In re Bayou Shores SNF, LLC

525 B.R. 160, 25 Fla. L. Weekly Fed. B 151, 2014 Bankr. LEXIS 5200, 2014 WL 7452363
CourtUnited States Bankruptcy Court, M.D. Florida
DecidedDecember 31, 2014
DocketCase No. 8:14-bk-09521-MGW
StatusPublished
Cited by2 cases

This text of 525 B.R. 160 (In re Bayou Shores SNF, LLC) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re Bayou Shores SNF, LLC, 525 B.R. 160, 25 Fla. L. Weekly Fed. B 151, 2014 Bankr. LEXIS 5200, 2014 WL 7452363 (Fla. 2014).

Opinion

MEMORANDUM OPINION AND ORDER ON CONFIRMATION

Michael G. Williamson, United States Bankruptcy Judge

The Court can only confirm a debtor’s proposed plan if it is feasible. Here, the Debtor, which operates a skilled nursing facility that derives 90% of its revenue from Medicare and Medicaid patients, has proposed a chapter 11 plan that is funded from its continuing operations. All of the creditors in the case have voted in favor of the plan. But the United States Department of Health & Human Services [162]*162(“HHS”) has objected that the plan is not feasible because it says the Debtor’s Medicare provider agreement was terminated prepetition, and as a consequence, so was its Medicaid provider agreement. This Court must now decide whether the Debt- or’s plan is feasible.

The Court concludes the plan is feasible because the Debtor has the right to assume the Medicare provider agreement under Bankruptcy Code § 365. Although HHS, through the Center for Medicare & Medicaid Services (“CMS”),1 gave the Debtor notice it was terminating its Medicare provider agreement prepetition, that termination was not complete and irreversible until the appeals piocess was complete. And the appeals process was not completed prepetition. For that reason, the Medicare provider agreement can be assumed under Bankruptcy Code § 365, which means the Debtor’s Medicaid provider agreement does not terminate as a matter of law. Because the Debtor’s Medicare and Medicaid provider agreements remain in effect, the Court concludes the Debtor’s plan is feasible and should be confirmed.

Background

The Debtor cares for patients with severe psychiatric conditions

The Debtor owns and operates a 159-bed skilled nursing facility known as the Rehabilitation Center in St. Petersburg, Florida.2 The Debtor currently has 109 patients, most of whom have Alzheimer’s, dementia, or other serious psychiatric conditions.3 The Debtor is one of the few facilities — if not the only one — in the area that is capable of meeting the needs of patients with challenging psychiatric needs.4

The Debtor relies on Medicare and Medicaid revenue

All but a handful of the Debtor’s patients are on Medicaid or Medicare. Medicare, of course, is a federal program that provides payment for skilled nursing services for aged or disabled individuals. Similarly, Medicaid is a joint federal and state program that provides medical assistance to low-income individuals who are disabled. Over 90% of the Debtor’s revenue is derived from Medicare and Medicaid.5

CMS and ARCA conduct surveys to ensure providers are complying with the Medicare and Medicaid program requirements

To receive payment under the Medicare and Medicaid programs, a skilled nursing facility such as the Debtor must comply with the requirements set forth in 42 C.F.R. Part'483, Subpart B. Skilled nursing facilities like the Debtor are subject to standard, special, and other surveys by the State or CMS — depending on whether the facility participates in one or both programs — to certify they are in compliance with applicable federal law.6 If a skilled nursing facility is certified to be in noncompliance, then CMS may terminate any Medicare provider agreements that are in effect at the time or apply alternative remedies instead of — or in addition to — termination.7

[163]*163In determining which remedies to apply, CMS must determine the seriousness of the deficiency that has caused the facility to be noneompliant.8 The seriousness of a deficiency generally ranges from “no actual harm with a potential for minimal harm” to “immediate jeopardy to resident health or safety.”9 “Immediate jeopardy” means “a situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.”10 Regardless of which remedies CMS decides to apply, a skilled nursing facility must complete a “plan of correction” that describes the actions the facility will take to correct any cited deficiencies and the date by which the deficiencies will be corrected.11

The Debtor is cited for three deficiencies

Between February 2014 and July 2014, the Debtor was cited for deficiencies — and determined to be in noncompliance — three separate times.12 The first deficiency had to do with recordkeeping. Á February 2014 survey revealed that, as a result of the facility’s transition to electronic medical records, some of the residents’ files contained conflicting entries with respect to “Do No Resuscitate Orders.”13 The second deficiency had to do with admissions procedures. In March 2014, an individual with a history of sexual exploitation or abuse was admitted to the Debtor’s facility.14 Staff members, however, failed to identify this threat and placed him in a room with another resident.15 Fortunately, the patient with the history of abuse— who was in the facility for less than 24 hours — did not touch or otherwise harm the other resident. The third deficiency had to do with facility security. In July 2014, a resident on the Debtor’s second-floor secure unit left the facility with visitors and was found unharmed on a nearby street corner fifteen minutes later.16 Although no resident was hurt in any of the three incidents, the Debtor was nevertheless cited for “immediate jeopardy” on each occasion.17

The Debtor is brought back into substantial compliance after the first two deficiencies

The Debtor immediately cured the first two deficiencies.18 In the case of the “Do Not Resuscitate” orders, the Debtor made sure that the orders for each resident matched.19 If a patient had a “Do Not Resuscitate Order,” the facility made sure the physician order said the patient was not to be resuscitated.20 As for the admissions procedures, the Debtor wrote a new set of policies and procedures governing [164]*164abuse of residents.21 After the Debtor cured the first two deficiencies, CMS revisited the facility and determined the Debtor was in substantial compliance.22 On May 29, 2014, CMS notified the Debtor it was in substantial compliance with the Medicare and Medicaid requirements as of May 13, 2014.23

The Debtor immediately cures the third deficiency

As with the first two deficiencies, the Debtor immediately cured the third deficiency. Specifically, the Debtor implemented an entirely new system for screening and assessing patients for potential elopement issues and changed the procedure for guests and patients to access the facility’s secure unit.24 The Debtor also took the additional step of hiring a third-party consultant — David Hoffman & Associates — to conduct an extensive review of the corrective measures the Debtor had taken and determine whether the Debtor had been brought back into substantial compliance.25

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Bluebook (online)
525 B.R. 160, 25 Fla. L. Weekly Fed. B 151, 2014 Bankr. LEXIS 5200, 2014 WL 7452363, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-bayou-shores-snf-llc-flmb-2014.