Health Facility Regulation | Hospital and Outpatient Services | Abortion Clinics | Ambulatory Surgery Centers | Birth Centers | Comprehensive Outpatient Rehab. Centers | Crisis Stabilization Units and Short Term Residential Treatment Facilities | Diagnostic Imaging | Hospitals | Partial Hospitalization Programs | Portable X-ray | Rehabilitation Agencies | Residential Treatment Centers for Children and Adolescents | Residential Treatment Facilities | Risk Manager | Rural Health Clinics | Utilization Review

Laura MacLafferty, Unit Manager
Hospital & Outpatient Services Unit
Bureau of Health Facility Regulation
2727 Mahan Drive, Mail Stop #31
Tallahassee, Florida 32308
Telephone: (850) 412-4549
Fax: (850) 922-4351
Email: hospitals@ahca.myflorida.com

Crisis Stabilization Units (CSU)

Crisis Stabilization Units (CSUs) provide brief psychiatric intervention, primarily for low-income individuals with acute psychiatric conditions.  Inpatient stays average 3 to 14 days, resulting in return to the patient’s own home or placement in a long-term mental health facility or other living arrangements.

Short Term Residential Treatment Facilities (SRT)

Short-term Residential Treatment Facilities (SRTs) were created to provide a step-down for residents of Crisis Stabilization Units (CSUs) needing a more extended, but less intensive level of active treatment for psychiatric conditions.  These programs were created to fill a service gap between CSUs and residential treatment facilities (RTFs).  SRTs may only admit adults.

Baker Act Receiving Facility

Each CSU must be designated as a Baker Act Receiving Facility by the Department of Children and Families (DCF) prior to being licensed by the Agency for Health Care Administration (AHCA). Also, SRTs must be affiliated with a designated Baker Act Receiving Facility prior to being licensed by AHCA. Information and applications for designation as a Baker Act Receiving Facility can be found on DCF's Substance Abuse & Mental Health web page.

Licensure Requirements

Facilities must meet license requirements through the submission of a completed application, required documentation, and completion of a satisfactory survey.

Initial Application

This includes new facilities and reactivation of an expired license.  At least 60 days before the effective date, an applicant must submit a licensure application, fees and supporting documents.  When all required information is received and acceptable, a licensure survey will be scheduled.  A license will be issued when documentation of a successful licensure survey is complete and filed.  Please note a valid license is required before services can be provided.

Renewal

To renew a current state license, the licensure application, renewal fee and supporting documents must be submitted to the Agency 120 to 60 days prior to the expiration date. A late fee of $50 per day, up to $500 will be assessed for any application not received 60 days prior to expiration. NOTE: A renewal application will not be accepted if the license is expired. An initial license application must be filed if the license has expired.

Change of Ownership (CHOW)

Chapter 408.803, Florida Statutes defines "Change of ownership" as: 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 does not apply to a licensee that is publicly traded on a recognized stock exchange. Also, a change solely in the management company or board of directors is not a change of ownership.

The licensure application, fee and supporting documents must be submitted at least 60 days prior to the date of acquisition of the crisis stabilization unit.  Before the application can be approved, a bill of sale or other closing document signed by the buyer and the seller and showing the effective date of the transfer must be received by the Agency.

Other Change During the Licensure Period

A change of physical address requires submission of an AHCA Form 3180-1003. Other documents that may be required include AHCA Form 3100-0007 and documentation verifying the applicant’s right to occupy the premises at the new address (i.e. warrant or quit claim deed; lease or rental agreement).  If the move results in a change of county, documentation verifying the Department of Children and Families supports the relocation, has funding appropriated to support the beds and if funding is recurring or non-recurring must be provided.

A bed change requires submission of an AHCA Form 3180-1003.  If adding beds to the current license, the per bed license fee must accompany the application and documentation verifying the Department of Children and Families supports the addition of beds, has funding appropriated to support the beds and if funding is recurring or non-recurring must be provided.  A license authorizing the additional beds will be issued when all documentation is received.  Please note a valid license is required before the additional beds can be utilized.

Voluntary Termination of a License

A licensee must inform the agency not less than 30 days prior to the discontinuance of operation and comply with the requirements listed in Chapter 408.810(4), Florida Statutes.

Accreditation

Facilities may choose to be accredited and may ask the Agency to accept their accreditation, in lieu of receiving routine on-site licensure surveys, by submitting the required documentation from an approved accreditation organization.  All facilities must submit to an on-site licensure survey at initial licensure.  The following accreditation organizations are recognized by AHCA for mental health facilities:  The Joint Commission; Council on Accreditation (COA); and Commission on Accreditation of Rehabilitation Facilities (CARF).  The required documentation includes:  the name of the accrediting organization, the beginning and expiration dates of the accreditation, accreditation status, type of accreditation, accreditation survey report, all responses to any compliance issues cited by the accrediting organization and any follow up reports.  

