59A-4.103. Licensure, Administration and Fiscal Management

(1) The licensee or applicant shall make application for an initial, renewal or change of ownership license to operate a nursing home facility and shall provide:

(a) All of the information required by this rule, Chapter 400, Part II, F.S., and Chapter 408, Part II, on the Health Care Licensing Application Nursing Homes, AHCA Form 3110-6001, July 2014, which is incorporated by reference. These forms may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-06014 and are available from the Agency for Health Care Administration, Long-Term Care Unit, 2727 Mahan Drive, Mail Stop #33, Tallahassee, FL 32308 or at the web address: http://ahca.myflorida.com/HQAlicensureforms; and,

(b) Proof of Financial Ability to Operate, AHCA Form 3100-0009, July 2009, which is incorporated by reference in subsection 59A-35.062(1), F.A.C., available from the Agency for Health Care Administration, Long Term Care Unit, 2727 Mahan Drive, Mail Stop #33, Tallahassee, Florida 32308 or online at http://ahca.myflorida.com/HQAlicensureforms.

(2) The licensure fees must be included with the application. The licensure fees are: a biennial fee of $100.00 per bed and a resident protection fee of $.50 per bed as required by Section 400.062(3), F.S., and the Data Collection and Analysis Assessment of $12.00 per bed as required by Section 408.20(1)(b), F.S. The assessment required by Section 408.20(1)(b), F.S. is waived for facilities having a certificate of authority under Chapter 651, F.S.

(3) A nursing home licensee may request an inactive license for part of a facility to use an occupied contiguous portion of the facility for an alternative use as authorized by Section 400.0712, F.S. Prior to providing alternative services, the facility must submit a written request to the Agency. A request may be submitted at any time during the licensure period and must provide: the intended use of the inactive portion, a floor plan of the building identifying the inactive area, the total number of inactive beds and the prospective date the beds will become inactive.

(a) Upon receipt of written approval by the Agency, as required in Section 408.808, F.S., to continue with the plan for the partial inactive license, the licensee must submit a completed Health Care Licensing Application, Nursing Homes, AHCA Form 3110-6001, July 2014, to the Agency within 60 days of the approval and a bed change request form for beds certified through the Centers for Medicare and Medicaid Services. The appropriate facility licensure application for the alternative use must accompany this application, unless the space will be utilized for services authorized under the existing nursing home licensure.

(b) If the alternative service license is approved, a partial inactive license will be issued concurrently with the issuance of the license for the alternative use. The expiration date of the partial inactive license will be the same date that the licensee’s nursing home must file for renewal of their nursing home license. The licensee must indicate the intent to continue the partial inactive license at each nursing home licensure renewal. Licensure fees will remain at the standard rate for nursing home beds, whether active or inactive, at the time of renewal and will not be assessed for another Agency license for the alternative use of the inactive beds.

(c) Notification to reactivate the inactive portion of the building and the appropriate change request form for beds certified through the Centers for Medicare and Medicaid Services, must be submitted to the Agency at least 30 days prior to the planned date to admit residents to the previously inactive beds. The inactive portion of the license will be reactivated upon Agency approval.

(4) Administration.

(a) The licensee of each nursing home must have full legal authority and responsibility for the operation of the facility.

(b) The licensee of each facility must designate one person, who is licensed by the Florida Department of Health, Board of Nursing Home Administrators under Chapter 468, Part II, F.S., as the Administrator who oversees the day to day administration and operation of the facility.

(c) Each nursing home must be organized according to a written table of organization.

(5) Fiscal Management.

(a) The licensee, for each nursing home it operates, must maintain fiscal records in accordance with the requirements of Chapter 400, Part II, F.S., and this rule.

(b) An accrual or cash system of accounting must be used to reflect transactions of the business. Records and accounts of transactions, such as, general ledgers and disbursement journals, must be brought current no less than quarterly and shall be available for review by authorized representatives of appropriate state and federal agencies.

