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AHCA: Home Care Units

Home Care Unit

Home Health Agencies


What's New:

Home Health Quarterly Report - Submit next quarterly report between April 1 - 15.

Changes to the State Regulation Set used by surveyors effective 10/1/13 – see the “Laws, Rules and Survey” tab

The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) has announced a temporary moratorium on the enrollment of new Medicare home health providers in Broward County and has extended the moratorium of Miami-Dade and Monroe counties. For information, see the CMS announcement with contact information at the Medicare-Medicaid tab. Questions about the status of your Medicare enrollment application for these counties? Call the Medicare Administrative Contractor, Palmetto GBA at 1-866-830-3925.

For all home health agencies --see the 2013 State Regulatory Update presentation for home health agencies explaining the changes in state rules and other information. 

Home health agency state rules have been revised and updated as of July 11, 2013.  See the “Laws, Rules and Survey” tab for information on all of the changes.

Renewal Reminder Notices are no longer being sent by certified letter.  You will now receive a renewal reminder postcard at least 90 days prior to the expiration of your license.  To ensure that you receive timely notice, please visit www.FloridaHealthFinder.gov  to verify that your mailing address is accurate.   See the Frequently Asked Question #10.1 on this web page for how to make a change of address.  Please contact the Home Care Unit by email HQAHOMEHEALTH@ahca.myflorida.com or by phone (850) 412-4403 if you have any questions.

Memo on 2012 law changes for home health agencies

2012 Regulatory Update Presentation, including changes in state law

How are Florida’s different home care providers regulated? comparison of home care providers

Bureau of Health Facility Regulation
Home Care Unit
2727 Mahan Drive - Mail Stop #34
Tallahassee, FL 32308
(850) 412-4403 Phone
(850) 922-5374 Fax

email: HQAhomehealth@ahca.myflorida.com

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Frequently Asked Questions

Click on the links below to see questions and answers
Changes effective 7/1/08 affecting licensure: Introduction
Types of licenses and who should apply: Section 1
Initial Home Health Agency Application Process: Section 2
Financial projections and Business Plan: Section 3
Medicare and Medicaid: Section 4
Home health agency location requirements: Section 5
Personnel and their qualifications: Section 6
Non-skilled agencies and agencies that provide only therapies: Section 7
Background screening requirements: Section 8
Home Health Aide Training information: Section 9
Reporting changes to my license information: Section 10
License renewal process: Section 11
Emergency Management Plan information: Section 12
Home health services questions: Section 13
Questions on home health agency law changes Section 14
Change of Ownership process Section 15
Making Personnel Changes Section 16

Introduction: Changes effective 7/1/08 and 7/1/09 affecting licensure :

PLEASE NOTE: Effective July 1, 2008 changes were made to the Florida Statutes which affect the licensure process for initial home health agency applicants:

  • AHCA cannot issue an initial or change of ownership license to an applicant that shares common controlling interests with another home health agency that is located within 10 miles of the applicant and in the same county.
  • An application for a home health agency license cannot be transferred to another home health agency or controlling interest before the license is issued.
  • A new home health agency applicant must submit proof of application for accreditation from an AHCA approved accrediting organization and become accredited prior to licensure. Thus AHCA will no longer conduct initial surveys of new applicants for a home health agency license. The new applicant must pass an initial survey conducted by one of the following AHCA approved accrediting organizations:
    • Accreditation Commission Health Care ACHC (919) 785-1214 or visit their web site at www.achc.org .
    • Community Health Accreditation Program CHAP 1-800-656-9656 or (202) 862-3413 or visit their web site at www.chapinc.org .
    • Joint Commission JC (630) 792-5000 or visit their web site at www.jointcommission.org .

Your agency must obtain accreditation that is not conditional or provisional within 120 days of AHCA’s 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.

PLEASE NOTE: Effective July 1, 2009 changes were made to the Florida Statutes which affect the licensure process for initial, renewal and change of ownership home health agency applicants:

  • In addition to current requirements for financial ability to operate, schedules submitted with applications for initial and change of ownership licenses must have:
    • Independent evidence of sufficient funds for start up, working expenses and contingencies.
    • Sources of funds through the break-even point to show that the applicant has the ability to fund all start up costs, working capital and contingency financing. Applicants must have funds for 3 months of average expenses.
  • For initial, renewal or change of ownership licenses for home health agencies applicants and controlling interests who are non-immigrant aliens as described in 8 U.S.C. s. 1101, must file a surety bond of at least $500,000 payable to the Agency, which guarantees that the home health agency will act in full conformity with all legal requirements for operation. The definition of non-immigrant alien is contained in the applications for initial, renewal and change of ownership applications. Questions about whether an applicant or controlling interest is a non-immigrant alien may need to be referred to an immigration attorney prior to submitting an application for home health agency licensure.
  • For applicants renewing their license in Miami-Dade County: AHCA will not renew licenses of home health agencies in counties with more than 1 home health agency per 5,000 persons, if the home health agency has been administratively sanctioned within the prior 2 years for certain violations as specified in 400.471(10), F.S.(2009) – see section 5 of SB 1986. This only affects Miami-Dade County which has 1 home health agency for every 2,782 persons of all ages.

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Section 1: Types of licenses and who should apply

1.1  Is my business required to have a home health agency license?

Businesses requiring licensure as a home health agency include the following:

  • Intend to offer more than one health care professional discipline including but not limited to nursing and/or therapies and/or home health aide services;
  • A home health professional and a home health aide or certified nursing assistant; or more than one home health aide ; more than one certified nursing assistant or a home health aide and a certified nursing assistant working together and intend to offer services in the home or
  • Intend to offer home health aide and/or certified nursing assistant service including hands on personal care but no skilled services

Home health services include the following:

  • Nursing
  • Physical, occupational, respiratory, or speech therapy
  • Home health aide services
  • Dietetics and nutrition practice and nutrition counseling
  • Medical supplies, restricted to drugs and biologicals prescribed by a physician

Also, home health agencies are exempt from home medical equipment licensing per state law.

 

1.2  What is the difference between a Home Health Agency, a Nurse Registry, a Health Care Services Pool and a Homemaker Companion service?

 Home Health Agencies:

  • provide services that are privately paid for by insurance or other means to patients in their home or place of residence.
  • provide staff to do services in health care facilities, schools, or other business entities on a temporary or school year basis providing a contract is in place.
  • can qualify for Medicare and/ or Medicaid reimbursements.
  • hire employees or contract with independent contractors to provide services.
  • provide at least one home health service with staff who are direct employees.

 

Nurse Registry:

  • provide services that are privately paid for or paid for by insurance or other means to patients in the patient’s home or place of residence.
  • provide staff to do services in health care facilities, schools, or other business entities on a temporary or school year basis providing a contract is in place.
  • use only registered nurses, licensed practical nurses, certified nursing assistants, home health aides, homemakers, and companions as independent contractors.
  • cannot have any employees except for the Administrator, Alternate Administrator and office staff – all direct care workers need to be independent contractors .
  • cannot qualify for Medicare or Medicaid reimbursement but may participate in the Medicaid Waiver program.

 

Health Care Services Pool:

  • place licensed , certified or trained persons at health care facilities or other business entities such as schools to support or supplement the facilities’ work force in temporary work situations such as employee absences, temporary skill shortages, seasonal workloads, and special assignments and projects.
  • cannot provide private duty services or enter into direct contracts with individuals to provide services in patient’s home or place of residence.
  • cannot qualify for Medicare and Medicaid reimbursements or Medicaid Waiver.

 

Homemaker Companion Services:

  • hire or contract with homemakers who do household chores that include housekeeping, cooking, shopping assistance, laundry, and other routine household activities.
  • hire or contract with companions to provide companionship for the client such as keeping a person company at home or going with the person on outings or to appointments.
  • cannot provide any hands-on personal care to a client which means assistance with the activities of daily living, such as bathing, dressing, eating, or personal hygiene, and assistance in physical transfer, ambulation, and in administering medication. Personal care cannot be done through this registration.

 

1.3 Can I have a nurse registry/home health/homemaker companion agency under one license number?

Nurse registries and home health agencies are separately licensed. Homemaker companion services are separately registered. There is no need to have a homemaker companion registration if you intend to get licensed as a home health agency or a nurse registry since the home health agencies and nurse registries can provide homemakers and companions under their licenses. These are only a few of the differences. For more information, please review the Florida Statutes and the Florida Administrative Code with each of these programs at this web site.

  If you have a question on whether or not your business needs to be licensed and the type of license call the Home Care Unit at (850) 412-4403 and ask to speak to a home health licensure specialist.

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Section 2: Initial Home Health Agency Application Process:

2.1 What forms do I complete to start a new home health agency?

PLEASE NOTE: One application AHCA Form 3110-1011 August 2011 Recommended.  (The July 2009 version is also still accepted.)  The application form is now used for all Initial, Renewal or Change of Ownership applications. This application combines all of the items previously found in the separate Initial, Renewal and Change of Ownership application; items from the Health Care Licensing Application and items from the Affidavit of Compliance with Screening AHCA 3110-1014 to eliminate duplicated information.

