HOME HEALTH AGENCIES

• Frequently Asked Questions
• Florida Statute (Title XXIX, Chapter 400, Part III)
• Chapter 408, Part II, Florida Statues - (health care licensing procedures effective 10/01/06)
• State Rules - Florida Administrative Code, Chapter 59A-8
  • Memo to home health agencies on state rule changes
• State Regulation Set used by surveyors
  • Summary of changes to state regulation set
• Federal Regulation Set used by surveyors, Appendix B of CMS State Operations Manual
• Initial Licensure Application and Forms
  • Initial Application Instructions
  • Initial Application AHCA form 3110-1001
  • Financial Schedules AHCA 3110-1013
  • For financial schedules in Excel format, email barnese@ahca.myflorida.com.
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • Voluntary Board Member Affidavit
  • Affidavit of Compliance with Background Screening for Administrator AHCA 3100-0008
  • Affidavit of Good Moral Character to be signed by Alternate Administrator
  • Affidavit of Compliance with Screening AHCA 3110-1014
  • Affidavit to be submitted by Financial Officer if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)

     

    NOTE: If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you.

 

• Notice to all Licensed Home Health Agencies:

• Address Requirements:

Initial applicants for licensure must submit: (1) proof of legal right to occupy the property (per section 408.810(6), Florida Statutes) -- proof may include copies of a lease, rental agreement, warranty deeds or contracts for deed and (2) INITIAL applicants must also include evidence of zoning which includes either a certificate of use, certificate of occupancy or a letter from the zoning department stating that the location is zoned appropriately as a home health agency

Change in Address: Notify the AHCA Licensed Home Health Programs Unit 14 days in advance of an address change, including changes in suite numbers. Zoning documentation & evidence of legal right to property, as described above, must be submitted. There is a $500 fine if AHCA does not receive the notification of a change in address 14 days in advance of the change.

• Personnel Changes

Home health agencies must notify the AHCA Licensed Home Health Programs Unit of any changes in the administrator or alternate administrator prior to or on the date of change (Section 59A-8.0095(1)(b) Florida Administrative Code).

For the Administrator send:

• A resume
• A fingerprint card or proof of level 2 background screening. Proof of prior screening can only be accepted if (1) it is less than 5 years old and (2) it was done by AHCA, the Department of Children and Families, the Department of Health, or the Agency for Persons with Disabilities
• A notarized Affidavit of Compliance with Background Screening, AHCA Form 3100-0008, November 2006 (see form above under the Initial Licensure Application or below under the Renewal Licensure Application)

For the Alternate Administrator send:

• A resume
• A notarized Affidavit of Good Moral Character, AHCA Form 3110-0001, December 2006 (see “Affidavit of Good Moral Character to be signed by Staff” below)

The Agency does not require notification on changes to the director of nursing or financial officer position, except when a renewal or change of ownership application is submitted.

• Renewal Licensure Application and Forms
• Renewal Application Instructions
• Renewal Application AHCA form 3110-1011
• Health Care Licensing Application
• Health Care Licensing Addendum
• Voluntary Board Member Affidavit
• Affidavit of Compliance with Background Screening for Administrator AHCA 3100-0008
• Affidavit of Good Moral Character to be signed by Alternate Administrator
• Affidavit of Compliance with Screening AHCA 3110-1014
• Affidavit to be submitted by Financial Officer if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)
• Change of Ownership Application and Forms
  • Change of Ownership Application Instructions
  • Change of Ownership Application AHCA form 3110-1012
  • Financial Schedules AHCA 3110-1013
    • For financial schedules in Excel format, email barnese@ahca.myflorida.com.
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • Voluntary Board Member Affidavit
  • Affidavit of Compliance with Background Screening for Administrator AHCA 3100-0008
  • Affidavit of Good Moral Character to be signed by Alternate Administrator
  • Affidavit of Compliance with Screening AHCA 3110-1014
  • Affidavit to be submitted by Financial Officer if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)
• Background Screening information
• Affidavit of Good Moral Character to be signed by staff & Alternate Administrator
• Emergency Management Plan
  • Emergency Management Plan Format - NO emergency management plans should be sent to the Office of Public Health Nursing in Tallahassee
    
