233.28 229.34 9/1/2015 · 2015. 9. 1. · medicaid reimbursement per diem rates provider number: 0...
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Medicaid Reimbursement Per Diem Rates
Provider Number: 0 001135-00
Date: 6/25/2015
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.28 229.34 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001135073120141001201310282014125147
SURREY PLACE CARE CENTER
110 SE LEE AVE
LIVE OAK, FL 32060
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 001136-00
Date: 6/25/2015
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.75 232.80 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001136073120141001201310302014093349
SIGNATURE HEALTHCARE OF PALM BEACH
4405 LAKEWOOD ROAD
LAKE WORTH, FL 33461
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 001416-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 211.03 211.20 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 001416123120130101201310292014124509
FLORIDA BAPTIST RETIREMENT CENTER
1006 33RD ST
VERO BEACH, FL 32960
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 002400-00
Date: 6/25/2015
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.49 260.53 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 002400083120140101201411192014133156
VILLAGE PLACE HEALTH AND REHAB CENTER
2370 HARBOR BLVD
PORT CHARLOTTE, FL 33952
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005219-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 229.96 233.54 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005219123120140701201404212015154724
OSCEOLA HEALTH CARE CENTER
4201 W NEW NOLTE ROAD
SAINT CLOUD, FL 34772
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005372-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.55 233.76 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005372063020140101201410122014133247
DEBARY HEALTH AND REHABILITATION CENTER
60 N HWY 17/92
DEBARY, FL 32713
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005374-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.74 234.09 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005374063020140101201410122014132004
FLAGLER HEALTH AND REHABILITATION CENTER
300 DR CARTER BOULEVARD
BUNNELL, FL 32110
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005379-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.49 231.92 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005379063020140101201410132014132230
LONGWOOD HEALTH AND REHABILITATION CENTER
1520 S GRANT ST
LONGWOOD, FL 32750
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005380-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 243.19 240.86 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005380063020140101201410132014150000
THE REHABILITATION CENTER OF WINTER PARK
1700 MONROE AVE
MAITLAND, FL 32751
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005381-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.59 244.54 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005381063020140101201410132014160002
BRYNWOOD HEALTH AND REHABILITATION CENTER
1656 SOUTH JEFFERSON STREET
MONTICELLO, FL 32344
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005383-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 228.54 225.40 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005383063020140101201410122014130233
CHIPOLA HEALTH AND REHABILITATION CENTER
4294 3RD AVENUE
MARIANNA, FL 32446
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005384-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.52 240.35 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005384063020140101201410122014131408
GLENCOVE HEALTH AND REHABILITATION CENTER
1027 E HWY 98
PANAMA CITY, FL 32401
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005385-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.07 231.55 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005385063020140101201410112014161020
PANAMA CITY HEALTH AND REHABILITATION CENTER
924 W 13TH ST
PANAMA CITY, FL 32401
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005386-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.69 232.18 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005386063020140101201410132014161243
RIVERCHASE HEALTH AND REHABILITATION CENTER
1017 STRONG RD
QUINCY, FL 32351
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005387-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.16 244.30 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005387063020140101201410132014155217
SUWANNEE HEALTH AND REHABILITATION CENTER
1620 HELVENSTON ST SE
LIVE OAK, FL 32064-3474
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005519-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 251.53 249.80 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim Total Prospective
Interim Component X Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005519063020140101201410112014160654
WAVE CREST HEALTH AND REHABILITATION CENTER
1415 S HICKORY ST
MELBOURNE, FL 32901
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005543-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 238.66 236.15 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005543063020140101201410122014135403
SEASIDE HEALTH AND REHABILITATION CENTER
324 WILDER BLVD
DAYTONA BEACH, FL 32114
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005547-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.51 229.69 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005547063020140101201410122014135946
PARKSIDE HEALTH AND REHABILITATION CENTER
451 S AMELIA AVE
DELAND, FL 32724
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005549-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.75 244.17 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005549063020140101201410122014124836
OAKS OF KISSIMMEE
320 N MITCHELL ST
KISSIMMEE, FL 34741
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005701-00
Date: 6/25/2015
Fiscal Year End: 5/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.26 232.61 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Avante Group, Inc.
