Hospital & Outpatient Services Unit
Bureau of Health Facility Regulation
2727 Mahan Drive, Mail Stop #31
Tallahassee, Florida 32308
Telephone: (850) 412-4549
Florida Relay Service (TDD): (800) 955-8771
Fax: (850) 488-5897
Residential Treatment Centers for Children and Adolescents (RTC) are 24 hour residential programs, including therapeutic group homes, licensed by the Agency. These centers were designed to provide mental health treatment and services to children under the age of 18 who have been diagnosed as having mental, emotional, or behavioral disorders.
NOTE: Treatment Centers that are classified as Therapeutic Group Homes are limited to 12 beds.
The Hospital and Outpatient Services Unit fax number, (850) 922-4351, will be discontinued as of November 1, 2016. Please note the new unit fax number is (850) 488-5897.
Renew Online – Providers can now renew their licenses through the Agency’s Online Licensing application.
Facilities must meet license requirements through the submission of a completed application, required documentation, and completion of a satisfactory survey.
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. Note: A valid license is required before services can be provided.
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 50% of the licensure fee or $500 (whichever is less) will be assessed for any application not received 60 days prior to expiration. A renewal application will not be accepted if the license is expired. An initial license application must be filed if the license has expired.
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 (see application checklist) must be submitted at least 60 days prior to the change of ownership. Before the application can be approved, any outstanding fees owed the State (owed by either party) must be paid anda 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.
A change of physical address requires submission of an application. 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.)
A bed change requires submission of an application. If adding beds to the current license, the per bed license fee must accompany the application. 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.
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.
Facilities may choose to be accredited and may ask the Agency to accept its accreditation, rather than receiving routine on-site licensure surveys, by submitting the required documentation from a recognized or 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.
|AHCA Form 3180-5004||
RTC Health Care Licensing Application [130KB, DOC]
RTC Health Care Licensing Application [465KB, PDF]
|All application types||Standard residential treatment center for children and adolescents application required to apply for or modify a RTC license.|
|Please provide this information to comply with the reporting requirements of Chapter 408, Part II, F.S.|
|Articles of Incorporation or similarly titled document as filed with the Florida Department State.|
|Proof of Right to Occupy Premises||Initial
Change of Address
|Documentation verifying the applicant’s right to occupy the premises at the physical address of the facility (i.e. warranty or quit claim deed; lease or rental agreement).|
|Compliance with Zoning Requirements||Initial
Change of Address
For all RTCs except Community Residential Homes, any documentation, dated within the last 6 months, from a local government identifying the facility is in compliance with local zoning requirements.
For a facility considered to be a Community Residential Home under Chapter 419, F.S., provide a completed Community Residential Home Affidavit of Compliance form.
|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.
|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.|
Change of Address (if move is to a new city and/or county)
|Occupational license issued to the facility by the local city and/or county government.|
|Recommended Form||HIV / AIDS Training Affidavit [22KB, PDF]||Initial
|HIV / AIDS affidavit assuring required facility staff will be trained.|
|Certificate of Insurance||Initial
|Certificate of Insurance verifying commercial or general liability insurance coverage (minimum required coverage is $300,000 per incidence and $1 million in aggregate).|
|Fire Safety Inspection Report||
|Satisfactory fire safety inspection report completed in the last 365 days|
|Sanitation Inspection Report||Initial
Change of Address
|Satisfactory sanitation inspection report completed in the last 365 days.|
|Form CF-MH 1065||Emergency Management Planning Criteria||
|Provides an outline to develop an emergency management plan. The plan must be approved by the county emergency operations center annually.|
|Fee Type||Amount||Who Pays||Due|
|Initial, renewal or CHOW Application||
$240 per bed.
$240 per bed.
|Late Application||$50 per day, up to 50% of the licensure fee or $500 (whichever is less)||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.|
Below is the suggested reporting form to use for filing incident reports that are required under Rule 65E-9.005(3)(l), F.A.C.
RTC Incident Report Form [132 KB, DOC]
Effective April 1, 2011, please direct all incident reports to:
The Agency for Health Care Administration
Complaint Administration Unit
2727 Mahan Drive, Mail Stop 49
Tallahassee, FL 32308
For Residential Treatment Centers that have contracted with Medicaid to provide Statewide Inpatient Psychiatric Program (SIPP) services, this report will also satisfy reporting requirements under the Medicaid contract.
Note: This reporting form does not impose new regulatory requirements and is not meant to replace the reporting requirements of the Department of Children and Families or reporting required of hospital programs under Chapter 395, Florida Statutes.
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.