AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NO.:RULE TITLE:
59A-35.060Licensure Application Process.
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. 41 No. 191, October 1, 2015 issue of the Florida Administrative Register.
The following sections of the proposed rule will be changed to read:
59A-35.060 Licensure Application Process.
(1) The applicant must apply for licensure using the program specific forms listed below which may be submitted online for renewals and the Health Care Licensing Application Addendum, AHCA Form 3110-1024, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX http://www.flrules.org/Gateway/reference.asp?No=Ref-05363. All forms are incorporated by reference and available online at: http://ahca.myflorida.com/HQAlicensureforms or, for online renewal submissions, at: http://apps.ahca.myflorida.com/SingleSignOnPortal for online submissions. For online renewal submissions, the information required on the Health Care Licensing Application Addendum, AHCA Form 3110-1024, September 2015, is incorporated into the program specific online forms listed below.
(a) Crisis Stabilization Units, as provided under Parts I and IV of Chapter 394, F.S.; Health Care Licensing Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility, AHCA Form 3180-5003, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility, AHCA Form 3180-5003OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(b) Short Term Residential Treatment Units, as provided under Parts I and IV of Chapter 394, F.S.; Health Care Licensing Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility; AHCA Form 3180-5003, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility; AHCA Form 3180-5003OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(c) Residential Treatment Facilities, as provided under Chapter 394, Part IV, F.S.; Health Care Licensing Application Residential Treatment Facility; AHCA Form 3180-5005, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Residential Treatment Facility; AHCA Form 3180-5005OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(d) Residential Treatment Centers for Children and Adolescents, as provided under Chapter 394, Part IV, F.S.; Health Care Licensing Application Residential Treatment Centers for Children and Adolescents; AHCA Form 3180-5004, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Residential Treatment Centers for Children and Adolescents; AHCA Form 3180-5004OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(e) Hospices, as provided under Chapter 400, Part IV, F.S.; Health Care Licensing Application Hospice, AHCA Form 3110-4001, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Hospice, AHCA Form 3110-4001OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(f) No change.
(g) Assisted Living Facilities, as provided under Chapter 429, Part I, F.S.; Health Care Licensing Application Assisted Living Facilities; AHCA Form 3110-1008, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Assisted Living Facilities; AHCA Form 3110-1008OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(h) Adult Family-Care Homes, as provided under Chapter 429, Part II, F.S.; Health Care Licensing Application Adult Family-Care Home; AHCA Form 3180-1022, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Adult Family-Care Home; AHCA Form 3180-1022OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(i) Adult Day Care Centers, as provided under Chapter 429, Part III, F.S.; Health Care Licensing Application Adult Day Care Center; AHCA Form 3180-1004, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX or for online renewals, Health Care Licensing Online Application Adult Day Care Center; AHCA Form 3180-1004OL, September 2015, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX.
(2) No change.
Rulemaking Authority 408.819 FS. Law Implemented 400.801, 408.802, 408.805, 408.806, 408.809, 408.810, 408.811 FS. History–New 7-14-10, Amended 5-4-15, ___________.
The following changes have been made to the Health Care Licensing Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility, AHCA Form 3180-5003, September 2015:
On pgs. 4 and 5
Section 4. Personnel will be renumbered as Section 5., and Section 5. Management Company Controlling Interests will be renumbered as Section 4.
On Pg. 7:
In Section 9. Supporting Documents, the words “Chapter 429, F.S.” will be changed to “Chapter 394, F.S.” and the “Documents to be Provided” text and the “Required for” text in the table will be changed to read:
Documents to be Provided:……….Required For:
Proof of current professional and general liability insurance coverage……………Initial, Renewal, Change of Ownership and Capacity Increase application types
Fire Safety Inspection Report……………..Initial, Renewal and Change of Ownership applications types
Department of Health Sanitation report……………Initial, Renewal and Change of Ownership applications types
Proof of compliance with local zoning requirements………………Initial, Change of Ownership, Change of Address applications types
Proof of Property Occupancy; examples Lease, Mortgage, and Transfer Agreement…………….Initial, Renewal, Change of Ownership, Request to Change Name or Address of Provider application types
Accreditation Report, if applicable…………..Initial, Renewal and Change of Ownership application types
Health Care Licensing Application Addendum, AHCA Form 3110-1024…………….Initial, Renewal and Change of Ownership application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100 for the administrator and financial officers………….Initial, Renewal and Change of Ownership applications type, if background screening was conducted by a state agency other than the Agency for Health Care Administration
Exemption from disqualification for documented offense, if applicable.…………All application types
Required disclosures related to actions taken by Medicare, Medicaid or CLIA, if applicable…………All application types, if documentation is required due to responses provided in application
Approved repayment plans, if applicable…………..All application types
The following changes have been made to the Health Care Licensing Online Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility, AHCA Form 3180-5003OL, September 2015:
The words “Health Care Licensing Online Application Crisis Stabilization Unit and Short-Term Residential Treatment Facility, AHCA Form 3180-5003OL, September 2015” and 59A-35.060(1), Florida Administrative have been added to the application.