4000 Hollywood Blvd, Suite 540-N
Hollywood, FL 33021-6744
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005701053120140601201310162014143610
AVANTE AT OCALA
2021 SW 1ST AVE
OCALA, FL 34471
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005811-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.34 247.04 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005811123120140701201404132015134820
PALATKA HEALTH CARE CENTER
110 KAY LARKIN DR
PALATKA, FL 32177
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005814-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 262.59 261.04 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005814063020140101201410122014121820
BOYNTON HEALTH CARE CENTER
7900 VENTURE CENTER WAY
BOYNTON BEACH, FL 33437-7402
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005826-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 228.96 228.86 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005826063020140101201410122014123932
ACCENTIA HEALTH & REHAB. CENTER OF TAMPA
1818 E FLETCHER AVE
TAMPA, FL 33612-3770
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005849-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 274.00 272.49 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005849063020140101201410132014160617
GLEN OAKS HEALTH CARE CENTER
1100 N PINE ST
CLEARWATER, FL 33756-4104
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005850-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.83 232.15 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005850063020140101201410132014132816
HERITAGE PARK
37135 COLEMAN AVE
DADE CITY, FL 33525-4526
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 005851-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.70 232.24 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 005851063020140101201410132014110207
LAKE EUSTIS CARE CENTER
411 W WOODWARD AVE
EUSTIS, FL 32726
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006339-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 236.59 236.54 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 006339063020140101201410132014112001
LAKE PLACID HEALTH AND REHABILITATION CENTER
125 TOMOKA BLVD S
LAKE PLACID, FL 33852-8123
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006340-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 231.44 230.13 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 006340063020140101201410132014110751
WINDSOR HEALTH AND REHABILITATION CENTER
602 E LAURA ST
STARKE, FL 32091
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006483-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.83 240.69 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 006483063020140101201410132014133428
SALERNO BAY HEALTH AND REHABILITATION CENTER
4801 SE COVE RD
STUART, FL 34997-1602
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006489-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 248.16 245.43 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 006489063020140101201410132014111430
ROYAL PALM BEACH HEALTH AND REHABILITATION CENTER
600 BUSINESS PARK WAY
ROYAL PALM BEACH, FL 33411-1747
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 006767-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 252.83 251.25 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 006767063020140101201410122014132634
OAKBROOK HEALTH AND REHABILITATION CENTER
250 BROWARD AVE
LABELLE, FL 33935
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 008793-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 234.62 233.42 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Cardinal Resources, LLC
16 Norcross Street
Roswell, GA 30075
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 008793123120130101201304232014152455
WOODS OF MANATEE SPRINGS
5627 9TH ST E
BRADENTON, FL 34203
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 010082-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 221.63 224.93 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 010082063020140701201304272015113542
COURTYARD GARDENS REHABILITATION CENTER
17781 THELMA AVENUE
JUPITER, FL 33458
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 010453-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.57 238.76 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 010453123120130101201305272014110339
HEARTLAND HEALTH CARE & REHABILITATION CENTER
5401 SAWYER RD
SARASOTA, FL 34233
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 011997-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.16 233.42 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
HCR Manor Care
333 North Summit Street
Toledo, OH 43604
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 011997123120130101201305272014095952
HEARTLAND HEALTH CARE AND REHABILITATION CENTER OF BOCA RATON
7225 BOCA DEL MAR DRIVE
BOCA RATON, FL 33433
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 011998-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 247.85 246.77 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Grace Healthcare, Inc
7201 Shallowford Rd, STE 200
