64I-5.002. Certification/Decertification of Rural Health Networks

(1) Network Certification Procedures. All applications by Phase I planning and development grant recipients for certification as eligible for Phase II operation grants shall be processed and reviewed as follows:

(a) An application for certification and two copies shall be submitted using an Application for Rural Health Network Certification and shall be sent to a requestor within one week of the Department having received a written request.

(b) An application will be accepted by the Department at any time during normal business hours (8:00 a.m. – 5:00 p.m., Eastern Time) and days (Monday – Friday) of the week, except for official state holidays.

(c) There is no fee for the submission of an application for certification.

(d) An application for certification must contain the following information:

1. Corporate information, including corporate name, address, telephone number, contact person, date of incorporation, and a current certificate of status per Section 607.0128, F.S.;

2. The name of the person filing the application;

3. Articles of incorporation, corporate bylaws, and applicable certificate from the Secretary of State;

4. A list of the board of directors, including name, address, telephone number, and affiliation category (i.e., health care provider, health care consumer, representative of government, representative of an employer, or representative of another organization);

5. Name of all board officers and their respective positions;

6. An organizational chart of the applicant;

7. A copy of a network provider membership application which contains a statement indicating the provider agrees to comply with the provisions of Section 381.0406(4), F.S.;

8. A detailed narrative description of the network service area, a map of the network service area, and, if the network service area contains only census tracts of a county, the applicant must submit a copy of the most current U.S. Census Report that defines the census tract as rural;

9. A list of the network provider members that represent the minimum membership requirements set forth in Section 381.0406(3), F.S., including the name, address, telephone number, license/certification number, provider type (use professional or facility licensure designation), and provider category (public health, primary care, emergency medical, acute inpatient care, or other category);

10. A list of county public health units participating in the network and a description of the network’s direct patient care services provided by the county public health units;

11. A detailed health care service delivery plan adopted by the network board of directors for the delivery of the core health care services described in Section 381.0406(12)(a), F.S.; and

12. A budget for the next fiscal year utilizing the format in Application for Rural Health Network Certification, the applicant must also provide a budget narrative, identifying the source of funds and projected expenditures by type of expenditure.

(e) The application for certification must be signed by a board member, attesting to the correctness of the application and the approval of the application by the board of directors.

(f) The following information and documents shall be available for review by the Department certification team during regular business hours at the offices of the applicant when the Department conducts an examination of the applicant for certification:

1. A list of the network provider members as defined in Sections 381.0406(2)(b) and (13), F.S., including the name, address, telephone number, license/certification number, provider type (use professional or facility licensure designation), provider category (public health, primary care, emergency medical, acute inpatient care, or other category), a list of core network services provided in accordance with Section 381.0406(12)(a), F.S., and a list of other network services provided by network providers in accordance with Section 381.0406(12)(a)1.-4., F.S.;

2. All current provider agreements which include provider service responsibilities, agreements to accept all patients referred to the provider by other network members, the extent to which the providers will provide care to persons who lack health insurance or are otherwise unable to pay for care, the procedures for the transfer and maintenance of patient records, the transportation method to be used to transport patients between providers, referral procedures, network procedures for the transfer of patients to urban providers, and scheduling procedures;

3. All current contracts or referral agreements the network has approved for tertiary care, specialty care, and other services;

4. A description of disease prevention and health promotion programs offered by the network to rural residents;

5. A copy of the protocol to coordinate and share patient records;

6. A copy of the procedures for maintaining, and where applicable, increasing the number of points of entry through which rural residents may enter the health care network within the rural health network service area;

7. A copy of the network’s quality assurance plan and a copy of the procedure manual for the network’s quality assurance system as referenced in subsection 64I-5.001(7), F.A.C. The quality assurance manual must contain the network’s quality assurance processes and procedures, names of staff, and procedures used to monitor and evaluate the individual providers’ quality assurance processes and procedures. These procedures must show that the network or the providers in the network are monitoring and evaluating patient’s access to care;

