holdings (laundry services)
Affiliations: Beth Abraham Health Services
(1991 – present)
Michael S. Fassler, LNHA (NYS and NJ)
President/CEO, CenterLight CHHA, CenterLight Health
System, Inc.
Stephen B. Mann, CPA, Secretary/
Treasurer
Senior VP of Finance Administration,
CenterLight Health System, Inc.
Affiliations: Best Choice Home Health Care,
(2000 – present), Beth Abraham Health
Services, (2000 – present), CenterLight
Healthcare MLTCP (2000 – present),
Comprehensive Care Management
D & T Center (2000 – present)
The Board of Directors of CenterLight Health System, Inc., are as follows:
Michael R. Potack, Chairman
(disclosed above)
Jerald I. Moskowitz, Vice Chairman
Retired
Edwin H. Stern, III, Secretary
Executive VP, Seiden Krieger Associates
(executive search consultants)
Affiliations: Montefiore Medical Center
(1968 – present),
Beth Abraham Health Services
(1969 – present)
Michael S. Fassler, LNHA, President/CEO
(disclosed above)
Vitina A. Biondo, Esq.
Unemployed
Affiliation: Schnurmacher Center for
Rehabilitation & Nursing
(2001 – present)
Henry S. Conston, Esq.
Self-employed attorney
Affiliation: Margaret Tietz Nursing & Rehabilitation
Center (1978 – present)
Dolores M. Fernandez, Ph.D.
Professor, Hunter College, CUNY
Neil J. Heyman
President, Southern New York Association, Inc.
CEO, New York Health Care Alliance, LLC
Affiliation: Margaret Tietz Nursing & Rehabilitation Center
(1997 - present)
Harvey J. Ishofsky, Esq.
President/CEO, 877Spirits.com
(gift concierge service)
Affiliation: Margaret Tietz Nursing &
Stefan A. Kampe
Retired
Project # 122120-E Exhibit Page 5
Rehabilitation Center
(2005 – present)
Steven D. Kantor, D.D.S.
Administrator, Grant & Kantor, D.D.S.
Affiliation: Beth Abraham Health Services
(2011 – present)
Rosemarie A. Loffredo
Retired
Cynthia L. Schwalm
Self-employed Healthcare Biotech
Consulting
Mark H. Weinstein
President, Golden Oldies, Ltd.
(home furnishings)
Affiliations: Margaret Tietz Nursing &
Rehabilitation Center (2007 – present),
Center for Nursing & Rehabilitation
(2000 – present)
Kenneth R. Weisshaar
Retired
Thomas R. Berkel
Retired
A search of the individuals named above revealed no matches on either the NYS OMIG Medicaid Disqualified Provider
List, or the US DHHS Office of the Inspector General Exclusion List.
The Office of the Professions of the NYS Education Department indicates no issues with the CPA and DDS licenses
associated with this application. The NYS Education Department also verifies the teaching certificates associated with
this application. The NYS Unified Court System verifies the active attorney registrations associated with this
application. The New Jersey Department of Health verifies the New Jersey nursing home administrator license
associated with this application. The NYSDOH Bureau of Professional Credentialing has indicated that Michael S.
Fassler holds a NYS NHA license in good standing, and that the Board of Examiners of Nursing Home Administrators
has never taken disciplinary action against this individual or his license.
A ten year review of the following facilities was performed as part of this review:
Center for Nursing and Rehabilitation, Inc. (RHCF and LTHHCP),
Beth Abraham Health Services (RHCF and LTHHCP),
Margaret Tietz Nursing and Rehabilitation Center (RHCF),
Schnurmacher Center for Nursing and Rehabilitation (RHCF),
Best Choice Home Health Care, Inc. (LHCSA),
CenterLight Healthcare (MLTCP and PACE),
Comprehensive Care Management Diagnostic and Treatment Center (D&TC - 11 locations),
Montefiore Medical Center (Hospital),
Prospect Home Care, Inc. (LHCSA), closed 2009
The Division of Residential Services has indicated the following:
Beth Abraham Health Services RHCF had a civil penalty of $30,000 imposed pursuant to a stipulation and
order dated June 2, 2010 for surveillance findings of April 27, 2009. Violations were cited in 10 NYCRR
415.12 Quality of Care, 415.20 Laboratory and Blood Bank, and 415.26 Organization and Administration.
Center for Nursing & Rehabilitation RHCF had a civil penalty of $24,000 imposed pursuant to a stipulation and
order dated August 22, 2011 for surveillance findings of January 29, 2010. Violations were cited in 10 NYCRR
415.4(b)(1)(ii) Report Allegations, 415.12 Quality of Care Highest Practicable Potential, 415.26 Administration,
and 415.20 Promptly Notify Physician of Lab Results.
Project # 122120-E Exhibit Page 6
The information provided by the Division of Residential Services has indicated that the nursing homes reviewed have
provided sufficient supervision to prevent harm to the health, safety and welfare of residents and to prevent recurrent
code violations.
The Division of Certification and Surveillance has indicated the following:
Montefiore Medical Center had a civil penalty of $14,000 imposed in 2007 for failure to report suspected child
abuse to the proper authorities. Montefiore Medical Center also had a civil penalty of $18,000 imposed in
2003 for violations of the Resident Working Hours regulation. Montefiore Dialysis Center had a civil penalty of
$52,000 imposed in 2005 based on conditions of participation, resulting in the closure of two dialysis center
sites.
The information provided by the Division of Certification and Surveillance has indicated that the hospital and D & T
Center have provided sufficient supervision to prevent harm to the health, safety and welfare of patients and to prevent
recurrent code violations.
The information provided by the Division of Home and Community Based Services has indicated that the licensed
home care services agencies and long term home health care programs have provided sufficient supervision to
prevent harm to the health, safety and welfare of patients and to prevent recurrent code violations.
The information provided by the Office of Managed Care has indicated that the MLTC plan and PACE program have
provided sufficient supervision to prevent harm to the health, safety and welfare of patients and to prevent recurrent
code violations.
A review of all personal qualifying information indicates there is nothing in the background of the principals listed
above to adversely effect their positions in the proposed organizational structure. The applicant has the appropriate
character and competence under Article 36 of the Public Health Law.
The applicant has also requested approval to serve the following downstate counties: Bronx, Kings, New York,
Queens, Richmond, Nassau, Suffolk, and Westchester. A recommendation for approval for the downstate counties
was presented to the Council and approved at the August 9, 2012 meeting.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget for the first and third years, in 2012 dollars, which is
summarized below:
Revenues:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for Service
Medicare Managed Care
Private Pay
Total Revenues
Expenses
Net Gain(Loss)
Year One
Year Three
$53,756
52,099
46,782
3,585
850
157,072
$45,535
160,724
104,851
0
2,040
313,150
$131,318
$269,545
$25,754
$43,605
Project # 122120-E Exhibit Page 7
Utilization by payor source for combined programs in the first and third years is as follows:
Payor
Medicare
Medicaid Fee-for-Service
Medicaid Managed Care
Private Pay
Charity Care
Year One
23.95%
35.07%
35.41%
.55%
5.02%
Year Three
23.31%
15.19%
55.78%
.62%
5.10%
Expense assumptions are commensurate with the projected utilization (visits and hours) and are based on current
salaries in the area for CHHA services. Utilization assumptions are based on the applicant’s review of the current
regional utilization for CHHA services. Revenues are reflective of current payment rates as well as recent
implementation of the Medicaid Episodic Payment System.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements, estimated at $44,924, appear reasonable based on two months of third year expenses
and will be provided through the existing operation.
The available of funds to cover the working capital requirements are shown on BFA Attachment A.
The submitted budget indicates that the applicant will achieve incremental net revenue of $25,754 and $43,605 in the
first and third years of operations, respectively. Revenue is based on current payment rates for Certified Home Health
Agencies.
Presented as BFA Attachment A is the 2009-2010 audited financial summary of Bethco Corporation and Affiliates
which is the parent company for CenterLight Health System, Inc, and which became CenterLight Health Systems, Inc.
in 2012, which shows the applicant has maintained positive working capital and net asset positions and achieved an
average net income of $14,981,241 for the period 2009-2010.
BFA Attachment B is the internal 2011 financial summary for Bethco, which shows that the applicant continues to
maintain positive working capital and net assets positions but they have a net loss of $7,432,242. The applicant
indicates that the 2011 loss is due to CenterLight Healthcare, Inc. increasing staffing and systems in order to prepare
for the anticipated growth based on the goals of the Medicaid redesign team.
BFA Attachment C is the Internal 2012 financial statement for Centerlight Health Systems, Inc. for the first 3 months of
operation, which shows that the operations maintain positive work capital and net asset positions and has a net loss of
$4,663,749 prior to non operating activity income of $5,495,883, which allowed the facility to have an overall positive
income position of $832,134.