Chattanooga, TN 37421
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 011998123120130101201308152014113656
GRACE REHABILITATION CENTER OF VERO BEACH
2180 10TH AVENUE
VERO BEACH, FL 32960
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 014169-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 242.07 248.02 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Hallmark Accounting
368 New Hempstead Road #309
New City, NY 10956
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 014169123120140201201404252015154626
GULF SHORE REHAB & NURSING
6767 86TH AVE N
PINELLAS PARK, FL 33782
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 015613-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.88 206.85 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Saber Healthcare Group, LLC
26691 Richmond Road
Bedford Heights, OH 44146
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 015613123120140101201405142015092143
ST. JAMES HEALTH AND REHABILITATION CENTER
239 CROOKED RIVER ROAD
CARRABELLE, FL 32322
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017221-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 233.33 231.06 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017221063020140101201410122014140646
BAYSIDE HEALTH AND REHABILITATION CENTER
4343 LANGLEY AVENUE
PENSACOLA , FL 32504
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017222-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 245.26 243.82 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017222063020140101201410132014134039
MARGATE HEALTH AND REHABILITATION CENTER
5951 COLONIAL DRIVE
MARGATE , FL 33063
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017223-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 240.85 238.40 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017223063020140101201410112014160148
ROSEWOOD HEALTHCARE AND REHABILITATION CENTER
3107 NORTH H STREET
PENSACOLA, FL 32501-1043
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017225-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 239.41 237.45 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017225063020140101201410122014142122
BAY BREEZE SENIOR LIVING AND REHABILITATION CENTER
3387 GULF BREEZE PARKWAY
GULF BREEZE, FL 32563
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017230-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.35 243.91 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017230063020140101201410132014105545
SILVERCREST HEALTH AND REHABILITATION CENTER
910 BROOKMEADE DRIVE
CRESTVIEW, FL 32539
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017236-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.06 244.55 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017236063020140101201410122014142356
SPECIALTY HEALTH AND REHABILITATION CENTER
6984 PINE FOREST ROAD
PENSACOLA, FL 32526
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017242-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 260.56 249.26 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017242063020140101201410122014123221
GRAND BOULEVARD HEALTH & REHAB. CENTER
138 SANDESTIN LANE
MIRAMAR BEACH, FL 32550
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 017301-00
Date: 6/25/2015
Fiscal Year End: 6/30/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.08 224.08 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 017301063020130701201210302013092602
LAKE BENNETT HEALTH AND REHABILITATION
1091 KELTON AVE
OCOEE, FL 34761
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 018066-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 226.59 231.77 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
FiveStar Quality Care Inc
400 Centre Street
Newton, MA 02458
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 018066123120140701201404042015134309
THE PARK SUMMIT AT CORAL SPRINGS
8500 ROYAL PALM BLVD
CORAL SPRINGS, FL 33065
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 018777-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 257.90 262.69 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 018777123120130101201305142014170004
BAY VILLAGE OF SARASOTA
8400 VAMO ROAD
SARASOTA, FL 34231
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019085-00
Date: 6/25/2015
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 227.16 200.26 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019085073120141001201312172014140247
GOLFVIEW HEALTHCARE CENTER
3636 10TH AVE N
SAINT PETERSBURG, FL 33713
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019282-00
Date: 6/25/2015
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 197.04 191.26 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019282073120141001201312162014164418
SOUTHERN PINES HEALTHCARE CENTER
6140 CONGRESS ST
NEW PORT RICHEY, FL 34653
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019284-00
Date: 6/25/2015
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 210.74 201.47 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019284073120141001201312172014134846
SIGNATURE HEALTHCARE OF JACKSONVILLE
2061 HYDE PARK RD
JACKSONVILLE, FL 32210
