Preview
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
OB and NICU Decertification
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Executive Summary
In accordance with Section 710.1(c)(S) of 10 New York Codes, Rules and Regulations (10 NYCRR), Mount Sinai
Beth Israel (MSBI) is submitting this Service Delivery Limited Review Application that seeks approval for the
decertification of 73 inpatient beds at the Hospital, broken down by the following certified bed categories: 42
inpatient maternity beds, 14 neonatal continuing care beds and 17 neonatal intermediate care beds. The
decertification of these beds, which the Hospital would like to occur on May 22, 2017, will eliminate all certified
beds from these three (3) bed categories on the operating certificate of the Hospital. MSBI is currently certified for
799 inpatient beds and will be certified for 726 inpatient beds upon implementation of this project, although the
daily census is far lower (see below). In addition, through this project, the 45-bassinet well-baby nursery (which is
not a certifiable bed category) will also close. Furthermore, MSBI is currently designated by the New York State
Department of Health as a Level 3 Perinatal Center, but it will no longer have this designation upon the
implementation of this project. MSBI is located at First Avenue at 16th Street, New York (New York County), New
York 10003.
The maternity beds are currently located on the 5lh floor of the Dazian Building (22 beds) and 5th floor of the
Karpas Building (20 beds) on the MSBI campus. The neonatal beds are currently located on the 4th floor of the
Dazian Building. Lastly, the well-baby nursery has two (2) locations- on the 5th floor of the Karpas Building and
the Slh floor of the Dazian Building.
This project is part of a larger effort of Mount Sinai to create a more integrated healthcare system, and to more
effectively use system resources, as described in the following paragraphs:
In 2016, MSBI experienced an occupancy rate of 56.7% for its 42 maternity beds, which was a decrease from the
69.2% occupancy in 2013. In January 2017, the occupancy rate continued to decline, to the point where MSBI
averaged only 5.7 deliveries per day, barely half the 10.5 deliveries per day experienced by MSBI in 2013.
Through this project, inpatient maternity patients who would typically be seen at MSBI will still able to be served
in Manhattan at Mount Sinai Hospital (MSH) or Mount Sinai West (MSW), or in Brooklyn at The Brooklyn
Hospital Center (TBHC), with which Mount Sinai is working to expand its strategic relationship, in order to better
serve the mothers and babies in Brooklyn. Each of these facilities has the capacity to handle the additional
maternity case volume.
MSH has 74 certified maternity beds and MSW has 72 certified maternity beds. In 2016, the average daily census
for the 74 maternity beds at MSH was 61.0 (leaving an average of 13.0 beds available each day) and the average
daily census for the 72 maternity beds at MSW was 40.9 (leaving an average of 31.1 beds available each day).
Although MSBI understands that some individuals may choose to seek care outside of the Mount Sinai system, the
Hospital believes that this project is in the best interest of patients from a clinical perspective, given its plans for the
transformation of the MSBI campus.
In 2016, MSBI experienced 268 discharges (with 2,431 patient days) for its 31 neonatal beds, representing an
average daily census of 6.6 and an occupancy rate of 21.4%, which was a decrease from the 44.6% occupancy in
2013. In the first 20 days of January 2017, the occupancy rate of the 31 neonatal beds at MSBI was only 5.6%.
Through this project, inpatient neonatal patients who would typically be seen at MSBI are still able to be served in
Manhattan at MSH (a Regional Perinatal Center) or MSW (a Level3 Perinatal Center), or in Brooklyn at TBHC (a
Lev"el3 Perinatal Center), all of which have the capacity to handle the additional neonatal case volume.
Of the 3,302 births at MSBI in 2016, a total of 1,891 (or 57.3%) were from mothers residing in Kings County,
which demonstrates that a portion of MSBI's maternity/neonatal patients could easily be seen at TBHC, closer to
their homes, upon decertification of the proposed beds. MSBI will work closely with TBHC, a 464-bed acute care
facility located at 121 DeKalb Avenue, Brooklyn (Kings County), New York 11201, to serve maternity and
neonatal patients who receive care at TBHC. TBHC is a clinical affiliate of the Mount Sinai Health System and an
academic affiliate of the lcahn School of Medicine at Mount Sinai. Through its relationship with TBHC, Mount
Sinai and its physicians are planning to work jointly in the provision of clinical care and quality oversight of the
obstetrics program at TBHC. TBHC has 42 certified maternity beds, 10 neonatal intensive care beds and 18
neonatal intermediate care beds that will help accommodate patients.
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
At no point will access to Mount Sinai physicians be interrupted. All obstetrics/gynecology patients will continue
to have access to their Mount Sinai physician for care; the only change will be the location where they will be able
to deliver. Outpatient services will continue to be provided by Mount Sinai physicians throughout the Mount Sinai
Downtown network. Additionally, Mount Sinai does not anticipate any job losses as a result of the closure of the
inpatient maternity beds, neonatal beds and wellwbaby nursery at MSBI, and it has already begun meeting and
working with its union partners to ensure that any affected union employees are retrained, if necessary, and offered
other union opportunities with equal pay within the Mount Sinai Health System.
