reglab/statecodes huggingface dataset:
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-13 - HEALTH PLAN QUALITY INDICATORS › Section 59B-13.001 - Health Plan Quality Indicators

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Reporting Instructions.
(a) Any health
				maintenance organization authorized to transact business in the state under
				chapter 641, F.S., as of January 1 of the report year shall report access and
				quality indicator data for Florida members to the Agency as identified in this
				rule and specified in the Healthcare Effectiveness Data and Information Set
				(HEDIS) Volume 2: Technical Specifications for Health Plans developed by the
				National Committee for Quality Assurance (NCQA), 1100 13th St. NW, Third Floor,
				Washington, DC 20005.
(b) Beginning
				with calendar year 2018 data, each health maintenance organization shall submit
				indicator data for each calendar year period no later than October 1 of the
				following year.
(c) Extensions to
				the indicator data due date will be granted by the Agency for a maximum of 30
				days from the due date in response to a written request signed by the chief
				executive officer of the health maintenance organization or his/her designee.
				The request must be received prior to the due date and the delay must be due to
				unforeseen and unforeseeable factors beyond the control of the reporting health
				maintenance organization. Extensions shall not be granted verbally.
(d) Each health maintenance organization must
				submit the HEDIS measures from the NCQA Interactive Data Submission System
				(IDSS) file as an Excel file.
(e)
				Each health maintenance organization shall send indicator data by electronic
				mail to HMOguide@ahca.myflorida.com and shall include in the electronic mailing
				the following information:
1. "HMO Indicator
				Data";
2. Health maintenance
				organization identification number assigned by the Agency;
3. Health maintenance organization name;
				and
4. File name in the format
				HMOyyyy.xls where yyyy is the year of the indicator
				data.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-13 - HEALTH PLAN QUALITY INDICATORS › Section 59B-13.002 - Definitions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.063(2), 408.08(5), 408.15(11), 641.51(9)
					 FS.
New 6-27-00, Repealed
					 12-4-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-13 - HEALTH PLAN QUALITY INDICATORS › Section 59B-13.003 - Uniform Data Specifications (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.063(2), 408.08(5), 408.15(11), 641.51(9)
					 FS.
New 6-27-00, Amended 10-22-02, Repealed
					 12-4-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-13 - HEALTH PLAN QUALITY INDICATORS › Section 59B-13.004 - Certification (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.063(2), 408.08(5), 408.15(11), 641.51(8)
					 FS.
New 6-27-00, Repealed
					 12-4-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-13 - HEALTH PLAN QUALITY INDICATORS › Section 59B-13.005 - Penalties for Report Deficiencies (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.063(2), 408.08(5), 408.15(11), 641.51(8)
					 FS.
New 6-27-00, Repealed
					 12-4-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-13 - HEALTH PLAN QUALITY INDICATORS › Section 59B-13.006 - Uniform Publication Format (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.063(2), 408.08(5), 408.15(11), 641.51(9)
					 FS.
New 6-27-00, Amended 10-22-02, Repealed
					 12-4-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.001 - Purpose

Current through Reg. 50, No. 138; July 16, 2024
(1) The rules in this chapter describe the
				requirements for reporting satisfaction survey data to the Agency for Health
				Care Administration (agency) for the purpose of providing consumers with
				comparative information about consumers' experience with their health plan or
				their health care if that experience is directly related to the services
				provided by all types of health plans subject to these requirements.
(2) The rules in this chapter describe the
				requirements for reporting information about the health insurer's health plans
				to the agency for the purpose of providing descriptive information about health
				plans to consumers.
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.061(1)(c), (e) FS.
New 12-25-05.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.002 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) "Health plan" means a health benefit plan
				as defined in Section
				627.6699(3)(k),
				F.S., that is, any hospital or medical policy or certificate, hospital or
				medical service plan contract, or health maintenance organization subscriber
				contract. The term does not include accident-only, specified disease,
				individual hospital indemnity, credit, dental-only, vision-only, Medicare
				supplement, long-term care, or disability income insurance; similar
				supplemental plans provided under a separate policy, certificate, or contract
				of insurance, which cannot duplicate coverage under an underlying health plan
				and are specifically designed to fill gaps in the underlying health plan,
				coinsurance, or deductibles; coverage issued as a supplement to liability
				insurance; workers' compensation or similar insurance; or automobile
				medical-payment insurance. The term does not include Medicare health plans,
				Medicaid health plans, or Florida Healthy Kids health plans described in
				Section 624.91, F.S. The term does not
				include limited or short term hospital, medical or surgical benefit
				policies.
(2) "Measurement year"
				means the year prior to the year in which the report is due to be submitted to
				the Agency for Health Care Administration (agency).
(3) "Insured" means a person who has health
				care coverage under a health plan of the health insurer.
(4) "Covered lives" means the sum of primary
				insureds (the total number of resident individual policyholders or resident
				group employee or member certificateholders) and covered dependents (the total
				number of individuals who are covered by the primary insured's plan and who
				receive coverage due to his or her dependent relationship to the primary
				insured).
(5) "Cost sharing" means
				any co-insurance, co-payment, deductible or similar arrangement the member
				agrees to pay upon receipt of covered health care
				services.
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.061(1)(c), (e) FS.
New 12-25-05.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.003 - Exclusions