All of the forms needed to complete the application for licensure are directly beneath Licensure Application and Forms on this web page and include:

  • The application for license, AHCA form 3110-1011 August 2011 Recommended (July 2009 is still accepted)
  • Financial Schedules AHCA form 3110-0009 July 2009
  • Affidavit of Compliance with Background Screening AHCA Form 3100-0008, August 2010 if the Administrator or Financial Officer provides proof of compliance with level 2 screening requirements submitted within the previous 5 years to meet any provider or professional licensure requirements of the Department of Health, the Agency for Persons with Disabilities, Department of Elder Affairs, or the Department of Children and Family Services;
  • Health Care Licensing Application Addendum AHCA Form 3110-1024

Applicants should complete the above forms as applicable. Additional documents required to be sent with the application includes the following as applicable

  • Attestation of Compliance with Distance Requirements AHCA Form3110-1026 for Initial and Change of Ownership applicants signed by the owner and notarized that attests the proposed home health agency is 10 or more miles from another home health agency in the same county owned by common controlling interests;
  • proof of application -- screen print from accrediting organization web site or letter for receipt of application for accreditation with either the Accreditation Commission Health Care (ACHC); Community Health Accreditation Program (CHAP), or the Joint Commission (JC);
  • current liability and professional malpractice insurance, not a binder;
  • report or letter from local government zoning office or a certificate of use or occupancy proving location is zoned for a home health agency; (An Occupational License or Business Tax Receipt does NOT meet this requirement)
  • proof of the applicant's legal right to occupy the property which may include copies of warranty deeds, lease or rental agreements, contracts for deeds, quitclaim deeds, or other such documentation;
  • a current bank statement or line of credit in the agency name showing sufficient funds to cover pre-opening costs prior to beginning operations, funding for contingencies and the funds necessary to cover three months of average expenses to sustain the home health agency until it reaches a positive cash flow;
  • a Business Plan signed by the applicant which details the home health agency’s methods to obtain patients and its plan to recruit and maintain staff;
  • corporate paperwork including certificate of status, affidavit of fictitious name if applicable, articles of incorporation or company organizational papers if an LLC and by laws;
  • proof of Employee Identification Number from the IRS;
  • proof of Level 2 background screening compliance for the administrator and financial officer that is not over five years old

The application, other required information and the licensure fee of $1,705.


Agency for Health Care Administration
Home Care Unit
2727 Mahan Drive, Mail Stop # 34
Tallahassee, Fl. 32308

The fee is non-refundable. It is very important for the applicant to be familiar with the laws and rules and what is required in the application for licensure.

If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 412-4403. 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.

2.2 How long does it take to get licensed?

It takes up to four months from the date the initial application is received by the Home Care Unit in Tallahassee to become licensed. The process includes the following steps:

  • initial application is received
  • Home Care Unit verifies that the proposed agency is not less than 10 miles from any other agencies in the same county owned by common controlling interests; if it is less than 10 miles the application and licensure fee is returned to the applicant
  • A letter is sent to the applicant confirming the application was received and will be reviewed
  • Agency staff have 30 days in law to review the application and respond in writing to the applicant describing items needing correction or request additional information
  • one omission letter is prepared and sent certified to the applicant
  • applicant has 21 days from the receipt of the letter to make corrections and/or provide missing information back to the Agency
  • staff review the response to the omission letter and determines if application is complete
  • the Agency receives proof that the proposed applicant becomes fully accredited (not conditional or provisional) within 120 days of receipt of the application in the Home Care Unit by one of the three approved accrediting organizations including Accreditation Commission Health Care (ACHC), Community Health Accreditation Program (CHAP) and the Joint Commission ( JC).
  • if the accreditation survey is passed, the applicant receives a license which expires two years from the date it is issued
  • The licensed home health agency must maintain their accreditation status or the license will be revoked

The applicant cannot begin serving patients until the accreditation survey is passed and the Home Care Unit issues a license. An applicant cannot operate a home health agency until the license has been issued per state law.

 

 2.3 What is the cost of the home health license?

The licensure fee, which needs to be included with the application, is $1,705 for a 2-year license. The licensure fee is non-refundable. Checks or money orders are accepted. Starter checks for new bank accounts are not accepted.  At this time, it is not possible to pay on-line.

 

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Section 3: Financial Projections and Business Plan:

3.1 How much funding should I have to start a home health agency?

There is no amount that every applicant could use as a starting point. Effective July 1, 2008 each home health agency applicant must prepare a business plan. Each agency’s plan for the services offered and the amount of staff to be hired is different. Once you complete your plan and retain a CPA to prepare your financial schedules you will be in a better position to determine how much funding you will need. Please note that the minimum amount of funding cannot be less than three (3) month’s average operating expenses.

Please note: If you are applying for Medicaid and/or Medicare the revenue from these sources does not begin until the agency completes a certification process which includes passing an unannounced survey by an approved accrediting organization. See the website for the How to get Medicare overview for more information on the accreditation process. Certification can take five to six months, or longer, to complete after the agency has been licensed by the state. Projecting revenue from Medicaid and/or Medicare to start during the first month of operations as a licensed home health agency is not feasible due to the length of the certification process.

3.2 What is included in the business plan and financial projections?

  The business plan, signed by the applicant, is required to be sent with the financial schedules. The plan must describe the home health agency’s methods to obtain patients and its plan to recruit and maintain staff. At a minimum the plan should include:

    1. description of the business
    2. services to be provided
    3. the existing market
    4. the level of competition in the market
    5. the applicant’s strategy to enter the market and obtain patients
    6. a time-line of major events (expected date of licensure, deemed status, etc)
    7. the level of available personnel including RN’s, LPN’s, Physical Therapists, etc
    8. the applicants strategy to recruit and maintain personnel
    9. description of the applicants admission policy for patients

Financial projections for the first two years of the operation of the home health agency prepared in accordance with Generally Accepted Accounting Principles and signed by a Certified Public Accountant need to be completed. Applicants must show independent evidence of sufficient funds for start up, working expenses and contingencies. There are certain items that are required in order to start an agency that are common to all agencies including:

    1. cash assets in the company name; personal assets are not acceptable; or
    2. committed lines of credit from a reputable lending institution;
    3. evidence of contingency funding equal to three(3) month’s average operating expenses during the first year of operation;
    4. projected balance sheet, income and expense statement, statement of cash flows for the first 2 years of operation which that show evidence of sufficient assets, credit and projected revenues to cover liabilities and expenses by the end of the second year of operation;
    5. cannot project an operating margin of 15 percent or greater for any month in the first year of operation and
    6. required application items that need to be budgeted for in the financial schedules and need to be in place at the time the application is submitted to the Agency including:
      • Accreditation fees for one of the Agency approved accrediting organizations.
      • Personnel: four positions need to be budgeted with either full or part time qualified employees: Administrator, Alternate Administrator, Director of Nursing and Financial Officer. If qualified, the same person may occupy two or three of the positions. If the home health agency is proposing a Director of Nursing who will be responsible for 3 to 5 home health agencies then a Registered Nurse delegate must be budgeted. Non-skilled agencies are not required to budget a director of nursing but must budget an RN to supervise the provision of services by home health aides and certified nursing assistants.
      • Liability and professional malpractice insurance up to at least $250,000 per claim for each type of coverage.
      • Office space in a properly zoned location for a home health agency business.
      • Office equipment such as phones, desks, filing cabinets, computers and other equipment as necessary.

3.3 What does the Home Care Unit look for in the financial schedules?

  The financial schedules need to be completed and signed by a Certified Public Accountant. A Certified Public Accountant at the Agency reviews the schedules and determines if any corrections or additional information is needed to prove financial ability to operate the home health agency. The reviewers look for the following:

  • First, the projections need to be reasonable. For example, projecting a single nurse to do 5000 hours of service a year would not be reasonable. Or, projecting no salaries for required positions that have no ownership in the agency would not be reasonable.
  • Second, is the information contained in the application consistent with financial schedules? For example, projecting 8 directly paid staff and not budgeting for all of them in the financial schedules would not be consistent.
  • Third, applicants applying for Medicare and/or Medicaid should not project revenue in the first four to six months of year one. Becoming a Medicare or Medicaid provider takes at least four to six months after the applicant receives their state license, assuming the survey for Medicare and/or Medicaid is passed successfully. Please read the Medicare and Medicaid overviews on this web page.
  • Finally, sufficient company owned assets to meet the projected needs will need to be included in order for the agency to demonstrate financial ability to operate. The agency needs to either show a profit or break even at the end of the two-year projections.

Make sure to read the instructions with each schedule and provide the information requested in the instructions.

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Section 4: Medicare and Medicaid

4.1 How does my agency become Medicare and Medicaid certified?

Please see “How to get Medicare” and “How to get Medicaid” information sheets under “Home Health Agencies” at the Home Care Unit pages of this web site.

PLEASE NOTE: Once you receive your license from the Agency, you must begin serving patients. You cannot wait to begin serving patients after your application for Medicare or Medicaid has been processed. Effective July 1, 2008 failure to provide at least one service directly to a patient for a period of 60 days is grounds for denial or revocation of the license. Waiting for Medicare or Medicaid certification is not a valid reason for having no patients. A home health agency must be operational and have patients to stay licensed.

4.2 How do I get a branch office approved for my home health agency?

  1. Branch office must be in a county on the parent agency’s license.
  2. Branch office must be in the same AHCA geographic area as the parent.
  3. Branch must be separately licensed unless it is in the same county as the parent. The process for getting a home health agency license is the same for all home health agencies that are licensed. See question #1 above.
  4. The administrator of the parent HHA may also be the administrator of the branch, if the requirements in 400.462(1), Florida Statutes, are met.
  5. For Medicare -
  6. A Medicare Enrollment Application (CMS Form 855A) must have the branch sections completed according to the instructions on the form and submitted to the regional home health intermediary, Palmetto GBA. The form can be printed from the CMS web site at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp (at this site, click on “CMS Forms” on the left side of the screen, then pick the 855A form from the list of forms that will appear). If you have questions about completing the form, please contact Palmetto GBA at 803-382-6167. The completed CMS Form 855A must be mailed to the following address:

     

Palmetto GBA

Part A Provider Enrollment (AG-331)

P.O. Box 100144

Columbia, S.C. 29202-3144

The home health agency must also submit the information required to meet the federal requirements shown at “How to Get Medicare”, “Approval Process for Branch Home Health Agency Offices” at the Home Health Agency pages of this website. This information is sent to the Home Care Unit for review and approval.