Based on the preceding, and subject to the noted contingency, it appears that the applicant has demonstrated the
financial capability to proceed in a financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Attachments
BFA Attachment A
Certified Financial Summary for Bethco Corporation and Affiliates (2009 and 2010)
BFA Attachment B
Internal Financial Summary for Bethco Corporation and Affiliates 2011
BFA Attachment C
Internal Financial Summary for Centerlight Health Systems, Inc. January 1-March
31, 2012
BFA Attachment D
Pro-forma Balance sheet Centerlight Health System
Project # 122120-E Exhibit Page 8
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3606 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the Regional Health Systems Agency, the staff of the New
York State Department of Health, and the Establishment and Project Review Committee of this
Council, and after due deliberation, hereby approves the following application to establish
establish CenterLight Certified Home Health Agency, a not-for-profit CHHA to operate in
Rockland County, and with the contingencies, if any, as set forth below and providing that each
applicant fulfills the contingencies and conditions, if any, specified with reference to the
application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER
APPLICANT/FACILITY
122120 E
CenterLight Certified Home Health Agency
APPROVAL CONTINGENT UPON:
1. Submission of new incremental budgets to be re-evaluated for financial feasibility for all
counties approved for establishment or expansion acceptable to the Department of Health.
[BFA]
2. Submission of a photocopy of the signed and dated Certificate of Incorporation of
CenterLight Certified Home Health Agency, acceptable to the Department. [CSL]
APPROVAL CONDITIONED UPON:
1. Pursuant to 10 NYCRR 760.8, the applicant shall be providing services in the entire
geographic area approved by the Council within one year of the Council’s approval. The
failure, neglect or refusal of an applicant for the establishment of a new certified home
health agency to commence operation of the certified home health agency within one year
of issuance of the Council’s approval or contingent approval of the application shall
constitute an abandonment of the application by the applicant, with any such approval to be
deemed cancelled and withdrawn without further action by the Council. [LTC]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
Public Health and Health
Planning Council
Project # 122121-E
Jewish Home Lifecare, Community Services
County: New York (New York)
Purpose: Establishment
Program: Certified Home Health Agency
Submitted: April 18, 2012
Executive Summary
Description
Jewish Home Lifecare, Community Services, a
recently formed not-for-profit corporation, requests
approval to establish a certified home health agency
(CHHA) to serve Rockland County. The applicant is a
member of the Jewish Home Lifecare System and
several not-for-profit and for profit organizations,
providing resident care, residential and related
services, including fundraising.
Via CON #121252-E, the Public Health and Health
Planning Council contingently-approved Jewish Home
Lifecare, Community Services on August 9, 2012 to
serve the downstate counties of Kings, Queens,
Richmond, Bronx, New York, Westchester, Nassau
and Suffolk.
On December 8, 2011 the Public Health and Health
Planning Council adopted an amendment to section
760.5 of Title 10, NYCRR. This emergency regulation
authorized the Commissioner of Health to issue a
request for applications (RFA) to establish new
certified home health agencies, or expand the
approved geographic service areas and/or approved
population of existing CHHA’s. Jewish Home Lifecare
submitted an application in response to the competitive
RFA, and was awarded RFA approval. This CON
application is in response to the RFA approval.
Effective May 1, 2012, a new Episodic Payment
System (EPS) reimbursement methodology to
reimburse CHHA providers for services provided to
Medicaid patients receiving home care services took
effect. The EPS is based on a price for 60-day
episodes of care which will be adjusted by patient
acuity and regional wage differences. The EPS was
recommended by the Medicaid Redesign Team (MRT
proposal # 5) and authorized in the 2011-12 enacted
budget. The EPS is designed to address the issue of
rapid growth in Medicaid costs per patient by better
aligning payments with needed services and is part of
a broad effort to promote the development of care
management arrangements for Medicaid recipients.
DOH Recommendation
Contingent approval.
Need Summary
The applicant provided a comprehensive analysis of
demographic data to establish public need based on
709.1(a) as well as unmet community need. Approval
of this application will allow Jewish Home Life to
enhance care coordination and extend their continuum
of care for discharges from acute care and nursing
home settings to home care.
Program Summary
A review of all personal qualifying information indicates
there is nothing in the background of the principals
listed above to adversely effect their positions in the
proposed organizational structure.
Financial Summary
There are no project costs associated with this
application.
Budget:
Revenues:
Expenses:
Gain/(Loss):
$
$
177,546
137,569
39,977
Subject to the noted contingency, it appears that the
applicant has demonstrated the capability to proceed
in a financially feasible manner.
Project # 122121-E Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval contingent upon:
1. Submission of an executed sublease agreement that is acceptable to the Department of Health. [BFA]
Approval conditional upon:
1. Pursuant to 10 NYCRR 760.8, the applicant shall be providing services in the entire geographic area approved by
the Council within one year of the Council’s approval. The failure, neglect or refusal of an applicant for the
establishment of a new certified home health agency to commence operation of the certified home health agency
within one year of issuance of the Council’s approval or contingent approval of the application shall constitute an
abandonment of the application by the applicant, with any such approval to be deemed cancelled and withdrawn
without further action by the Council. [CHA]
Council Action Date
October 11, 2012.
Project # 122121-E Exhibit Page 2
Need Analysis
Background
Jewish Home Lifecare, Community Services is a proposed not-for-profit corporation requesting approval to establish a
new Article 36 Certified Home Health Agency (CHHA) to serve the downstate counties of Bronx, Kings, New York,
Queens, Richmond, Westchester, Nassau, and Suffolk and the upstate county of Rockland.
On December 8, 2011 the Public Health and Health Planning Council adopted an amendment to Section 750.5 of Title
10, NYCRR authorizing the Commissioner of Health to issue a request for applications (RFA) to establish new certified
home health agencies (CHHAs) or expand existing CHHAs. Public need was based on established criteria in section
709.1(a) of Title 10 and that approval of the application would facilitate implementation of Medicaid Redesign
Initiatives to shift Medicaid beneficiaries from traditional fee-for-service programs to managed care, managed long
term care systems, integrated health systems or similar care coordination models, or that approval would ensure
access to CHHA services in counties with less than 2 existing CHHAs.
Solicitation
The RFA for the establishment of new or expansion of existing CHHAs was released on January 25, 2012, with RFA
applications due on March 9, 2012 and CON applications due on April 20,2012.
Applicants were further permitted to submit questions to the Department to seek additional clarification regarding this
process. The Department’s answers were provided to all applicants prior to the submission deadline, to ensure
consistent information was shared regarding the process.
Competitive Review
The applications were reviewed competitively by the Department and recommendations are being made separately for
Downstate and Upstate counties. Downstate counties consist of the counties Kings, Queens, New York, Richmond,
Bronx, Nassau, Suffolk, and Westchester. Upstate counties consist of the remaining counties in New York State not
listed in the preceding Downstate counties. All applications were reviewed for each county they proposed to serve. If
applicants requested Upstate and Downstate counties, they are being presented to the Public Health and Health
Planning Council with other applicants who have requested the same county or counties.
The CON determination of need was based on the applicant’s response to the RFA. The applications were reviewed
competitively on criteria that included, but were not limited to:
•
Organizational capacity to successfully implement the MRT initiatives and potential of the proposal to support
the goals of the Department in advancing MRT initiatives;
•
Knowledge and experience in the provision of home health services;
•
Demonstration of public need based on 709.1(a) as well as a description of community need and the health
needs of the community supported by data;
•
Potential of the approved application to produce efficiencies in the delivery of home care services to the home
care population;
•
Comprehensive and effective quality assurance plan which described how the agency will use data to
implement an ongoing quality assessment and performance improvement program that leads to measurable
and sustained improvement in performance.
The proposal demonstrated the applicant’s organizational capacity to successfully implement the MRT initiatives and
support the goals of the Department in advancing these initiatives. The applicant discussed the establishment of a
partnership with a MLTCP to facilitate the transition of Medicaid beneficiaries from fee-for-service programs to
MLTCP's. The applicant detailed extensive experience with care coordination for dual eligibles through their existing
home care programs and provided details on established community linkages that enhance their continuum of care.
Project # 122121-E Exhibit Page 3
The applicant provided a comprehensive analysis of demographic data to establish public need based on 709.1(a) as
well as unmet community need. The applicant’s operation of LTHHCPs, and LHCSA’s establishes their knowledge
and experience in the provision of home health services. Each of their agencies has a history of providing consistently
high levels of care. The application provided a description how the agency will use patient data to implement an
ongoing quality assessment and performance improvement program that leads to measurable and sustained
improvement in health outcomes. Approval of this application will allow Jewish Home Life to enhance care
coordination and extend their continuum of care for discharges from acute care and nursing home settings to home
care.
The applicant also requested approval to serve the following Downstate counties: Bronx, Kings, New York, Queens,
Richmond, Westchester, Nassau and Suffolk Counties. A recommendation for approval for the Downstate counties
was presented to the Council and approved at the August 9, 2012 meeting.
Recommendation
From a need perspective, approval is recommended.
Programmatic Analysis
Background
Jewish Home Lifecare, Community Services is a proposed not-for-profit corporation requesting approval to become
established as a CHHA under Article 36 of the Public Health Law, with approval to serve the upstate county of
Rockland.
The applicant proposes to operate the CHHA from an office located at 104 West 29th Street, New York, New York
10021. The applicant proposes to provide the following health care services:
Nursing
Physical Therapy
Speech Language Pathology
Nutrition
Home Health Aide
Occupational Therapy
Medical Social Services
Medical Supplies, Equipment, and Appliances
The Board of Directors of Jewish Home Lifecare, Community Services will be as follows:
Russell Makowsky – Chair, Trustee
Chief Financial Officer, Senior Managing Director,
Tishman Speyer
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
• Educational Alliance (2006-present)
Olumide S. Wilkey – Treasurer, Trustee
Certified Financial Advisor, UBS Financial
Services, Inc.