  • Change in Plan review procedures (Department of Health Memo dated November 6, 2006)
  • Emergency Management Plan Review Contacts
  • Protecting Patients Files
• Requirement for Information and Training on Alzheimer's Disease and Related Disorders
  • Questions & answers on the training & information requirements
  • Information to give to staff - here is an example that can be used
  • Dept of Elder Affairs state rules on the training for home health agencies, 58A-8, Florida Administrative Code: http://fac.dos.state.fl.us/faconline/chapter58.pdf
• How to get Medicare
  • CMS Medicare Home Health Agency Manual
  • October 23, 2007 Memo from Liz Dudek
  • Approval Process for Medicare Branch Home Health Agency Offices
• How to get Medicaid
  • Medicaid Home Health Services Handbook
  • October 23, 2007 Memo from Liz Dudek
  • Approval Process for Medicaid Branch Home Health Agencies - see page 1-5 of Medicaid Home Health Services Handbook.
• For agencies that plan to get Medicare or Medicaid, you may obtain a copy of the OASIS Start-Up Survival Guide on the Florida OASIS Webpage. If you continue to need assistance with OASIS, please call the Florida OASIS Help Desk at 1-800-900-1962.
• Home health aide competency test - this is available to licensed home health agencies only. Contact the Home Care Unit by calling (850) 414-6010 or email beneshj@ahca.myflorida.com.
• Health Care Advanced Directives
• List of licensed agencies - www.FloridaHealthFinder.gov

HOSPICES

• Frequently Asked Questions
• Florida Statute (Title XXIX, Chapter 400, Part IV, Hospices)
• Chapter 408, Part II, Florida Statues (health care licensing procedures effective 10/01/06)
• State Rules (Florida Administrative Code, Chapter 58A-2, Hospice, April 24, 2007)
• State Regulation Set used by surveyors
• Summary of Initial Hospice Licensure Process – Please note: State law requires a certificate of need before applying for a license. Go to Certificate of Need (CON) for more information. An initial hospice application checklist may be requested by calling the Licensed Home Health Programs Unit at (850) 414-6010.

NOTE: If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you.

 

• Change of Ownership Application Process – A change of ownership application checklist may be requested by calling the Licensed Home Health Programs Unit at (850) 414-6010.
• Renewal Licensure Application and Related Forms
  • Hospice Renewal Application (AHCA 3110-4001, Revised 08/02) - REQUIRED
  • Health Care Licensing Application - REQUIRED
  • Health Care Licensing Application Addendum - REQUIRED
  • Voluntary Board Member Affidavit– to be completed by each voluntary board member if the licensee is a not-for-profit corporation/organization (This is only required for members who have joined the board since the last renewal application was submitted. Previous submissions are maintained in AHCA files.)
• Background Screening information
  • Affidavit of Compliance with Background Screening Requirements - to be submitted if proof of previous compliance with level 2 standards is provided instead of fingerprint cards (see Background Screening information above)
• Emergency Management Planning
  • Comprehensive Emergency Management (CEMP) Format for Hospices, DOEA Form H-001, March 2007
  • Emergency Management Plan Review
    • Change in CEMP review procedures (Department of Health Memo dated November 6, 2006)
    • County Health Department Points of Contact for CEMP review
• Requirements for Information and Training on Alzheimer’s Disease and Dementia-Related Disorders – Section 400.6045, Florida Statutes
• All employees, upon beginning employment, must receive basic written information about interacting with persons who have Alzheimer’s disease or dementia-related disorders. Use of The Alzheimer’s Patient and Hospice Care fact sheet developed by Florida Hospices and Palliative Care, Inc. in partnership with the Alzheimer’s Association Chapters of Florida meets this requirement. Association Fact Sheet - (231KB)
• Employees providing direct care to patients with Alzheimer's disease or dementia-related disorders, hired on or after July 1, 2003, must receive Department of Elder Affairs (DOEA) approved training on Alzheimer’s disease and dementia-related disorders within 9 months after beginning employment. For information regarding training requirements, approval of trainers/curriculum and locating approved training providers, please see the University of South Florida’s Training Academy on Aging (DOEA contractor) website at http://www.trainingonaging.usf.edu/products/products_hospice.htm.
• Getting Medicare Certification for a Hospice
  • Initial Hospice Medicare Provider Enrollment
  • Initial Surveys for New Medicare Providers
• List of licensed providers - www.FloridaHealthFinder.gov

