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15.1 Who should submit the Change of Ownership application?
The Buyer is the applicant.
15.2 How soon may the Buyer operate the agency?
The Change of Ownership is an initial licensure application. The Seller is responsible for the operation of the agency until the license is transferred to the Buyer. The Buyer must submit the application at least 60 days prior to the actual transfer of ownership. Failure to do so will result in a fine of $50.00/day to a maximum of $500.00. We cannot issue a license to an agency whose ownership has changed prior to our receipt of the change of ownership application. Once the application is received, it will be reviewed within the first 30 days. If it is incomplete, a letter will be sent detailing the omissions. The Buyer then has 21 days from their receipt of the letter in which to respond with the items or clarifications requested. The Agency for Health Care Administration [AHCA] will not issue the license to the Buyer until the legal documents transferring ownership have been received. When the license is issued, the effective date will be backdated to the date of the actual transfer of ownership indicated in the ownership transfer documents.
15.3 Can the date of ownership transfer be stated as the day AHCA approves the change of ownership application?
No. A change of ownership application must include the effective date of the change of ownership. The effective date of the change of ownership shall not be extended more than 60 days from the effective date reported on the application; written notification of a change in the effective date must be received by the AHCA prior to the originally reported effective date. The AHCA will deem the application withdrawn if the change of ownership does not occur within 60 days of the reported effective date.
15.4 How long does it take to change the ownership of a home health agency license?
The average processing time, from beginning to end, is 90-120 days.
15.5 Is it faster to apply for an initial license?
The average processing time for an initial license, from beginning to end, is also 90-120 days.
15.6 What is accreditation and who must be accredited?
Accreditation is now required of all initial home health agency applicants and initial applicants through changes of ownership. A new home health agency must submit proof of application for accreditation from an AHCA approved accrediting organization and become accredited prior to licensure. There are currently three approved accreditation companies. They are:
Your agency must obtain accreditation that is not conditional or provisional within 120 days of the Agency for Health Care Administrations [AHCA] receipt of the application for initial licensure at the AHCA Home Care Unit or your application will be withdrawn from further consideration. Once licensed, the accreditation status must be maintained for ongoing licensure of your agency as a home health agency.
15.7 What if the agency being purchased is already accredited?
Just because the Seller is accredited does not mean that the Buyer will be automatically accepted. The Buyer may contract with one of the other approved accreditation organizations or submit a letter from the Sellers accrediting organization saying that they are aware of the pending change of ownership and that they are willing to continue the accreditation of the agency under the new ownership.
15.8 How do I know if the change we are planning is a change of ownership?
The current definition of Change of Ownership can be found at Florida Statutes 408.803(5) Change of ownership means:
(a) An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or
b) An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is publicly traded on a recognized stock exchange.
A change solely in the management company or board of directors is not a change of ownership.
15.10 If a home health agency that is a Medicare provider undergoes a change of ownership, does the agency maintain their Medicare provider status underthe new ownership?
Medicare is a Federal program and is governed by Federal rules, not the Agency for Health Care Administration [AHCA] which is part of the State of Florida government. Questions regarding the Federal Rules and Regulations should be directed to the fiscal intermediary. Currently, under Federal Regulations Section 424.550(b)(1), Unless an exception in (b)(2) of this section applies, if there is a change in majority ownership of a home health agency by sale (including asset sales, stock transfers, mergers, and consolidations) within 36 months after the effective date of the HHA’s initial enrollment in Medicare or within 36 months after the HHA’s most recent change in majority ownership, the provider agreement and Medicare billing privileges do not convey to the new owner. The prospective provider/owner of the HHA must instead:
Enroll in the Medicare program as a new (initial) HHA under the provisions of SS 424.510 of this subpart.
Obtain a State survey or an accreditation from an approved accreditation organization.
The term Change in Majority Ownership is defined in Federal Regulations 424.502 Definitions.
Change in Majority Ownership occurs when an individual or organization acquires more than 50% direct ownership interest in an HHA during the 36 months following the HHA’s initial enrollment into the Medicare program or the 36 months following the HHA’s most recent change in majority ownership (including asset sale, stock transfer, merger, and consolidation). This includes an individual or organization that acquires majority ownership in an HHA through the cumulative effect of asset sales, stock transfers, consolidations, or mergers during the 36-month period after Medicare billing privileges are conveyed or the 36-month period following the HHA’s most recent change in majority ownership. Buyer/applicants should review 15.26.1 in Chapter 15 of the Medicare Program Integrity Manual. They can view at the manual at www.cms.gov/manuals - Click on “Internet-Only Manuals” & pick from the list.
Note that for the purposes of “change of majority ownership” according to CMS, assumption of a greater than 50 percent direct ownership interest can generally occur in one of two ways. First, an outside party that is currently not an owner can purchase more than 50 percent of the business in a single transaction. Second, an existing owner can purchase an additional interest that brings its total ownership stake in the business to greater than 50 percent. For instance, if a 40 percent owner purchased an additional 15 percent share of the HHA, this would constitute a change in majority ownership.
15.11 Regardless of whether or not the anticipated ownership changes meet the Federal definition of “Change of Ownership”, what is the process to continue as a Medicare provider? In addition to the State process discussed above, what Federal forms must I complete, and to whom do I send them?
You must complete the Medicare Enrollment Application (CMS 855A) to report a change of ownership. The CMS 855A must be submitted to your Fiscal Intermediary for approval. You may obtain this form from the CMS web site at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp, then select the “CMS forms” link.
Additionally, listed below are forms required in order to complete the Federal change of ownership process once the CMS 855A has be approved by the Fiscal Intermediary. You may contact the Home Care Unit at (850) 412-4403 to obtain these forms:
The 3 forms listed above must be completed and mailed to:
Agency for Health Care Administration
Home Care Unit
2727 Mahan Drive, MS 34
Tallahassee, FL 32308
15.12 What if the home health agency I wish to purchase is a Medicaid Provider? Can I keep the Medicaid Provider status?
Medicaid is a Federal program administered by the State. Medicaid numbers do not transfer to the new owners when there is a change of ownership. The Medicaid definition of change of ownership mirrors the State definition stated above. Whether the anticipated ownership changes meet the definition of “Change of Ownership” of not, you should read the section on our web page [the same page where you found this list of Frequently Asked Questions] entitled “How to get Medicaid” for the most current policies and procedures that you should follow.
15.13 Do I need a survey before I can change the license ownership?
YES. Effective July 11, 2013 and in accordance with Florida Administrative Code 59A-8.003, an application for a home health agency change in ownership will not be approved unless the home health agency (seller) has successfully completed an unannounced inspection within the 24 months immediately prior to the submission of the change of ownership application.
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