Mel P. Barkan, Esq. – Trustee
Counsel, Windels Marx Lane and Mittendorf, LLP
Affiliations:
• The Bridge, Inc. and Affiliates
Ann Berman – Trustee
Freelance Writer, Self
Susan Glickman – Vice Chair, Trustee
Retired
Edward W. Gordon – Trustee
President/Executive, W.W. Gordon & Co., Inc. –
Preservation Capital Partners
Project # 122121-E Exhibit Page 4
Affiliations:
• Senior Health Partners (2005-2010)
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Edward A. Greenberg – Trustee
Retired
Affiliations:
• Senior Health Partners (2002-2006)
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
Scott A. Hasen – Trustee
Vice President, Healthcare Research Analyst, J.P
Mogan
Joy A. Henshel – Trustee
Retired
Affiliations:
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Nancy Hirschtritt, LCSW – Trustee
Retired
Jonathan Hochberg – Trustee
President, Hillview Capital Advisors, LLC
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
William Kummel – Trustee
Logistics and Marketing Management Consultant,
Rational Partners, LLC
Marilyn Margon – Trustee
Self, Consulting Business
David A. Strumwasser, Esq. – Trustee
Retired
Affiliations:
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Joan Wachtler, LCSW – Trustee
Retired
Audrey S. Weiner, NHA – Trustee
President/CEO, Jewish Home LIfecare
Affiliations:
• Senior Health Partners (2002-2010)
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Project # 122121-E Exhibit Page 5
The Board of Directors of Jewish Home Lifecare System is as follows:
Stanley H. Pantowich, CPA – Chair
Chairman, TAG Associates, LLC
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Susan Glickman – Vice Chair, Trustee
(Previously Disclosed)
David R. Haas, CPA – Vice Chair and Treasurer
Self Employed, DRH Associates
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Lisa Feiner – Trustee
Health Coach, Self
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Jay Furman, Esq. – Trustee
President, RD Management, LLC
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Elizabeth L. Grayer, Esq. – Trustee
President, Legal Momentum
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Joel A. Hirshtritt, Esq. – Trustee
Lawyer, Tannenbaum Helpern Syracuse and
Hirshtritt, LLC
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Jonathan Hochberg – Trustee
(Previously Disclosed)
Michael Luskin, Esq. – Trustee
Partner, Hughes Hubbard & Reed, LLP
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Russell E. Makowsky, Esq. – Trustee
(Previously Disclosed)
Lynn Oberlander, Esq. – Trustee
General Counsel, The New Yorker
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Paul D. Polivy, CPA – Trustee
Managing Director, Citigroup
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Project # 122121-E Exhibit Page 6
•
•
Weinberg Campus, Bronx,
Jewish Home Lifecare, Manhattan
Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Gene D. Resnick, M.D. – Trustee
Chief Medical Officer, Aptiv Solutions, Inc.
Affiliations:
• Jewish Home Lifecare, Harry & Jeanette
Weinberg Campus, Bronx,
• Jewish Home Lifecare, Manhattan
• Jewish Home Lifecare, Sarah Neuman
Center, Westchester
•
•
Weinberg Campus, Bronx,
Jewish Home Lifecare, Manhattan
Jewish Home Lifecare, Sarah Neuman
Center, Westchester
Audrey S. Weiner – Trustee
(Previously Disclosed)
A search of the individuals named above revealed no matches on either the NYS OMIG Medicaid Disqualified Provider
List, or the US DHHS Office of the Inspector General Exclusion List.
The Office of the Professions of the State Education Department, the New York State Physician Profile and the Office
of Professional Medical Conduct, where appropriate, indicate no issues with the licensure of the health professionals
associated with this application.
The NYS Unified Court System verifies the active attorney registrations associated with this application.
The Bureau of Professional Credentialing has indicated that Audrey S. Weiner, NHA license #03864, holds a NHA
license in good standing and that the Board of Examiners of Nursing Home Administrators has never taken disciplinary
action against this individual or his license.
The applicant has confirmed that the proposed financial/referral structure has been assessed in light of anti-kickback
and self-referral laws, with the consultation of legal counsel, and it is concluded that proceeding with the proposal is
appropriate.
A 10 year review of the operations of the following facilities was performed as part of this review:
Jewish Home Lifecare, Harry & Jeanette Weinberg Campus, Bronx LTHHCP
Jewish Home Lifecare, Manhattan LTHHCP
Hapi Westchester
Jewish Home Lifecare, Harry & Jeanette Weinberg Campus, Bronx
Jewish Home Lifecare, Manhattan
Jewish Home Lifecare, Sarah Neuman Center, Westchester
Senior Health Partners
The Bridge, Inc. and Affiliates
Educational Alliance
The Division of Certification and Surveillance has indicated that the hospitals reviewed have exercised sufficient
supervisory responsibility to protect the health, safety and welfare of patients and to prevent recurrent code violations.
The Bureau of Quality Assurance and Surveillance for Nursing Homes has indicated the following:
Jewish Home Lifecare, Harry & Jeanette Weinberg Campus, Bronx was fined six thousand dollars ($6,000) pursuant
to a stipulation and order dates September 18, 2010 for surveillance findings of June 23, 2009. Deficiencies were
found under 10 NYCRR 415.4(b) Resident Behavior and Facility Practices: Staff Treatment of Residents, 415.12
Quality of Care and 415.26 Organization and Administration.
Project # 122121-E Exhibit Page 7
Jewish Home and Hospital for the Aged was fined two thousand dollars ($2,000) pursuant to a stipulation and order
dates August 25, 2011 for surveillance findings of March 12, 2010. Deficiencies were found under 10 NYCRR
415.12(I)(1) Quality of Care: Hydration.
Jewish Home and Hospital for the Aged was fined two thousand dollars ($2,000) pursuant to a stipulation and order
dates March 22, 2010 for surveillance findings of February 18, 2009. Deficiencies were found under 10 NYCRR
415.12(h)(2) Quality of Care: Accidents.
Jewish Home and Hospital for the Aged was fined two thousand five hundred dollars ($2,500) pursuant to a stipulation
and order dates March 3, 2006 for surveillance findings of October 30, 2003. Deficiencies were found under 10
NYCRR 415.12(b) Resident Behavior and Facility Practices: Staff Treatment of Residents, 415.4(b)(1)(2)(3) Resident
Behavior and Facility Practices: Staff Treatment of Residents, 415.15(b)(2)(iii) Medical Services: Physician Services.
Sarah Neuman Center for Healthcare and Rehabilitation was fined two thousand dollars ($2,000) pursuant to a
stipulation and order dates August 8, 2008 for surveillance findings of January 18, 2008. Deficiencies were found
under 10 NYCRR 415.12(c)(1)&(2) Quality of Care: Pressure Sores.
The information provided by the Bureau of Quality Assurance and Surveillance for Nursing Homes has indicated that
the nursing home reviewed has provided sufficient supervision to prevent harm to the health, safety and welfare of
residents and to prevent recurrent code violations. When code violations have occurred, it was determined that the
operators investigated the circumstances surrounding the violation and took steps appropriate to the gravity of the
violation that a reasonably prudent operator would take to promptly correct and prevent the recurrence of the
violations.
The information provided by the Division of Home and Community Based Services has indicated that the licensed
home care services agencies and long term home health care programs have provided sufficient supervision to
prevent harm to the health, safety and welfare of patients and to prevent recurrent code violations.
The information provided by the Office of Managed Care has indicated that the MLTC plan has provided sufficient
supervision to prevent harm to the health, safety and welfare of patients and to prevent recurrent code violations.
The information provided by the Office of Mental Health has indicated that the applicant has provided sufficient
supervision to prevent harm to the health, safety and welfare of residents and to prevent recurrent code violations.
A review of all personal qualifying information indicates there is nothing in the background of the principals listed
above to adversely effect their positions in the proposed organizational structure. The applicant has the appropriate
character and competence under Article 36 of the Public Health Law.
The applicant has also requested approval to serve the following downstate counties: New York, Westchester,
Nassau, Suffolk Counties. A recommendation for approval for the downstate counties was presented to the Council
and approved at the August 9, 2012 meeting.
Recommendation
From a programmatic perspective, approval is recommended.
Financial Analysis
Operating Budget
The applicant has submitted an incremental operating budget, in 2012 dollars, for the first and third years, as
summarized below:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Year One
$15,859
14,175
18,431
Year Three
$11,552
100,073
53,021
Project # 122121-E Exhibit Page 8
Medicare Managed Care
Other
Total Revenues
0
150
$48,615
12,900
0
$177,546
Expenses
$37,539
$137,569
Net Gain
$11,076
$39,977
Utilization by payor source in the first and third years is as follows:
Medicaid Fee-for-Service
Medicaid Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Other
Charity Care
Year One
44.43%
44.43%
8.52%
0%
.62%%
2.00%
Year Three
8.82%%
79.10%
6.25%
3.32%
.51%
2.00%
Expense assumptions are based on nursing visits approximately 3 visits per month; rehabilitation therapy
approximately 2 visits per month; social services approximately 1 visit per month and home health aides approximately
20 visits per month. Utilization assumptions are based on the historical experience of facilities in the geographical
area. Revenues are reflective of current payment rates as well as the recent implementation of the Medicaid Episodic
Payment System.
Capability and Feasibility
There are no project costs associated with this application.
Working capital requirements, estimated at $22,928, appear reasonable based on two months of third year expenses
and will be provided through existing operations. Presented as BFA Attachment A are the 2010 and 2011 certified
financial statements of Jewish Home Lifecare Community Services, which indicates the availability of sufficient funds
to meet the working capital requirement.