The Total Project Cost for this project is $500, which is comprised solely of the Limited Review Application fee,
and is being submitted as part of initial submission of the Application.
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Limited Review Application
State of New York Department of Health
Office of Primary Care and Health Systems Management
LRA Cover Sheet
Project to be Proposed/Applicant Information
This application is for those projects subject to a limited review pursuant to 10 NYCRR 710.l(c)(5)-(7). Please check the appropriate
box(es) reflective of the project being proposed by your facility (NOTE- Some projects may involve requisite "Construction". If so,
and total project costs are below designated thresholds, then both boxes must be checked and necessary LRA Schedules submitted).
Please read the LRA Instructions to ensure submission of an appropriate and complete application:
D Minor Construction- Minor construction project with total project costs of up to $6,000,000 (or up to $15,000,000, if not
relating to clinical space- check "Non-Clinical" box below).
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, 5, and 6.
D Equipment- Project related to the acquisition, relocation, installation or modification of certain medical equipment, with
total project costs of up to $6,000,000. (NOT necessary for "1-for-1" replacement of existing equipment without
construction, pursuant to Chapter 174 of the Laws of2011 amending Article 28 of the Public Health law to eliminate limited
review and CON review for one for one equipment replacement)
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5.
181 Service Delivery- Project to decertifY a facility's beds/services; add services which involve a total project cost under
$6,000,000; or convert beds within approved categories. (If construction associated, also check "Construction" above.)
Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12. *Ifproposing to decertify beds within a nursing home, provide a
description ofthe proposed alternative use ofthe space including a detailed sketch (unless the decertification is being
accomplished by eliminating beds in multiple-bedded rooms).
D Health Information Technology- Project to purchase and implement health information technology or
other information systems, with a total project cost between $6,000,000 and $15,000,000.
Necessary LRA Schedules: Cover Sheet, 2, 3, 9, and 12. Also include Vendor Contract language (Appendix D).
D Cardiac Services- Project by an appropriately certified facility to add electrophysiology (EP) services;
or add, upgrade or replace a cardiac catheterization laboratory or equipment. (If construction
associated, also check "Construction" above.)
Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12.
D Relocation of Extension Clinic- Project to relocate an extension clinic within the same service area.
Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5. Also include a Closure Plan for vacating extension clinic.
D Part-Time Clinic- Project to operate, change services offered, change hours of operation or relocate a part-time clinic
site- for applicants already certified for "part-time clinic". (If construction associated, also check "Construction"
above.)
Necessary LRA Schedules: Cover Sheet, 8, 10, 11, and 12.
OPERATING CERTIFICATE NO. CERTIFIED OPERATOR TYPE OF FACILITY
7002002H Mount Sinai Beth Israel Hospital
OPERATOR ADDRESS- STREET & NUMBER PFI NAME AND TITLE OF CONTACT PERSON
First A venue at 16th Street 1439 Frank M. Cicero, Cicero Consulting Associates
CITY
New York
I
COUNTY
New York
ZIP
10003
STREET AND NUMBER
701 Westchester Avenue, Suite 210W
PROJECT SITE ADDRESS- STREET & NUMBER PFI CITY I
STATE ~ZIP
First Avenue at 16th Street
CITY
New York
1 COUNTY
New York
1439
ZIP
10003
White Plains
TELEPHONE NUMBER
(914) 682-8657
lNY
FAXNUMBER
(914) 682-8895
10604
TOTAL PROJECT COST: $ 500 (Application Fee only) CONTACT E-MAIL: conadmin@ciceroassociates.com
(Rev S/2014)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Limited Review A plication Schedule LRA 7
State of New York Department of Health/Office of Health Systems Management
Proposed Operating Budget
Budget .Current Year* First Year* Third Year*
(Projected) (Projected)
Revenues
Service Revenue $39,429,713 $0 $0
Grants Funds
Foundation
Other
Fees
Other Income
(1) Total Revenues $ 39,429,713 $0 $0
Expenses
Salaries and Wage Expense $15,291,988 $0 $0
Employee Benefits $7,478,363 $0 $0
Professional Fees
Medical & Surgical Supplies
Non-Medical Equipment
Purchased Services
Other Direct Expense $13,158,298 $0 $0
Utilities Expense
Interest Expense
Rent Expense
Depreciation Expense $18,557,613 $0 $0
Other Expenses
(2) Total Expense $ 54,486,262 $ - $ -
Net Total - (1-2) $ (15,056,549) $ -$ -
• The Current Year represents year 2016 statistics for the inpatient Maternity and NICU beds at MSBI. The
Year 1 and Year 3 operating budget demonstrates that these beds will be decertified by MSBI through this
project.