Current through Reg. 50, No. 138; July 16, 2024
Health insurers who meet the criteria in subsections (1), (2)
				  or (3) of this section are exempt from the data collection and reporting
				  requirements of Rules
				  59B-14.001 through
				  59B-14.008, F.A.C.
(1) Health insurers with less than $1, 000,
				000 in direct premiums earned for new and renewal business specific to covered
				Florida residents from all health plans as described in subsection
				59B-14.002(1),
				F.A.C., in the year prior to the measurement year.
(2) Health insurers with less than 5, 000
				covered lives in the state of Florida for all health plans excluding
				self-insured plans at any time during the measurement year.
(3) New health insurers starting operations
				after January 1 of the measurement year excluding health insurers formed by the
				merger of one or more health insurers that had more than $1, 000, 000 in direct
				premiums earned for new and renewal business specific to covered Florida
				residents from all health plans as described in subsection
				59B-14.002(1),
				F.A.C., in the year prior to the measurement year.
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.061(1)(c), (e) FS.
New 12-25-05.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.004 - Satisfaction Survey Reporting Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1) Beginning July 1, 2006, health insurers
				shall report annual survey data using the Consumer Assessment of Health Plans
				(CAHPS) questionnaire of the National Committee for Quality Assurance (NCQA)
				and supplemental questions described in paragraphs (a), (b) and (c) below to
				the Agency for Health Care Administration (agency) performed for a random
				sample of Florida insureds fielded during the first half of the year following
				the measurement year except that health insurers defined under Chapter 627,
				F.S., shall report selected CAHPS data to include health plan customer service,
				health plan claims processing, obtaining information about the health plan,
				overall satisfaction with the health plan, age of insured, gender of insured,
				health status of insured, race of insured, level of education of insured,
				ethnic group of insured and the supplemental questions described in paragraphs
				(a), (b) and (c) of this subsection. The data shall be submitted with an
				acceptable audit report as provided in subsection (6) below.
(a) Would you recommend your health plan to
				your family or friends?
1. Definitely
				yes;
2. Probably yes;
3. Probably not;
4. Definitely not.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.005 - Health Plan Reporting Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Health insurers shall report health plan data to the Agency for Health Care
				Administration (agency) on July 1 of each year for each of the insureds
				included in the satisfaction survey results to be reported on July 1 of the
				same year as specified in Rule
				59B-14.004, F.A.C. The reported
				health plan data must be current as of the date the sampling frame is
				prepared.
(2) Health plan data
				shall be reported for each insured sampled as described in paragraphs (a)
				through (f) below. All data elements (a) through (f) are required except that
				data elements (e) and (f) may be reported as UNKNOWN if the information is
				missing or unavailable. The percentage of unknown responses for any data
				element must not exceed 2 percent of total records, except that for measurement
				year 2005, the percentage of unknown responses for any data element must not
				exceed 5 percent of total records.
(a) Report
				the Florida company code assigned by the Florida Office of Insurance
				Regulation.
(b) Report the NAIC
				company code as assigned by the National Association of Insurance
				Commissioners.
(c) Report the
				measurement year in four digits.
(d) Designate the plan type as:
1. Health plan of health maintenance
				organization as defined under Chapter 641, F.S.; or
2. Health plan of health insurer defined
				under Chapter 627, F.S.
(e) Report the county of record for the
				insured in text, capitalizing the first letter, without using abbreviations or
				the word "County." Report the insured's county of residence except for employer
				groups, report the county where the employer is located. Report Dade County as
				Miami-Dade.
(f) Designate covered
				benefits as:
1. Network; or
2. No network.
If the health plan conditions payment of covered benefits on
				  the use of providers with whom the health insurer has entered into written
				  agreements to provide such benefits by altering cost sharing or in any manner
				  altering covered benefits, report subparagraph 1. network. If the health plan
				  does not condition payment of covered benefits on the use of providers who have
				  entered into written agreements with the health insurer to provide such
				  benefits by altering cost sharing or in any manner altering covered benefits,
				  report subparagraph 2. no network. Report responses as a single digit, 1 or
				  2.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.006 - Health Plan Contact Information