The submitted budget indicates that the applicant will have a gain of $11,076 and a gain of $35,977 during the first
and third years, respectively. Revenues are reflective of current payment rates as well as the recent implementation
of the Medicaid Episodic Payment System. The submitted budget appears reasonable.
As shown on BFA Attachment A, Jewish Home and Lifecare, Manhattan had an average negative working capital
position and an average positive net asset position. The applicant has indicated that the reason for the negative
working capital position is that the facility did not receive payment for the 2002 rebased rate until 2011. The applicant
achieved an average operating excess of revenues over expenses of $2,821,960 during the period shown. Also, the
applicant achieved an average change in net assets of $2,886,075 during the period shown. The applicant incurred a
change in net assets of ($4,043,930) in 2011 due to adjustments to pension liability funded status of ($8,434,432).
Subject to the noted contingency, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 122121-E Exhibit Page 9
Attachments
BFA Attachment A
Financial Summary Jewish Home Lifecare Community Services
BFA Attachment B
Organizational Chart of Jewish Home Lifecare System
Project # 122121-E Exhibit Page 10
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3606 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the Regional Health Systems Agency, the staff of the New
York State Department of Health, and the Establishment and Project Review Committee of this
Council, and after due deliberation, hereby approves the following application to establish a
certified home health agency to serve Rockland County, and with the contingencies, if any, as
set forth below and providing that each applicant fulfills the contingencies and conditions, if any,
specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER
APPLICANT/FACILITY
122121 E
Jewish Home Lifecare, Community Services
APPROVAL CONTINGENT UPON:
1. Submission of an executed sublease agreement that is acceptable to the Department of
Health. [BFA]
APPROVAL CONDITIONED UPON:
1. Pursuant to 10 NYCRR 760.8, the applicant shall be providing services in the entire
geographic area approved by the Council within one year of the Council’s approval. The
failure, neglect or refusal of an applicant for the establishment of a new certified home
health agency to commence operation of the certified home health agency within one year
of issuance of the Council’s approval or contingent approval of the application shall
constitute an abandonment of the application by the applicant, with any such approval to be
deemed cancelled and withdrawn without further action by the Council. [CHA]
Documentation submitted to satisfy the above-referenced contingencies
(4 copies) should be submitted within sixty (60) days to:
Mr. Keith McCarthy
Acting Director
Bureau of Project Management
NYS Department of Health
Empire State Plaza
Corning Tower, Room 1842
Albany, New York 12237
STATE OF NEW YORK DEPARTMENT OF HEALTH
-
MEMORANDUM
TO:
Public Health and Health Planning Council
FROM:
James Dfi1êneral Cdunsel
DATE:
August 16,2012
SUBJECT:
Proposed Certificate of Amendment of the Certificate of Incorporation of
North Shore University Hospital Stem Family Center for Extended Care and
_J%
Rehabilitation
Attached is the proposed Certificate of Amendment of the Certificate of
Incorporation of North Shore University Hospital Stem Family Center for Extended Care and
Rehabilitation. This not-for-profit corporation seeks Public Health and Health Planning Council
approval to change its name to “North Shore-LIJ Stem Fathily Center for Rehabilitation.” Public
Health and Health Planning Council approval for a change of corporate name is required in this
instance by Not-for-Profit Corporation Law § 804 (a) and 10 NYCRR 600.11 (a)(1).
§
Also attached is a letter dated February 28, 2012 from Lauren Campisi, attorney
for the corporation. As explained in that letter, the name change is intended to more accurately
reflect the services provided by the hospital. The corporation has shifted its core business to
short-term rehabilitation. Additionally, the corporation wishes to more closely align itself with
the North Shore-LIJ system.
The Department has no objection to the proposed name change, and the proposed
Certificate of Amendment of the Certificate of Incorporation of North Shore University Hospital
Stern Family Center for Extended Care and Rehabilitation is in legally acceptable form.
Attachments
[‘Jort
siioreLlj
145 Community Drive
GreatNeck Newvark 11021
:
7t
off Ce of Lgai Affairs
,r
-
Lauren E. campisi. Esq.
Senior Associate General Counsel
February 28, 2012
Public Health and Health Planning Council (“Council”)
New York State Department of Health
Coming Tower
Empire State Plaza
Albany, New York 12237
Re:
Proposed Certificate of Amendment of the Certificate of
Incorporation of North Shore University Hospital Stern Family
Center for Extended Care and Rehabilitation to North Shore-LIJ
Stern Family Center for Rehabilitation (“Stem”)
Dear Council:
We respectfiully submit this letter in support of our name change application and
wish to explain the reasoning for the proposed change.
Stem was ináorporated on November 24, 1967 under the name North Shore
Hospital Nursing Home, Inc. In 1989, the name of the corporation was changed to North
Shore University Hospital Center for Extended Care and Rehabilitation and then, in 2006,
the name was changed to North Shore University Hospital Stern Family Center for
Extended Care and Rehabilitation.
At the time of the most recent name change, Stern served a frail elderly long tenn
care population. Over the past six (6) years, to meet the needs of our patients, medical
advances and the changing market, Stem has shifted its core business to short term
rehabilitation. Stem’s current patient mix reflects eight-five percent (85%) short term
and fifteen percent (15%) long term care.
For purposes of: (I) more closely aligning itself with the North Shore-L1J Health
System; (2) mitigating confusion for both internal and external customers; and
(iii) accurately reflecting its core business, the corporation wishes to removed “Extended
Care” from its new name, North Shore-LJJ Stern Family Center for Rehabilitation.
4202 I
Please do not hesitate to contact me should you have any questions or concerns
regarding the above or our request in general.
B. Campisi
2
CERTIFICATE OF AMENDMENT
OF THE
CERTIFICATE OF INCORPORATION
OF
NORTH SHORE UNIVERSITY HOSPITAL
STERN FAMILY CENTER FOR EXTENDED CARE AND REHABILITATION
(Under Section 803 of the Not-For-Profit Corporatiàn Law)
Lauren E. Camjiisi, Esq.
Senior Associate Genera) Counsel
Office of Legal Affairs
North Shore-LU Health System, inc.
145 Community Drive
Great Neck, New York 11021
#l52l
CERTIFICATE OF AMENDMENT
OF THE
CERTIFICATE OF INCORPORATION
OF
NORTH SHORE UNIVERSITY HOSPITAL STERN FAMILY CENTER
FOR EXTENDED CARE AND REHABILITATION
Under Section 803 of the Not-for-Profit Corporation Law
I, THE UNDERSIGNED, Michael J. Dowling, being the President and Chief
Executive Officer of North Shore University Hospital Stern Family Center for Extended
Care and Rehabilitation, do hereby certib’
The name of the corporation is North Shore University Hospital Stem
Family Center for Extended Care and Rehabilitation (hereinafter call the “Corporation”).
The Corporation was formed under the name North Shore Hospital Nursing Home, Inc.
2,
The Certificate of Incorporation was filed by the Department of State on
November 24, 1967 pursuant to the New York State Membership Corporations Law.
3.
The Corporation is a corporation as defined in subparagraph (a)(5) of
Section 102 of the Not-for-Profit Corporation Law and is a type B corporation under
Section 201 of the Not-for-Profit Corporation Law, and shall remain a type B corporation
after the filing of this Certificate of Amendment.
4.
The Certificate of Incorporation is hereby amended to change the name of
the Corporation to North Shore-LU Stem Family Center for Rehabilitation.
5.
To effectuate the amendment described in Paragraph 4 of this Certificate
of Amendment of the Certificate of Incorporation, Article I of the Certificate of
Incorporation is hereby amended to read in its entirety as follows:
I.
The name of the Corporation is North Shore-LU Stern Family
Center for Rehabilitation.
6.
This amendment of the Certificate of Incorporation was authorized by vote
of the sole member of the Corporation in accordance with Section 802 of the Not-forProfit Corporation Law.
7.
The Secretary of State of the State of New York is hereby designated as
agent of the Corporation upon whom process against it may be served. The post office
#19521
address to which the Secretary of State shall mail a copy of any process against the
Corporation served upon him is: North Shore-LU Stern Family Center for Rehabilitation,
0/0 North Shore-Long Island Jewish Health System, Inc., 145 Comm
unity Drive, Great
Neck, New York 11021, Attention: Office of Legal Affairs.
TN WITNESS WHEREOF, the undersigned has executed this Certificate of
Amendment on this 24- day of January, 2012, and hereby affirm, under penalties of
pei5ury, that the statements herein are true.
£7
MichaelfDow1ing
Presidand Chief Exec ti
‘I
2
Officer
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, on this 11th
day of October, 2012, approves the filing of the Certificate of Amendment of Certificate of
Incorporation of North Shore University Hospital Stern Family Center for Extended Care and
Rehabilitation, dated January 24, 2012.
Division of Home & Community Based Services
Character and Competence Staff Review
Name of Agency:
Address:
County:
Structure:
Application Number:
International Home Care Services of NY, LLC
Rego Park
Queens
Limited Liability Company
1991-L
Description of Project:
International Home Care Services of NY, LLC, a limited liability company, requests approval to obtain
licensure as a home care services agency under Article 36 of the Public Health Law.
The proposed members of International Home Care Services of NY, LLC comprise the following
individuals:
Karina Elnatanova – Member, 50%
Manager, Elina Consulting Co.