6. For Medicaid–

See page 1-5 of the Medicaid Home Health Services Coverage and Limitations Handbook. There is a link to this handbook under “How to Get Medicaid” at the Home Health Agency pages of this web site.

 

4.3 Who do I contact if I have questions regarding patient billing for Medicare and Medicaid certified agencies?

These questions should be directed to the fiscal intermediary and/or fiscal agent.

The Medicare fiscal intermediary for Florida corporations is Palmetto GBA. Their telephone number is toll free 1-866-801-5301 (Option 2), Monday – Friday 8 a.m. until 4 p.m.; and the web site is www.palmettogba.com .

The Medicaid fiscal agent is ACS State Healthcare. Their telephone number is 800-377-8216. The fiscal agent’s web site can be reached through the AHCA web site, http://ahca.myflorida.com and click on “Medicaid” and the click on “Medicaid Fiscal Agent.”

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Section 5: Home health agency location requirements:

5.1 Can I operate a home health agency out of my home?

No, a home health agency cannot be operated from a private residence. A home health agency is not a home-based business due to the traffic with staff coming in and out of the office and the unannounced inspections by AHCA. There are no square footage requirements for your office location. You need room for administrative staff and space for file cabinets to hold confidential files. When you submit your application you must provide the following information:

  • Evidence of zoning which can be a report or letter from the local government zoning office, a certificate of use or occupancy indicating that the office location is zoned appropriately for use as a home health agency
  • and evidence of legal right to occupy the office such as a lease, deed, rental agreement or contract

 

5.2 How many counties can I serve with my home health agency license? How do I add counties?

The state home health agency rules at 59A-8.007(1), Florida Administrative Code, requires that home health agencies apply for a license within a single geographic service area. Agencies are restricted to operate within the boundaries established in law. At the time of initial licensure, the applicant indicates on the application how many counties within the geographic service area they wish to serve.

If an agency wishes to operate in a county which is not located in the existing geographic service area, that agency needs to have an office in the other county and submit an initial home health agency application to AHCA to obtain a separate license prior to opening and serving patients. Once the application has been approved and an initial survey has been passed, the new office will receive a separate license number and can begin serving patients.

5.3 What are the Geographic Service Area boundaries?

  • Area 1 Escambia, Walton, Santa Rosa and Okaloosa
  • Area 2 Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon,
  • Liberty, Madison, Taylor, Wakulla and Washington
  • Area 3 Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,
  • Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union
  • Area 4 Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia
  • Area 5 Pasco and Pinellas
  • Area 6 Hardee, Highlands, Hillsborough, Manatee and Polk
  • Area 7 Brevard, Orange, Osceola and Seminole
  • Area 8 Charlotte, Collier, Desoto, Glades, Hendry, Lee and Sarasota
  • Area 9 Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
  • Area 10 Broward
  • Area 11 Dade and Monroe

 

5.4 Where are the Agency field offices located and what areas do they cover:

There are eight Agency for Health Care Administration field offices. These are the offices that send out surveyors to home health agencies to conduct surveys or investigate complaints. Program related questions need to be directed to the Agency’s Home Care Unit in Tallahassee, (850) 414-6010. The field offices include the following locations:


Field Office

Geographic Service Area

Phone Number

Tallahassee

Areas 1 and 2

(850) 412-4540

Alachua

Area 3

(386) 462-6201

Jacksonville

Area 4

(904) 798-4201

St Petersburg

Areas 5 and 6

(727) 552-2000

Orlando

Area 7

(407) 420-2502

Fort Myers

Area 8

(239) 335-1315

Delray Beach

Areas 9 and 10

(561) 381-5840

Miami

Area 11

(305) 593-3100

 

5.5 Can I move my license to another county in another geographic service area?

A license cannot be relocated to a county in another geographic service area. The licensee must submit an initial application for a home health agency license for the new location.

 

5.6 How do I change the address of my home health agency?

Per 59A-35.040 (2) (b) Florida Administrative Code the home health agency must submit their requested change of address at least 21 days in advance of the move in order to avoid a $500 fine. This includes changes in suite numbers. The home health agency must submit zoning documentation and evidence of legal right to the property. Zoning documentation can include a certificate of use, certificate of occupancy or a letter from the zoning department in your city or county that states the location is zoned appropriately for a home health agency. A business tax receipt is not evidence of zoning.

Legal right to property includes a lease, rental agreement, warranty deeds or contract for deeds. (See s. 408.810 (6) F.S. for information).

Effective July 14, 2010, the home health agency must submit the change of address using the sections of the home health agency application form, AHCA Form 3110-1011 July 2009 or August 2011 recommended, with a $25 fee. Read the Application Checklist Section D Change During Licensure Period for instructions on which sections of the application to complete and the items that need to be submitted to the Agency.

 

5.7 How do I add a Satellite office or Drop-off Site?

A Satellite office is another home health agency office in the same county as the agency’s main office. Supplies and records can be stored at a satellite office and phone business can be conducted the same as in the main office. The satellite office shares administration with the main office and is not separately licensed. You can have a sign and can advertise the location of the satellite.

Licensed only agencies: To add or change the location of a satellite: please complete and send sections 1,2,13 and 15 of the Health Care Licensing Application AHCA Form 3110-1011 along with the $25 fee. Include evidence of zoning and legal right to the property. 21 days advance notice is required.

Medicare and/or Medicaid certified agencies: A satellite office needs to be approved as a branch office by Medicare and Medicaid. Please see the above question 4.2 How do I get a branch office approved for my home health agency?

The satellite office for licensed agencies only will be added to the front of the license and sent to you. The satellite (branch) office for Medicare and/or Medicaid agencies will be added to the license when the branch is approved.

A Drop-off site can be opened in any county within the geographic service area specified on the license. A drop-off site may be used for pick-up or drop-off of supplies or records, for agency staff to use to complete paperwork or to communicate with the main office, existing or prospective agency staff or existing patients or clients. Training of home health agency staff can be done at a drop off site. Prospective patients cannot be contacted and billing cannot be done from a drop-off location. No other business shall be conducted at the drop-off site including the housing of clinical records. The agency name cannot appear at the location unless required by law or by the rental contract. The location cannot appear on agency letterhead or agency advertising.

To establish a drop-off site, send a letter to the Home Care Unit with the address information of the location. The letter will be added to your licensure file. There is no charge for adding a drop-off site.

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Section 6: Required personnel and their qualifications:

There are four required administrative positions to start a home health agency that offers skilled services: Administrator, Alternate Administrator, Director of Nursing and Financial Officer. See Section 16 for how to make personnel changes.


If any of these positions will be designated to submit the online Home Health Quarterly Report, REMEMBER to go to https://apps.ahca.myflorida.com/SingleSignOnPortal to register and submit a new User Agreement.

There is no requirement for a Medical Director.

Effective July 1, 2008 an Administrator, Alternate Administrator and the Director of Nursing can only work for multiple agencies with identical controlling interests.

 

6.1 What are the required qualifications for the Administrator and Alternate Administrator?

A home health agency needs to have an Administrator and an Alternate Administrator to obtain a home health license. An “Administrator" is a direct employee for whom one of the following pays withholding taxes: a home health agency; a management company that has a contract to manage the home health agency on a day-to-day basis; or an employee leasing company that has a contract with the home health agency to handle the payroll and payroll taxes for the home health agency. The Administrator needs to be a

  • licensed physician, physician assistant, or registered nurse licensed to practice in this state or
  • an individual having at least 1 year of supervisory or administrative experience in
    • home health care
    • hospital
    • ambulatory surgical center
    • assisted living facility or a
    • nursing home
If the home health agency changes the administrator, this must be reported to the Agency within 21 days per 408.810 (3) (a), F.S. Failure to do so will result in a $500 fine per 408.813 (3) (b), F.S.

The home health agency does not have to inform the Agency of a change in the alternate administrator except at the time of renewal of the license.

Effective July 1, 2008 an Administrator may manage up to a maximum of five licensed home health agencies if all five home health agencies have identical controlling interests as defined in s. 408.803, F.S. and are located within one Agency geographic service area or within one immediately contiguous county. “Contiguous” means the borders of the counties touch each other. There needs to be a licensed home health agency in each of the counties that are contiguous.

Identical controlling interests is defined as home health agencies that share the same legal entity (EIN); have the exact same people or entities with the exact same percentage of ownership; have the exact same board of directors (if applicable) and have the exact same people or entities with the exact same percentage of ownership in the management company (if applicable).

If the home health agency is licensed under this chapter and is part of a retirement community that provides multiple levels of care, the individual serving as the Administrator may direct up to a maximum of four additional home health agencies licensed under chapter 400 or chapter 429, F.S., if all four entities have identical controlling interests as defined in s. 408.803, F.S.

An Administrator designates, in writing, for each licensed home health agency, a qualified Alternate Administrator to serve during absences. The Alternate Administrator needs to meet the same qualifications as the Administrator. The Administrator and the Alternate Administrator may be either full or part time employees.

Effective July 1, 2008 an Administrator of a home health agency who is also a licensed physician, physician assistant, or a registered nurse may also be the Director of Nursing.

An Administrator may serve as a Director of Nursing for up to five home health agencies only if there are 10 or fewer full-time equivalent employees and contracted personnel in each home health agency and a RN delegate is named for each of the five agencies.

The Administrator or their alternate needs to be available to the public for any eight consecutive hours between 7:00 AM to 6:00 PM Monday through Friday of each week excluding legal and religious holidays. Available to the public means being readily available at the home health agency or by phone.


