59A-12.0071. Accreditation

As a condition of doing business in the state, each HMO or PHC shall apply for accreditation within 1 year and be accredited within 2 years of the organization’s receipt of its Certificate of Authority. HMOs and PHCs with existing Certificates of Authority must apply for accreditation within 1 year and be accredited within 2 years of the effective date of this rule. All HMOs and PHCs must undergo reaccreditation not less than once every 3 years. Accreditation and reaccreditation must be awarded by an accreditation organization approved by the agency pursuant to Rule 59A-12.0072, F.A.C.

(1) The agency will provide technical assistance, upon request by an HMO or PHC, in order to assist new or existing organizations to develop and maintain quality assurance systems.

(2) The agency will monitor and determine the accreditation status of all existing HMOs and PHCs on an ongoing basis and group them into the following categories:

(a) Three year accreditation;

(b) Less than three year accreditation;

(c) Not applied and surveyed for accreditation within the appropriate time frame;

(d) Applied for accreditation but not surveyed within the appropriate time frame;

(e) Surveyed, findings of the accreditation agency not final;

(f) Failed accreditation survey;

(g) New HMO or PHC, accreditation not currently due.

(3) The agency shall verify the compliance of HMOs and PHCs with the accreditation requirement with the accreditation organizations and shall initiate action for HMOs and PHCs classified under paragraphs (2)(c), (d) and (f) above. For those HMOs and PHCs under paragraph (2)(e) above, the agency shall not take administrative action until receipt of the final determination of accreditation from either the HMO, PHC or the accrediting body.

(4) The agency shall file an administrative order to show cause against those HMOs and PHCs under paragraphs (2)(c), (d) and (f) which are not in compliance with the accreditation requirement.

(5) The penalties to be assessed against organizations not achieving accreditation will be as follows:

ACCREDITATION STATUS	PENALTY
Not applied for accreditation	Suspension of enrollment for a period not to exceed one year or until
within the time frames of this rule	accreditation is received if less than one year; Two counts of willful
	violation as specif ied under Section 641.52(5), F.S.
Applied, not surveyed within the time	Suspension of enrollment for a period not to exceed one year or until
frames of this rule	accreditation is received if less than one year; One count of willful violation
	as specifi ed under Section 641.52(5), F.S.
Failed initial or renewal accreditation survey	No fine; Suspension of enrollment beyond the current enrollment level for a
Failed follow-up accreditation survey conducted	period not to exceed one year or until accreditation is received if less than
subsequent to a failed accreditation survey.	one year; Revocation of the Health Provider Certificate

(6) For those HMOs and PHCs failing an accreditation survey the agency shall assess the need to mitigate the penalties specified under subsection (5) based upon:

(a) The financial viability of the organization as determined by the Department of Financial Services pursuant to Sections 641.225 and 641.2261, F.S.; and,

(b) The extent of the organization’s efforts to initiate corrective action.

(7) Those HMOs and PHCs classified under paragraphs (2)(c), (d) or (f) will be surveyed by the agency to ensure compliance with minimum standards for a Health Provider Certificate specified in Chapter 59A-12, F.A.C.

(8) For those HMOs and PHCs failing the initial accreditation survey the agency shall require the HMO or PHC to enter into a corrective action process for the purpose of achieving accreditation.

(9) The agency shall monitor the progress of those organizations not in compliance in cooperation with the accreditation organization to ensure that HMOs and PHCs come into compliance with the accreditation requirement.

(10) Those HMOs and PHCs failing an initial or renewal accreditation survey must receive at least accreditation under paragraph (2)(b) during a subsequent accreditation survey by the original accrediting organization. Accreditation must be received within one year of the final accreditation decision by the accrediting agency or within a time frame mutually agreeable to the agency, the accreditation organization, and the HMO or PHC. An HMO or PHC may, at any time, seek accreditation from another accreditation organization provided that the HMO or PHC enters into a corrective action process under subsection (8) to achieve accreditation with the original accreditation organization.

Rulemaking Authority 641.56 FS. Law Implemented 641.495, 641.512, 641.515(1), 641.52(1)(e), (g) FS. History–New 3-11-92, Formerly 10D-100.0071, Amended 11-21-94, 4-10-03.