The Agency is proposing to amend the rules governing home health agencies to update the home health agency licensing application form to conform to changes in Chapters 400, Part III and 408, Part II, F.S., and Chapter 59A-35, F.A.C.; revise ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NOS.:RULE TITLES:

59A-8.003Licensure Requirements

59A-8.004Licensure Procedure

59A-8.007Geographic Service Area

PURPOSE AND EFFECT: The Agency is proposing to amend the rules governing home health agencies to update the home health agency licensing application form to conform to changes in Chapters 400, Part III and 408, Part II, F.S., and Chapter 59A-35, F.A.C.; revise provisions regarding accreditation of non-skilled agencies; remove duplicative language already contained in Chapter 408, F.S.; and update rule references regarding the location of incorporated forms, and revise provisions for changes in geographic service areas.

SUMMARY: The Agency is proposing to amend the rules governing home health agencies to update the home health agency licensing application form, incorporated by reference in Rule 59A-8.003, F.A.C., to conform to changes in Chapter 408, Part II, F.S., Section 400.471(2)(h), F.S., and Chapter 59A-35, F.A.C. Since Chapter 2014-142, Laws of Florida, exempts non-skilled home health agencies that are not Medicaid or Medicaid certified from accreditation, Rule 59A-8.003, F.A.C., adds that the home health agency shall notify AHCA if the agency elects to give up accreditation. Language regarding the investigation of complaints is deleted since the content is in Section 408.811, F.S. In Rule 59A-8.004, F.A.C., the reference for the location of the application form is changed to refer to Rule 59A-8.003, F.A.C., instead of Chapter 59A-35, F.A.C. In Rule 59A-8.007, F.A.C., the rule is amended to modify requirements pertaining to a change in geographic service areas.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has been prepared by the Agency.

A statement of estimated regulatory costs has been prepared for proposed rule revisions in Rule 59A-8.003 and is available from the person listed below. The following is a summary of the SERC:

For proposed rule section 59A-8.003, F.A.C., license fees are increased by the Consumer Price Index pursuant to 408.805(2), F.S. The biennial license fee will increase by $45.00. Based on the number of currently licensed facilities, the total regulatory impact for a 5 year period is $233,662.50. There is no projected growth as the number of licensed facilities has decreased by 11% over the past 5 years.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A SERC has been prepared by the agency for rule 59A-8.003. For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 400.497 FS.

LAW IMPLEMENTED: 400.464, 400.471, 400.474, 400.484, 400.497, 408.806, 408.807, 408.810 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: February 18, 2015, 1:00p.m. – 2:00p.m.

PLACE: Agency for Health Care Administration, Ft. Knox Bldg. 3, Conference Room C, 2727 Mahan Drive, Tallahassee, FL 32308

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Anne Menard, Home Care Unit, Bureau of Health Facility Regulation, [phone] or [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Anne Menard, Home Care Unit, Bureau of Health Facility Regulation, [e-mail], [phone]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-8.003 Licensure Requirements.

(1) The issuance of an initial license shall be based upon compliance with Chapter 400, Part III, F.S., and this rule as evidenced by a signed and notarized, complete and accurate Health Care Licensing Application, Home Health Agency, AHCA Form 3110-1011, July 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX, home health agency application, as referenced in paragraph 59A-35.060(1)(m), F.A.C., and the results of a survey conducted by an accrediting organization or AHCA, as required in Section 400.471(2), F.S. The application form is available online at http://www/ahca.myflorida.com/HQAlicensureforms.

(2) An application for renewal of the current license must be submitted to AHCA on the form in section (1) of this rule at least 60 days prior to the date of expiration of the license, pursuant to Section 408.806, F.S. It is the responsibility of the home health agency to submit an application within the specified time frames whether or not they receive separate notification from AHCA of the impending expiration of the license. Home health agencies will be surveyed by AHCA or an accrediting organization as defined in Rule 59A-8.002, F.A.C. pursuant to Sections 408.811 and 400.471(2), F.S. Home health agencies will be surveyed on an unannounced basis at least every 36 months. Area offices may do follow up surveys to check on correction of deficiencies at any time on an unannounced basis. An exit conference will be conducted to report the findings and to receive additional information or clarification concerning the survey.

(3) Surveys of Accredited Home Health Agencies:

(a) It is the responsibility of the home health agency to request exemption from state licensure surveys pursuant to Section 400.471(2), F.S., by submitting documentation of accreditation by an approved accrediting organization and the most recent survey from the accrediting organization to the AHCA Home Care Unit.

(b) Home health agencies that complete (a) will not be subject to licensure surveys by AHCA except under the following circumstances:

1. The home health agency has been denied accreditation, has received a preliminary determination of denial of accreditation, or has received a provisional, conditional, or deferred accreditation report from the accrediting organization on its most recent survey, or

2. The home health agency has received accreditation but has not authorized the release of the report to the AHCA, or has not ensured that AHCA has received the accrediting organization’s report.