6.2 What are the required qualifications for the Director of Nursing?

A home health agency providing skilled services is required to have a Director of Nursing in order to obtain a home health agency license. A "Director of Nursing" means a direct employee for whom one of the following pays withholding taxes: a home health agency; a management company that has a contract to manage the home health agency on a day-to-day basis; or an employee leasing company that has a contract with the home health agency to handle the payroll and payroll taxes for the home health agency. The Director of Nursing qualifications include being a

  • registered nurse and direct employee of the agency who is a graduate of an approved school of nursing and is licensed in this state
  • who has at least 1 year of supervisory experience as a registered nurse

The Director of Nursing is responsible for overseeing the professional nursing and home health aide delivery of services of the agency.

Effective July 1, 2008, a Director of Nursing may serve up to two licensed home health agencies if

  • the agencies have identical controlling interests (see question 6.1) as defined in s 408.803 and
  • are located within one Agency geographic service area or within one immediately contiguous county.

Effective July 1, 2008 a Director of Nursing may manage up to five licensed home health agencies if

  • all of the home health agencies have identical controlling interests (see question  6.1) as defined in s. 408.803 and
  • are located within one agency geographic service area or within an immediately contiguous county and
  • each of the five home health agencies has a registered nurse delegate who meets the qualifications of a Director of Nursing and has been given a written delegation from the Director of Nursing to serve in his or her absence for each of the five home health agencies as per 400.476 (2), F.S.

If the home health agency is part of a retirement community that provides multiple levels of care, the individual serving as the Director of Nursing may direct up to a maximum of four additional home health agencies that are owned, operated, or managed by the same corporation. The Director of Nursing may be a full or part time position.

The Director of Nursing needs to be available to the public for any eight consecutive hours between 7:00 AM and 6:00 PM Monday through Friday of each week excluding legal and religious holidays. Available to the public means being readily available at the home health agency or by phone.


6.3 What are the qualifications for the Financial Officer?

The home health agency needs to have a Financial Officer (or similarly titled individual) to be responsible for the financial operations. There are no educational or experience requirements in law for the Financial Officer. The individual needs to clear a level 2 Background screen and may reside out of the State of Florida in a corporate office location. Any of the other required positions listed above may also serve as the Financial Officer.

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Section 7: Non-skilled agencies and agencies that provide only therapies:

7.1 If my agency is only going to offer non-skilled services and is not Medicare or Medicaid certified, do I need to have a Director of Nursing?

No . Home health agencies that offer only home health aide and homemaker/companion services and do not offer nursing or other therapy services and are not Medicare or Medicaid certified do not require a Director of Nursing. They need, however, to have an RN on staff to supervise the care provided by home health aides and certified nursing assistants per Section 400.487 (3), Florida Statutes and Section 59A-8.0095 (3) (b), Florida Administrative Code. This individual does not have to be full time. Non-skilled agencies do not have to notify the Agency when the RN is terminated or replaced except at the time their license is renewed.

7.2 If my agency is only going to offer physical, occupational, or speech therapy and is not Medicare or Medicaid certified do I need to have a Director of Nursing?

Home health agencies that offer therapy services only do not have to have a director of nursing.

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Section 8: Background screening requirements:

8.1 What are the background screening requirements for home health agency owners and administrative and direct service staff?

PLEASE NOTE: Changes in law during the 2010 legislative session changed the background screening and hiring process for health care providers. The changes are:

  1. Replaces all Level 1 background screening with Level 2 screening
  2. Requires Level 2 screening for:
    • Any person seeking employment who may provide personal care or services directly to clients, or have access to client’s living areas, personal property or client funds;
    • Any contractor who provides personal care or services directly to clients;
    • Administrators and Financial Officers
    • A controlling interest (owner, officer, board member) if AHCA has reason to believe the person has been convicted of a disqualifying offense.
  3. Requires Level 2 rescreening every 5 years.
  4. Applicants should be rescreened according to the following staggered schedule
    • Individuals for whom the last screening was conducted on or before December 31, 2004, must be rescreened by July 31, 2013.
    • Individuals for whom the last screening conducted was between January 1, 2005, and December 31, 2008, must be rescreened by July 31, 2014.
    • Individuals for whom the last screening conducted was between January 1, 2009, through July 31, 2011, must be rescreened by July 31, 2015.
  5. Level 2 screening in the previous 5 years by AHCA, Department of Health, Agency for  Persons with Disabilities, Department of Children and Department of Financial Services (when employed by a continuing care retirement community) and the Department of Elder Affairs can be accepted if the person has not been unemployed for more than 90 days. The employee must complete and sign an Affidavit of Compliance with Background Screening Requirements AHCA Form 3100-0008, August 2010.
  6. The Affidavit of Compliance with Background Screening Requirements AHCA Form 3100-0008 was revised effective August 2010 to include new disqualifying offenses.  All persons required to be screened above must sign this form. 
Please go to this link to read the information that was prepared for licensed providers for the new requirements for background screening effective August 1, 2010:  Background Screening.

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Section 9: Home Health Aide training information:

9.1 What are the training requirements for Home Health Aides and Certified Nursing Assistants? What are the requirements for working in a Medicare or Medicaid certified home health agency? Where can I obtain a listing of schools offering the training?

The Fact Sheet on Home Health Aides at the Home Care Unit pages of this web site provides a summary of the requirements for home health aides. (You can also view this fact sheet by going to the home page of the AHCA web site, click on “Providers” then click on “Home Care Unit” under “Licensing/Program Offices” and then click on “Home Health Aide.”) This summary was written for home health aides. Persons who are applying for a home health agency license or are currently operating a home health agency cannot just use this summary. Licensed home health agencies need to comply with all requirements in state law and rules. Home health agencies need to meet the requirements in the state home health agency law and rules for home health aides:

  • State rules: 59A-8.0095(5), Florida Administrative Code. (You can view the rules on the same list of documents at our web site as these Frequently Asked Questions.)
  • State law: Section 400.488, Florida Statutes. (You can also view this section of the statutes on the same list of documents as these Frequently Asked Questions.)
  • State Regulation Set: See standards H 240 through 256. (The Regulation Set is also at our web site on the same list of documents as these Frequently Asked Questions.)

Medicare and Medicaid home health agencies need to meet additional requirements established by the U.S. Dept of Health and Human Services, Centers for Medicare and Medicaid Services. These requirements are in found in:

  • Federal home health agency regulations: 42 Code of Federal Regulations Part 484.36 http://www.gpoaccess.gov/cfr/retrieve.html
  • Federal Regulation Set used by Surveyors: See link to the Appendix B of the Medicare State Operations Manual on the same list of documents as these Frequently Asked Questions. The home health aide standards are at G 202 through G 232.

 

Where to obtain a listing of schools :

  • Public adult vocational technical schools throughout the state offer training. You can find a listing of these vocational technical schools in the phone book under your county public school system or at the Department of Education’s web site: http://data.fldoe.org/workforce/contacts/default.cfm .
  • Non-public career education schools also offer training: Here’s a link to the list at the Department of Educations web site, http://www.fldoe.org/cie/ . Click on School/College Search and you can obtain a listing of schools in your county.

 9.2 If I wanted to start a school of my own to train Home Health Aides, whom would I contact?

Contact the Commission for Independent Education in the Department of Education. The phone number is 850-245-3200. The toll free number is 888-224-6684. Or, visit their web site at www.fldoe.org/cie/ for information on the requirements.

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Section 10: Reporting changes to my license information:

10.1 How do I report a change of address?

  • Send the $25 fee and the AHCA Home Health Agency application Sections 1, 2 and 15 to the Home Care Unit 21 days in advance of the effective date of the move
  • State the effective date of the move
  • Include proof of zoning with either a copy of a report or letter from the local zoning office or a certificate of use or occupancy
  • Include proof of your right to occupy the property: copies of warranty deeds, lease or rental agreements, contracts for deeds, quitclaim deeds or other documentation
  • Failure to inform the Agency 21 days in advance of the new location will result in a $500 fine
  • 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)

 

10.2 How do I add counties to my license?

Home health agencies may add counties that are located within their geographic service area. Effective July 14, 2010 per 59A-35 Florida Administrative Code adding a county will require the applicant to complete the AHCA Form 3110-1011 July 2009 or the recommended August 2011 and a $25 fee to add counties. Read the Application Checklist Section D. to find out which sections of the application must be completed and submitted. In addition to the application the home health agency needs to submit a written plan to the Agency Home Care Unit office in Tallahassee which includes:

  • description of the coverage of the new counties taking into account the number of anticipated new patients and
  • description of the level of supervision provided to the staff serving in the new counties.

The Agency central office will review the home health agency’s previous survey findings and any administrative actions taken including fines, suspensions, revocations or injunctions. The Home Care Unit will make the decision and inform the home health agency. If approved, a new license will be issued containing the approved counties.

 

10.3 How do I report a change in the name of our agency?

  • Send the $25 fee and the AHCA Home Health Agency application Sections 1, 2 and 15 reporting the name change and effective date to the Home Care Unit
  • Include a copy of the Affidavit for Fictitious Name obtained from the State of Florida, Division of Corporations if you will be operating under a name other than the name of the partnership or corporation.
  • Include a copy of the Certificate of Status obtained from the State of Florida, Division of Corporations if the corporation is changing its legal name
  • Send amended articles of incorporation showing the name change.

Once all of the information is received the specialist for your area will print a new license certificate with the new name and mail it to you.

Please note that a name change is not the same as a change in the corporation or partnership or their owners. If you intend to have a new corporation or partnership or new owners take over the operation of your home health agency which may or may not result in a change of the employee identification number (EIN) this is considered a change of ownership and an application needs to be submitted for a change of ownership with the licensing fee. See question #10.4 below.