(Rev. 7/2015) 1
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Limited Review Application
State of New York Department of Health/Office of Healtb Systems Management
Ischedule LRA 7
* Various inpatient services may be reimbursed as discharges or days. Applicant should indicate which method checkbox.
applies to this table by choosing the appropriate checkbox
Patient Days D Patient Discharges
Inpatient Services Source of Total Current Year** First Year Incremental** Third Year Incremental**
Revenue Patient Net Revenue* Patient Days Net Revenue* Patient Days Net Revenue*
Days or or or
% Dollars($) % Dollars·($) % Dollars-($)
discharges* discharges* discharges*
Commercial Fee for
Service 1,405 37.5% $19,958,014
Managed
Care 92 2.5% $922,876
Medicare Fee for
Service 7 0.2% $61,772
Managed
Care 5 0.1% $51 307
Medicaid Fee for
Service 136 3.6% $1,556,728
Managed
Care 2,054 54.9% $16,578,454
Private Pay 42 1.1% $294,448
OASAS
OMH
Charity Care
Bad Debt
All Other 1 0.0% $6,114
Total 3,742 100.0% $39,429,713 0 0.0% so 0 0.0% so
•• The Current Year represents year 2016 statistics for the Inpatient Maternity and NICU beds at MSBI that will be decertified through this project. The Year 1
and Year 3 operating budget demonstrates that these beds will be decertified by MSBI through this project.
(Rev. 7/2015) 2
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Oupatient Services Total Current Year First Year Incremental Third Year Incremental
Source of Revenue Net Revenue Net Revenue Net Revenue
Visits Visits Visits
% Dollars($) % Dollars($) % Dollars($)
Commercial Fee for
Service
Managed
Care
Medicare Fee for
Service N/A N/A N/A
Managed
Care
Fee for
--- --- ---
Medicaid
Service Inpatient Inpatient Inpatient
Managed
Care Project Only Project Only Project Only
Private Pay
OASAS
OMH
Charity Care
Bad Debt
AIL Other
Total
Total of Inpatient
and Outpatient
Services $39,429,713 so so
Title of Attachment Filename of Attachment
11. In an attachment,
provide the basis and Revenues by payer are
supporting calculations based upon the experience N/A
for all revenues by of the Hospital.
payor.
2. In an attachment, Private Pay/Charity Care
provide the basis for based on the experience of N/A
charity care. the Hospital.
(Rev. 7/2015) 3
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Limited Review Application Schedule LRA 8
State of New York Department of Health/Office of Health Systems Management
Staffing
Number of FfEs to the Nearest Tenth
Staffing Categories Current Year* First Year of Third Year of
**** implementation implementation
**** ****
Health Providers**:
Physician Assistant 2.50
Registered Nurse 98.32
Nurse Practitioner 7.66
Social Worker & Psychologist 1.00
Physical Therapist & PT Assistant 1.00
Other Therapist & Assistant 1.00
Support Staff***:
Management & Supervision 3.72
Teclmician & Specialist 7.57
Aides, Orderlies & Attendants 42.84
Infection Control, Environmental and Food Service 1.05
Clerical and Other Administrative 8.46
Total Number of Employees 175.12 0 0
.. appbcation
* Last complete year prior to submtttmg
** "Health Providers" includes all providers serving patients at the site. A Health Provider is any staff who can
provide a billable service -physician, dentist, dental hygienist, podiatrist, physician assistant, physical therapist, etc.
*** All other staff.
****The Current Year represents year 2016 staffine for the 73 inpatient Maternity and NICU beds at MSBI that will be
decertified throul!h this project. The Year 1 and Year 3 operating budget demonstrates these 73 beds will be decertified by
MSBI through this project.
Describe how the number and mix of staff were determined:
.The number and mix of staff were based upon the fact that all 73 certified inpatient beds will be decertified through this
project. Nevertheless, Mount Sinai does not anticipate any job losses as a result of the closure of the inpatient beds at
MSBI, and it has already begun meeting and working with its union partners to ensure that any affected union
employees are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai
Health ~tern.
PLEASE COMPLETE THE FOLLOWING:
1. Are staff paid and on payroll? [gl Yes D No
2. Provide copies of contracts for any independent contractor. N/A
3. Please attach the Medical Doctors C.V. N/A - Bed Decertification
4. Is this facility affiliated with any other facilities? [8l Yes D No Please refer to the Schedule LRA
(If yes, please describe affiliation and/or agreement.) 8 Attachment
(Rev. 71712010)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
MOUNT SINAI BETH ISRAEL
SCHEDULE LRA 8 ATTACHMENT
STATEMENT RE: ARTICLE 28 NETWORK
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
MOUNT SINAI BETH ISRAEL
ARTICLE 28 NETWORK DESCRIPTION
Mount Sinai Hospitals Group, Inc. (MSHG), a not-for"profit corporation, is the active parent and
co-operator of Mount Sinai Hospital (including its division, Mount Sinai Hospital of Queens),
Mount Sinai Beth Israel, Mount Sinai Brooklyn, Mount Sinai St. Luke's, Mount Sinai Roosevelt
and the New York Eye and Ear Infirmary ofMount Sinai.