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 019287-00
Date: 6/25/2015
Fiscal Year End: 7/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 218.39 215.86 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Signature Healthcare LLC
12201 Bluegrass Parkway
Louisville, KY 40299
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 019287073120141001201310282014143434
GOLFCREST HEALTHCARE CENTER
600 NORTH 17TH AVE
HOLLYWOOD, FL 33020
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 021261-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 214.01 211.36 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Gulf Coast Healthcare, LLC
40 South Palafox Place
Suite 400
Pensacola, FL 32502
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 021261063020140101201410122014134040
COASTAL HEALTH AND REHABILITATION CENTER
820 N CLYDE MORRIS BLVD
DAYTONA BEACH, FL 32117
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 022138-00
Date: 6/25/2015
Fiscal Year End: 8/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 253.39 235.93 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Greystone Healthcare Management, LLC
4042 Park Oaks Blvd, Suite 300
Tampa, FL 33610
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 022138083120140101201411142014115530
CARLTON SHORES HEALTH AND REHAB CENTER
1350 S NOVA RD
DAYTONA BEACH, FL 32114
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 022987-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 215.75 212.57 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
WW Healthcare Consultants, LLC
1978 8th Avenue NW
Hickory, NC 28603
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 022987123120130101201304282014093018
BLOUNTSTOWN HEALTH AND REHABILITATION CENTER
16690 SW CHIPOLA RD
BLOUNTSTOWN, FL 32424
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 022994-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 209.40 220.72 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 022994063020140701201311062014151233
THE HOME ASSOCIATION, INC.
1203 E 22ND AVE
TAMPA, FL 33605
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 023067-00
Date: 6/25/2015
Fiscal Year End: 3/31/2015
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 258.71 265.15 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 023067033120151001201404292015144210
OKEECHOBEE HEALTHCARE FACILITY
1646 HIGHWAY 441 N
OKEECHOBEE, FL 34972
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 024167-00
Date: 6/25/2015
Fiscal Year End: 6/30/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 228.11 212.03 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
Senior Care Group, Inc.
1240 Marbella Plaza Drive
Tampa, FL 33619
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 024167063020140701201311102014083423
KEY WEST HEALTH & REHABILITATION
5860 W JUNIOR COLLEGE RD
KEY WEST, FL 33040
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 026536-00
Date: 6/25/2015
Fiscal Year End: 12/31/2013
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 257.65 255.80 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 026536123120130101201310272014120537
WEST BROWARD REHABILITATION AND HEALTHCARE
7751 W BROWARD BLVD
PLANTATION, FL 33324
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 030479-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 232.02 230.48 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 030479123120140701201404222015081635
THE HEALTH CENTER OF WINDERMERE
4875 CASON COVE DRIVE
ORLANDO, FL 32811
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 030484-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 241.93 234.33 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 030484123120140701201404212015093359
THE HEALTH CENTER OF PLANT CITY
701 N WILDER RD
PLANT CITY, FL 33566-7547
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 030487-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 237.28 238.09 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim Component Total Prospective with Interim Component
Settlement based on cost
Prior Provider Prospective data
Basis:
Budget
X Unaudited costs
Field audited costs
Desk audited costs
Changes:X Rate Semester Change
Distribution:Contract Management / Fiscal Agent
Permanent File
For Information Only
No Change in Rate
Thomas Parker
Medicaid Cost Reimbursement Planning and Finance
No Home Office
6GVMV Report Calculated: 6/25/2015 8:48:00 AM Report Printed :6/30/2015 ID: 030487123120140701201404242015124209
THE HEALTH CENTER OF PENSACOLA
8475 UNIVERSITY PARKWAY
PENSACOLA, FL 32514
Home Office:
-
Medicaid Reimbursement Per Diem Rates
Provider Number: 0 030490-00
Date: 6/25/2015
Fiscal Year End: 12/31/2014
Audit Status: Unaudited
Provider Type:Current New Effective
Rate Rate Date
Nursing Home Single Level 246.19 247.77 9/1/2015
State of Florida Office of Medicaid Cost Reimbursement Planning and Finance
2727 Mahan Drive - Mail Stop 23
Tallahassee, Florida 32308
Rate Type:
Interim X Prospective
Total Interim X Total Prospective
Interim
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