Private Payment: The Resident does not have a third-party payment source in place; his/her care will be billed at private pay rates. The private pay room and board rate (“Daily Basic Rate”) is $475.26 per day for a private room, $453.90 per day for a semi private room and $ 432.54 per for a three to four bedded room. Ancillary services are not included in the Daily Basic Rate. Ancillary services, such as physician services, rehabilitation therapies, oxygen, dental and diagnostic services, laboratory, x-ray, podiatry, optometry, medications, urinary care supplies, trach, and ostomy supplies, surgical supplies, parenteral and enteral feeding supplies, transportation, services, and extraordinary rehabilitation devices, are not included in the Daily Basic Rate and will be billed separately according to the Facility’s and/or service providers’ charge schedules. Rate of payment to the Facility may differ for individuals with additional sources of payment such as third-party coverage. A copy of the Facility charge schedule for ancillary services is attached to this Agreement and included in your admission package. In addition, certain items and services, such as beauty/barber services; personal telephone, newspaper delivery etc. (see Attachment A – “Non-Clinical Services”) are not covered in the Daily Basic Rate or by health insurance plans and the Resident is responsible to pay for such services. Room and board charges are billed monthly on a one-month advance basis. Ancillary charges are billed in the month following the month that the services were provided. Bills are generated at the end of each month and cover the next month of room and board charges (“Monthly Advance Payment”) and the previous month’s ancillary charges. All payments are due upon receipt of the monthly bill. The Daily Basic Rate and charges for ancillary and/or additional services are subject to increase upon thirty (30) days written notice to the Resident, Resident Representative and/or Sponsor.
Listing of Ownership:
Ben Landa
Miklos Gottlieb
Name and Business Address of Landlord:
Franklin Realty Associates LLC
135 Franklin Avenue, Franklin Square, NY11010
Provision of Goods and Services
BASIC SERVICES
THE FOLLOWING ITEMS AND SERVICES ARE AVAILABLE TO ALL RESIDENTS AND ARE INCLUDED IN THE MEDICARE PART A, BASIC MEDICAID, AND THE PRIVATE PAY ROOM AND BOARD RATE:
Board, including therapeutic or modified diets as prescribed by a physician (excluding enteral and parenteral feeding), and including Kosher food provided upon the request of a Resident who as a matter of religious belief wishes to follow Jewish dietary laws.
* If these items or services are necessary for other than routine treatment, they may not be included in the basic Medicaid and Private Pay room and board rate and may be billable to the Resident, Medicare Part B or other third-party insurance. (See chart below)
NOTICE TO RESIDENTS AND THEIR FAMILIES
This notice provides you with important information regarding how you may look up complaints, citations, inspections, enforcement actions, and penalties taken against the facility.
There are two ways to access this information:
If you have any questions, please contact our Admissions, Administration or Social
Work departments for further information.