Bureau of Long Term Care Services
Home Care Unit
2727 Mahan Drive - Mail Stop #34
Tallahassee, FL 32308
(850) 412-4403 Phone
(850) 922-6059 Fax

email: HQAHOMEHEALTH@ahca.myflorida.com

HOSPICES

• Frequently Asked Questions
• Florida Statute (Title XXIX, Chapter 400, Part IV, Hospices)
• Chapter 408, Part II, Florida Statues (health care licensing procedures)
• State Rules (Florida Administrative Code, Chapter 58A-2, Hospice, August 11, 2008)
  • AHCA licensing procedure rules for all programs - 59A-35
• State Regulation Set used by surveyors
• Federal Regulation Set used by surveyors (CMS State Operations Manual, Appendix M)
• Summary of Initial Hospice Licensure Process – Please note: State law requires a certificate of need before applying for a license. Go to Certificate of Need (CON) for more information.

NOTE: If after reviewing the application forms and statutory and rule requirements on our 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.

• Licensure Application and Related Forms

  • Health Care Licensing Application, Hospice, AHCA Recommended Form 3110-4001, Revised August 2010 – REQUIRED
  • Health Care Licensing Application Addendum, AHCA Recommended Form 3110-1024, August 2010 – REQUIRED
  • Proof of Financial Ability to Operate, AHCA Form 3100-0009, July 2009, Schedules 1 – 7, REQUIRED for all initial and change of ownership applications
  • Attestation of Compliance with Applicable Life Safety Codes for Additions to Existing Hospice Inpatient Facilities/Residential Units, AHCA Recommended Form, March 2009 - to be submitted with request for bed addition to an existing freestanding hospice inpatient facility or residential unit (Please refer to the Frequently Asked Questions above.)
• Background Screening Information
• Emergency Management Planning
  • Comprehensive Emergency Management (CEMP) Format for Hospices, DOEA Form H-001, March 2007
  • Emergency Management Plan Review
    • Change in CEMP review procedures (Department of Health Memo dated November 6, 2006)
    • Emergency Plan Information Resource: Florida Department of Health County Health Department Emergency Management Plan of Review Contacts
• Requirements for Information and Training on Alzheimer’s Disease and Dementia-Related Disorders – Section 400.6045, Florida Statutes
• All employees, upon beginning employment, must receive basic written information about interacting with persons who have Alzheimer’s disease or dementia-related disorders. Use of The Alzheimer’s Patient and Hospice Care fact sheet developed by Florida Hospices and Palliative Care, Inc. in partnership with the Alzheimer’s Association Chapters of Florida meets this requirement. Association Fact Sheet - (231KB)
• Employees providing direct care to patients with Alzheimer's disease or dementia-related disorders, hired on or after July 1, 2003, must receive Department of Elder Affairs (DOEA) approved training on Alzheimer’s disease and dementia-related disorders within 9 months after beginning employment. For information regarding training requirements, approval of trainers/curriculum and locating approved training providers, please see the University of South Florida’s Training Academy on Aging (DOEA contractor) website at http://www.trainingonaging.usf.edu/.
• Getting Medicare Certification for a Hospice
  • Initial Hospice Medicare Provider Enrollment
  • Initial Surveys for New Medicare Providers, CMS memo (S&C 08-03), November 5, 2007,
• List of licensed providers - www.FloridaHealthFinder.gov

Back to Home Page