Applications and Forms

Form Number Name For Description
AHCA Form 3180-1003

Health Care Licensing Application (MS Word 339KB)

Health Care Licensing Application (PDF 299KB)

 

All application types Standard crisis stabilization unit/ short-term residential treatment facility/residential treatment facility application required to apply for or modify a CSU/SRT license.
AHCA Form 3110-1024

Application Addendum
(MS Word 127KB)

Initial
Renewal
CHOW

Please provide this information to comply with the reporting requirements of Chapter 408, Part II, Florida Statutes.
AHCA Form 3100-008 Affidavit of Compliance with Background Screening Requirements

Initial
Renewal
CHOW
(if applicable)

Use this form to document current level 2 background screening performed via another state agency.  Screening results must be attached.
  Business Articles Initial
CHOW
Articles of Incorporation or similarly titled document as filed with the Florida Department State.
  Proof of Right to Occupy Premises Initial
CHOW
Change of Address
Any documentation verifying the applicant’s right to occupy the premises at the physical address of the facility (i.e. warrant or quit claim deed; lease or rental agreement).
  Compliance with Zoning Requirements Initial
CHOW
Change of Address
Any documentation from a local government identifying the facility as in compliance with local zoning requirements.
  Certificate of Occupancy

Initial due to new construction.

Change of address due to new construction.

Specific documentation from a local government granting the right to occupy a facility.

  Management Agreement Initial
CHOW
(if applicable)
Contract between the owner and a management company for management of services.
  Closing Document CHOW Bill of sale or similar document signed by the buyer and the seller indicating the date of transfer of ownership.
  Statement of Outstanding Deficiencies CHOW Statement from the buyer assuring any uncorrected licensure survey deficiencies will be corrected timely.
  Statement of Outstanding Payments CHOW Statement from the buyer identifying any outstanding balance owed AHCA, and indicating who will pay and when.
  Program Description Initial

Renewal (optional for accredited facilities, unless changes have occurred since the initial application)

CHOW
Description of the program which includes: an outline of the program and services provided; a description of the resident population served; description of the age groups to be admitted; description of services to minors, if any; and a staffing pattern description (hours, coverage per shift, number and types of staff), including the names and license or registration number of each licensed or registered person.
  Table of Organization Initial

Renewal (optional for accredited facilities, unless changes have occurred since the initial application)

CHOW
Table of organization that shows all management levels.
  Resume of Facility Manager Initial

Renewal (optional for accredited facilities, unless changes have occurred since the initial application)

CHOW
Resume for the individual designated on the application as the facility manager.
  Certificate of Insurance Initial
Renewal
CHOW
Certificate of Insurance verifying commercial or general liability insurance coverage (minimum required coverage is $300,000 per incidence and $1 million in aggregate).
  Baker Act Receiving Facility Designation Certificate Initial
Renewal
CHOW
Change of address
Copy of the Baker Act Receiving Facility designation certificate issued by the Department of Children and Families (DCF).
  Proof of funding and support from DCF. Initial
CHOW
Change of address
Copy of letter verifying the Department of Children and Families (DCF) has funding appropriated to support the beds requested and if funding is recurring or non recurring or a copy of the current DCF funding contract may be provided.
 

HIV/AIDS
Training Affidavit

Initial
Renewal
CHOW
HIV/AIDS training affidavit assuring required facility staff will be trained.
  Fire Safety Inspection Initial
Renewal
CHOW
Change of address
Satisfactory fire safety inspection report completed in the last 365 days.
  Sanitation Inspection Initial
Renewal
CHOW
Change of address
Satisfactory sanitation inspection report completed in the last 365 days.

Licensure Fees

Fee Type Amount Who Pays Due
Initial, renewal or CHOW Application

$197.92 per bed

Applicant With application.
Late Application $50 per day, up to $500 All late applications If an application is not received at least 60 days prior to the anticipated effective date. Payment can be made any time during the application process or upon issuance of a final order.
Capacity Increase

$197.92 per bed

Applicant With application.
Background Screening A level 2 background screen is required of the administrator responsible for the day to day operations of the facility and the chief financial officer. Please visit the Agency's background screening web page for additional information regarding vendors, fees, locations etc. Background screens must be repeated every 5 years.

Background Screening

A level 2 background screen is required of the administrator responsible for the day to day operations of the facility and the chief financial officer. Please visit the Agency's background screening web page for additional information regarding vendors, fees, locations etc. Background screens must be repeated every 5 years.

Department of Health Approval for Onsite Sewage Disposal Systems

AHCA Emergency Status System (ESS)

The AHCA Emergency Status System (ESS) is a web-based application designed to track the status of 24-hour care providers regulated by AHCA. The system allows direct data entry by provider staff that have an active user agreement with AHCA. Data entry may include details of impacts and damages, evacuation status, available beds, special medical client needs, and names and phone numbers of emergency contacts.

ESS data is organized around Events. Events are specific emergencies (hurricane) or activities (Super bowl) that require tracking of information. For example, a hurricane would be an event and would be given a name consistent with a storm such as "Jeanne". This enables all activities (evacuation, impact and needs) to be associated with a specific event and when an event is complete or closed, those activities are archived with that event.

ESS is always available but some information can only be entered when an event is open. Emergency contact information and generator information can be entered at any time. The ESS web address is http://ess.myflorida.com

Statute/Rule Authority

Resources (Trauma Informed Care)

Updated January 31, 2014

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Health Facility Regulation | Hospital and Outpatient Services | Abortion Clinics | Ambulatory Surgery Centers | Birth Centers | Comprehensive Outpatient Rehab. Centers | Crisis Stabilization Units and Short Term Residential Treatment Facilities | Diagnostic Imaging | Hospitals | Partial Hospitalization Programs | Portable X-ray | Rehabilitation Agencies | Residential Treatment Centers for Children and Adolescents | Residential Treatment Facilities | Risk Manager | Rural Health Clinics | Utilization Review
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