Irina Elnatanova, HHA – Member, 50%
st
Marketing, 1 Choice Home Care Services, Inc.
Home Health Aide, Care at Home – Diocese of
Brooklyn (2005-2007)
A search of the individuals named above revealed no matches on either the Medicaid Disqualified
Provider List or the OIG Exclusion List.
The applicant proposes to serve the residents of the following counties from an office located at 99-32
th
66 Road, Unit 5G, Rego Park, New York 11374:
Bronx
Queens
Kings
Richmond
Nassau
New York
The applicant proposes to provide the following health care services:
Nursing
Physical Therapy
Home Health Aide
Occupational Therapy
Personal Care
Nutrition
Speech-Language Pathology
Medical Social Services
Review of the Personal Qualifying Information indicates that the applicant has the required character and
competence to operate a licensed home care services agency.
Contingency
Submission of any and all information requested by the Division of Legal Affairs, in a form and manner
acceptable to the Department.
Recommendation:
Date:
Contingent Approval
September 11, 2012
Division of Home & Community Based Services
Character and Competence Staff Review
Name of Agency:
Omega Care & Health Inc.
d/b/a Right at Home
Patchogue
Suffolk
For-Profit Corporation
1943-L
Address:
County:
Structure:
Application Number:
Description of Project:
Omega Care & Health Inc., d/b/a Right at Home, a business corporation, requests approval to obtain
licensure as a home care services agency under Article 36 of the Public Health Law.
Omega Care & Health Inc. has proposed to operate as a Franchisee of Right at Home Inc.,
The applicant has authorized 200 shares of stock, which are owned as follows:
Raymond Acevedo – 10 Shares
Surveyor/Contraction Layout, International Union
Operating Engineers
Lilethe Acevedo – LPN,10 Share
Owner/Manager, Right at Home
The remaining 180 shares of stock remain unissued.
The Board of Directors of Omega Care & Health Inc., d/b/a Right at Home comprises the following
individual:
Raymond Acevedo – President, Treasurer
(Previously Disclosed)
Lilethe Acevedo – Vice President, Secretary
(Previously Disclosed)
The Office of the Professions of the State Education Department indicates no issues with the licensure of
the health professional associated with this application.
A search of the individuals named above revealed no matches on either the Medicaid Disqualified
Provider List or the OIG Exclusion List.
The applicant proposes to serve the residents of the following counties from an office located at 475 East
Main Street, # 108, Patchogue, New York 11772
Nassau
Suffolk
The applicant proposes to provide the following health care services:
Nursing
Personal Care
Housekeeper
Home Health Aide
Homemaker
Review of the Personal Qualifying Information indicates that the applicant has the required character and
competence to operate a licensed home care services agency.
Contingency
Submission of any and all information requested by the Division of Legal Affairs, in a form and manner
acceptable to the Department.
Recommendation:
Date:
Contingent Approval
September 11, 2012
Division of Home & Community Based Services
Character and Competence Staff Review
Name of Agency:
Address:
County:
Structure:
Application Number:
Tioga County Health Department
Owego
Tioga
Public
2166-L
Description of Project:
Tioga County Health Department, a government subdivision, requests approval to obtain
licensure as a home care services agency under Article 36 of the Public Health Law.
The applicant currently operates a certified home health agency (CHHA), a long term home
health care program (LTHHCP) and a diagnostic and treatment center. Tioga County Health
Department is requesting approval to become licensed as a licensed home care services agency
to enable the county to continue to provide essential public health nursing services.
The applicant proposes to serve the residents of Tioga County from an office located at:
1062 State Route 38, P.O. Box 120, Owego, New York 13827-0120.
The applicant proposes to provide the following health care services:
Nursing
Medical Social Services
Nutrition
The information provided by the Division of Home and Community Based Services has indicated
that the certified home health care agency (CHHA) and long term home health care program
(LTHHCP) reviewed have provided sufficient supervision to prevent harm to the health, safety
and welfare of patients and to prevent recurrent code violations.
The information provided by the Division of Certification and Surveillance has determined that the
Article 28 diagnostic and treatment center reviewed has exercised sufficient supervisory
responsibility to protect the health, safety and welfare of patients and to prevent recurrent code
violations.
Since the applicant is a public entity, it is not subject to a character and competence review.
Contingency
Submission of any and all information requested by the Division of Legal Affairs, in a form and
manner acceptable to the Department.
Recommendation: Contingent Approval
Date:
August 6, 2012
Division of Home & Community Based Services
Character and Competence Staff Review
Name of Agency:
Address:
County:
Structure:
Application Number:
Gotham Per Diem, Inc.
Bronx
Bronx
For-Profit Corporation
1999-L
Description of Project:
Gotham Per Diem, Inc., a for-profit corporation, requests approval for a proposed corporate
restructuring of a home care services agency under Article 36 of the Public Health Law.
Gotham Per Diem, Inc., is a licensed home care services agency, and was previously approved
as a home care services agency by the Public Health Council at its September 23, 1994 meeting
and subsequently licensed as 9525L001.
At that time, the stock was owned by Caroline M. Barrett – 40 shares and the Charles Spear
Charitable Trust – 160 shares. The sole trustee of the Charles Spear Charitable Trust is Caroline
M. Berrett.
Gotham Per Diem, Inc. is seeking approval to transfer 100% of the capital stock from its present
owners; Caroline M. Barrett and the Charles Spear Charitable Trust to the Gotham Per Diem
Employee Stock Ownership Trust (“ESOP”).
The Trustee of the ESOP Trust, to which the Company’s stock will be transferred to is GreatBanc
Trust Company, and independent institutional trustee of ESOPs. GreatBanc’s corporate
headquarters is located in Illinois.
GreatBanc’s function with respect to the Plan is precisely that which it performs as a Trustee. No
officer or director of GreatBanc will have direct authority over the Gotham Per Diem ESOP. As an
independent Trustee, GreatBanc’s functions will be limited solely to administrative and ministerial
activities.
The ESOP attained its legal existence on January 1, 2010. The transfer of stock to the Trustee
has not taken place. It will only occur after Public Health and Health Planning Council approval
and all contingencies, if any, are satisfied.
At the closing, a total of 100,000 shares of Company common stock will be issued and
outstanding. All of those shares will be transferred to the Trustee.
A Committee was formed as the governing body of the ESOP Trust. Under the terms of the Trust,
the Committee, comprised of three members, is responsible for the management and direction of
the ESOP Trust, in furtherance of which it is charged with making all financial, operational,
investment and other decisions affecting the conduct of the business of that Trust.
The Committee, who also comprise the Board of Directors of the Company, comprises the
following individuals:
Caroline M. Barrett – Chairman
President, Chief Executive Officer,
Director, Principle Stockholder, Gotham
Per Diem, Inc.
Sole Trustee, Charles Spear Charitable
Trust
Robert N. Cooperman, Esq. – Secretary
President/Partner, Cooperman Lester Miller, LLP
James F. Galvin – Member
Controller, Gotham Per Diem, Inc.
Caroline M. Barrett is exempt from character and competence review due to the fact that she was
previously approved by the Public Health Council for this operator.
A search of the individuals named above revealed no matches on either the Medicaid Disqualified
Provider List or the OIG Exclusion List.
A Certificate of Good Standing has been received for Robert N. Cooperman, Esq.
A 10 year review of the operations of the following agency was performed as part of this review:
Gotham Per Diem, Inc.
The information provided by the Division of Home and Community Based Services has indicated
that the applicant has provided sufficient supervision to prevent harm to the health, safety and
welfare of residents and to prevent recurrent code violations.
The applicant will continue to provide the following health care services:
Nursing
Occupational Therapy
Respiratory Therapy
Home Health Aide
Physical Therapy
Nutrition
Personal Care
Housekeeper
Homemaker
Medical Social Services
Speech-Language Pathology
The applicant will continue to serve the residents of the following counties from an office located
rd
at 115 East 23 Street, New York, New York 10010:
Bronx
Richmond
Kings
Westchester
New York
Queens
The applicant will continue to serve the residents of the following counties from an office located
at 2488 Grand Concourse, Bronx, New York 10458:
Bronx
Richmond
Kings
Westchester
New York
Queens
Review of the Personal Qualifying Information indicates that the applicant has the required
character and competence to operate a licensed home care services agency.
Contingency
Submission of any and all information requested by the Division of Legal Affairs, in a form and
manner acceptable to the Department.
Recommendation:
Date:
Contingent Approval
September 10, 2012
RESOLUTION
RESOLVED, that the Public Health and Health Planning Council, pursuant to the
provisions of Section 3605 of the Public Health Law, on this 11th day of October, 2012, having
considered any advice offered by the staff of the New York State Department of Health and the
Establishment and Project Review Committee of the Council, and after due deliberation, hereby
approves the following applications for licensure, and with the contingencies, if any, as set forth
below and providing that each applicant fulfills the contingencies and conditions, if any,
specified with reference to the application, and be it further
RESOLVED, that upon fulfillment by the applicant of the conditions and
contingencies specified for the application in a manner satisfactory to the Public Health and
Health Planning Council and the New York State Department of Health, the Secretary of the
Council is hereby authorized to issue the approval of the Council of the application, and be it
further
RESOLVED, that upon the failure, neglect or refusal of the applicant to submit
documentation or information in order to satisfy a contingency specified with reference to the
application, within the stated time frame, the application will be deemed abandoned or
withdrawn by the applicant without the need for further action by the Council, and be it further
RESOLVED, that upon submission of documentation or information to satisfy a
contingency specified with reference to the application, within the stated time frame, which
documentation or information is not deemed sufficient by Department of Health staff, to satisfy
the contingency, the application shall be returned to the Council for whatever action the Council
deems appropriate.