Current through Reg. 50, No. 138; July 16, 2024
(1) Each
				health insurer shall include the following company and contact information when
				submitting a report required in this section to the Agency for Health Care
				Administration:
(a) Name of company;
(b) Florida company code assigned by the
				Florida Office of Insurance Regulation;
(c) NAIC company code as assigned by the
				National Association of Insurance Commissioners;
(d) Measurement year;
(e) Covered lives in Florida on December 31
				of the measurement year;
(f) Year
				beginning continuous license in Florida;
(g) Company website;
(h) Company telephone number;
(i) Contact name;
(j) Contact title;
(k) Contact address;
(l) Contact direct telephone
				number;
(m) Contact e-mail
				address;
(n) Contact FAX
				number;
(o) Survey vendor
				name;
(p) Survey vendor
				organization;
(q) Survey vendor
				telephone number;
(r) Auditor
				name;
(s) Auditor
				organization;
(t) Auditor telephone
				number; and,
(u) Designate plan
				type as:
1. Health plans of health maintenance
				organizations as defined under Chapter 641, F.S.; or
2. Health plans of health insurers defined
				under Chapter 627, F.S.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.007 - Certification

Current through Reg. 50, No. 138; July 16, 2024
(1) Each health insurer shall provide
				certification that the survey in Rule
				59B-14.004, F.A.C., was
				performed according to NCQA specifications and that the information submitted
				is true and accurate as provided in Section
				408.061(1)(c),
				F.S.
(2) The certification shall be
				submitted to the Agency for Health Care Administration (agency) by July 1 of
				each year using the Certification of Health Plan Consumer Report form (HPCR-1)
				incorporated by reference. The HPCR-1 will be available from the agency website
				at: http://ahca.myflorida.com/. The signed Certification of Health Plan
				Consumer Report may be submitted electronically using a pdf file with a scanned
				signature.
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.061(1)(c), (e) FS.
New 12-25-05.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-14 - HEALTH PLAN CONSUMER REPORT › Section 59B-14.008 - Administrative Penalties

Current through Reg. 50, No. 138; July 16, 2024
(1) Failure to
				report as required in this section in whole or in part is subject to
				administrative fines as provided in Section
				408.08(5),
				F.S., unless the health insurer has been granted an extension of up to 30 days
				by the Agency for Health Care Administration for reasons of extraordinary or
				hardship circumstances such as a natural disaster or emergency event impacting
				the health insurer or the collection of data required in this section. Health
				insurers must request the extension, in writing, prior to the due dates
				specified in Rules 59B-14.004 and
				59B-14.005, F.A.C.
(2) The Agency for Health Care Administration
				shall notify the Office of Insurance Regulation if a health insurer fails to
				report in whole or in part as provided in Section
				408.08(4),
				F.S.
Rulemaking Authority 408.08(4), 408.08(5), 408.15(8),
					 408.15(11) FS. Law Implemented
					 408.061(1)(c),
					 (e)
					 FS.
New 12-25-05.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.001 - Purpose (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e) FS. Law
					 Implemented 408.05(3)(l)1. FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.002 - Definitions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e) FS. Law
					 Implemented 408.05(3)(l)1. FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.003 - Exclusions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e) FS. Law
					 Implemented 408.05(3)(l)1. FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.004 - Reporting Requirements (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e) FS. Law
					 Implemented 408.05(3)(l)l. FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.005 - Hospital Contact Information (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e) FS. Law
					 Implemented 408.05(3)(l)1. FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.006 - Certification (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e) FS. Law
					 Implemented 408.05(3)(l)1. FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-15 - SURGICAL INFECTION PREVENTION DATA COLLECTION › Section 59B-15.007 - Administrative Penalties (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 408.061(1)(a), 408.061(1)(e), 408.08(2),
					 408.08(5), 408.15(11) FS. Law Implemented 408.05(3)(l)1.
					 FS.
New 11-27-05, Repealed
					 6-8-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-16 - ELECTRONIC HEALTH RECORDS › Section 59B-16.001 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
As used in Rules
				  59B-16.001 through
				  59B-16.002, F.A.C.:
(1) "Health care provider" means any person
				or organization that furnishes, bills, or is paid for health care services in
				the normal course of business.
(2)
				"Electronic format" means an electronic copy of the forms provided in Rule
				59B-16.002, F.A.C., in a
				Portable Document Format (PDF).
Rulemaking Authority 408.051(4)(b), 408.15(8) FS. Law
					 Implemented 408.051(4) FS.
New 7-28-10, Amended
					 5-14-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-16 - ELECTRONIC HEALTH RECORDS › Section 59B-16.002 - Universal Patient Authorization Forms

