Health Care Clinic Licensing Application
Medical/Clinic Director Attestation Form [30KB, DOC]
Health Care Licensing Application Addendum
Proof of Financial Ability to Operate Form [361KB, XLS]
Attestation of Compliance with Background Screening Requirements [430KB, PDF] - Refer to Rule 59A-35A.090 (2)(3), F.A.C.
Initial or Change of Ownership applications only - Any proof of financial ability to operate documents submitted to the Agency fall under the “Sunshine” law and would be available for public inspection, if requested. The only items that would not be available would be items that are exempt from public inspection, which include personal health care information protected under HIPAA and account numbers on items like bank statements. Public records are governed by Chapter 119, Florida Statutes. The Agency does not have the authority to grant a public records exemption.
Licensed health care clinics providing MRI services must provide documentation of accreditation by a national accrediting organization that is approved by the Centers for Medicare and Medicaid Services for magnetic resonance imaging and advanced diagnostic imaging services within 1 year after initial licensure. A clinic that is accredited or that is within the original 1-year period after licensure and replaces its core magnetic resonance imaging equipment shall be given 1 year after the date on which the equipment is replaced to attain accreditation. A clinic may request a single, 6-month extension if it provides evidence to the agency establishing that, for good cause shown, the clinic cannot be accredited within 1 year after licensure, and that accreditation will be completed within the 6-month extension.
After obtaining accreditation a clinic must maintain accreditation as a condition of renewal of its license.
A clinic that files a change of ownership application must comply with the original accreditation timeframe requirements of the transferor.
When a clinic adds, replaces, or modifies magnetic resonance imaging equipment and the accrediting organization requires new accreditation, the clinic must be accredited within 1 year after the date of the addition, replacement, or modification. A single, 6-month extension may be requested if the clinic provides evidence of good cause to the agency.
Failure to obtain and/or maintain MRI accreditation may result in disciplinary action. The agency may deny the application or revoke the license of any entity formed for the purpose of avoiding compliance with the accreditation provisions and whose principals were previously principals of an entity that was unable to meet the accreditation requirements within the specified timeframes.
Statutory Authority: Section 400.9935(7), Florida Statutes
Note: Accreditation status does not satisfy the requirement for a complete Agency health care clinic licensure inspection.
|Accrediting Organization||Web Address|
|American College of Radiology (ACR)||https://www.acr.org/|
|InterSocietal Accreditation Commission (IAC)||https://intersocietal.org/|
|The Joint Commission (TJC)||http://www.jointcommission.org/|
Initial, Renewal, or Change of Ownership License Applications: Applicants and controlling interests [owners of at least 5% of the business entity, sole proprietors and partners] who are nonimmigrant aliens, as described in Title 8 U.S.C. s. 1101 (a) (15) must file a surety bond of at least $500,000, payable to the agency, which guarantees that the health care clinic will act in full conformity with all legal requirements for operation. A $500,000 bond must be obtained in compliance with s. 408.8065 (2), Florida Statutes.