Supporting Documents page – The words “Chapter 59A-4” will be changed to “Chapter 65E-9”. The words “HIV/AIDS Affidavit” will be changed to “Proof of HIV/AIDS training.
Payment Summary page – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The biennial licensure fee is $197.92 per bed
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
The following changes have been made to the Health Care Licensing Application Residential Treatment Facility; AHCA Form 3180-5005, September 2015:
On pg. 4
Section 4. Personnel will be renumbered as Section 5., and Section 5. Management Company Controlling Interests will be renumbered as Section 4.
On pg. 6
In Section 9. Supporting Documents, the words “Chapter 429, F.S.” will be changed to “Chapter 394, F.S.” and the “Documents to be Provided” text and the “Required for” text in the table will be changed to read:
Documents to be Provided:……………Required For:
Proof of current general liability insurance coverage…………….Initial, Renewal, Change of Ownership and Capacity Increase application types
Fire Safety Inspection Report………..Initial, Renewal, Change of Ownership and Capacity Increase application types
Department of Health Septic System or Water Supply Evaluation Report…………Initial and Capacity Increases application types
Documentation signed by the appropriate local government official, which states that the applicant has met local zoning requirements…………Initial, Change of Ownership and Capacity Increase application types
Proof of Property Occupancy; examples Lease, Mortgage, and Transfer Agreement, if applicable…………Initial, Renewal, Change of Ownership, Request to Change Name or Address of Provider application types
Accreditation Report, if applicable………..Initial, Renewal and Change of Ownership application types
Health Care Licensing Application Addendum, AHCA Form 3110-1024………..Initial, Renewal and Change of Ownership application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008 for the administrator and financial officer…………..Initial, Renewal and Change of Ownership application types, if background screening was conducted by a state agency other than the Agency for Health Care Administration
Proof of exemption from disqualification for documented offense, if applicable………..All application types
Required disclosures related to action taken by Medicare, Medicaid or CLIA, if applicable…………All application types, if documentation is required due to responses provided in the application
Approved repayment plans, if applicable…….All application types
The following changes have been made to the Health Care Licensing Online Application Residential Treatment Facility, AHCA Form 3180-5005OL, September 2015:
The words “Health Care Licensing Online Crisis Stabilization Unit and Short-Term Residential Treatment Facility, AHCA Form 3180-5005OL, September 2015” and “Section 59A-35.060(1), Florida Administrative Code” will be added to the application form.
Supporting Documents page – The words “Chapter 59A-4” will be changed to “Chapter 65E-9”. The words “HIV/AIDS Affidavit” will be changed to “Proof of HIV/AIDS training.
Payment Summary page – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The license fee is $191.83 per bed.
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
The following changes have been made to the Health Care Licensing Application Residential Treatment Centers for Children and Adolescents; AHCA Form 3180-5004, September 2015:
On pgs. 4 and 5
Section 4. Personnel will be renumbered as Section 5., and Section 5. Management Company Controlling Interests will be renumbered as Section 4.