 

10.4 How do I do a change of ownership of a home health agency?

  A change of ownership as defined in 2009 Chapter 408, Part II Florida Statutes is

  • the licensee changes to a different legal entity with a different EIN number or
  • when 51% or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned
  • a change solely in the management company or board of directors is not a change of ownership.

All types of legal entities, including Limited Liability Companies are included in the change of ownership definition.

A change of ownership application needs to be completed and sent to the Home Care Unit 60 days prior to the change. An application for Change of Ownership AHCA Form 3110-1011 revised August 2011 to incorporate changes to the law effective July 1, 2009. is required as well as the forms needed to comply with the reporting requirements in Chapter 408, Part II of the Florida Statutes which are posted at this website.

 

10.5 Who do I need to notify when I close my home health agency?

The home health agency needs to inform the Agency in writing not less than 30 days prior to the closing. Patients also need to be informed in writing of the closing. A copy of a notice of closure in the newspaper in the county(s) where the provider was located that advises patients of the discontinuance of the home health agency can be done in place of a written notice to each patient. The notice must appear at least once per week for four consecutive weeks.

The home health agency needs to provide copies of the clinical records to the patients or their legal guardian if requested. If continuing services are needed by patients, the home health agency needs to find another provider or contact a provider chosen by the patient. All clinical records must be forwarded to the new provider of services for the patient.

Once the home health agency closes, the license needs to be returned to the Agency. The home health agency remains responsible for retaining closed clinical records for six years for patients that received skilled services. Service provision plans for patients that received non-skilled services need to be retained for 3years.

 

10.6 How do I report a change to the service our home health agency provides directly?

You can report the change in services being provided directly and under contract on your application for renewal of your home health agency license. Also, if you are a Medicare or Medicaid certified home health agency, CMS will only accept changes in the direct services with the recertification survey report. You will need to have the change in direct service made to the CMS 1572 form with the surveyor as part of the recertification survey from either your accrediting organization or AHCA. Otherwise, no changes in direct service will be accepted.

 

10.7 How do I obtain a replacement license certificate?

You need to complete sections 1, 2 and 15 of the home health application. Indicate on page two that you are requesting a replacement certificate. Send the applications sections along with a check for $25 and send to the Agency for Health Care Administration, Home Care Unit MS# 34 2727 Mahan Drive, Tallahassee, Fl 32308.

 

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Section 11: License renewal process:

11.1 How often do I renew my license?

A home health license is issued for two years. Renewal applications are due to the Agency 60 days prior to the expiration date on the license. A renewal reminder postcard will be sent to your home health agency at least 90 days prior to the expiration of your license.

11.2 What are the steps to follow when renewing my license?

The steps you need to follow for renewal of your license include:

  • Download the application AHCA Form 3110-1011 August  2011 recommended or July 2009 from the website and complete it
  • Complete the other applicable forms including Health Care Licensing Addendum AHCA Form 3110-1024
  • Include level 2 background screening clearance information for Administrator and Financial Officer if they are new since the last renewal and the Home Care Unit has not already been notified.  If they submit proof of level 2 screening that is not more than 5 years old from the Department of Children and Families, Department of Elder Affairs, Agency for Persons with Disabilities, Department of Health or AHCA Medicaid then AHCA Form 3100-008 August 2010 Affidavit of Compliance with Background Screening Requirements must be signed and submitted with the renewal application (See http://ahca.myflorida.com/providers.shtml - click on “Background Screening” for new level 2 screening requirements)
  • Include documentation of current liability and malpractice insurance
  • If the application for initial licensure was submitted after July 1, 2008, renewals for these agencies must include a copy of their current accreditation report from an Agency approved accrediting organization

 

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Section 12: Emergency Management Plan information:

12.1 Does my Emergency Management Plan need to be approved before I am licensed or have my license renewed?

The plan needs to be developed prior to the initial survey and a copy made available to show the surveyor. (See the Emergency Management Plan Format in the listing of documents under “Home Health Agencies” at this web site for the required content of your plan.) The address and contact person for the local County Health Department comprehensive emergency management plan (CEMP) reviewer is also located in the “Emergency Management Plan Review Contacts” under “Home Health Agencies” on this web site.

Please note that the Department of Health may have designated a Regional Comprehensive Plan reviewer. It is possible that your plan may be reviewed by a Regional individual who is not located in your local county health department. Department of Health regions are not the same as AHCA geographic service area designations. Check the website Emergency Management Plan Review Contacts at the website prior to sending your plan for review or updates.

12.2 Who is responsible for the emergency management plan in my agency?

Every home health agency must designate a safety liaison to serve as the primary contact for emergency operations and implementation of the emergency management plan.

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Section 13: Home health services questions

13.1 Are orders from an Advanced Registered Nurse Practitioner for care acceptable or do the orders have to be from a physician?

There are differences in the federal requirements for the certified home health agencies and the state law for state-licensed-only home health agencies.

If your home health agency is Medicare and/or Medicaid certified, home health agency federal regulations require that orders for care come from a physician only. The federal regulations at do not accept orders from an Advanced Registered Nurse Practitioner.  If you are getting orders from an Advanced Registered Nurse Practitioner on behalf of the physician she/he works for, the physician needs to also sign them before billing for services. Here is the home health agency federal regulation, 42 Code of Federal Regulation 484.18(c) that requires physician orders:

"(c) Standard: Conformance with physician orders. Drugs and treatments are administered by agency staff only as ordered by the physician with the exception of influenza and pneumococcal polysaccharide vaccines, which may be administered per agency policy developed in consultation with a physician, and after an assessment for contraindications. Verbal orders are put in writing and signed and dated with the date of receipt by the registered nurse or qualified therapist (as defined in Sec. 484.4 of this chapter) responsible for furnishing or supervising the ordered services. Verbal orders are only accepted by personnel authorized to do so by applicable State and Federal laws and regulations as well as by the home health agency’s internal policies."

If your home health agency is not Medicare or Medicaid certified and these are private paying or insurance patients (and not Medicare or Medicaid patients that your agency is under contract with a certified agency to provide services for), the state law permits the home health agency to accept orders from an Advanced Registered Nurse Practitioner or physician’s assistant. Here is the home health agency state law, section 400.487(2), Florida Statutes that permits licensed-only, non-certified agencies to accept Advanced Registered Nurse Practitioner orders:

"(2) When required by the provisions of chapter 464; part I, part III, or part V of chapter 468; or chapter 486, the attending physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, shall establish treatment orders for a patient who is to receive skilled care. The treatment orders must be signed by the physician, physician assistant, or advanced registered nurse practitioner before a claim for payment for the skilled services is submitted by the home health agency. If the claim is submitted to a managed care organization, the treatment orders must be signed within the time allowed under the provider agreement. The treatment orders shall be reviewed, as frequently as the patient's illness requires, by the physician, physician assistant, or advanced registered nurse practitioner in consultation with the home health agency."

13.2 Can the plan of care specify a range of services or does the exact number of visits per week have to be specified?

For Medicare home health agencies, the CMS Medicare Benefit Policy Manual, Chapter 7 - Home Health Services, states:

“30.2.2 - Specificity of Orders

The orders on the plan of care must indicate the type of services to be provided to the patient, both with respect to the professional who will provide them and the nature of the individual services, as well as the frequency of the services.

 

EXAMPLE 1:

SN x 7/wk x 1 wk; 3/wk x 4 wk; 2/wk x 3 wk, (skilled nursing visits 7 times per week for 1 week; 3 times per week for 4 weeks; and 2 times per week for 3 weeks) for skilled observation and evaluation of the surgical site, for teaching sterile dressing changes and to perform sterile dressing changes. The sterile change consists of (detail of procedure).

Orders for care may indicate a specific range in the frequency of visits to ensure that the most appropriate level of services is provided during the 60-day episode to home health patients. When a range of visits is ordered, the upper limit of the range is considered the specific frequency.

EXAMPLE 2:

SN x 2-4/wk x 4 wk; 1-2/wk x 4 wk for skilled observation and evaluation of the surgical site.

Orders for services to be furnished "as needed" or "PRN" must be accompanied by a description of the patient's medical signs and symptoms that would occasion a visit and a specific limit on the number of those visits to be made under the order before an additional physician order would have to be obtained.”

For Medicaid home health agencies, the Florida Medicaid Home Health Services Coverage and Limitations Handbook, chapter 2 requires the frequency and duration of the services.

The home health agency law and rules do not address this for licensed-only home health agencies.

 

13.3  If I want to set up a business to provide therapists to be subcontractors for home health agencies what license do I need? 

Answer: The kind of license you need depends on what you intend to do. 

  1. If you intend to subcontract with home health agencies for your business to provide therapy to patients on an on-going, as-needed basis – the therapists are assigned to patients by your business, make home visits to patients under the name of your business, you supervise the work of the therapists, and bill the home health agency for the visits made – you would need a home health agency license unless:   

    (a) your business is a certified rehabilitation agency or a comprehensive outpatient rehabilitation facility (CORF).  The state law exempts from home health agency licensing certified rehabilitation agencies and CORFs (400.464(5)(m), Florida Statutes) . 
    (b) you provide just one type of therapy, such as such as only physical therapy.  An entity that provides a single health care professional discipline is not an organization for the purposes of home health agency licensing per 400.462 (22), Florida Statutes. 