NURSE REGISTRIES

• Frequently Asked Questions
• Florida Statutes (Title XXIX, Chapter 400, Part III)
• Chapter 408, Part II, Florida Statues(health care licensing procedures effective 10/01/06)
• State Rules - Florida Administrative Code, Chapter 59A-18
  • Memo to nurse registries on state rules changes
• State Regulation Set used by surveyors
  • Summary of Changes to State Regulation Set
• Initial Licensure Application and Forms
  • Initial Application Instructions
  • Initial Application for License AHCA Form 3110-7001
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • Voluntary Board Member Affidavit
  • Affidavit of Compliance with Screening, AHCA Form 3110-1014
  • Affidavit to be submitted if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)

   

  NOTE: If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you.

• Notice to all Licensed Nurse Registries
  • Nurse Registries undergoing a change of ownership should use the Initial Application AHCA Form 3110-7001. In addition to the required forms, a change of ownership application must also include the bill of sale, if available, and a copy of a signed and dated asset purchase agreement indicating that a change of ownership is pending.

Nurse Registries changing their address must send in a letter notifiying the Agency of the effective date of the move and include evidence of compliance with local zoning (a letter or form from the local zoning authorities) and have a fire inspection completed.

• Renewal Licensure Application and Forms

• Renewal Application Instructions
• Renewal Application for License AHCA Form 3110-7004
• Health Care Licensing Application
• Health Care Licensing Addendum
• Voluntary Board Member Affidavit
• Affidavit of Compliance with Screening, AHCA Form 3110-1014
• Affidavit to be submitted if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)
• Background Screening information
• Emergency Management Plan
  • Emergency Management Plan Format
  • Memo sent to Nurse Registries on 2006 law changes
  • Emergency Management Plan Review Contacts
• List of licensed agencies - www.FloridaHealthFinder.gov

HOMEMAKER, COMPANION SERVICES

• Frequently Asked Questions
• Florida Statutes (Title XXIX, Chapter 400, Part III Homemaker, Companion Services )
• Chapter 408, Part II, Florida Statues (health care licensing procedures effective 10/01/06)
• State Rules - Florida Administrative Code, 59A-8.025 State Rules - Florida Administrative Code, Chapter, 59A-8.02 5, Minimum Standards for Homemaker, Companion Providers
• State Regulation Set used by surveyors
• Licensure Application and Related Forms - Initial & Renewal Registration

  See instructions on first page of application below.
  The registration fee is $50 for a 2-year registration.

  • Homemaker Companion Services Application for Registration
  • Health Care Licensing Application Addendum- Required
  • Voluntary Board Member Affidavit– to be completed by each voluntary board member if the licensee is a not-for-profit corporation/organization
  • Affidavit of Compliance with Screening Requirements - to be completed by managing employee
  • Affidavit of Compliance with Background Screening Requirements - to be submitted if proof of previous compliance with level 2 standards is provided instead of fingerprint cards (see Application Checklist, the 1st page of the Homemaker Companion Services Application above)

NOTE: If after reviewing the application forms, Frequently Asked Questions, and Florida Statutes you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are items missing from your application once received, send you a letter that gives you another chance to complete the application successfully. If you need help in filling out the application forms, we would advise you to seek help from an attorney or a consultant.