On Pg. 7:
In Section 10. Supporting Documents, the words “Chapter 429, F.S.” will be changed to “Chapter 394, F.S.” and the “Documents to be Provided” text and the “Required for” text in the table will be changed to read:
Documents to be Provided:………………….Required For:
Proof of current professional and general liability insurance coverage……………Initial, Renewal, Change of Ownership and Capacity Increase application types
Fire Safety Inspection Report…………….Initial, Renewal, Change of Ownership and Capacity Increase application types
Department of Health Septic system or Water Supply evaluation Report…………………Initial and Capacity Increases application types
Proof of compliance with local zoning requirements………………..Initial, Change of Ownership, and Change of Address application types
Proof of Property Occupancy; examples Lease, Mortgage, and/or Transfer Agreement, if applicable…………Initials, Change of Ownership, and Change of Address application types
Accreditation Report, if applicable……………..Initial, Renewal and Change of Ownership application types
Health Care Licensing Application Addendum, AHCA Form 3110-1024………………..Initial, Renewal and Change of Ownership application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008 for the administrator and financial officers………………… Initial, Renewal and Change of Ownership application types, If background screening was conducted by a state agency other than the Agency for Health Care Administration
Exemption from disqualification for documented offense, if applicable…………….All application types
Required disclosures related to actions taken by Medicare, Medicaid or CLIA, if applicable…………….All application types, if documentation is required due to responses provided in application
Approved repayment plans, if applicable……………….All application types
The following changes have been made to the Health Care Licensing Online Application Residential Treatment Centers for Children and Adolescents; AHCA Form 3180-5004OL, September 2015:
The words “Health Care Licensing Online Application Residential Treatment Centers for Children and Adolescents; AHCA Form 3180-5004OL, September 2015” and “Section 59A-35.060(1), Florida Administrative Code” will be added to the application form.
Supporting Documents page – The words “Chapter 59A-4” will be changed to “Chapter 65E-9”. The words “HIV/AIDS Affidavit” will be changed to “Proof of HIV/AIDS training.
Payment Summary page – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The biennial licensure fee is $240.00 per bed
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
The following changes have been made to the Health Care Licensing Application Hospice, AHCA Form 3110-4001, September 2015:
On pgs. 3 and 4
Section 4. Personnel will be renumbered as Section 5., and Section 5. Management Company Controlling Interests will be renumbered as Section 4.
On Pg. 8:
In Section 15. Supporting Documents, the words “Chapter 429, F.S.” will be changed to “Chapter 394, F.S.” and the “Documents to be Provided” text and the “Required for” text in the table will be changed to read:
Documents to be Provided:………………Required for:
Accreditation with deemed status – documentation and report…………………..Initial, Renewal and Change of Ownership applications types, if hospice is accredited with deemed status
Proof of Financial Ability to Operate, AHCA Form 3100-0009………………..Initial and Change of Ownership application types
Certificate of Need……………………….Initial and Addition of New Inpatient Facility application types
Proof of legal right to occupy the property for principal office and each satellite office, inpatient facility and residential unit………………..Initial, Change of Ownership involving change of licensee and change of address application types
Certificate of occupancy signed by local authorized zoning, building and electrical officials………………Initial, Change of Ownership and change of address – principal office only; addition & renovation of inpatient facility application types
Plan for delivery of services per section 400.606(1), F.S.………………Initial and Change of Ownership application types
Proof of federal employer identification number (EIN) from the Internal Revenue Service (IRS)………………Initial and Change of Ownership application types
Documentation of change of ownership transaction stating effective date and executed by all parties……………Change of Ownership application and any change of controlling interest affecting % ownership of licensee application types
Signed agreement to correct any existing licensure deficiencies……………..Change of Ownership application type
Statement that administrative records will be retained and available for inspection by the Agency…………..Change of Ownership application type
Medical director’s proof of hospital admitting privileges per 58A-2.014(1), F.A.C. (if not previously reported)……………Any application type, if medical director has changed
Health Care Licensing Application Addendum, AHCA Form 3110-1024…………….Initial, Renewal and Change of Ownership application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008 for administrator and financial officer…………………..Initial, Renewal and Change of Ownership application types, if background screening was conducted by a state agency other than the Agency for Health Care Administration
Proof of exemption from disqualification for documented offense……………….Any application types, if required for administrator, financial officer or any controlling interest due to responses provided in application
Required Disclosures – if documentation is required due to responses provided in section 6 above…………Any application types, if required for applicant, licensee or any controlling interest due to responses provided in application
Approved repayment plan – if documentation is required due to responses provided in section 7 above………….Any application types, if required for applicant, licensee or any controlling interest due to responses provided in application
The following changes have been made to the Health Care Licensing Online Application Hospice, AHCA Form 3110-4001OL, September 2015:
The words “Health Care Licensing Online Application Hospice, AHCA Form 3110-4001OL, September 2015” and “Section 59A-35.060(1), Florida Administrative Code” will be added to the application form.
Supporting Documents page – The words “Chapter 59A-25” will be changed to “Chapter 58A-2”.
