Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59A - Health Facility and Agency Licensing › Chapter 59A-12 - HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH CLINICS › Section 59A-12.003 - Administration, Forms, Fees

Current through Reg. 50, No. 138; July 16, 2024
(1) Application.
				"Application for Health Care Provider Certificate", AHCA Form 3002, Feb. 1998,
				obtained from the Agency for Health Care Administration, 2727 Mahan Drive, Mail
				Stop #26, Tallahassee, Florida 32308, which forms are incorporated herein by
				reference, must be completed in the manner specified within the application in
				order for each individual item to be considered complete for the purpose of
				determining that a properly completed application has been filed. The
				application shall be accompanied by a filing fee of $1, 000.00 payable to AHCA
				and shall be completed by each entity desiring to obtain a Health Care Provider
				Certificate as an HMO or PHC. The application shall specify the contact person
				or persons for the HMO or PHC. During the review of the entity only contact
				persons specified within the application shall be allowed access to the
				application materials submitted.
(2) Application Review Process for Health
				Care Provider Certificate. Upon receipt of the Application for Health Care
				Provider Certificate from a proposed HMO or PHC, AHCA shall review the
				application within 30 days of receipt. AHCA shall provide notification to the
				proposed HMO or PHC of deficiencies in the application within this 30-day
				period. The applicant has 90 days from the date of the filing of the
				application to file any additional information requested by AHCA. By the end of
				the 90-day period if the additional information has not been received the
				application will be denied in accordance with Chapter 120, F.S. Within 90 days
				after the application has been completed AHCA shall approve or deny the
				application.
(3) Certificate of
				Authority. The application for a Health Care Provider Certificate must include
				a copy of the letter from the Department of Financial Services accepting the
				receipt of an application for a Certificate of Authority submitted by the
				organization.
(4) Geographic Area
				Expansions. The HMO or PHC may not change its geographic area unless it follows
				the applicable requirements set forth in Section
				641.495(2),
				F.S. Each HMO or PHC shall submit the required notarized "Affidavit by HMO for
				Expansion of Service Area", AHCA Form 3160-1005, April 2002, which is hereby
				adopted and incorporated by reference. Copies may be obtained by writing AHCA,
				2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308.
(5) Annual Assessment. The Agency for Health
				Care Administration shall determine the regulatory assessment percentage
				necessary to be imposed for each calendar year. AHCA Form "Regulatory
				Assessment Worksheet for Health Maintenance Organizations, Prepaid Health
				Clinics, and Exclusive Provider Organizations", AHCA Form 3160-1004, July 1995,
				which is hereby adopted and incorporated by reference, will be provided to the
				organization for calculating the annual regulatory assessment percentage and
				premium volume. Copies may be obtained by writing the Agency for Health Care
				Administration, 2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308.
				The annual regulatory assessment shall not exceed the statutory limitations and
				must be paid by the date specified in the Administrative Assessment
				Order.
Rulemaking Authority 641.36, 641.41, 641.56, 641.58 FS. Law
					 Implemented 120.60(2), 641.21, 641.22, 641.47, 641.495
					 FS.
New 1-28-88, Formerly 10D-100.003, Amended
					 4-10-03.