NUMBER:
2169 L
FACILITY:
Greene County Public Health Nursing Service
(Greene County)
1991 L
International Home Care Services of NY, LLC
(Bronx, Queens, Kings, Richmond, Nassau and New
York Counties)
1943 L
Omega Care & Health Inc. d/b/a Right at Home
(Nassau and Suffolk Counties)
2166 L
Tioga County Health Department
(Tioga County)
1999 L
Gotham Per Diem, Inc.
(Bronx, Richmond, Kings, Westchester, New York and
Queens Counties)
New York State Department of Health
Public Health and Health Planning Council
October 11, 2012
B
.
APPLICATIONS FOR ESTABLISHMENT AND CONSTRUCTION OF
HEALTH CARE FACILITIES
CATEGORY 4: Applications Recommended for Approval with the Following:
™ PHHPC Member Recusals
™ Establishment an Project Review Committee Dissent, or
™ Contrary Recommendation by HSA
Ambulatory Surgery Centers – Establish/Construct
Number
Applicant/Facility
121140 B
Endoscopy Center of Niagara
(Niagara County)
Mr. Booth – Interest
Dr. Gutiérrez – Abstained at
EPRC
Dr. Martin – Abstained at
EPRC
Exhibit #25
E.P.R.C.
Recommendation
Contingent Approval
Public Health and Health Planning
Council
Project # 121140-B
Endoscopy Center of Niagara, LLC
County: Niagara (Niagara Falls)
Purpose: Establishment and Construction
Program: Ambulatory Surgery Center
Submitted: March 20, 2012
Executive Summary
Description
Endoscopy Center of Niagara, LLC, an existing New York
State limited liability company, requests approval to establish
and construct a single-specialty freestanding ambulatory
surgery center (FASC) specializing in gastroenterology
procedures. The FASC will be located at 6933 Elaine Drive,
Niagara Falls, and be comprised of two procedure rooms,
which will accommodate the current and future needs of the
community. Endoscopy Center of Niagara, LLC is a joint
venture, with membership as shown below:
Northtowns Venture, LLC
-- Class B Membership
Endoscopy Center of Western New York, LLC
-- Class A Membership
51.0%
In response to the Department’s inquiry to local
hospitals regarding the impact of the proposed ASC in
the service area, objections were received from Mount Saint
Mary’s Hospital and Health Center. The Department does
not find the comments submitted sufficient to warrant
reversal or modification of the recommendation for five-year
limited life approval.
49.0%
Total project costs are estimated at $2,026,286.
Northtowns Venture, LLC is owned equally by both Niagara
Falls Memorial Medical Center (NFMMC) and VISK, Inc
(previously known as General Homecare, Inc.). VISK, Inc. is
a wholly-owned subsidiary of Kaleida Health. They are a
passive parent entity. Kaleida Health will provide the funding
for VISK, Inc. for the project, and will be providing a
subvention agreement for this funding.
Endoscopy Center of Western New York, LLC which is a
class A member is comprised of 15 individuals, 11 of whom
are Class A and 4 are Class B, listed below:
Members
Christopher Bartolone, M.D. (A)
David Garson, M.D. (A)
Richard Kaplan, M.D. (A)
Michael Kozower, M.D. (A)
Yogesh Maheshwari, M.D. (A)
Siddhartha Shah, M.D. (A)
Raymond Tuoti, M.D. (A)
Mr. Kenneth Hoffman (A)
Mr. John Poisson (B)
Ms. Karen Sablyak (B)
Peter Bloom, M.D, (A)
Naima Mian, D.O. (A)
Stanley Pietrak, M.D. (A)
Mr. Frank Principati (B)
Mr. W. Barry Tanner (B)
The primary difference between the A and B membership are
that Class A members are active in the daily operations of
the facility while Class B members are not, and are involved
primarily with the overall Board decisions for the facility.
Interest
8.3770%
8.3770%
8.3770%
8.3770%
8.3770%
8.3770%
8.3770%
1.8324%
13.0758%
13.0758%
3.7923%
3.7923%
3.7923%
1.0000%
1.0000%
DOH Recommendation
Contingent approval, with an expiration of the operating
certificate five years from the date of its issuance, should the
operator not comply with the conditions of approval granted
this CON.
Need Summary
The proposed project will address the needs of the
participating physicians’ patients, who are currently served at
Endoscopy Center of Western New York and NFMMC. It is
projected that there will be 3,672 procedures performed in
the year 1 and 4,159 procedures in year 3.
Program Summary
Staff have reviewed the ten-year surveillance history of all
associated facilities. The review found that any citations
were properly corrected with appropriate remedial action.
Financial Summary
Project costs will be met with $226,286 in cash and a
$1,800,000 loan from Wells Fargo Bank (6 yrs. @ 6%).
Budget:
Revenues:
Expenses:
Gain/(Loss):
$ 2,529,824
1,865,668
$
664,156
Subject to noted contingencies, it appears that the applicant
has demonstrated the capability to proceed in a financially
feasible manner.
Project # 121140-B Exhibit Page 1
Recommendations
Health Systems Agency
There will be no HSA recommendation for this application.
Office of Health Systems Management
Approval with an expiration of the operating certificate five years from the date of its issuance is
recommended contingent upon:
1.
2.
Submission of a check for the amount enumerated in the approval letter, payable to the New York State Department of
Health. Public Health Law Section 2802.7 states that all construction applications requiring review by the Public Health
and Health Planning Council shall pay an additional fee of fifty-five hundredths of one percent of the total capital value of
the project, exclusive of CON fees. [PMU]
Submission of a signed agreement with an outside independent entity satisfactory to the Department to provide annual
reports to the DOH beginning in the second year of operation. Said reports shall include:
•
•
•
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Data showing actual utilization including procedures;
Data showing breakdown of visits by payor source;
Data showing number of patients who need follow-up care in a hospital within seven days after ambulatory
surgery;
• Data showing number of emergency transfers to a hospital;
• Data showing percentage of charity care provided, and
• Number of nosocomial infections recorded during the year in question. [RNR]
Submission of an executed building lease that is acceptable to the Department. [BFA]
Submission of an executed administrative services agreement that is acceptable to the Department. [BFA]
Submission of a loan commitment for the Working capital requirement that is acceptable to the Department. [BFA]
Submission of a loan commitment that is acceptable to the Department. [BFA]
Submission of a subvention agreement that is acceptable to the Department. [BFA]
The submission of State Hospital Code (SHC) Drawings, acceptable to the Department, as described in BAEFP Drawing
Submission Guidelines DSG-01. [AER]
Submission of a photocopy of an Amendment to the Article of Organization of Endo Center of Niagara, LLC, which is
acceptable to the Department. [CSL]
Submission of a photocopy of an Amendment to the Operating Agreement of Endo Center of Niagara, LLC, which is
acceptable to the Department. [CSL]
Submission of a photocopy of an Administrative Services Agreement, which is acceptable to the Department. [CSL]
Submission of a photocopy of an Amendment to the Articles of Organization of Endoscopy Center of Western New York,
LLC, which is acceptable to the Department. [CSL]
Submission of a photocopy of an Amendment to the Operating Agreement of Endoscopy Center of Western New York,
LLC, which is acceptable to the Department. [CSL]
Submission of a photocopy of an amendment to the Articles of Organization of Northtown Ventures, LLC, which is
acceptable to the Department. [CSL]
Submission of a photocopy of an amendment to the Operating Agreement of Northtown Ventures, LLC, which is
acceptable to the Department. [CSL]
Approval conditional upon:
1.
2.
3.
4.
5.
6.
The submission of Final Construction Documents, signed and sealed by the project architect, as described in BAEFP
Drawing Submission Guidelines DSG-01, prior to the applicant’s start of construction. [AER]
The applicant shall complete construction by April 1, 2012 in accordance with 10 NYCRR Part 710.2(b)(5) and
710.10(a), if construction is not completed on or before that date, this may constitute abandonment of the approval and
this approval shall be deemed cancelled, withdrawn and annulled without further action by the Commissioner. [AER]
The staff of the facility must be separate and distinct from staff of other entities. [HSP]
The signage must clearly denote the facility is separate and distinct from other adjacent entities. [HSP]
The entrance to the facility must not disrupt any other entity's clinical program space. [HSP]
The clinical space must be used exclusively for the approved purpose. [HSP]
7. The submission of a CON or other licensing extension application required by the Department prior to expiration
date of the operating certificate issued pursuant to this CON, seeking extension of the operating certificate of the
ambulatory surgery center. [PMU]
Project # 121140-B Exhibit Page 2
Council Action Date
October 11, 2012.
Need Analysis
Background
Endoscopy Center of Niagara, LLC (ECN) seeks to establish and construct an Article 28 diagnostic and treatment
center to be certified as a single-specialty freestanding ambulatory surgery center specializing in gastroenterology
procedures, to be located at 6933 Elaine Drive, Niagara Falls, 14304, in Niagara County.
Analysis
The primary service area for this project is Southern Niagara County and Northern Erie County.