Mount Sinai Hospital (MSH) is located at One Gustave L. Levy Place, New York (New York
County), New York 10029. MSH also has a division, Mount Sinai Hospital of Queens, which is
located at 25-10 30th Avenue, Long Island City (Queens County), New York 11102. Mount
Sinai Beth Israel is located at First Avenue at 161h Street, New York (New York County), New
York 10003. Mount Sinai Brooklyn is located at 3201 Kings Highway, Brooklyn (Kings
County), New York 11234. Mount Sinai St. Luke's is located at 1111 Amsterdam Avenue, New
York (New York County), New York 10025. Mount Sinai Roosevelt is located at 1000 Tenth
Avenue, New York (New York County), New York 10019. New York Eye and Ear Infirmary of
Mount Sinai is located at 310 East 14tli Street, New York (New York County), New York 10003.
The following table provides information on operating certificate numbers and PFI numbers for
the above-referenced facilities:
Operating
PFI#
Facility Name Certificate #
Mount Sinai Hospital 7002024H 1456
Mount Sinai Hospital of Queens 7002024H 1639
Mount Sinai Beth Israel 7002002H 1439
Mount Sinai Brooklyn 7002002H 1324
Mount Sinai St. Luke's 7002032H 1469
Mount Sinai Roosevelt 7002032H 1466
New York Eye and Ear Infirmary of Mount Sinai 7002026H 1460
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Limited Review Application Schedule LRA 10 r-
State of New York Department of Health/Office of Health Systems Management
Impact of Limited Review Application on Operating Certificate
(services specific to the site)
Instructions:
"Current" Column: Mark "x" in the box only if the service currently appears on the operating certificate (OpCert) not
including requested changes
"Add" Column: Mark "x" in the box this CON application seeks to add.
"Remove" Column: Mark "x" in the box this CON application seeks to decertify.
"Pro osed" Column: Mark "x" in the box corres ondin to all the services that will ultimate}
rategorv/Authorized Service Code Current Add Remove Prooosed
Chemical Dependence - Rehabilitation --- 30 30
Chemical Dependence - Detoxification --- 31 31
Coronary Care --- 8 8
Intensive Care --- 36 36
Maternity --- 42 -42 0
Medical/Surgical --- 504 504
Neonatal Continuing Care --- 14 -14 0
Neonatal Intermediate Care --- 17 -17 0
Pediatric -- 20 20
Pediatric ICU --- 5 5
Psychiatric --- 92 92
TOTAL 799 -73 726
Does the applicant have any previously submitted Certificate ofN eed (CON) applications that have not been
completed involving addition or decertification of beds?
[8J Yes (Enter CON numbers to the right) 162405-L I 162406-L I
(Rev. 71712010)
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024
NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024
Limited Review Application Schedule LRA 12
State of New York Department of Health/Office of Health Systems Management
Assurances
The undersigned, as a duly authorized representative of the applicant, hereby gives the following assurances:
a) The applicant has OJ' will have a fee simple or such other estate or interest in the site, including necessary easements and
rights-of-way, sufficient to assure use and possession for the purpose of the construction and operation of the facility.
b) The applicant will obtain the approval of the Commissioner of Health of all required submissions, which shall conform to the
standards of construction and equipment in Subchapter C of Title 10 (Health) ofthe Official Compilation of Codes, Rules
and Regulations ofthe State of New York (Title 10).
c) The applicant will submit to the Commissioner of Health final working drawings and specifications, which shall confo1m to
the standards of construction and equipment of Subchapter C of Title I0, prior to contracting for construction, unless
otherwise pl'ovided for in Title IO.
d) The applicant will cause the project to be completed in accordance with the application and approved plans and
specifications.
e) The applicant will provide and maintain competent and adequate architectural and/or engineering inspection at the
construction site to insure that the completed work conforms to the approved plans and specifications.
f) If the project is an addition to a facility already in existence, upon completion of construction all patients shall be removed
from areas of the facility that are not in compliance with pertinent provisions of Title 10, unless a waiver is granted by the
Commissioner of Health, under Title l 0.
g) The facility will be operated and maintained in accordance with the standards prescribed by law.
h) The applicant will comply with the provisions of the Public Health Law and the applicable provisions of Title 10 with respect
to the operation of all established, existing medical facilities in which the applicant has a controlling interest.
i) The applicant understands and recognizes that any approval oftbis application is not to be construed as an approval of, nor
does it provide assurance of, reimbursement for any costs identified in the application. Reimbursement for all cost shall be in
accordance with and subject to the provisions of Part 86 of Title 10.
Signature
I KelUleth L. Davis, M.D.
