What is AHCA?
The Agency for Health Care Administration (AHCA) is the state agency charged with the responsibility of licensing and regulating Florida’s health care facilities and providers. These include nursing homes, assisted living facilities, hospices, home health agencies, nurse registries, adult day care centers, and hospitals. Without a valid license, these entities cannot legally operate in Florida, are subject to citations, fines, penalties, and ultimately even license suspension or revocation. In addition to licensing, AHCA also regulates the form and manner by which certain services are reimbursed under Florida’s Medicaid program , and processes Florida Medicaid provider applications (at both the entity and individual provider levels). Thus, in addition to the more traditional regulatory functions of a "licensing agency," AHCA largely administers Florida’s Medicaid program as it relates to non-core institutions, or entities that do not directly provide inpatient hospital or medical care. Core institutions, including hospitals, are regulated (peripherally) by AHCA, but also have a significant role assigned to them under the Florida Department of Health. As partner state agencies, AHCA and the Department of Health, along with the Agency for Persons with Disabilities, coordinate their efforts in order to efficiently regulate Florida’s healthcare system.
Which Facilities Require an AHCA License?
The following types of health facilities and services require licensure by AHCA, unless exempt:
- (1) Nursing Home Facilities;
- (2) Assisted Living Facilities;
- (3) Home Health Agencies, both public and private, and including all persons, other than an individual employed by the agency, who are engaged in providing or administering home health services within the state, except any such person licensed or registered under the provisions of chapter 467, chapter 486, chapter 490, chapter 491, or chapter 641, pursuant to s. 400.464(2);
- (4) Home Medical Equipment Providers;
- (5) Habilitation Providers, both public and private;
- (6) Intermediate Care Facilities for the Developmentally Disabled;
- (7) Compounding Pharmacies; and
- (8) Hospital Wards, Units, Departments, and Roving Nuclear Medicine Services, in a hospital licensed pursuant to chapter 395; and
- (9) (a) Hospices; and
- (9) (b) Medicare certified hospices.
(c) Any of the above which is owned or operated by the state or any of its political subdivisions is exempt from this part.
AHCA License Requirements 101
The essential requirements of an AHCA license are largely state specific. However, as a general matter, there are several minimum requirements applicable to all health care facilities seeking an AHCA license.
In general, an AHCA license authorizes a health care facility to operate under a particular classification. In other words, an AHCA license is valid only when the health care facility operates within that classification. For example, an AHCA license for a hospital authorizes the licensee to operate the hospital only. It does not authorize the licensee to operate a nursing facility or a home health agency. Further, while each license is state specific, the scope of a license is narrow. A health care facility should not expect regardless of licensure to be authorized as a professional corporation.
An applicant for an AHCA license must submit an application to the state agency responsible for licensing AHCA in the state in which the health care facility is located. As part of its application, a health care facility must submit documentation which demonstrates it is financially, administratively, and logistically capable of providing quality health care and maintaining compliance with applicable federal, state, and local regulations. While the details of an AHCA license application vary from state to state, the following are generally required: (a) executive summary and background; (b) proof of compliance with applicable medical malpractice insurance requirements; (c) evidence of compliance with certificate of need (CON) process requirements, if applicable; (d) examples of policies, procedures, and forms with respect to patient care, discharge, billing, business, and human resources; (e) operating budget; (f) staffing plan; and (g) administrator certification and CDPH license (for longer-term facilities).
Applying for an AHCA License
For most facilities applying for licensure from the Agency for Health Care Administration (AHCA), the licensing process begins with the completion and submission of an AHCA Form 3100-0002 Form 3100-0002, Application for Licensure, Site Approval, and License Renewal. The Application is relatively straightforward. It asks questions related to the proposed physical plant, the type and size of facility, the resident capacity, the proposed providers, management, and contact personnel, among other things. Be sure to include the name of the facility in all e-mails to AHCA of questions or information submitted in response to questions. It is not uncommon for e-mails sent to AHCA by an applicant to go astray in the normal course of email communication. The name of the facility on each page of an application would at least help to clarify the purpose and intent of the e-mail.
There is no license application fee that must be submitted with the application. After it is submitted, however, an applicant will be required to submit application fees and a fee for an initial survey. The application fees vary by type of facility, however, they are typically as follows:
$250 for a Home Health Agency
$500 for an Adult Day Care/Health Center
$2,000 for a Skilled Nursing Facility, Intermediate Care Facility, Assisted Living Facility or Adult Companion Service
$5,000 for a Nursing Home
$5,000 for a Swing Bed
$100 per bed for Initial Licensure of an Extended Old-Age Home Facility
$100 per bed for Initial Licensure of an Extended Congregate Care Facility
$150 per bed for Initial Licensure of an Adult Day Training Program
$100 per bed for Initial Licensure of a Hospice
$200 per bed for Initial Licensure of a Nursing Home
$500 for Initial Licensure of a Multilevel Continuing Care Facility
The applicant will also have to submit a fee for an initial survey, which varies and is based on the number of beds.
AHCA accepts application information via fax, mail, and email. The preferred methods for AHCA to receive applications are as follows:
Common Issues with AHCA Licensure
Ensuring that the project provides sufficient space for the number of beds, services and future growth is critical. Inadequate sizing can result in revoked permits and expensive remodels. Assembling an expert team of design professionals with strong regulatory experience is essential.
Another common problem occurs when planners fail to take a total project view, especially with respect to relying on a letter of intent from a financier. A financing letter is only as good as the financial institution that is offering it. While a useful tool for demonstrating to AHCA that the financing is "reasonably assured" , a home or skilled facility cannot rely on a letter in lieu of an actual financing commitment.
Many license applicants do not understand that in the eyes of AHCA, the operator and the owner are one in the same. Direct and indirect ownership interests are a red flag to AHCA. Planning for the future is important. AHCA views the operation of three or more facilities by the same people as a corporation. Every corporation must be incorporated in Florida and licensed as a Florida corporation. If three facilities are operated by the same people, they must be organized under separate Florida corporations even if they have common ownership.
Complying with AHCA Standards
An ACHA license is not permanent after you have obtained one, as facilities are subject to periodic inspections and must renew their license every three years. ACHA inspects licensed healthcare facilities at least every 24 months to ensure that they meet the individual requirements for that type of facility. Upon showing full compliance with the standards for licensure, the facility will be granted a full license for three years. Each facility must apply for a license renewal by January 31 the year that its license expires. The renewal application must include supporting documents of compliance with standards, and facilities may not have a lapse in licensing. Permitting the license to lapse results in penalties.
Advantages of Obtaining an AHCA License
There are several benefits to holding an AHCA License. First, it provides legitimacy to healthcare facilities or entities. Without AHCA Licensure, a healthcare entity cannot legally operate in the state. For example, unless an assisted living facility holds an Assisted Living Facility license, its administrators cannot perform basic functions of management that require the authority granted by such a license, including over the following: remove, transfer, or discharge a resident who poses a danger to him or herself; manage and direct the ongoing operation of the facility; or handle the funds of the facility . Additionally, healthcare operations that lack an AHCA Licensure for the type of facility they offer are barred from contracting with an insurance company, further disallowing operations that require licensure from collecting compensation for such treatment. Further, without licensure, a healthcare entity is barred from taking advantage of Medicare or Medicaid reimbursement programs.