8. A copy of the network’s risk management program, as referenced in subsection 64I-5.001(8), F.A.C., which shall include measures to minimize the risk of injury and adverse incidents to patients including risk management and risk prevention education and training, and the procedures for monitoring the individual providers’ risk management systems for minimizing risk;

9. A description of the network’s information system, which will be utilized to measure the network’s success in accomplishing the following within the network service area:

a. Improving access to care;

b. Increasing the number of skilled health professionals;

c. Developing more efficient and effective uses of private and public resources;

d. Providing a continuum of quality health services; and

e. Increasing the utilization of the statutory rural hospitals for appropriate health care services.

10. A copy of marketing materials to be used by the network to recruit health care providers and inform the general public of the services to be offered by the network;

11. Documentation that identifies the activities the network has undertaken or will undertake to recruit and retain health care providers.

(2) Network Certification Application Review Procedures.

(a) The Department of Health, Office of Rural Health shall review all applications in the context of the review criteria specified in Section 381.0406, F.S., and Chapter 64I-5, F.A.C.

(b) Applications shall be reviewed according to the following timetable:

1. Completeness Review.

a. Within 15 calendar days after the application is received, the Department shall determine whether the application is complete.

b. An application shall not be deemed complete by the Department unless all information required by statute and rule has been submitted by the applicant.

c. If the application is deemed incomplete by the Department, the Department shall request, by certified mail, specific information necessary for the application to be deemed complete.

d. If an applicant does not provide to the Department the specific additional information within 21 days of receipt of the Department’s request, the application shall be deemed withdrawn from consideration.

e. Subsequent to an application being deemed complete by the Department, no further application information or amendment will be accepted by the Department.

f. The Department of Health will, within 7 days of declaring the application complete, request the Office of Rural Health to have the appropriate office review team contact the applicant and establish an appropriate time for an on-site visit to verify that the applicant has in its offices the information identified in paragraph 64I-5.002(1)(f), F.A.C.

g. The Department shall issue a report within 60 calendar days from the date the application(s) is deemed complete.

(3) Issuance or Denial of Certification.

(a) The Department shall notify the applicant by certified mail of the approval or denial of the network certification within 60 calendar days from the date the application was deemed complete. The Department shall publish its notice of approval or denial decision in the Florida Administrative Weekly within 14 calendar days after a letter of approval or denial has been issued.

(b) The network certification shall be signed by the State Surgeon General or his designee and shall become effective on the date when signed. Network certification shall remain valid unless it is decertified by the Department.

(c) If the Department’s decision is to deny an application, the applicant must request an administrative hearing within 21 days after the publication of the Department’s decision in the Florida Administrative Weekly of the letter of denial of the network certification. If no hearing is timely requested, the Department’s decision shall become the final order of the Department.

(d) If a request for an administrative hearing is timely filed and a final order is subsequently entered which grants network certification, a network certification shall be signed by the State Surgeon General or his designee. Network certification shall be effective on the date when the final order is filed in the Office of the Agency Clerk.

(4) Decertification Procedures.

(a) Upon receipt of a written complaint or the discovery of evidence that a certified network has failed to meet the requirements of this rule, the Department shall notify the network, in writing, by certified mail, of such complaint or evidence and request a response to the complaint, in writing. The notice shall contain either a copy of the complaint or the evidence.

(b) A network shall respond to a Department notice of alleged failure to meet certification criteria within 25 days of receipt.

(c) Within 30 days after receipt of a network’s documentation of compliance with the applicable certification criteria, the Department of Health shall review the applicable documentation, and notify the network, in writing by certified mail whether the network is in compliance with the applicable rules and regulations.

(d) Within 60 days of receiving a notice from the Department that the network fails to meet certification criteria, a network must provide documentation to the Department which demonstrates that the network has taken the necessary steps to come into compliance with applicable certification criteria.

