AHCA: Hospital & Outpatient Services Unit

About the Agency for Health Care Administration (AHCA)

Our Agency was statutorily created by Chapter 20, Florida Statutes as the chief health policy and planning entity for the state. We are primarily responsible for the state's $16 billion Medicaid program that serves over 2.2 million Floridians, the licensure of the state's 36,000 health care facilities and the sharing of health care data through the Florida Center for Health Information and Policy Analysis.

Last year we worked with legislators to tackle the problem of Florida's uninsured and appreciate your support for initiatives like Cover Florida. Cover Florida plans will be offered beginning January 1, 2009, and we hope they will make a difference for the state's 3.6 million uninsured. We also worked with you to target fraud in home health agencies, to make available price and outcome information on 150 different procedures, and to stretch our budget resources to serve as many people as possible.

This year we will be working with you to continue to reduce the number of uninsured across the state, to enhance our ability to target fraudulent providers, to reduce unnecessary regulation, to reduce administrative costs in order to ensure that dollars go to serve patients and more.

Our mission is Better Health Care for All Floridians.

More information is available in AHCA - A General Overview (PDF 1.1MB)

Contact the Agency for Health Care Administration (AHCA)

Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, FL 32308
(888) 419-3456
Click to Send an E-mail

AGENCY DEPARTMENTS: For contact information for particular bureaus or departments click Inside AHCA or call the toll-free number (888) 419-3456. After choosing English, Spanish, or Creole then press 3.

AREA OFFICES: The Agency has offices throughout Florida. The Area Medicaid Offices can help with Medicaid questions (for beneficiaries and providers) and has a list of Medicaid providers. The Health Quality Assurance Offices conduct surveys of health care facilities/providers and help facilities/providers with quality assurance. To find an office near you click Regional Maps.

COMPLAINTS: To file a complaint against a health care facility/provider or health maintenance organization (HMO) regulated by AHCA or to file a complaint against a health care professional licensed by the Florida Dept. of Health: Call the toll-free number (888) 419-3456. To read more about the complaint process click here.

MEDICAID: The Area Medicaid Offices can help with Medicaid questions and has a list of Medicaid providers. To find Area Medicaid Offices and other Medicaid information click www.MyMedicaid-Florida.com. To report Medicaid fraud or abuse, call the toll-free number (888) 419-3456. After choosing English, Spanish, or Creole then press 5.

PUBLICATIONS & FORMS: Click Publications to view and download AHCA publications and Forms. Some of these can be ordered by calling the toll-free number (888) 419-3456. After choosing English, Spanish, or Creole then press 4.

Utilization Review (Private Review Agent)

This program consists of registration of an agent who performs utilization review services for third-party payers on a contractual basis for hospital (outpatient or inpatient) services. The registration process does not include full-time employees, personnel, or staff of health insurers, health maintenance organizations, or hospitals, or wholly owned subsidiaries thereof or affiliates under common ownership, when performing utilization review for their respective hospitals, health maintenance organizations, or insurers of the same insurance group. Agents contracted with the Federal or State government that perform utilization review of medicare or medicaid claims or reviewing workers' compensation claims do not have to be registered under this section. Also, self-insurance funds or service organizations performing reviews of claims pursuant to chapter 440, F.S. or part VII of chapter 626, F.S. are not required to be registered under this section.

Initial/Renewal/Change of Ownership Registration Requirements

All applications for registration must be submitted with a biennial registration fee of $514. There are no survey requirements.

To renew a current state registration that is due to expire, you must print the application for registration form below and submit the completed form(s) with the renewal fee prior to the expiration date of the registration. Renewal applications must be received by the Agency at least 60 days in advance of expiration of a registration or a late fee will be assessed.

Required documentation/forms

Application for Registration for Private Review Agents (.pdf)

NOTE: A renewal application will not be accepted if your utilization review (private review agent) registration is expired. An initial license application must be filed if your registration has expired.

All corporation must document their registration with the Florida Department of State.

Health Care Licensing Application

Addendum

Voluntary Board Member Affidavit

Affidavit of Compliance with Background Screening Requirements

These forms are recommended for use beginning October 1, 2006, to comply with the reporting requirements pursuant to Chapter 408, Part II, Florida Statutes. Please provide this information in addition to the licensing application for the specific provider/facility type.

Background Screening

Florida Department of Law Enforcement and FBI fingerprinting must be completed by the administrator, managing employee, and any other similarly titled individual who is responsible for the daily operation of the facility. Background screening must be repeated every five years, or sooner if there is a new hire. Please go to the background screening section of this web site for additional documentation that must be submitted with your application.

Statute/Rule Authority

Updated March 5, 2009

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