(c) A licensee must obtain a surety bond as required by Section 400.162, F.S.; it must be based on twice the average monthly balance in the resident trust fund during the prior fiscal year or $5,000, whichever is greater. A licensee who owns more than one nursing home may purchase a single surety bond to cover the residents’ funds held in nursing homes located within the state. A surety bond must contain substantially the same language as is found in the Nursing Home Patient Trust Surety Bond, AHCA Form 3110-6002, May 2008, which is incorporated by reference, and may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-06016 and from the Agency online at http://ahca.myflorida.com. The surety bond must be filed with the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #33, Tallahassee, Florida 32308.

(d) A self-insurance pool, which may be an interest bearing account, may be established for non-certified facilities only to provide compensation to any resident suffering financial loss in accordance with the provisions of Section 400.162(5)(c), F.S., as the result of one or more of the member licensees violating any of the provisions of Section 400.162, F.S.

1. Such self-insurance pool must be administered under the direction of an elected board of trustees. The membership of the board of trustees must be composed of one representative from each participating licensee.

2. An application for establishing a self-insurance pool must be made by the trustees to the Agency. Such application shall contain the following information: the names, complete addresses, and affiliation of the trustees; the name and complete address of each licensee participating in the pool; the total dollar amount of the pool; and the name and complete address of the bank in which the account is maintained and the account number. The application must be accompanied by:

a. An individual application from each licensee applying for membership in the self-insurance pool. Such application must contain the following information: the name, telephone number, and complete address of the facility and the licensee, the name of the facility’s administrator, manager or supervisor, his or her license and renewal number; the names of all employees involved in the administration of the resident trust fund account; the average monthly balance in the resident trust fund account during the prior year; the total dollar amount the licensee has deposited in the self-insurance pool; and the name and complete address of the bank in which the account is maintained and the account number.

b. Prima facie evidence showing that each individual member of the pool has deposited an amount equal to twice the average monthly balance of the trust fund account or $5,000.00 dollars, whichever is greater, in a separate account maintained by the board of trustees in the name of the self-insurance pool in a bank authorized under Chapter 658, F.S., in the State of Florida that is a member of the Federal Reserve System to secure performance of payment of all lawful awards made against any member or members of the self-insurance pool as required by Section 400.162(5), F.S., and this rule.

3. After the inception date of the pool, prospective new members of the pool must submit an application for membership to the board of trustees. Such application must contain the information specified in subparagraph (5)(d)2. of this rule. The trustees may approve the application for membership in accordance with these rules. If so approved, the application for membership in accordance with these rules must be filed with the Agency at the Agency for Health Care Administration, Long-Term Care Unit, 2727 Mahan Drive, Mail Stop #33, Tallahassee, FL 32308.

4. The amount deposited in such an account must be maintained at all times.

(e) If, at any time during the period for which a license is issued, a licensee who has not purchased a surety bond or entered into a self-insurance agreement is requested to hold funds in trust as provided in Section 400.162(5), F.S., the licensee must notify the Agency, in writing, of the request at the Agency for Health Care Administration, Long-Term Care Unit, 2727 Mahan Drive, Mail Stop #33, Tallahassee, FL 32308, and make application for a surety bond or for participation in a self-insurance agreement within seven business days of the request. Copies of the application, along with written documentation of related correspondence with an insurance agency or group, must be maintained and must be available for review. All notices required by this rule provision must be sent to the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #33, Tallahassee, Florida 32308.

Rulemaking Authority 400.062, 400.0712(3), 400.162(5)(c), 400.23, 408.034, 408.810(8), 408.819 FS. Law Implemented 400.062, 400.071, 400.0712, 400.102, 400.111, 400.141, 400.162, 400.20, 408.805, 408.806, 408.808, 408.810 FS. History–New 4-1-82, Amended 4-1-84, 8-1-85, 1-1-86, 11-12-89, 12-25-90, 10-6-91, Formerly 10D-29.103, Amended 4-18-94, 2-6-97, 5-5-02, 12-21-15.