Florida Agency for Health Care Administration Health Care Facility Licensure Rule Hearing Report: January 6

On January 6, 2010, the Florida Agency for Health Care Administration (“AHCA”) held a Rule Hearing on proposed Rule Chapter 59A-35 regarding health care facility licensing procedures.  This proposed Rule Chapter would establish licensure requirements, application procedures and administrative proceedings for all AHCA-licensed health care facilities.

AHCA officials presiding over the Hearing noted that testimony would be considered in application to the proposed Chapter adoption.  Further, AHCA will consider additional comments expected imminently from the Joint Administrative Procedures Committee.

Testimony included expressed concerns with the following specific proposed Rules:

• 59A-35.070 – Would increase the fee from $1,000 to $3,000 as a penalty for failing to submit a change of ownership application and license
• 59A-35.062 – Would exempt small facilities from proof of financial ability to operate
• 59A-35.062 – Would eliminate the requirement that all documents be compiled and signed by a certified public accountant
• 59A-35.065 and 59A-35.070 – Would provide for AHCA discretion, rather mandatory rejection, if an application for renewal is received after a license has expired
• 59A-35.100 – Would restrict multiple licensees at the same physical address and could restrict home health services that house both a Medicare and Medicaid licensee
• 59A-35.150 – Changing the word “corrected” to “ceases” was suggested for the purposes of tolling the time for fines relating to the violation of a moratorium.

Following discussion, the meeting concluded.  AHCA officials noted that these Rules supersede all other existing licensing regulations.

Chapter 59A-35 is being developed to establish uniform procedures for licensure requirements, application procedures and administrative proceedings for all health care providers licensed by the Agency for Health Care Administration and includes the following proposed Rules:

59A-35.020: Applicability
59A-35.030: Definitions
59A-35.040: License required; display
59A-35.050: Fees required; adjustments
59A-35.060: Licensure application process.
59A-35.062: Proof of Financial Ability to Operate
59A-35.064: Initial Application
59A-35.065: License Renewal
59A-35.070: Change of ownership.
59A-35.080: License categories.
59A-35.090: Background screening; prohibited offenses.
59A-35.100: Minimum license requirements.
59A-35.110: Reporting requirements; Electronic submission
59A-35.120: Right of inspection; copies; inspection reports
59A-35.140: Administrative fines.
59A-35.150: Moratorium; emergency suspension.

A good faith estimate has been made of transactional costs likely to be incurred by individuals and entities, including local government entities that are required to comply with the requirements of the proposed Rules.

Because some regulated entities are sole proprietors and others are large corporations, the sophistication of licensees varies, so paperwork and submission time estimates were not deemed by AHCA to be feasible for the multiple types of providers it regulates.  However, it is expected that, over time, the transactional costs associated with provider implementation of the proposed Rules will decrease.

The entities and individuals affected by the proposed Rules will be required to become familiar with new, standardized forms to be used by all regulated providers. While this familiarization is expected to require some additional time in the first licensure submission, the standardization of the application processes will ultimately not require additional time across the two-year licensure period.

An elimination of one of the annual licensure applications (for most provider types) is expected to represent an efficiency to the regulated entity.

The proposed Rules would impose background screening fees that were not previously required of some providers, as well as require fee increases for categories of providers that do not currently pay fees sufficient to cover the cost of their own regulation. The following provider types do not currently pay fees that cover the cost of AHCA licensing programs:

• Abortion Clinics
• Adult Family Care Homes (AFCH)
• Assisted Living Facilities (ALF)
• Ambulatory Surgical Centers
• Birth Centers
• Homemaker Companion Services Providers
• Health Care Services Pools
• Home Medical Equipment Providers
• Homes for Special Services (HHS)
• Hospices
• Hospitals
• Multiphasic Health Testing Centers (MHTC)
• Prescribed Pediatric Extended Care Centers (PPEC)
• Risk Managers

Under the proposed Rules, licensed providers would be required to submit an application and license fee for a change of ownership sixty days prior to the change and will be charged a late fee of $50 per day for each day that application is late, up to a maximum fine of $1,000.

Small entities that do not have electronic submission capabilities will be required to secure access to computers through public facilities such as libraries or purchase time or equipment to enable them to submit information electronically.  This Rule is expected to have a minor impact on some local governments that hold AHCA licenses from AHCA.

AHCA regulates nearly thirty categories of health care providers, which comprises more than 32,000 licensees.

In 2006, the Florida Legislature passed Chapter 2006-192, Laws of Florida, that established a revised, standardized licensure process. 

These proposed Rules would establish procedures for implementing that licensure, with requirements and forms that are consistent for all providers and that would accommodate the new two-year licensure period for all licensees.

The categories of AHCA facilities include:

• Abortion Clinics
• Adult Day Care Centers (ADCC)
• Adult Family Care Homes (AFCH)
• Ambulatory Surgical Centers
• Assisted Living Facilities (ALF)
• Birth Centers
• Clinical Laboratories
• Crisis Stabilization Units and Short Term Residential Treatment Facilities
• Drug-free Workplace Laboratories
• Health Care Clinics
• Health Care Services Pools
• Homes for Special Services (HHS)
• Home Health Agencies
• Homemaker Companion Services
• Home Medical Equipment Providers
• Hospices
• Hospitals
• Intermediate Care Facilities for the Developmentally Disabled Persons (ICFDD)
• Multiphasic Health Testing Centers (MHTC)
• Nurse Registries
• Nursing Homes
• Organ, Tissue and Eye Procurement Organizations
• Prescribed Pediatric Extended Care Centers (PPEC)
• Residential Treatment Centers for Children and Adolescents
• Residential Treatment Facilities
• Risk Managers
• Transitional Living Facilities (TLF)

AHCA regulatory programs include facilities that are not licensed under state law and do not pay fees under the proposed Rules, but that are AHCA-certified and monitored:

• Commercial HMOs/PHCs/EPOs
• Diagnostic Imaging Services
• Medicaid HMOs
• Comprehensive Outpatient Rehabilitation Facilities
• Partial Hospitalization Programs
• Portable X-ray Equipment
• Rehabilitation Agencies
• Rural Health Clinics

Implementing and enforcing the proposed standardized licensing rules is not expected to result in a significant increase in AHCA’s budget.

To view the meeting Notice and full texts of the proposed Rules, click here.

 

Should you have any questions or comments, please contact Colodny Fass.

 

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