  2. If you intend to subcontract with home health agencies to provide therapists who will actually work as therapy staff for the home health agency on a temporary basis – the home health agency supervises and assigns each therapist to specific patients; the therapists go to the home identified as staff from the home health agency; and you bill the home health agency for use of the temporary staff -- you would need a health care services pool license under 400.980 Florida Statutes.  However, you must comply with the following:
    • The state law says that a health care services pool “provides temporary employment in health care facilities, residential facilities, and agencies for licensed, certified, or trained health care personnel” (400.980 (1), Florida Statues). 
    • “Temporary employment” means “employment whereby a pool hires its own employees or independent contractors and assigns them to health care facilities to support or supplement the facilities’ work force in special works situations such as employee absences, temporary skill shortages, seasonal workloads, and special assignments and projects” (59A-27.001 (1), Florida Administrative Code). 
    • Therefore, to provide temporary therapy staff to a home health agency, the home health agency must already employ its own therapists. The health care services pool would only provide the home health agency with temporary therapists to fill in when one of their own therapists was on leave or in special situations as stated in the Florida Administrative Code quoted above.  Therapists could not be provided to the home health agencies on an on-going basis.

 

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Section 14:

These Frequently Asked Questions and Answers are provided for general informational purposes only. They do not constitute, and should not be substituted for, professional legal advice. These Frequently Asked Questions and Answers are not an interpretation of law nor are they statements of AHCA policy. Each situation is different and each situation deserves individual attention. Due to the complex nature of the state and federal laws that govern health care facilities, home health agencies and other readers should consult with a health care attorney for their particular issue. Readers should recognize that there are federal laws enforced by the federal government and other state laws enforced by the Florida Attorney General’s Office that apply to home health agencies. Readers should also recognize that statutes, rules and their interpretations may change over time.

 

14.1 Marketing in General – F.S. 400.474

14.1.1 Does F.S. 400.474 prohibit a home health agency from advertising?

Answer: No. There are no state laws that prohibit home health agencies from advertising in newspapers, other print media, television, radio or the internet.

 

14.1.2 Does F.S. 400.474 prohibit a home health agency from having a booth at a health fair, shopping mall or senior center and giving away inexpensive marketing items such as pens, pads, and other items with the home health agency’s name on it?

Answer: F.S. 400.474 does not prohibit a home health agency from having a marketing booth. F.S. 400.474(6)(g), however, prohibits a home health agency from giving cash, or its equivalent, to a Medicare or Medicaid beneficiary. If your home health agency is Medicare or Medicaid certified, please refer to the U.S. Department of Health and Human Services Office of Inspector General’s Special Advisory Bulletin on the Social Security Act Sec. 1128A (a)(5) (Offering Gifts and Other Inducements to Beneficiaries) dated 8/30/2002 at:  https://oig.hhs.gov/fraud/docs/alertsandbulletins/SABGiftsandInducements.pdf

 

14.1.3 Does F.S. 400.474 prohibit a home health agency from sponsoring a Walk/Run on behalf of a health organization such as the Alzheimer’s Association?

14.1.4 Does F.S. 400.474 prohibit a home health agency from being a sponsor at the National Association for Continuing Education conference that has about 100 physicians in attendance? Does it make a difference whether the home health agency is identified on an information board and its services are posted?

Answer: Such sponsorships are not expressly prohibited by F.S. 400.474. A sponsorship, however, may not serve as a conduit for a home health agency to illegally provide remuneration to physicians or others in violation of F.S. 400.474. As set forth below, subject to certain exceptions and safe harbors under the Federal Anti-Kickback Statute and federal Stark Law and their respective implementing regulations, a home health agency may not provide remuneration to any physician who is not the home health agency’s single medical director. The nature of the charitable event or educational program, the amount of money spent on the event or program, the amenities provided, and other material factors, may be reviewed on a case-by-case basis in order to determine whether prohibited remuneration was provided.

14.2 Copies of Contracts – F.S. 400.474(6)(d) and F.S. 400.474(6)(k)

The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that: . . .

(d) Fails to provide the agency, upon request, with copies of all contracts with assisted living facilities which were executed within 5 years before the request.

* * *

(k) Fails to provide to the agency, upon request, copies of all contracts with a medical director which were executed within 5 years before the request.

 

14.2.1 In two places of the 2008 amendment [400.474(6)(d) and (k)], it refers to providing copies of contracts to the Agency which were executed within 5 years of the request. Since the amendment took effect on July 1, 2008, does this mean 5 years back from request for example? This would be prior to the effective date of the bill. Or, does the 5 years count forward from July 1, 2008?

Answer: The requirements and penalties set forth under F.S. 400.474(6)(d) and (k) apply only to contracts that were executed between the home health agency and an assisted living facility or medical director after July 1, 2008. The Agency, however, may request copies of such contracts executed prior to July 1, 2008, pursuant to F.S. 408.811.

14.3 Medical Directors and Physicians - Questions about F.S. 400.474(6)(h).

The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that:

(h) Has more than one medical director contract in effect at one time or more than one medical director contract and one contract with a physician-specialist whose services are mandated for the home health agency in order to qualify to participate in a federal or state health care program at one time.

14.3.1 Is a home health agency required to have a medical director?

Answer: No. Home health agency state licensure law does not require a medical director.

14.3.2 Is a home health agency required to have a physician?

Answer: No. Only Medicare and Medicaid home health agencies are required to have a physician on the group of professional personnel that advises the home health agency. The group is to meet a minimum of once per year. (42 CFR 484.16).

14.3.3 May a home health agency have more than one medical director?

Answer: No. Under F.S. 400.474(6)(h), a home health agency may not have “more than one medical director contract in effect at one time or more than one medical director contract and one contract with a physician-specialist whose services are mandated for the home health agency in order to qualify to participate in a federal or state health care program at one time.”

14.3.4 May a home health agency accept referrals from its one medical director?

Answer: Yes, assuming that the patient referral is not in violation of some other law.

14.3.5 May a home health agency accept referrals from physicians other than its medical director?

Answer: Yes, assuming that the patient referral is not in violation of some other law.

14.3.6 Does a patient have the freedom to choose which home health agency he or she may receive health care services?

Answer: Yes.

14.4 Remuneration in General.

14.4.1 Is it illegal for a home health agency to give remuneration to entities, physicians and other individuals under certain circumstances?

Answer: Yes. F.S. 400.474(6) sets forth several circumstances in which it is illegal for a home health agency to provide remuneration, as defined by F.S. 400.462(27), to certain entities and individuals as set forth more particularly in F.S. 400.474(6)(a), (e), (i) and (j). Other federal and state laws may also prohibit a home health agency from providing remuneration to certain entities and individuals. There are federal laws enforced by the federal government, including the Federal Anti-Kickback Statute and the federal Stark Law, and other state laws enforced by the Florida Attorney General’s Office, including the Florida Patient Self-Referral Act of 1992 (F.S. 456.053), Florida Anti-Kickback Statute (F.S. 456.054), and Florida Fee-Splitting Statute (F.S. 458.331), Florida Patient Brokering Act (F.S. 817.505), that may apply. Depending upon the type of facility, portions of Chapter 400 may apply.

14.4.2 What is the definition of “remuneration” under Florida law?

Answer: As defined in F.S. 400.462(27), "remuneration" means “any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind.”

However, if the term is used in any provision of law relating to health care providers, the term does not apply to an item that has an individual value of up to $15, including, but not limited to, a plaque, a certificate, a trophy, or a novelty item that is intended solely for presentation or is customarily given away solely for promotional, recognition, or advertising purposes.

 

14.4.3 What is “fair market value” under Florida law?

Answer: Under F.S. 400.462(11), “fair market value” is “the value in arms length transactions, consistent with the price that an asset would bring as the result of bona fide bargaining between well-informed buyers and sellers who are not otherwise in a position to generate business for the other party, or the compensation that would be included in a service agreement as the result of bona fide bargaining between well-informed parties to the agreement who are not otherwise in a position to generate business for the other party, on the date of acquisition of the asset or at the time of the service agreement.”

14.4.4 What are the penalties or actions that the Agency may seek against a home health agency that gives remuneration in violation of F.S. 400.474(6)?

Answer: Pursuant to F.S. 400.474(6), the Agency “may” deny, revoke, or suspend the license of a home health agency and “shall” impose a fine of $5,000 against a home health agency that provides remuneration in violation of this statute. In addition, pursuant to F.S. 400.471(10)(h), the Agency “may not issue a renewal license for a home health agency in any county having at least one licensed home health agency and that has more than one home health agency per 5,000 persons, as indicated by the most recent population estimates published by the Legislature's Office of Economic and Demographic Research, if the applicant or any controlling interest has been administratively sanctioned by the agency during the 2 years prior to the submission of the licensure renewal application” if the home health agency has violated F.S. 400.474(6)(a).

14.4.5 Are there statutory exceptions under Florida law that would permit a home health agency to give remuneration under circumstances?

Answer: Yes. In 2009, the Florida Legislature enacted exceptions to F.S. 400.474(6)(e) and (j). The 2009 amendment states: “Nothing in paragraph (e) or paragraph (j) shall be interpreted as applying to or precluding any discount, compensation, waiver of payment, or payment practice permitted by 42 U.S.C. s. 1320a-7(b) or regulations adopted thereunder, including 42 C.F.R. s. 1001.952 or s. 1395nn or regulations adopted thereunder.” Paragraph (6)(e) includes case managers, discharge planners, facility-based staff members, or third-party vendors involved in the discharge planning process of a facility licensed under chapter 395, chapter 429, or chapter 400, from whom the home health agency receives referrals. Paragraph (6)(j) includes physicians, members of a physician's office staff, and immediate family members of a physician.

14.5 Remuneration to Certain Case Managers, Discharge Planners, Facility Based Staff Members and Third Party Vendors - Questions about F.S. 400.474(6)(e).

The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that:

* * *

(e) Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395, chapter 429, or this chapter from whom the home health agency receives referrals.

* * *

Nothing in paragraph (e) or paragraph (j) shall be interpreted as applying to or precluding any discount, compensation, waiver of payment, or payment practice permitted by 42 U.S.C. s.1320a-7(b) or regulations adopted thereunder, including 42 C.F.R. s.1001.952, or s. 1395nn or regulations adopted thereunder.