Name (Please Type)
President and CEO, Mount Sinai Hospitals Group
Title (Please Type)
(Rev. 71712010)
Preview
FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 OB and NICU Decertification FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Executive Summary In accordance with Section 710.1(c)(S) of 10 New York Codes, Rules and Regulations (10 NYCRR), Mount Sinai Beth Israel (MSBI) is submitting this Service Delivery Limited Review Application that seeks approval for the decertification of 73 inpatient beds at the Hospital, broken down by the following certified bed categories: 42 inpatient maternity beds, 14 neonatal continuing care beds and 17 neonatal intermediate care beds. The decertification of these beds, which the Hospital would like to occur on May 22, 2017, will eliminate all certified beds from these three (3) bed categories on the operating certificate of the Hospital. MSBI is currently certified for 799 inpatient beds and will be certified for 726 inpatient beds upon implementation of this project, although the daily census is far lower (see below). In addition, through this project, the 45-bassinet well-baby nursery (which is not a certifiable bed category) will also close. Furthermore, MSBI is currently designated by the New York State Department of Health as a Level 3 Perinatal Center, but it will no longer have this designation upon the implementation of this project. MSBI is located at First Avenue at 16th Street, New York (New York County), New York 10003. The maternity beds are currently located on the 5lh floor of the Dazian Building (22 beds) and 5th floor of the Karpas Building (20 beds) on the MSBI campus. The neonatal beds are currently located on the 4th floor of the Dazian Building. Lastly, the well-baby nursery has two (2) locations- on the 5th floor of the Karpas Building and the Slh floor of the Dazian Building. This project is part of a larger effort of Mount Sinai to create a more integrated healthcare system, and to more effectively use system resources, as described in the following paragraphs: In 2016, MSBI experienced an occupancy rate of 56.7% for its 42 maternity beds, which was a decrease from the 69.2% occupancy in 2013. In January 2017, the occupancy rate continued to decline, to the point where MSBI averaged only 5.7 deliveries per day, barely half the 10.5 deliveries per day experienced by MSBI in 2013. Through this project, inpatient maternity patients who would typically be seen at MSBI will still able to be served in Manhattan at Mount Sinai Hospital (MSH) or Mount Sinai West (MSW), or in Brooklyn at The Brooklyn Hospital Center (TBHC), with which Mount Sinai is working to expand its strategic relationship, in order to better serve the mothers and babies in Brooklyn. Each of these facilities has the capacity to handle the additional maternity case volume. MSH has 74 certified maternity beds and MSW has 72 certified maternity beds. In 2016, the average daily census for the 74 maternity beds at MSH was 61.0 (leaving an average of 13.0 beds available each day) and the average daily census for the 72 maternity beds at MSW was 40.9 (leaving an average of 31.1 beds available each day). Although MSBI understands that some individuals may choose to seek care outside of the Mount Sinai system, the Hospital believes that this project is in the best interest of patients from a clinical perspective, given its plans for the transformation of the MSBI campus. In 2016, MSBI experienced 268 discharges (with 2,431 patient days) for its 31 neonatal beds, representing an average daily census of 6.6 and an occupancy rate of 21.4%, which was a decrease from the 44.6% occupancy in 2013. In the first 20 days of January 2017, the occupancy rate of the 31 neonatal beds at MSBI was only 5.6%. Through this project, inpatient neonatal patients who would typically be seen at MSBI are still able to be served in Manhattan at MSH (a Regional Perinatal Center) or MSW (a Level3 Perinatal Center), or in Brooklyn at TBHC (a Lev"el3 Perinatal Center), all of which have the capacity to handle the additional neonatal case volume. Of the 3,302 births at MSBI in 2016, a total of 1,891 (or 57.3%) were from mothers residing in Kings County, which demonstrates that a portion of MSBI's maternity/neonatal patients could easily be seen at TBHC, closer to their homes, upon decertification of the proposed beds. MSBI will work closely with TBHC, a 464-bed acute care facility located at 121 DeKalb Avenue, Brooklyn (Kings County), New York 11201, to serve maternity and neonatal patients who receive care at TBHC. TBHC is a clinical affiliate of the Mount Sinai Health System and an academic affiliate of the lcahn School of Medicine at Mount Sinai. Through its relationship with TBHC, Mount Sinai and its physicians are planning to work jointly in the provision of clinical care and quality oversight of the obstetrics program at TBHC. TBHC has 42 certified maternity beds, 10 neonatal intensive care beds and 18 neonatal intermediate care beds that will help accommodate patients. FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 At no point will access to Mount Sinai physicians be interrupted. All obstetrics/gynecology patients will continue to have access to their Mount Sinai physician for