HOME HEALTH AGENCIES

• Frequently Asked Questions
• Regulatory Update Presentation, including changes in state law effective July 1, 2009
• Florida Statute (Title XXIX, Chapter 400, Part III)
• New state laws effective July 1, 2009
  • Chapter 2009-193, Laws of Florida  
  • Senate Bill 1986  - sections 1, 5,6,8, 9, 10, 47, 48, 50, 51, and 55 pertain to home health agencies
• Chapter 408, Part II, Florida Statues - (health care licensing procedures for all types of licenses)
• State Rules - Florida Administrative Code, Chapter 59A-8
• State Regulation Set used by surveyors (has not yet been updated for 2009 state law changes)
• 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 HQAHOMEHEALTH@ahca.myflorida.com.
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • Attestation of Compliance with Distance Requirements
  • 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 and CHOW 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

Effective July 1, 2008: AHCA may not issue an initial license to an applicant for a home health agency if

• the applicant shares common controlling interests (owners, board of directors, officers, members, etc.) with another licensed home health agency that is located within 10 miles of the applicant and
• is in the same county.

The agency will return the application and the licensure fees. (Section 400.471 (7), Florida Statutes)

Change in Address: Notify the AHCA Home Care 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 Home Care 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 current 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 current 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)

• NEW Director of Nursing Requirements effective July 1, 2008 per Section400.476 (2) (a) through (c), F.S:

Effective July 1, 2008, home health agencies offering skilled nursing care:

• may not operate for more than 30 calendar days without a director of nursing;
• AHCA Home Care Unit must be notified within 10 business days after termination of the services of the director of nursing;
• the home health agency must notify AHCA Home Care Unit within 10 days after the new director of nursing is hired.

If the home health agency that provides skilled nursing care operates for more than 30 days without a director of nursing:

• the home health agency commits a class II deficiency
• AHCA may, in addition to the fine, issue a moratorium or revoke the license

AHCA shall fine a home health agency that fails to notify the agency

• $1,000 for the first violation and
• $2,000 for a repeat violation

For the Director of Nursing notification to AHCA send to Charlene Corley by mail or fax (850) 922 5374 or e-mail corleych@ahca.myflorida.com :

• A current resume
• Copy of current Florida RN license
• Cover letter notifying AHCA that this is an appointment or the resignation of a Director of Nursing

Directors of Nursing may manage up to 2 agencies that:

• have identical controlling interests
• are located in the same geographic service area or in one contiguous county

Directors of Nursing may manage up to 5 agencies that:

• have identical controlling interests
• are located in the same geographic service area or in one contiguous county and
• have a registered nurse delegate who meets the same qualifications as the director of nursing at each of the agencies who has a written delegation from the director of nursing to serve in his or her absence

For the Registered Nurse Delegate notification to AHCA send:

• A current resume
• Copy of current Florida RN license

 

• Renewal Licensure Application and Forms
• Renewal Application Instructions
• Renewal Application AHCA form 3110-1011
• Health Care Licensing Application
• Health Care Licensing Addendum
• 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 HQAHOMEHEALTH@ahca.myflorida.com.
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • Attestation of Compliance with Distance Requirements
  • 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)
• State Rules (Florida Administrative Code, Chapter 58A-2, Hospice, August 11, 2008)
• State Regulation Set used by surveyors
• Federal Regulation Set used by surveyors (CMS State Operations Manual, Appendix M)
• 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.

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.

 

• Licensure Application and Related Forms
  • Health Care Licensing Application, Hospice, AHCA Recommended Form, July 2009 (8 pages) - REQUIRED
  • Health Care Licensing Application Addendum, AHCA Recommended Form (3 pages) - REQUIRED
  • Affidavit of Compliance with Level 2 Background Screening for Covered Employees, AHCA Form 3100-0007, November 2006 (1 page) – REQUIRED
  • Attestation of Compliance with Applicable Life Safety Codes for Additions to Existing Hospice Inpatient Facilities/Residential Units, AHCA Recommended Form, March 2009 - to be submitted with request for bed addition to an existing freestanding hospice inpatient facility or residential unit (Please refer to the Frequently Asked Questions above.)
• Background Screening Information
  • Affidavit of Compliance with Background Screening Requirements, AHCA Form 3100-0008, November 2008 (3 pages) - 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/.
• Getting Medicare Certification for a Hospice
  • Initial Hospice Medicare Provider Enrollment
  • Initial Surveys for New Medicare Providers, CMS memo (S&C 08-03), November 5, 2007,
• List of licensed providers - www.FloridaHealthFinder.gov

NURSE REGISTRIES

• Frequently Asked Questions
• Regulatory Update Presentation, including changes in state law effective July 1, 2009
• Florida Statutes (Title XXIX, Chapter 400, Part III)
  • 2009 law changes effective 7-1-09
• Chapter 408, Part II, Florida Statues (health care licensing procedures)
• State Rules - Florida Administrative Code, Chapter 59A-18
• State Regulation Set used by surveyors
• Initial Licensure Application and Forms
  • Initial Application Instructions
  • Initial Application for License AHCA Form 3110-7001
  • Health Care Licensing Application
  • Health Care Licensing Addendum
  • 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
• 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 & Change of Ownership Registration

See instructions on first page of application below.

• Homemaker Companion Services Application for Registration
• 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
• Florida Statutes (Title XXIX, Chapter 400, Part VII, Home Medical Equipment Providers)
  • 2009 state law changes, Chapter 2009-193, Laws of Florida
• Chapter 408, Part II, Florida Statues (health care licensing procedures)
• 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 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 Recommended Form, July 2009)
  • Health Care Licensing Application Addendum -(AHCA Recommended Form) - REQUIRED
  • Affidavit of Compliance with Screening Requirements (AHCA Form 3110-1006, Revised Dec 06)
  • Home Medical Equipment Provider, Request to Amend License for Name and/or Address (AHCA Recommended Form, July 2009) – 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 – 7 (AHCA Recommended Form, July 2009)

     

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)
• Affidavit of Good Moral Character – for all employees – to be kept at home medical equipment provider office for review by surveyors
• 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