The 10 participating physicians of Endoscopy Center of Niagara (ECN) have committed to perform approximately
3,900 procedures at ECN in the first year. These procedures are currently being performed either at the Endoscopy
Center of Western New York, LLC (ECWNY) or at Niagara Falls Memorial Medical Center (NFMMC).
The applicant is committed to serving all persons in need of for the procedure regardless of the source of payment;
additionally, the applicant is committed to providing two (2%) percent charity care, reduced compensation or
uncompensated care.
The proposed location is near the campus of the NFMMC. NFMMC and Kaleida Health will provide backup and
emergency services.
The applicant has submitted an Organizational Mission Statement that identifies the populations and communities that
will be served and ensures that charity care will be provided. The applicant has also submitted a statement that the
proposed financial/referral structure has been assessed in light of anti-kickback and self-referral laws, with
consultation of the legal counsel. Both of these statements are acceptable.
Conclusion
This project will increase access to service for patients in Southern Niagara County and Northern Erie County.
Recommendation
From a need perspective, contingent approval is recommended.
Programmatic Analysis
Background
Establish a diagnostic and treatment center that will also be federally certified as an ambulatory surgery center.
Proposed Operator
Site Address
Surgical Specialties
Operating Rooms
Procedure Rooms
Hours of Operation
Staffing (1st Year / 3rd Year)
Medical Director(s)
Emergency, In-Patient and
Backup Support Services
Agreement and Distance
Endoscopy Center of Niagara, LLC
6933 Elaine Drive, Niagara Falls
Gastroenterology
0
2
Monday through Friday from 7:00 am to 5:00 pm (Extended as
necessary to accommodate patient needs).
8.75 FTEs / 9.25 FTEs
Yogesh Maheshwari / Raymond Tuoti
Niagara Falls Memorial Medical Center
6.1 miles and 18 minutes
Project # 121140-B Exhibit Page 3
On-call service
Access to the facility’s on-call physician during hours when the
facility is closed.
Character and Competence
The members of the LLC are:
Class A Member
Endoscopy Center of Western NY, LLC
Christopher Bartolone, MD
David Garson, MD
Richard Kaplan, MD
Michael Kozower, MD
Yogesh Maheshwari, MD
Siddhartha Shah, MD
Raymond Tuoti, MD
Kenneth Hoffman
John Poisson
Karen Sablyak
Peter Bloom, MD
Naima Mian, DO
Frank Principati
W. Barry Tanner
Class B Member
Northtowns Venture, LLC
Niagara Falls Memorial Medical Center (50%)
Sheila Kee
Joseph Ruffalo
VISK, Inc. (50%)
Donald Boyd
John Kessler
Judith Baumgartner
49%
Manager
President / Manager
Treasurer
Manager
51%
Vice President / Manager
Secretary / Manager
Endoscopy Center of Western New York, LLC includes practicing physicians as well as members of Physician
Endoscopy, LLC (PELL). PELL is a national provider of administrative and consulting services to gastroenterological
practices. Additionally, these PELL members have been approved in New York State as members of several Article
28 ambulatory surgery centers.
The members of Northtowns Ventures, LLC are Niagara Falls Memorial Medical Center and VISK, Inc. (whose sole
passive member is Kaleida Health). The Board of Managers of Northtowns is comprised of current board members or
executive staff of Niagara Falls, Kaleida, and Visiting Nurse Association of WNY.
Staff from the Division of Certification & Surveillance reviewed the disclosure information submitted regarding licenses
held, formal education, training in pertinent health and/or related areas, employment history, a record of legal actions,
and a disclosure of the applicant’s ownership interest in other health care facilities. Licensed individuals were checked
against the Office of Medicaid Management, the Office of Professional Medical Conduct, and the Education
Department databases as well as the US Department of Health and Human Services Office of the Inspector General
Medicare exclusion database.
Additionally, the staff from the Division of Certification & Surveillance reviewed the ten-year surveillance history of all
associated facilities. Sources of information included the files, records, and reports found in the Department of Health.
Included in the review were the results of any incident and/or complaint investigations, independent professional
reviews, and/or comprehensive/focused inspections. The review found that any citations were properly corrected with
appropriate remedial action.
•
In 2005 Kaleida Health was fined $4,000 based on the investigation at Millard Fillmore Suburban Hospital of an
occurrence where a patient was admitted for left sided hernia repair. Although the consent and marking indicated
Project # 121140-B Exhibit Page 4
the left side, the operation proceeded on the right side. The error was not noted until the surgeon was dictating
post op notes and others were closing the wound. The operation resumed at that point and the correct side was
operated on.
•
•
•
•
•
In 2006 Kaleida Health was fined $10,000 based on the investigation of care rendered in the Millard Fillmore
Suburban Hospital ER. It was determined that the patient received inadequate care including testing ordered but
not done. Upon readmission, restraints were ordered without physical examination of the patient who deteriorated
and died.
In 2007 Kaleida Health was fined $24,000 based on the investigation of the care rendered to two teenagers in
Women & Children’s Hospital ER. Due to delayed treatment and/or inappropriate treatment, both resulted in
deaths.
In 2005 Niagara Falls Memorial Medical Center was fined $12,000 based on the investigation of an occurrence
reported by the facility in which a patient who had gastric bypass surgery was readmitted with significant
symptoms, but there was a delay in diagnosing peritonitis, and the patient died.
In 2006 Niagara Falls Memorial Medical Center was fined $10,000 based on the investigation of a complaint
regarding a baby death. A pregnant patient arrived at the hospital with prematurely ruptured membranes. The
baby was delivered with severe complications, was transferred and died. It was determined that the baby received
inadequate care at the facility and the transfer to a higher level of care was delayed.
Augusta Endoscopy Center, LLC located in Georgia has not yet filed three annual surveys in accordance with
Georgia law. According to the Georgia Department of Community Health, the facility has not been brought to
enforcement, and the facility disputes that the surveys are required by law. The issue is in the hearing process.
Compliance with Applicable Codes, Rules and Regulations
The medical staff will ensure that procedures performed at the facility conform to generally accepted standards of
practice and that privileges granted are within the physician's scope of practice and/or expertise. The facility’s
admissions policy will include anti-discrimination regarding age, race, creed, color, national origin, marital status, sex,
sexual orientation, religion, disability, or source of payment. All procedures will be performed in accordance with all
applicable federal and state codes, rules and regulations, including standards for credentialing, anesthesiology
services, nursing, patient admission and discharge, a medical records system, emergency care, quality assurance and
data requirements. The Center intends to review the list acceptable procedures annually and as needed to determine
the appropriateness of adding new procedures consistent with individual physician expertise.
Recommendation
From a programmatic perspective, contingent approval is recommended.
Financial Analysis
Administrative Services Agreement
The applicant has submitted a draft administrative services agreement, the terms are summarized below:
Facility:
Contractor:
Services Provided:
Endo Center of Niagara, LLC
Endoscopy Center of Western New York, L.L.C.
Institute cost containment policies and procedures regarding staffing, supplies and
capital and other expenditures, assist with establishment of fee schedules and advise
company of managed care contracting opportunities, implement financial accounting and
management reporting systems approved by the company, assist company in meeting
the following mutual goals, (1) provide a consistent level of quality services to physicians
and patients of facility, (2) operate company on a sound financial basis, (3) operate
company at appropriate levels of staffing and (4) develop and recommend departmental
policies, systems and procedures to achieve an efficient operation governing company.
Develop an Annual Budget; assist in the development and implementation of an
organization structure and written bylaws, policies, procedures and protocols to facilitate
the efficient and legal operation of the company. The development and implementation
of an organizational structure and written bylaws, policies, procedures and protocols to
facilitate the efficient and legal formation and operation of the medical staff. Including
Project # 121140-B Exhibit Page 5
the development and implementation of medical staff committees and credentialing
criteria subject to approval of the board of managers. Development and
recommendation of financial procedures and controls to achieve orderly operation of
Company and to reasonably safeguard the assets of the Company. Including the
establishment of accounting procedures, reporting methods, fee schedules, cost
reporting, asset management, billing procedures and credit and collection procedures, all
done upon the direction of the company. Assist in developing and providing written
monthly financial report packages, including itemized operating expense reports.
Provide operational assistance in order to assist the company in complying with
governmental regulations. Additional operational services include: Operational reviews,
designing and recommending control procedures to ensure that charges for services are
captured efficiently and accurately, recommend preadmission and scheduling protocols
and pre-certification process. Assist in maintaining the physical assets of the company,
provide monthly statistical information, establish systems and controls for purchasing
inventory and distribution and charge control functions. Housekeeping and maintenance
services, accreditation and committee operations. Monitor policies and procedures;
obtain all relevant insurance for the company. Provide assistance with normal daily
operations of the facility.
6 years with (3) additional 6 year terms
Annual Fee $105,000 Fee will increase 2% per year after the first year
Term:
Fee:
Staff notes that the arrangement proposed in the subject application between the facility and Endoscopy Center of
Western New York, LLC, in which all of the owners of ECWNY are also owners of the facility, appears to constitute a
representative governance structure, and appear to be in compliance with the principles set forth by the Department in
that regard.
Lease Rental Agreement
The applicant will lease approximately 5,900 square feet in a to be built building at 6933 Elaine Drive, Niagara Falls,
NY(Niagara County), under the terms of the draft lease agreement summarized below:
Lessor:
Lessee:
Term:
Rental:
Provisions:
6933 Elaine Drive, LLC
Endo Center of Niagara, LLC
10 years with 3 (5) year renewal terms
$129,800 Per Year ($22.00 per sq.ft.) $10,816.67 per month. With a 3% annual
increase in the current years rent.