• Background Screening information

List of registered providers - www.FloridaHealthFinder.gov

HOME MEDICAL EQUIPMENT (HME) PROVIDERS

• Frequently Asked Questions
• May 7, 2007 Agency mailing to licensed home medical equipment providers and initial applicants regarding rule revisions & updated state survey standards
• Florida Statutes (Title XXIX, Chapter 400, Part VII, Home Medical Equipment Providers)
• Chapter 408, Part II, Florida Statues (health care licensing procedures effective 10/01/06)
• State rules (Florida Administrative Code, Chapter 59A-25, Minimum Standards for Home Medical Equipment Providers, March 13, 2007)
• State Regulation Set used by surveyors
  • Summary of June 1, 2007 changes to State Regulation Set
• Summary of Initial HME Licensure Process
• Licensure Application and Related Forms – forms necessary for licensure as a home medical equipment provider are as follows:
  • Health Care Licensing Application, Home Medical Equipment Provider (AHCA Form 3110-1005, Revised Dec 06) – REQUIRED – previous versions of the application form will not be accepted after June 1, 2007
  • Health Care Licensing Application Addendum -(AHCA Recommended Form) - REQUIRED
  • Affidavit of Compliance with Screening Requirements (AHCA Form 3110-1006, Revised Dec 06) - In order to meet the requirements of sections 435.04(5) and 435.05(3), F.S., a licensed home medical equipment provider must submit this affidavit “annually, under penalty of perjury”.
  • Voluntary Board Member Affidavit (AHCA Recommended Form) - to be completed by each voluntary board member if the licensee is a not-for-profit corporation/organization
  • Home Medical Equipment Provider, Notification of Change of Address (AHCA Form 3110-1020, Dec. 06) – This form must be submitted not less than 24 hours prior to the actual move to avoid a fine.
  • Proof of Financial Ability to Operate – all initial and change of ownership applicants are require to submit either:
    • Home Medical Equipment Provider Bond (AHCA Form 3110-1018, Revised August 2006) in the amount of $50,000;
    • A copy of a $50,000 Florida Medicaid Provider Surety Bond or
    • Home Medical Equipment Provider, Proof of Financial Ability to Operate, Schedules 1 – 3 (AHCA Form 3110-1021, Dec 06)

   

  NOTE: If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you.

• Background Screening information
• Affidavit of Compliance with Background Screening Requirements - to be submitted if proof of previous compliance with level 2 standards is provided instead of fingerprint cards (see Background Screening information above)
• Emergency Management Planning
• Comprehensive Emergency Management Plan (CEMP) Format for Home Medical Equipment (HME) Providers, AHCA Form 3110-1019, Dec. 06 – All licensed home medical equipment providers must prepare a CEMP. A copy of the plan must be submitted to the local county health department for each county listed on the provider’s license (unless the county health department does not require submission of CEMPs), by June 1, 2007. Applicants must prepare and submit a plan to the appropriate county health departments prior to survey by the Agency and/or licensure.
• County Health Department Points of Contact for CEMP Review
• List of licensed providers - www.FloridaHealthFinder.gov

HEALTH CARE SERVICES POOLS

• Frequently Asked Questions
• Florida Statute (Title XXIX, Chapter 400, Part IX, section 400.980, Health Care Services Pools)
• Chapter 408, Part II, Florida Statues (health care licensing procedures effective 10/01/06)
• State Rules - Florida Administrative Code, Chapter 59A-27, Minimum Standards for Health Care Services Pools Providers
• Licensure Application and Related Forms
  • Initial/Renewal Application Instructions
  • Initial/Renewal Health Care Services Pools Application for Registration
  • Health Care Licensing Application - Required
  • Health Care Licensing Application Addendum - Required
  • Voluntary Board Member Affidavit – to be completed by each voluntary board member if the licensee is not-for-profit corporation/organization
  • Affidavit to be submitted if proof of compliance is provided instead of fingerprint cards (see Background Screening information below)

NOTE: If after reviewing the application forms, Frequently Asked Questions, Florida Statutes, and State Rules you have additional questions, please call (850) 414-6010. Staff will be happy to answer questions, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are items missing from your application once received, send you a letter that gives you another chance to complete the application successfully. If you need help in filling out the application forms, we would advise you to seek help from an attorney or a consultant.

• Background Screening information
• List of registered providers - www.FloridaHealthFinder.gov