3. The home health agency that provides only non-skilled services and is not Medicare or Medicaid certified  is no longer required to be accredited as of July 1, 2014 pursuant to 400.471(2)(h), F.S. If the home health agency elects to give up its accreditation, the home health agency will inform AHCA by providing a copy of the letter it sent to its accrediting organization that shows the accreditation termination date. 

(4) AHCA will conduct investigations of complaints regarding licensure violations as required in 408.811, F.S.. Complaint investigations will be unannounced. An entrance conference will be conducted to inform the administrator of the nature of the complaint. An exit conference will be conducted to report the findings and to receive additional information or clarification concerning the investigation.

(5) In addition to any other penalties imposed pursuant to this rule, the agency may assess costs related to an investigation that results in a successful prosecution, pursuant to Section 400.484(3), F.S. The prosecution can be resolved by stipulation settlement or final hearing. The following costs may apply: travel costs related to the investigation; investigative time by AHCA’s surveyor or surveyors including travel time; processing time by AHCA’s professional staff and administrative support staff of Field Operations, and processing time for administrative support staff and professional staff of the AHCA Licensed Home Health Programs Unit in Tallahassee. The costs related to AHCA’s professional staff and support staff will be determined according to the hourly rate of pay for those positions.

(6) An application package for a change of ownership shall be made on the forms  a form prescribed by AHCA, as referenced in section (1) of this rule paragraph 59A-8.060(1)(m), F.A.C.

(a) The buyer or lessee must make application to AHCA for a new license at least 60 days before the date of the transfer of ownership as required by Sections 408.807(1) and (2), F.S.

(b) At the time of the transfer of ownership all patient or client records held by the current licensee shall be transferred to the applicant.

(c) An application for a change of ownership license will not be approved if a home health agency has not demonstrated compliance with the requirements in Chapter 408, Part II, and Chapter 400, Part III, F.S., through an unannounced inspection not more than 24 months prior to submission of the application, pursuant to Section 400.497(6), F.S.

1. The inspection may be done by an accrediting organization. However, if the home health agency being sold is accredited or was licensed July 1, 2008 or later, the inspection must be done by an accrediting organization as required in Section 400.471(2), F.S.; or

2. The inspection may be conducted in conjunction with an unannounced Medicare or Medicaid certification or recertification survey.

(d) Failure to apply for a change of ownership of a licensed home health agency as required by Section 408.806(2)(b), F.S., shall result in a fine set and levied by AHCA pursuant to Section 400.474(1), (2)(a), and 408.813(3)(b), F.S. This is also applicable to owners who incorporate and do not report this change of ownership to the home health agency.

(7) A licensed home health agency may operate a satellite office. A satellite office must be located in the same county as the agency’s main office. Supplies and records can be stored at a satellite office and phone business can be conducted the same as in the main office. The satellite office shares administration with the main office and is not separately licensed. Signs and advertisements can notify the public of the satellite office location. If the agency wants to open an office outside the county where the main office is located, the second office must be separately licensed.

(8) A licensed home health agency may operate a drop-off site in any county within the geographic service area specified on the license. A drop-off site may be used for pick-up or drop-off of supplies or records, for agency staff to use to complete paperwork or to communicate with the main office, existing or prospective agency staff, or the agency’s existing patients or clients. Prospective patients or clients cannot be contacted and billing cannot be done from this location. The drop-off site is not a home health agency office, but merely a work station for direct care staff in large areas where the distance is too great for staff to drive back frequently to the home health agency office. Training of home health agency staff can be done at a drop-off site. A drop-off site shall not require a license. No other business shall be conducted at these locations, including housing of records. The agency name cannot appear at the location, unless required by law or by the rental contract, nor can the location appear on agency letterhead or in advertising.

(9) If a change of address is to occur, or if a home health agency intends to open a satellite office, the home health agency must provide notice in writing to the AHCA Home Care Unit in Tallahassee and the AHCA area office as required in Rule 59A-35.040, F.A.C. The home health agency must submit to the AHCA Home Care Unit a certificate of occupancy, certificate of use, or evidence that the location is zoned for a home health agency business for the new address and evidence of legal right to the property in accordance with Section 408.810(6), F.S.

(10) A home health agency has the following responsibility in terms of hours of operation:

(a) The home health agency administrator and director of nursing, or their alternates, must be available to the public for any eight consecutive hours between 7:00 a.m. and 6:00 p.m., Monday through Friday of each week, excluding legal and religious holidays. Available to the public means being readily available on the premises or by telecommunications.

(b) When the administrator and the director of nursing are not on the premises during designated business hours, a staff person must be available to answer the phone and the door and must be able to contact the administrator and the director of nursing by telecommunications. This individual can be a clerical staff person.

(c) If an AHCA surveyor arrives on the premises to conduct an unannounced survey and the administrator, the director of nursing, or a person authorized to give access to patient records, are not available on the premises they, or the designated alternate, must be available on the premises within an hour of the arrival of the surveyor. A list of current patients must be provided to the surveyor within two hours of arrival if requested.

(d) The home health agency shall have written policies and procedures governing 24 hour availability to licensed professional nursing staff by active patients of the home health agency receiving skilled care. These procedures shall describe an on-call system whereby designated nursing staff will be available to directly communicate with the patient. For agencies which provide only home health aide and homemaker, companion and sitter services and who provide no skilled care, written policies and procedures shall address the availability of a supervisor during hours of patient service.