14.5.1 What are the facilities licensed under Chapter 395, Chapter 429, and Chapter 400, of the Florida Statutes?

Answer: Chapter 395 facilities are hospitals, ambulatory surgery centers, and mobile surgical facilities. Chapter 429 facilities are assisted living facilities, adult family care homes and adult day care centers. Chapter 400 facilities include skilled nursing facilities (more commonly known as nursing homes), home health agencies, nurse registries, hospices, transitional living facilities, prescribed pediatric extended care centers, home medical equipment providers, intermediate care facilities for the developmentally disabled, health care services pools, and health care clinics.

 

14.5.2 May a home health agency give remuneration to case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395, chapter 429, or chapter 400, from whom the home health agency receives referrals?

Answer: The answer to this question depends upon the remuneration given by the home health agency to the individual. On its face, F.S. 400.474(6)(e) prohibits a home health agency from giving any type of remuneration to the individuals enumerated in the statute. In 2009, however, the Florida Legislature created an exception for this subsection and recognized the exceptions of the Federal Anti-Kickback Statute and the federal Stark Law. Thus, arrangements involving remuneration that are permitted under the federal laws referenced in the 2009 amendment will not be construed by the Agency as a violation of F.S. 400.474(6)(e).

As the federal exceptions and their interpretations change over time, so does their application by the Agency. The giving of remuneration that is not protected by federal law is subject to Agency enforcement and sanction under state law. The interpretation of this area of federal law and the numerous variations of remuneration are generally beyond the scope of a Frequently Asked Question. There is an abundance of reference materials concerning this area of federal law. Home health agencies should consult with their own health care attorney and review the opinions of the federal Inspector General regarding these federal exceptions and safe harbors.

 

14.5.3 Is there a federal exception or safe harbor that would allow a home health agency to give nominal forms of remuneration to case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395, chapter 429, or chapter 400, from whom the home health agency receives referrals?

Answer: It appears that the Federal Anti-Kickback Statute and its implementing regulations set forth no exception or safe harbor that covers the offering of nominal items, such as a pen or a pad with the name of the home health agency, cookies or cakes given during the holiday season, or an occasional modest meal during a face-to-face presentation. In addition, the federal Stark Law applies to financial relationships that involve only physicians. To date, however, the federal government has apparently not sought sanctions for the giving of nominal forms of remuneration like those set forth above because such nominal items were not likely to induce a patient referral. Further, for enforcement purposes, the federal government has interpreted “nominal” to be no more than $10 per item, and of $50 in the aggregate on an annual basis. In order to remain consistent with the federal government’s position, the Agency will construe F.S. 400.474(6)(e) in a manner to permit remuneration of $10 per item, and of $50 in the aggregate on an annual basis, for any one individual. It would be prudent for a home health agency to maintain an accurate and updated expense log to monitor the amount of funds spent annually on items that constitute remuneration. Similarly, in order to maintain consistency with the federal government’s enforcement of these federal laws, when a home health agency gives remuneration (regardless of the total value) to an individual set forth in F.S. 400.474(6)(e) with the intent to induce a patient referral to that home health agency, the giving could be construed as a violation of F.S. 400.474(6)(e).

 

14.6 Remuneration to Non-Medical Director Physicians - Questions about F.S. 400.474(6)(i).

The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that: . . .

(i) Gives remuneration to a physician without a medical director contract being in effect. The contract must:

1. Be in writing and signed by both parties;

2. Provide for remuneration that is at fair market value for an hourly rate, which must be supported by invoices submitted by the medical director describing the work performed, the dates on which that work was performed, and the duration of that work; and

3. Be for a term of at least 1 year.

The hourly rate specified in the contract may not be increased during the term of the contract. The home health agency may not execute a subsequent contract with that physician which has an increased hourly rate and covers any portion of the term that was in the original contract.

 

14.6.1 May a home health agency give remuneration to a physician who is not a medical director of the home health agency?

Answer: The answer to this question depends upon the remuneration given by the home health agency to the physician. On its face, F.S. 400.474(6)(i) and (j) prohibit a home health agency from giving any type of remuneration to a physician who is not the home health agency’s single medical director. In 2009, however, the Florida Legislature created an exception for F.S. 400.474(6)(j) and recognized the exceptions of the Federal Anti-Kickback Statute and the federal Stark Law. Paragraph (6)(j) includes physicians. As such, arrangements involving remuneration given to a physician that are permitted under the federal laws referenced in the 2009 amendment will not be construed by the Agency as being a violation of F.S. 400.474(6)(i). Under federal law, an annual aggregate of $355 (as of 2009) is permitted. It would be prudent for a home health agency to maintain an accurate and updated expense log to monitor the amount of funds spent annually on items that constitute remuneration. The Agency notes, however, than an express condition under the Stark Law’s non-monetary compensation exception set forth under 42 C.F.R. 411.357(k) is that the compensation arrangement must not violate the Federal Anti-Kickback Statute or any federal or Florida law governing billing or claims submission. Thus, any remuneration (regardless of the total value) given by the home health agency to a non-medical director physician with the intent to induce the physician to make patient referrals to that home health agency could be construed as being a violation of F.S. 400.474(6)(i) unless there exists an express exception or safe harbor to the Federal Anti-Kickback Statute or implementing regulations.

As the federal exceptions and their interpretations change over time, so does their application by the Agency. The giving of remuneration that is not protected by federal law is subject to Agency enforcement and sanction under state law. The interpretation of this area of federal law and the numerous variations of remuneration are oftentimes beyond the scope of a Frequently Asked Question. There is an abundance of reference materials concerning this area of federal law. Home health agencies should consult with their own health care attorney and review the opinions of the federal Inspector General regarding these federal exceptions and safe harbors.

 

14.7 Remuneration to Physicians, Physician’s Office Staff and Immediate Family Members - Questions about F.S. 400.474(6)(j).

The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that: . . .

(j) Gives remuneration to:

1. A physician, and the home health agency is in violation of paragraph (h) or paragraph (i);

2. A member of the physician's office staff; or

3. An immediate family member of the physician, if the home health agency has received a patient referral in the preceding 12 months from that physician or physician's office staff.

* * *

Nothing in paragraph (e) or paragraph (j) shall be interpreted as applying to or precluding any discount, compensation, waiver of payment, or payment practice permitted by 42 U.S.C. s.1320a-7(b) or regulations adopted thereunder, including 42 C.F.R. s.1001.952, or s. 1395nn or regulations adopted thereunder.

 

14.7.1 May a home health agency give remuneration to a physician’s office staff member who has referred a patient to the home health agency within the past twelve months?

Answer: Please refer to the analysis set forth in FAQ 14.5.2 and FAQ 14.5.3.

 

14.7.2 May a home health agency hire an immediate family member of a physician who refers patients to the home health agency?

Answer: The answer to this question depends upon the remuneration given by the home health agency to the individual. On its face, F.S. 400.474(6)(j) prohibits a home health agency from giving any type of remuneration to the individuals enumerated in the statute. In 2009, however, the Florida Legislature created an exception for this subsection and recognized the exceptions of the Federal Anti-Kickback Statute and the federal Stark Law. Thus, arrangements involving remuneration that are permitted under the federal laws referenced in the 2009 amendment will not be construed by the Agency as being a violation of F.S. 400.474(6)(j).

The federal exceptions, under certain circumstances, permit a health care provider to employ an immediate family member of a physician that refers patients to the health care provider. The circumstances look to the nature of the employment and the employee’s compensation in order to determine whether there is a bona fide employment relationship. Thus, a home health agency may be permitted to hire a physician’s immediate family member as long as the employment is permitted under federal law. The monetary compensation of the employee should be fair and commensurate with type of work being performed. If a home health agency has a concern about a particular employment, it should review the circumstances of each potential employment with their counsel to determine whether a federal safe harbor applies.

As the federal exceptions and their interpretations change over time, so does their application by the Agency. The giving of remuneration that is not protected by federal law is subject to Agency enforcement and sanction under state law. The interpretation of this area of federal law and the numerous variations of remuneration are oftentimes beyond the scope of a Frequently Asked Question. There is an abundance of reference materials concerning the Federal Anti-Kickback Statute. Home health agencies should consult with their own health care attorney and review the opinions of the federal Inspector General regarding these federal exceptions.

 

14.7.3 May a home health agency lease space from a referring physician?

Answer: Please refer to the analysis set forth in FAQ 14.7.2. There are federal exceptions that may apply to property leases. Whether a property lease falls under an exception will depend upon the particular circumstances and terms of the lease. A primary consideration is whether the price terms are set at a “fair market value.” Property leases substantially below fair market value may be construed by the Agency as a violation of F.S. 400.474(6)(j) and subject a home health agency to sanctions. Other considerations include the duration of the lease and the actual use of the space. Each property lease and the circumstances of each negotiation are different. If a home health agency has a concern about the legality of a property lease, it would be prudent for it to review the particular circumstances of each property lease with its health care attorney to determine whether a federal exception or safe harbor applies.

 

14.8. Assisted Living Facilities (ALFs)

The agency may deny, revoke, or suspend the license of a home health agency and shall impose a fine of $5,000 against a home health agency that:

* * *

(b) Provides services to residents in an assisted living facility for which the home health agency does not receive fair market value remuneration.

(c) Provides staffing to an assisted living facility for which the home health agency does not receive fair market value remuneration.

* * *

400.518(4), F.S. The agency shall impose an administrative fine of $15,000 if a home health agency provides nurses, certified nursing assistants, home health aides, or other staff without charge to a facility licensed under chapter 429 in return for patient referrals from the facility.

 

14.8.1 May a home health agency provide monthly blood pressure clinics in an assisted living facility if it charges a nominal fee?

Answer: No. The fee charged by the home health agency must be at “fair market value.” Please refer to F.S. 400.474(6)(b) and F.S. 400.462(11).

