AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NO.:RULE TITLE:
59A-13.004License Procedure
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 39, No. 247, December 23, 2013 issue of the Florida Administrative Register.
The following sections of the proposed rule will be changed to read:
59A-13.004 License Procedure.
(1) No change.
(2) Application for a license to operate a PPEC center must be made on the Health Care Licensing Application, Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002, July 2014 September 2013, “Licensure Application: Prescribed Pediatric Extended Care Center,” hereby incorporated by reference, which must be submitted by the owner or administrator to the Agency. This form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX and available from the Agency for Health Care Administration, 2727 Mahan Drive, MS-33, Tallahassee, Florida 32308, or at the web address at: http://ahca.myflorida.com/HQAlicensureforms. In addition to a completed application, applicants for initial, renewal and change of ownership must submit the following:
(a) through (7) No change.
The following changes have been made to the Application Checklist on the Health Care Licensing Application, Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002, September 2013:
Pg. 1-3, Footer:
The form revision date was updated to change the revision date from “September 2013” to “July 2014”.and the website where the form is made available was updated to read, “http://ahca.myflorida.com/HQAlicensureforms”.
On Pg. 1
The Agency logo has been updated.
The website where the form is made available was updated to read “http://ahca.myflorida.com/HQAlicensureforms”.
On Pg. 1, Section A.
The background screening web address has been updated to http://ahca.myflorida.com/backgroundscreening
On Pg. 2, Section B.
The website where the form is made available was updated to read “http://ahca.myflorida.com/HQAlicensureforms”.
On Pg. 2, Section C.
The website where the form is made available was updated to read “http://ahca.myflorida.com/HQAlicensureforms”.
The following changes have been made to the Health Care Licensing Application, Prescribed Pediatric Extended Care Centers, AHCA Form 3110-8002, September 2013:
Pg. 1-5, Footer:
The form revision date was updated to change the revision date from “September 2013” to “July 2014”.
The website where the form is made available was updated to read “http://ahca.myflorida.com/HQAlicensureforms”.
On Pg. 1
The Agency logo has been updated.
On Pg. 5, Section 8. Affidavit
The section title has been changed from “Affidavit” to “Attestation”.
The statements in this section have been replaced with the following:
I, _________________________, under penalty of perjury, attest as follows:
(1) Pursuant to Section 837.06, Florida Statutes, I have not knowingly made a false statement with the intent to mislead the Agency in the performance of its official duty.
(2) Pursuant to Section 408.815, Florida Statutes, I acknowledge that false representation of a material fact in the license application or omission of any material fact from the license application by a controlling interest may be used by the Agency for denying and revoking a license or change of ownership application.
(3)Pursuant to Section 408.806, Florida Statutes, the applicant is in compliance with the provisions of Section 408.806 and Chapter 435, Florida Statutes.
(4) Pursuant to Sections 408.809 and 435.05, Florida Statutes, every employee of the applicant required to be screened has attested, subject to penalty of perjury, to meeting the requirements for qualifying for employment pursuant to Chapter 408, Part II, and Chapter 435, Florida Statutes, and has agreed to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer.
(5) Pursuant to Section 435.05, Florida Statutes, the applicant has conducted a level 2 background screening through the Agency on every employee required to be screened under Chapter 408, Part II, or Chapter 435, Florida Statutes, as a condition of employment and continued employment and that every such employee has satisfied the level 2 background screening standards or obtained an exemption from disqualification from employment.