(e) Failure to be available or to respond, as defined in paragraphs (a) through (c) above, will result in a $500 fine, pursuant to Section 400.474(1), F.S. A second incident will be grounds for denial or revocation of the agency license.

(11) The initial, change of ownership and renewal fee for home health licensure is $1,705.

(12) If licensure application fee checks are returned by the financial institution due to insufficient funds, the issuance of a license may be delayed, denied or revoked.

(13) Upon revocation, suspension, voluntary or involuntary termination of a license, the home health agency shall return its license to AHCA. If the provider voluntarily chooses to terminate the license, the provider must notify AHCA, as required in Section 408.810(4)(a), F.S. This includes submitting a letter to the address: AHCA Home Care Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308, officially declaring the closure date of the home health agency.

Rulemaking Authority 400.497 FS. Law Implemented 400.464, 400.471, 400.474, 400.484, 400.497, 408.806, 408.807, 408.810 FS. History–New 4-19-76, Formerly 10D-68.03, Amended 4-30-86, 8-10-88, 5-30-90, 6-12-91, Formerly 10D-68.003, Amended 4-27-93, 10-27-94, 1-30-97, 1-17-00, 7-18-01, 9-22-05, 8-15-06, 3-29-07, 7-11-13,____ .

 

59A-8.004 Licensure Procedure.

(1) An application for licensure, initial, change of ownership, or renewal, shall be made on the forms a form prescribed by the AHCA in paragraph 59A-8.003(1) and 59A-35.060(1)(m), F.A.C. These forms are available online at http://www/ahca.myflorida.com/HQAlicensureforms.

(2) For initial and change of ownership applications and name changes, an affidavit of fictitious name is required when the home health agency chooses to operate under a name other than the name of the partnership, corporation or limited liability company pursuant to Section 865.09, F.S.

(3) For initial applications, including changes of ownership, the applicant must submit proof of financial ability to operate, pursuant to Sections 400.471, 408.810, 408.8065, F.S., and Rule 59A-35.062, F.A.C.

(4) An applicant for initial license shall sign the form AHCA 3110-1026, Attestation of Compliance with Distance Requirements, March 2013, which is incorporated by reference (http://www.flrules.org/Gateway/reference.asp?No=Ref-02766), pursuant to Section 400.471(7), F.S. The form may be obtained at the AHCA web site, http://ahca.myflorida.com/homecare; at the site, select “Home Health Agency” and then select the “Application” tab. The authorized representative signing this form attests no officer or controlling interest of the applicant agency are officers or controlling interests of another home health agency located within 10 miles of the applicant agency and is in the same county.

(5) Background screening for the administrator and the financial officer shall be in accordance with level 2 standards for screening set forth in Section 408.809, F.S. and Rule 59A-35.090, F.A.C.

(6) Level 2 background screening for employees and contractors shall be done as required in Rule 59A-35.090, F.A.C. and Section 408.809, F.S.

Rulemaking Authority 400.497 FS. Law Implemented 400.471, 400.512, 408.810, 408.806, 408.8065, 408.809 FS. History–New 4-19-76, Formerly 10D-68.04, Amended 4-30-86, 8-10-88, 5-30-90, 6-12-91, 10-6-91, Formerly 10D-68.004, Amended 4-27-93, 10-27-94, 1-30-97, 1-17-00, 7-18-01, 9-22-05, 8-15-06, 3-29-07, 7-11-13,_____.

 

59A-8.007 Geographic Service Area.

(1) All home health agencies must apply for a geographic service area on their initial license application. Home health agencies may apply for a geographic service area which encompasses one or more of the counties within the specific AHCA area boundaries, pursuant to Sections 408.032(5) and 400.497(9)(7), F.S., in which the main office is located provided that the license application. includes a plan for:

(a) Coverage of the professional staff which takes into account the projected number of clients in the requested geographic service area, and

(b) Supervision of the staff in the requested geographic service area. AHCA shall authorize a geographic service area if there are a sufficient number and type of staff and supervision to meet the needs of the geographic service area.

(2) In any request for expansion of the geographic service area, the home health agency’s previous history of survey results and administrative actions including fines, suspensions, revocations or injunctions will be reviewed to establish the home health agency’s ability to provide quality services within the requested area. In addition, the application for an expanded geographic service area must include a plan for:

(a) Coverage of the professional staff which takes into account the projected number of clients in the requested geographic service area, and

(b) Supervision of the staff in the requested geographic service area.

(3) The counties listed on the home health agency license should reflect counties in which the home health agency expects to provide services. If an agency refuses to serve residents of a specific county and that county is listed on the agency’s license, AHCA shall remove that county from the agency’s license. Refusal to provide services to a resident solely based on their residence in a specific county must be verified by AHCA prior to removing the county from the license.

Specific Authority 400.497 FS. Law Implemented 400.497 FS. History–New 10-27-94, Amended 1-17-00, 7-18-01,                                         _____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Anne Menard

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 16, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: October 31, 2014