Triple Net Lease
The applicant has indicated that the lease arrangement will be an arms length lease arrangement. However, several
of the proposed members of Endo Center of Niagara, LLC, have ownership interests in 6933 Elaine Drive, LLC.
Therefore, the applicant has provided two letters of rent reasonableness from licensed Realtors to show that this is an
arms length lease, and that the above stated terms are within the current market rate for the area.
Total Project Cost and Financing
Total project costs for new construction and movable equipment is estimated at $2,026,286, itemized as follows:
New Construction
Design Contingency
Construction Contingency
Architectural/Engineering Fees
Other Fees (consultant fees)
Movable Equipment
Financing Costs
Interim Interest Expense
Application Fee
Additional Processing Fee
$924,120
92,412
46,206
73,930
50,000
766,545
18,000
42,000
2,000
11,073
Project # 121140-B Exhibit Page 6
Total Project Cost
$2,026,286
Project costs are based on an October 1, 2012 construction start date and a 6 month construction period.
The applicant’s financing plan appears as follows:
Equity
Wells Fargo Loan 6% for 6 Years
$
226,286
1,800,000
Operating Budget
The applicant has submitted an operating budget in 2012 dollars, for the first and third years of operation, summarized
below:
Revenues:
Expenses:
Operating
Interest
Depreciation and Rent
Total Expenses
Year One
$2,201,553
Year Three
$2,529,824
$1,461,624
136,850
357,099
$1,955,573
$1,402,744
96,483
366,441
$1,865,668
$245,980
$664,156
3,672
$532.56
4,159
$448.59
Net Income
Utilization: (Visit)
Cost Per Visit
Utilization by payor source for the first and third years is as follows:
Commercial Fee-for-Service
Commercial Managed Care
Medicare Fee-for-Service
Medicare Managed Care
Medicaid Fee-for-Service
Medicaid Managed Care
Charity Care
Year 1
12.96%
40.90%
32.92%
6.29%
1.63%
3.30%
2.00%
Year 3
12.45%
41.48%
32.15%
7.09%
1.42%
3.41%
2.00%
Expense assumptions are based on the experience of the participating physicians in providing healthcare services
through a private practice as well as the projections and experience of other freestanding ambulatory surgery centers
in New York State. Utilization for the first year and third years of operation is based on the participating physicians’
current caseload with a slight decrease for year one due to the applicant understands of typical start-up issues with a
new FASC.
Capability and Feasibility
The initiation of operations as a financially viable entity will be provided through $226,286 in cash equity by the
proposed member with the remaining $1,800,000 for the project coming from a loan from Wells Fargo at the above
stated rate.
Presented as BFA Attachments A, B and C are the financial statements for Niagara Falls Memorial Medical Center,
Visk, Inc. and Endoscopy Center of Western New York, LLC (ECWNY), respectively, which indicates the availability of
sufficient funds for the stated levels of equity.
Working capital requirements, estimated at $310,945 appear reasonable based on two months of third year expenses.
The facility will provide $155,945 in cash equity for this project and will borrow the remaining $155,000 from Wells
Project # 121140-B Exhibit Page 7
Fargo Bank with a 5 year term and a 6% interest rate. A letter of interest has been supplied by Wells Fargo Bank.
Presented as BFA Attachments A, B and C are the financial statements for Niagara Falls Memorial Medical Center,
Visk, Inc. and Endoscopy Center of Western New York, LLC (ECWNY), respectively, which indicates the availability of
sufficient funds for the stated levels of equity. Presented as BFA Attachment F is the pro-forma balance sheet as of
the first day of operation, which indicates positive member’s equity position of $382,231.
The submitted budget indicates a net income of $245,890 and $664,156 would be maintained during the first and third
years of operation, respectively. Budgeted net income appears reasonable.
As shown on BFA Attachment A, The certified financial summary for Niagara Falls Memorial Medical Center had an
average negative working capital position and average positive net asset position, and generated an average net
income of $2,614,811 during the period 2008 through 2010. The 2008 loss was caused by issues with the overall
financial conditions of the medical center (pension liability adjustment) and the operations of the medical center and
the delivery of patient care. In 2010, the medical center implemented a plan to correct and improve the financial
conditions and operations of the medical center. This plan focused on 6 key objectives: Expand primary care,
strengthen outpatient services, reduce operating costs, enhance patient revenues, increase patient safety and
transform the delivery of patient care. This can be seen in the interim 2011 financial statements for the facility, shown
as BFA Attachment B.
As shown on BFA Attachment B, The interim financial summary for Niagara Falls Memorial Medical Center had an
average negative working capital position and average positive net asset position, and generated an average net
income of $4,385,288 for the period January 1, 2011 through October 31, 2011.
As shown on BFA Attachment C, The certified financial summary for Visk, Inc had average positive working capital
and net asset positions, and generated an average net income of $22,652 for 2011. The facility however does not
have liquid resources to cover their portion of the project cost, but will be receiving the necessary funds through a
subvention agreement from Kaleida Health.
As shown on BFA Attachment D, The interim financial summary for Visk, Inc. had average positive working capital and
net asset positions, and generated an average net loss of $7,163 for the period January 1, 2012 through August 31,
2012. The loss was due to minor administrative expenses incurred by the entity due to the fact that it has not been
operational for several years. The loss will be covered by the passive parent entity Kaleida Health, but it appears that
as a result of this project, the facility will experience a net operating income at the end of the year.
As shown on BFA Attachment E, The certified financial summary for Kaleida Health had average positive working
capital and net asset positions, and generated an average net income of $39,676,000 during the period 2009 through
2010.
As shown on BFA Attachment F, The interim financial summary for Kaleida Health had average positive working
capital and net asset positions, and generated an average net loss of $11,567,000 for the period January 1, 2011
through November 30, 2011.The 2011 loss was caused by the wind down of one of the tertiary care hospitals, Millard
Fillmore Gates, which experienced significant losses in its final year of operations which was 2011 in which the
services were being transferred from Millard Fillmore to Buffalo General Hospital and Gates Vascular Institute. The
transition and closure was completed in the first quarter of 2012. The facility has been able to achieve positive
financial results since the closure.
As shown on BFA Attachment G the certified financial summary for Endoscopy Center of Western New York, LLC
(ECWNY), had average positive working capital and net asset positions, and generated an average net income of
$1,455,336 during the period 2009 through 2011.
Subject to the noted contingencies, it appears that the applicant has demonstrated the capability to proceed in a
financially feasible manner, and contingent approval is recommended.
Recommendation
From a financial perspective, contingent approval is recommended.
Project # 121140-B Exhibit Page 8
Attachments
BFA Attachment A
Certified Financial Summary for Niagara Falls Memorial Medical Center
2008-2010
BFA Attachment B
Interim Financial Summary for Niagara Falls Memorial Medical Center
January 2011-October 2011
BFA Attachment C
Certified Financial Summary for Visk, Inc.
BFA Attachment D
Interim Financial Summary for Visk, Inc.
BFA Attachment E
Certified Financial Summary for Kaleida Health 2009-2010
BFA Attachment F
Interim Financial Summary for Kaleida Health January 2011-November
2011
BFA Attachment G
Financial Summary for Endoscopy Center of Western New York, LLC
(ECWNY)
BFA Attachment H
Pro-forma Balance Sheet of Endoscopy Center of Niagara, LLC
BHFP Attachment
Map
Supplemental Information
Outreach
Below are presented summaries of responses by hospitals to letters from the Department asking for information on the
impact of the proposed ambulatory surgery center (ASC) in their service areas. There follows a summary of the
applicant’s response to DOH’s request for information on the proposed facility’s volume of surgical cases, the sources
of those cases, and on how staff will be recruited and retained by the ASC.
Facility:
Niagara Falls Memorial Medical Center
621 Tenth Street
Niagara Falls, New York 1214302
No response.
Facility:
Kenmore Mercy Hospital
2950 Elmwood Avenue
Kenmore, New York 14217
No response.
Facility:
Mount Saint Mary’s Hospital
and Health Center
5300 Military Road
Lewiston, New York 14092
Project # 121140-B Exhibit Page 9
Mount Saint Mary’s objects to the application on the belief that the applicant physicians who perform
endoscopy procedures at the Mount Saint Mary’s would transfer those cases to the proposed ASC. This
would represent a loss of 65 percent of the hospital’s current endoscopy patients, with an associated annual
loss in net patient services revenue of $2.1 million. This estimate does not include the anticipated revenue
increases from the hospital’s recent expansion of its gastroenterology laboratory from two procedure rooms to
three, nor the $423,000 in costs associated with that expansion. The hospital provided no information on the
impact these losses would have on its community-oriented services.
Utilization at Mount St. Mary’s Hospital and Health Center:
Current
Gastro
Center Use
60%
Endoscopy Cases
Ambulatory
Inpatient
3,600
400
Endoscopy Cases by
Applicant Physicians
Reserved Gastro.
Center Time
for Applicant Physicians
2,331
NA
In 2009, Mount Saint Mary’s experienced an operating gain of $2.2 million on total operating revenues of
$104.9 million. In 2010, the hospital had a loss of $867,000 on operating revenues of $105.9 million. The
hospital’s current assets in 2009 were $32.2 million and current liabilities were $15.5 mi