care; the only change will be the location where they will be able to deliver. Outpatient services will continue to be provided by Mount Sinai physicians throughout the Mount Sinai Downtown network. Additionally, Mount Sinai does not anticipate any job losses as a result of the closure of the inpatient maternity beds, neonatal beds and wellwbaby nursery at MSBI, and it has already begun meeting and working with its union partners to ensure that any affected union employees are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai Health System. The Total Project Cost for this project is $500, which is comprised solely of the Limited Review Application fee, and is being submitted as part of initial submission of the Application. FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Limited Review Application State of New York Department of Health Office of Primary Care and Health Systems Management LRA Cover Sheet Project to be Proposed/Applicant Information This application is for those projects subject to a limited review pursuant to 10 NYCRR 710.l(c)(5)-(7). Please check the appropriate box(es) reflective of the project being proposed by your facility (NOTE- Some projects may involve requisite "Construction". If so, and total project costs are below designated thresholds, then both boxes must be checked and necessary LRA Schedules submitted). Please read the LRA Instructions to ensure submission of an appropriate and complete application: D Minor Construction- Minor construction project with total project costs of up to $6,000,000 (or up to $15,000,000, if not relating to clinical space- check "Non-Clinical" box below). Necessary LRA Schedules: Cover Sheet, 2, 3, 4, 5, and 6. D Equipment- Project related to the acquisition, relocation, installation or modification of certain medical equipment, with total project costs of up to $6,000,000. (NOT necessary for "1-for-1" replacement of existing equipment without construction, pursuant to Chapter 174 of the Laws of2011 amending Article 28 of the Public Health law to eliminate limited review and CON review for one for one equipment replacement) Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5. 181 Service Delivery- Project to decertifY a facility's beds/services; add services which involve a total project cost under $6,000,000; or convert beds within approved categories. (If construction associated, also check "Construction" above.) Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12. *Ifproposing to decertify beds within a nursing home, provide a description ofthe proposed alternative use ofthe space including a detailed sketch (unless the decertification is being accomplished by eliminating beds in multiple-bedded rooms). D Health Information Technology- Project to purchase and implement health information technology or other information systems, with a total project cost between $6,000,000 and $15,000,000. Necessary LRA Schedules: Cover Sheet, 2, 3, 9, and 12. Also include Vendor Contract language (Appendix D). D Cardiac Services- Project by an appropriately certified facility to add electrophysiology (EP) services; or add, upgrade or replace a cardiac catheterization laboratory or equipment. (If construction associated, also check "Construction" above.) Necessary LRA Schedules: Cover Sheet, 7, 8, 10, and 12. D Relocation of Extension Clinic- Project to relocate an extension clinic within the same service area. Necessary LRA Schedules: Cover Sheet, 2, 3, 4, and 5. Also include a Closure Plan for vacating extension clinic. D Part-Time Clinic- Project to operate, change services offered, change hours of operation or relocate a part-time clinic site- for applicants already certified for "part-time clinic". (If construction associated, also check "Construction" above.) Necessary LRA Schedules: Cover Sheet, 8, 10, 11, and 12. OPERATING CERTIFICATE NO. CERTIFIED OPERATOR TYPE OF FACILITY 7002002H Mount Sinai Beth Israel Hospital OPERATOR ADDRESS- STREET & NUMBER PFI NAME AND TITLE OF CONTACT PERSON First A venue at 16th Street 1439 Frank M. Cicero, Cicero Consulting Associates CITY New York I COUNTY New York ZIP 10003 STREET AND NUMBER 701 Westchester Avenue, Suite 210W PROJECT SITE ADDRESS- STREET & NUMBER PFI CITY I STATE ~ZIP First Avenue at 16th Street CITY New York 1 COUNTY New York 1439 ZIP 10003 White Plains TELEPHONE NUMBER (914) 682-8657 lNY FAXNUMBER (914) 682-8895 10604 TOTAL PROJECT COST: $ 500 (Application Fee only) CONTACT E-MAIL: conadmin@ciceroassociates.com (Rev S/2014) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Limited Review A plication Schedule LRA 7 State of New York Department of Health/Office of Health Systems Management Proposed Operating Budget Budget .Current Year* First Year* Third Year* (Projected) (Projected) Revenues Service Revenue $39,429,713 $0 $0 Grants Funds Foundation Other Fees Other Income (1) Total Revenues $ 39,429,713 $0 $0 Expenses Salaries and Wage Expense $15,291,988 $0 $0 Employee Benefits $7,478,363 $0 $0 Professional Fees Medical & Surgical Supplies Non-Medical Equipment Purchased Services Other Direct Expense $13,158,298 $0 $0 Utilities Expense Interest Expense Rent Expense Depreciation Expense $18,557,613 $0 $0 Other Expenses (2) Total Expense $ 54,486,262 $ - $ - Net Total - (1-2) $ (15,056,549) $ -$ - • The Current Year represents year 2016 statistics for the inpatient Maternity and NICU beds at MSBI. The Year 1 and Year 3 operating budget demonstrates that these beds will be decertified by MSBI through this project. (Rev. 7/2015) 1 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Limited Review Application State of New York Department of Health/Office of Healtb Systems Management Ischedule LRA 7 * Various inpatient services may be reimbursed as discharges or days. Applicant should indicate which method checkbox. applies to this table by choosing the appropriate checkbox Patient Days D Patient Discharges Inpatient Services Source of Total Current Year** First Year Incremental** Third Year Incremental** Revenue Patient Net Revenue* Patient Days Net Revenue* Patient Days Net Revenue* Days or or or % Dollars($) % Dollars·($) % Dollars-($) discharges* discharges* discharges* Commercial Fee for Service 1,405 37.5% $19,958,014 Managed Care 92 2.5% $922,876 Medicare Fee for Service 7 0.2% $61,772 Managed Care 5 0.1% $51 307 Medicaid Fee for Service 136 3.6% $1,556,728 Managed Care 2,054 54.9% $16,578,454 Private Pay 42 1.1% $294,448 OASAS OMH Charity Care Bad Debt All Other 1 0.0% $6,114 Total 3,742 100.0% $39,429,713 0 0.0% so 0 0.0% so •• The Current Year represents year 2016 statistics for the Inpatient Maternity and NICU beds at MSBI that will be decertified through this project. The Year 1 and Year 3 operating budget demonstrates that these beds will be decertified by MSBI through this project. (Rev. 7/2015) 2 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Oupatient Services Total Current Year First Year Incremental Third Year Incremental Source of Revenue Net Revenue Net Revenue Net Revenue Visits Visits Visits % Dollars($) % Dollars($) % Dollars($) Commercial Fee for Service Managed Care Medicare Fee for Service N/A N/A N/A Managed Care Fee for --- --- --- Medicaid Service Inpatient Inpatient Inpatient Managed Care Project Only Project Only Project Only Private Pay OASAS OMH Charity Care Bad Debt AIL Other Total Total of Inpatient and Outpatient Services $39,429,713 so so Title of Attachment Filename of Attachment 11. In an attachment, provide the basis and Revenues by payer are supporting calculations based upon the experience N/A for all revenues by of the Hospital. payor. 2. In an attachment, Private Pay/Charity Care provide the basis for based on the experience of N/A charity care. the Hospital. (Rev. 7/2015) 3 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Limited Review Application Schedule LRA 8 State of New York Department of Health/Office of Health Systems Management Staffing Number of FfEs to the Nearest Tenth Staffing Categories Current Year* First Year of Third Year of **** implementation implementation **** **** Health Providers**: Physician Assistant 2.50 Registered Nurse 98.32 Nurse Practitioner 7.66 Social Worker & Psychologist 1.00 Physical Therapist & PT Assistant 1.00 Other Therapist & Assistant 1.00 Support Staff***: Management & Supervision 3.72 Teclmician & Specialist 7.57 Aides, Orderlies & Attendants 42.84 Infection Control, Environmental and Food Service 1.05 Clerical and Other Administrative 8.46 Total Number of Employees 175.12 0 0 .. appbcation * Last complete year prior to submtttmg ** "Health Providers" includes all providers serving patients at the site. A Health Provider is any staff who can provide a billable service -physician, dentist, dental hygienist, podiatrist, physician assistant, physical therapist, etc. *** All other staff. ****The Current Year represents year 2016 staffine for the 73 inpatient Maternity and NICU beds at MSBI that will be decertified throul!h this project. The Year 1 and Year 3 operating budget demonstrates these 73 beds will be decertified by MSBI through this project. Describe how the number and mix of staff were determined: .The number and mix of staff were based upon the fact that all 73 certified inpatient beds will be decertified through this project. Nevertheless, Mount Sinai does not anticipate any job losses as a result of the closure of the inpatient beds at MSBI, and it has already begun meeting and working with its union partners to ensure that any affected union employees are retrained, if necessary, and offered other union opportunities with equal pay within the Mount Sinai Health ~tern. PLEASE COMPLETE THE FOLLOWING: 1. Are staff paid and on payroll? [gl Yes D No 2. Provide copies of contracts for any independent contractor. N/A 3. Please attach the Medical Doctors C.V. N/A - Bed Decertification 4. Is this facility affiliated with any other facilities? [8l Yes D No Please refer to the Schedule LRA (If yes, please describe affiliation and/or agreement.) 