Payment Summary page – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The biennial licensure fee is $ 1,218.00
•The biennial health care assessment fee is $ 300.00
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
The following changes have been made to the Health Care Licensing Application Assisted Living Facilities; AHCA Form 3110-1008, September 2015:
On pg. 3
In Section 2.B. Type of License, the following language will be added in the **Note box: “If the assisted living facility has been licensed for less than two years, the initial ECC license will be issued as a Provisional License and may not exceed six months. The licensee shall notify the Agency, in writing, when it has admitted at least one ECC resident, after which an unannounced inspection shall be made to determine compliance with the requirements an ECC license. A licensee with a Provisional ECC License that demonstrates compliance with all requirements of an ECC license during the inspection shall be issued an ECC license.”
On pgs. 5 and 6
Section 4. Personnel will be renumbered as Section 5., and Section 5. Management Company Controlling Interests will be renumbered as Section 4.
On pg. 6
In Section 5. Personnel, the duplicate Date of Birth field will be deleted.
On pg. 9
In Section 9. Consumer Information, the religious affiliations will be revised to delete “Christian” and add “Christian Non Denomination”, “Christian Science”, “Adventist”, “Baptist”, “Catholic”, “Lutheran”, “Methodist”, and “Presbyterian”.
On pg. 10
In Section 10. Supporting Documents, the “Documents to be Provided” text and the “Required for” text in the table will be changed to read:
Documents to be Provided:………………..Required For:
Certificate of Liability Insurance……………Initial, Renewal, Change of Ownership and Capacity Increase application types
Fire Safety Inspection Report………………………Initial, Renewal, Change of Ownership and Capacity Increase application types
Department of Health Septic System or Water Supply Evaluation Report……………Initial and Capacity Increases application types
Department of Health Food Permit…………….All application types, for providers with 11 beds or more
Department of Health Residential Group Care Inspection Report……………Initial, Renewal, Change of Ownership and Capacity Increase application types
Documentation signed by the appropriate local government official, which states that the applicant has met local zoning requirements…………….Initial, Change of Ownership and Capacity Increase application types
Documentation proving compliance with the Community Residential Homes site selection requirements specified pursuant to Chapter 419, Florida Statutes……………Initial, Change of Ownership and Capacity Increase application types, for providers that are community residential homes
Surety or Continuation Bond…………….All application types that check YES on Section 8A
Proof of Financial Ability to Operate (AHCA Form 3100-0009)……………Initial and Change of Ownership application types
Copy of Administration’s high school diploma or GED certificate………….Initial, Change of Ownership or New Administrators application types
Proof of Property Occupancy, Examples: Lease, Mortgage, and Transfer Agreement…………….Initial, Renewal, Change of Ownership, Request to Change Name or Address of Provider application types
Health Care Licensing Application Addendum, AHCA Form 3110-1024……………Initial, Renewal and Change of Ownership application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008 for the administrator and financial officers…………. Initial, Renewal and Change of Ownership application types, If background screening was conducted by a state agency other than the Agency for Health Care Administration
Exemption from disqualification for documented offense, if applicable……………All application types
Required disclosures related to actions taken by Medicare, Medicaid or CLIA, if applicable………..All application types, if documentation is required due to responses provided in application
Approved repayment plan, if applicable……………All application types
The following changes have been made to the Health Care Licensing Online Application Assisted Living Facilities; AHCA Form 3110-1008OL, September 2015:
The words “Health Care Licensing Online Application Assisted Living Facilities; AHCA Form 3110-1008OL, September 2015” and “Section 59A-35.060(1), Florida Administrative Code” will be added to the application form.
Consumer Information page – The religious affiliations will be revised to delete “Christian” and add “Christian Non Denomination”, “Christian Science”, “Adventist”, “Baptist”, “Catholic”, “Lutheran”, “Methodist”, and “Presbyterian”.