(e) Should the Department determine that the network still does not meet the applicable certification criteria, the Department shall file an administrative complaint decertifying the network, reciting the factual basis for the decertification of the network.

(f) The network must file a request for hearing within 21 days of receipt of the decertification notice in accordance with Chapter 120, F.S.

(g) If the network is decertified by final order, the decertified network shall return, within 60 days of receipt of the decertification notice, the full amount of any unused Phase II operational funds, if any grant funds were received, as of the date of receipt of the decertification letter, accompanied by the network’s financial records for the Phase II grant period prior to decertification.

(5) Monitoring Procedures. The Department of Health shall monitor certified rural health networks for compliance with the conditions of certification. Any certified network found by the Department to be in noncompliance with conditions of certification is subject to decertification of its certification. Compliance with the following requirements will be part of the monitoring process of the Department:

(a) Each certified network shall submit to the Department an annual statement attesting that it is in compliance with the criteria in this rule. The first annual statement shall be submitted after the date of certification and annually on that date the following years.

(b) Each certified network shall maintain a current file which includes all documentation required for certification, including copies of all provider agreements. This file shall be available for inspection by the Department and by the public during the regular business hours of the network.

(6) Modification of a Certification. Any certified network desiring modification of its certification shall submit a written request to the Department documenting good cause for modification. Examples of good cause include, but are not limited to:

(a) Changes in the rural health network’s service area; and

(b) Changes in the network’s ability to provide optional services.

(7) Public Access to Rural Health Network Certification Records.

(a) Any individual wishing to examine rural health network certification records will make an appointment with the librarian of the Office of Rural Health.

(b) No more than one network file may be examined at a time and must be returned to the Office of Rural Health before another file may be obtained.

(c) No file may be removed from the Department’s premises.

(d) All files are to be picked up from the Office of Rural Health and returned to the office after examination.

(e) The hours during which records are available are as follows:

1. Visitors will be permitted to examine and copy files during normal working hours between 8:30 a.m. and 4:30 p.m., Monday through Friday.

2. Visitors are prohibited access to the file room and no files are to be removed from the Office of Rural Health.

(f) Procedures governing copying are as follows:

1. Copying of certification records will be done on the copy machines in the Office of Health Policy.

2. Each individual must complete a Request for Public Records, each time copies are made. The form, which will be provided by the Office of Rural Health, must be completed in its entirety giving both the beginning and ending auditron numbers and the total copies made.

3. Office of Rural Health staff will not copy files for the public.

4. No person may unbind or unstaple certification-related documents while reviewing or copying records.

5. Materials must be refiled in the same sequential order as found.

(g) Procedures governing information listings are as follows:

1. The Department will maintain listings of rural health network certification information for purposes of identifying specific files.

2. These listings are available to the public for inspection, without an appointment, at any time between 8:00 a.m. and 5:00 p.m., Monday through Friday, during normal business hours.

3. A fee will be charged for record access as follows:

a. The charge for copies produced will be $.15 per page plus the file retrieval fee.

b. A file retrieval fee will be charged for each individual request to review a rural health network certification file. The file retrieval fee is $3.00 per file.

c. A certification copy fee of $3.00 will be charged for certification of copies of each rural health network certification file by the office librarian.

d. Any person who fails to pay the charges at the time of copying will not be allowed to take the copied documents with them.

e. The person will not be allowed to copy any other rural health network documents until the charges are paid in full.

4. Computer searches and computer generated reports of rural health network certification data will be available upon written request for a fee as determined below.

a. Charges will be determined based upon staff time required to generate the report, mailing charges, plus a standard computer usage charge of $10.00.

b. Charges for computer printouts or data diskettes must be paid at the time the reports are requested.

Specific Authority 381.0406(17) FS. Law Implemented 381.0406(16) FS. History–New 1-29-95, Amended 8-18-96, Formerly 59F-1.005.