8 Attachment (Rev. 71712010) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 MOUNT SINAI BETH ISRAEL SCHEDULE LRA 8 ATTACHMENT STATEMENT RE: ARTICLE 28 NETWORK FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 MOUNT SINAI BETH ISRAEL ARTICLE 28 NETWORK DESCRIPTION Mount Sinai Hospitals Group, Inc. (MSHG), a not-for"profit corporation, is the active parent and co-operator of Mount Sinai Hospital (including its division, Mount Sinai Hospital of Queens), Mount Sinai Beth Israel, Mount Sinai Brooklyn, Mount Sinai St. Luke's, Mount Sinai Roosevelt and the New York Eye and Ear Infirmary ofMount Sinai. Mount Sinai Hospital (MSH) is located at One Gustave L. Levy Place, New York (New York County), New York 10029. MSH also has a division, Mount Sinai Hospital of Queens, which is located at 25-10 30th Avenue, Long Island City (Queens County), New York 11102. Mount Sinai Beth Israel is located at First Avenue at 161h Street, New York (New York County), New York 10003. Mount Sinai Brooklyn is located at 3201 Kings Highway, Brooklyn (Kings County), New York 11234. Mount Sinai St. Luke's is located at 1111 Amsterdam Avenue, New York (New York County), New York 10025. Mount Sinai Roosevelt is located at 1000 Tenth Avenue, New York (New York County), New York 10019. New York Eye and Ear Infirmary of Mount Sinai is located at 310 East 14tli Street, New York (New York County), New York 10003. The following table provides information on operating certificate numbers and PFI numbers for the above-referenced facilities: Operating PFI# Facility Name Certificate # Mount Sinai Hospital 7002024H 1456 Mount Sinai Hospital of Queens 7002024H 1639 Mount Sinai Beth Israel 7002002H 1439 Mount Sinai Brooklyn 7002002H 1324 Mount Sinai St. Luke's 7002032H 1469 Mount Sinai Roosevelt 7002032H 1466 New York Eye and Ear Infirmary of Mount Sinai 7002026H 1460 FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Limited Review Application Schedule LRA 10 r- State of New York Department of Health/Office of Health Systems Management Impact of Limited Review Application on Operating Certificate (services specific to the site) Instructions: "Current" Column: Mark "x" in the box only if the service currently appears on the operating certificate (OpCert) not including requested changes "Add" Column: Mark "x" in the box this CON application seeks to add. "Remove" Column: Mark "x" in the box this CON application seeks to decertify. "Pro osed" Column: Mark "x" in the box corres ondin to all the services that will ultimate} rategorv/Authorized Service Code Current Add Remove Prooosed Chemical Dependence - Rehabilitation --- 30 30 Chemical Dependence - Detoxification --- 31 31 Coronary Care --- 8 8 Intensive Care --- 36 36 Maternity --- 42 -42 0 Medical/Surgical --- 504 504 Neonatal Continuing Care --- 14 -14 0 Neonatal Intermediate Care --- 17 -17 0 Pediatric -- 20 20 Pediatric ICU --- 5 5 Psychiatric --- 92 92 TOTAL 799 -73 726 Does the applicant have any previously submitted Certificate ofN eed (CON) applications that have not been completed involving addition or decertification of beds? [8J Yes (Enter CON numbers to the right) 162405-L I 162406-L I (Rev. 71712010) FILED: NEW YORK COUNTY CLERK 02/07/2024 02:07 PM INDEX NO. 151136/2024 NYSCEF DOC. NO. 34 RECEIVED NYSCEF: 02/07/2024 Limited Review Application Schedule LRA 12 State of New York Department of Health/Office of Health Systems Management Assurances The undersigned, as a duly authorized representative of the applicant, hereby gives the following assurances: a) The applicant has OJ' will have a fee simple or such other estate or interest in the site, including necessary easements and rights-of-way, sufficient to assure use and possession for the purpose of the construction and operation of the facility. b) The applicant will obtain the approval of the Commissioner of Health of all required submissions, which shall conform to the standards of construction and equipment in Subchapter C of Title 10 (Health) ofthe Official Compilation of Codes, Rules and Regulations ofthe State of New York (Title 10). c) The applicant will submit to the Commissioner of Health final working drawings and specifications, which shall confo1m to the standards of construction and equipment of Subchapter C of Title I0, prior to contracting for construction, unless otherwise pl'ovided for in Title IO. d) The applicant will cause the project to be completed in accordance with the application and approved plans and specifications. e) The applicant will provide and maintain competent and adequate architectural and/or engineering inspection at the construction site to insure that the completed work conforms to the approved plans and specifications. f) If the project is an addition to a facility already in existence, upon completion of construction all patients shall be removed from areas of the facility that are not in compliance with pertinent provisions of Title 10, unless a waiver is granted by the Commissioner of Health, under Title l 0. g) The facility will be operated and maintained in accordance with the standards prescribed by law. h) The applicant will comply with the provisions of the Public Health Law and the applicable provisions of Title 10 with respect to the operation of all established, existing medical facilities in which the applicant has a controlling interest. i) The applicant understands and recognizes that any approval oftbis application is not to be construed as an approval of, nor does it provide assurance of, reimbursement for any costs identified in the application. Reimbursement for all cost shall be in accordance with and subject to the provisions of Part 86 of Title 10. Signature I KelUleth L. Davis, M.D. Name (Please Type) President and CEO, Mount Sinai Hospitals Group Title (Please Type) (Rev. 71712010)