Payment Summary page – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The biennial licensure fee is $387.73 plus $64.96 per private pay bed fee (not to exceed $14,253.64)
•The extended congregate care fee is $546.07 plus $10.15 per bed fee times total bed capacity
•The limited nursing service fee is $322.77 plus $10.15 per bed fee times total bed capacity
•The biennial assessment fee is $2 per bed (annual fee of $1 per bed x 2 years) not to exceed $300 per facility (annual cap of $150 x 2 years)
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
The following changes have been made to the Health Care Licensing Application Adult Family-Care Home; AHCA Form 3180-1022, September 2015:
On pgs. 5 and 6
In Section 7. Supporting Documents, the “Documents to be Provided” text and the “Required for” text in the table will be changed to read:
Documents to be Provided:……………..Required For:
Fire Safety Inspection Report…………Initial, Renewal, Change of Ownership and Capacity Increase application types
Department of Health Residential Group Care Inspection Report……….Initial, Renewal and Capacity Increase application types
Proof of Property Occupancy, Examples: Lease, Mortgage, and Transfer Agreement……………Initial, Renewal, Change of Ownership, Request to Change Name or Address of Provider application types
Income and Expenses Report (AHCA Form 3180-1017)…………Initial application types
Documentation signed by the appropriate local government official, which states that the applicant has met local zoning requirements…………….Initial application types
Documentation proving compliance with the Community Residential Homes site selection requirements specified pursuant to Chapter 419, Florida Statutes………..Initial application types
Health Care Licensing Application Addendum, AHCA Form 3110-1024………..Initial and Renewal application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008 for the administrator and financial officers……….Initial and Renewal application types, if background screening was conducted by a state agency other than the Agency for Health Care Administration
Exemption from disqualification for documented offense, if applicable…………All application types
Required disclosures related to actions taken by Medicare, Medicaid or CLIA, if applicable…………All application types, if documentation is required due to responses provided in application
Approved repayment plan, if applicable…………..All application types
The following changes have been made to the Health Care Licensing Online Application Adult Family-Care Home; AHCA Form 3180-1022OL, September 2015:
The words “Health Care Licensing Online Application Adult Family-Care Home; AHCA Form 3180-1022OL, September 2015” and “Section 59A-35.060(1), Florida Administrative Code” will be added to the application form.
Provider/Facility Information page – The following language will be added: “Pursuant to section 408.806 (1)(a) , Florida Statutes, an application for licensure must include: the name, address and Social Security number of the applicant, administrator or similarly titled person who is responsible for the day to day operation of the provider, and financial officer or similarly titled person who is responsible for the financial operation of the licensee or provider. Disclosure of Social Security number(s) is mandatory. The Agency for Health Care Administration shall use such information for purposes of securing the proper identification of persons listed on this application for licensure.”
Payment Summary page – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The biennial licensure fee is $226.34
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
The following changes have been made to the Health Care Licensing Application Adult Day Care Center; AHCA Form 3180-1004, September 2015:
On pgs. 3 and 4
Section 4. Personnel will be renumbered as Section 5., and Section 5. Management Company Controlling Interests will be renumbered as Section 4.
On pg. 6
In Section 9. Supporting Documents, the “Required for” text next to the “Documents to be Provided” in the table will be changed to read:
Documents to be Provided:………………Required For:
Certificate of Liability Insurance……………..Initial, Renewal, Change of Ownership and Capacity Increase application types
Fire Safety Inspection Report……………..Initial, Renewal, Change of Ownership and Capacity Increase application types
Department of Health Septic System or Water Supply Evaluation Report…………Initial application types
Department of Health Food Permit……………All application types
Proof of Financial Ability to Operate (AHCA Form 3100-0009)………………Initials and Change of Ownership application types
Proof of Property Occupancy, Examples: Lease, Mortgage, and Transfer Agreement……………...Initial, Renewal, Change of Ownership, Request to Change Name or Address of Provider application types
Documentation signed by the appropriate local government official, which states that the applicant has met local zoning requirements……….Initials and Change of Ownership application types
Health Care Licensing Application Addendum, AHCA Form 3110-1024…………..Initial, Renewal and Change of Ownership application types
Attestation of Compliance with Background Screening Requirements, AHCA Form 3100-0008 for the administrator and financial officers………….. Initial, Renewal and Change of Ownership application types, if background screening was conducted by a state agency other than the Agency for Health Care Administration
Copy of exemption from disqualification for documented offense, if applicable………….All application types
Required disclosures related to actions taken by Medicare, Medicaid or CLIA, if applicable…………..All application types, if documentation is required due to responses provided in application
Approved repayment plans, if applicable……………All application types
The following changes have been made to the Health Care Licensing Online Application Adult Day Care Center; AHCA Form 3180-1004OL, September 2015:
The words “Health Care Licensing Online Application Adult Day Care Center; AHCA Form 3180-1004OL, September 2015” and “Section 59A-35.060(1), Florida Administrative Code” will be added to the application form.
Payment Summary – The following language will be added:
Biennial Licensure Fee and Other Amounts Due Upon Submission of Application
•The biennial licensure fee is $172.55
•Other amounts due (fines, assessment, fees, etc.) will be detailed in the application