 

14.8.2 May a home health agency provide monthly educational programs for residents in an assisted living facility?

Answer: Yes, provided that the educational program does not include the providing of services to the assisted living facility residents. Once services are provided, the home health agency must charge a fair market value for the services. Please refer to F.S. 400.474(6)(b). F.S. 400.462(14) defines “home health services” as “health and medical services and medical supplies furnished by an organization to an individual in the individual's home or place of residence.”

 

14.8.3 A home health agency operates a satellite office in an assisted living facility. The residents of the facility may stop in this office if they have a health care problem and the home health agency nurse will check them without cost to see if a referral needs to be made to resident’s physician. Is this allowable?

Answer: No.

 

14.9 - Other Questions

14.9.1 Does F.S. 400.474(6)(e) prohibit a home health agency from entering into a contract with All-Scripts (ECIN)? This software is used by the hospital discharge planning staff. There is an understanding that referrals can be faxed to home health agencies, but it would be easier to receive the referral on the computer.

Answer: No. See AHCA letter on AllScripts.

14.9.2 May a hospital “require” its staff to refer patients to a home health agency owned by or sharing ownership or controlling interests with the hospital?

Answer: No. Such a requirement violates the hospital federal regulation. 42 CFR 482.43.

14.9.3 How does a home health agency report that its Director of Nursing left the home health agency or that the home health agency hired a new Director of Nursing?

Answer: Send a letter, facsimile transmission or electronic mail message to the Home Care Unit of the Agency.

The mailing address is:

Home Care Unit, Attention Charlene Corley
AHCA Home Care Unit
2727 Mahan Drive – Mail Stop 34
Tallahassee, FL 32308
 
The facsimile transmission number is (850) 922-5374.
The electronic mail address is charlene.corley@ahc.myflorida.com.

Go to Section 16 in the Frequently Asked Questions for information on how to do a personnel change.

 

14.9.4 May a home health agency contract with another home health agency to provide some services to its patients?

Answer: Yes, as long as all requirements in state law are met.

14.9.5 If a home health agency #1 offers patients to home health agency #2, can home health agency #2 contract with that agency to provide the services or staffing?

Answer: No.

14.9.6 Can a home health agency contract with a health care services pool to provide services to its patients?

Answer: No. Please see related question 13.3

14.9.7 If a health care services pool offers patients to a home health agency, can the home health agency contract with the services pool to provide the services or staffing?

Answer: No.

14.9.8 Under F.S. 400.471(9), an application for a new home health agency license cannot be transferred to another home health agency or controlling interest prior to issuance. Does this apply to changes in members of a limited liability company?

Answer: Yes

14.9.9 Is accreditation required when ownership changes?

Answer: Yes

14.9.10 May the owner of a home health agency purchase another home health agency that is located less than 10 miles away?

Answer: No.

14.9.11 Does a new home health agency need to be accredited in order to receive a home health agency license?

Answer: Yes.

14.9.12 Does a home health agency that will not provide any skilled services, but will be limited to only home health aide, certified nursing assistant, homemaker and companion services, need to be accredited in order to get a home health agency license?

Answer: Yes.

14.9.13 How does someone make a complaint about a home health agency that is violating the law?

Answer: Call the AHCA complaint call center (888) 419-3456.

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Section 15: Change of Ownership process

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:

Accreditation Commission Health Care ACHC (919) 785-1214 or visit their website at www.achc.org.

Community Health Accreditation Program CHAP (800) 656-9656 or (202) 862-3413 or visit their website at www.chapinc.org

Joint Commission JC (630) 792-5000 or visit their website at www.jointcommission.org.

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 under the 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:

HCFA 1561 (2  with originals signature), Health Insurance Benefit Agreement

HS 690 (2  with originals signature), Assurance of Compliance Medicare

Certification Civil Rights Information Request Form and required attachments

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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Section 16: Making Personnel Changes

If any of the personnel changes will be for positions that will be designated to submit the online Home Health Quarterly Report, remember to go to https://apps.ahca.myflorida.com/SingleSignOnPortal to register and submit a new User Agreement.

Home health agencies must notify the AHCA Home Care Unit of any changes in the administrator, alternate administrator, director of nursing and alternate director of nursing. Changes in Financial officers or the RN for non-skilled agencies can be sent with the renewal application. Individuals must meet the qualifications for the positions as stated in Florida Statutes Chapter 400 and Florida Administrative Code 59A-8. (See Section 6 of the Frequently Asked Questions)

NEW: Please complete the Personnel Change Information Needed worksheet. This worksheet describes what forms are needed and provides information on the new personnel. Send the information document and required forms, if any, to Charlene Corley by mail to Agency for Health Care Administration, Home Care Unit Mail Stop # 34, 2727 Mahan Drive, Tallahassee, Florida, 32308 or fax (850) 922-5374 or e-mail to Charlene.Corley@ahca.myflorida.com.

Home Health Agency AHCA Application Form 3110-1011 is NOT required to be completed and sent with the worksheet.

For the Administrator and Financial Officer:  Complete the information on the Personnel Change Information Needed worksheet.

Please also submit the following:

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, Department of Elder Affairs or the Agency for Persons with Disabilities

Affidavit of Compliance with Background Screening, AHCA Form 3100-0008, if the screening was done by another state agency as listed above.

If the individual does not have a level 2 background screening clearance then please go to the Agency’s background screening web page for information on the requirements for fingerprinting and the locations throughout the state where the scanning of fingerprints is done: http://ahca.myflorida.com/backgroundscreening. The Yellow Box at the Background Screening page has instructions and information on the new process for fingerprinting effective August 1, 2010.

Please also note the following regarding the Administrator:

AHCA shall fine a home health agency $500 that fails to notify the agency within 21 days of a change in administrator per 408.813 (3), F.S. and 59A.35.110 (1) (c), F.A.C.

Administrators may manage up to 5 agencies that:

have identical controlling interests

are located in the same geographic service area or in one contiguous county

each licensed entity has a qualified alternate administrator to serve during the administrator's absence.

Alternate Administrator: Complete the information on the Personnel Change Information Needed worksheet.

Director of Nursing: Complete the information on the Personnel Change Information Needed worksheet.

Please also note the following regarding the Director of Nursing:

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

Home health agencies offering skilled nursing care must:

not operate for more than 30 calendar days without a director of nursing;

notify in writing the AHCA Home Care Unit within 10 business days after termination of the services of the director of nursing;

notify in writing 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 $5,000 class II fine, issue a moratorium or revoke the license

AHCA shall fine a home health agency that fails to notify the agency about change in DON

$1,000 for the first violation and

$2,000 for a repeat violation

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/ alternate director of nursing 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

Alternate Directors of Nursing: Complete the information on the Personnel Change Information Needed worksheet.

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Application


Licensure Application and Forms for Initial, Renewal and Change of Ownership

Personnel Change Information Needed Worksheet

 

NOTE: If after reviewing the application forms and statutory and rule requirements on our Web site you have additional questions, please call (850) 412-4403. 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.

 


Time frame for review of appplications and issuing licenses:

The Agency has 30 days to review your application. You will be notified in writing of any apparent errors or omissions and any additional information that is required. It May take an additional 60 days after all items are received to issue your license due to large number of applications received. [408.806(3), Florida Statutes]

If the renewal application and fee are received prior to the license expiration date, the license shall not be deemed to have expired if the license expiration date occurs during the Agency’s review of the renewal application. [408.806(2)(a), Florida Statutes]


Background Screening

Applicants must have:

Level 2 background screening by scanned fingerprints for administrator and financial officer.

Click on link below for more info on screenings, fees, and to find a LiveScan site near you:

Background Screening information

Also note:

Getting your "AHCA number" for scanning-- The above link refers to using your AHCA number for scheduling appointments for scanning or for the validation form used at the scanning site. AHCA number is the file number. New applicants will get a letter from AHCA with the number to be used for background screening ater the application is received. If you do not receive a letter after submitting your application, call the AHCA Home Care Unit for the number. Those already registered should follow instructions at the Web site.

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Laws, Rules and Survey


Florida Statutes, including law changes from 2013 Florida Legislature

State Rules - Florida Administrative Code, Chapter 59A-8

Changes effective July 11, 2013 with reasons for the changes

Summary listing of changes

AHCA licensing procedure rules for all programs - 59A-35


State Regulation Set used by surveyors The Agency has revised the state survey standards effective October 1, 2013.  Please click on the underlined words “State Regulation Set used by surveyors” to view the updated document.

Summary of updates to the survey standards in the State Regulation Set.

Home Health Agency Update:  State Regulation Set used by Surveyors - View the attached presentation that explains the changes.

List of All State Survey Standards

Federal Regulation Set used by surveyors, Appendix B of CMS State Operations Manual

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Medicare/Medicaid


Medicare


Medicaid


List of Pending Initial Medicare and Medicaid Applications - this list will be updated by close of business on Wednesdays only if there has been updates to this list.

 

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Other


Background Screening information

Emergency Management Plan

Requirement for Information and Training on Alzheimer's Disease and Related Disorders

Dept of Elder Affairs state rules on the Alzheimer's Disease and Related Disorders training for home health agencies, 58A-8, Florida Administrative Code: https://www.flrules.org/gateway/ChapterHome.asp?Chapter=58A-8

Home health aide competency test - this is available to licensed home health agencies only. Contact the Home Care Unit by calling (850) 412-4403 or email HQAHOMEHEALTH@ahca.myflorida.com.

Health Care Advanced Directives

List of licensed agencies - www.FloridaHealthFinder.gov

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Health Facility Regulation | Home Care Unit | Assisted Living Unit | Long Term Care Unit | Emergency Resources

Reporting Medicaid Fraud