Current through Reg. 50, No. 138; July 16, 2024
(1) The Universal Patient Authorization Form
				for Full Disclosure of Health Information for Treatment and Quality of Care
				including instructions for completing the form is posted at:
www.FHIN.net
. The form may be printed,
				completed, signed and scanned into an electronic format as provided in
				subsection 59B-16.001(2),
				F.A.C. The Universal Patient Authorization Form for Full Disclosure of Health
				Information for Treatment and Quality of Care, Form Florida AHCA FC4200-004
				7.1.2011 is incorporated by reference and the Spanish language version,
				Formulario de Autoización Universal para Dar a Conocer
				Información Médica Completa para Tratamiento & Calidad de
				Cuidado, Form Florida AHCA FC4200-006 7.1.2011,
https://www.flrules.org/gateway/reference.asp?NO=Ref-01202
,
				is incorporated by reference.
(2)
				The Universal Patient Authorization Form for Limited Disclosure of Health
				Information including instructions for completing the form is posted at:
www.FHIN.net
. The form may be printed,
				completed, signed and scanned into an electronic format as provided in
				subsection 59B-16.001(2),
				F.A.C. The Universal Patient Authorization Form for Limited Disclosure of
				Health Information, Form Florida AHCA FC4200-005 7.1.2011 is incorporated by
				reference and the Spanish language version, Formulario de Autoización
				Universal para Dar a Conocer Información Médica Completa para
				Tratamiento & Calidad de Cuidado, Form Florida AHCA FC4200-006 7.1.2011,
https://www.flrules.org/gateway/reference.asp?NO=Ref-01202
.
Rulemaking Authority 408.051(4)(b), 408.15(8) FS. Law
					 Implemented 408.051(4) FS.
New 7-28-10, Amended
					 5-14-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59B - Cost Management and Control › Chapter 59B-17 - DIABETES OUPATIENT SELF-MANAGEMENT › Section 59B-17.001 - Diabetes Outpatient Self-Management Training and Educational Services Standards

Current through Reg. 50, No. 138; July 16, 2024
All health insurance policies, group health insurance
				  policies and health maintenance contracts subject to the requirements of
				  Sections 627.6408,
				  627.65745 and
				  641.31, F.S., shall provide, if
				  the patient's treating provider or a provider who specializes in the treatment
				  of diabetes certifies that such services are necessary:
Diabetes outpatient self-management training and education
				  services based on the current standards endorsed by the American Diabetes
				  Association as outlined in the "National Standards for Diabetes Self-Management
				  Education and Support" published in Diabetes Care, September 20, 2012, which is
				  incorporated by reference. Copies of these standards are available from the
				  Agency for Health Care Administration, Bureau of Managed Health Care, 2727
				  Mahan Drive, Mail Stop #26, Tallahassee, FL 32308, or the American Diabetes
				  Association at 1701 North Beauregard Street, Alexandria, VA
				  22311.
Rulemaking Authority 627.6408(3), 627.65745(3), 641.31(26)
					 FS. Law Implemented 627.6408, 627.65745, 641.31
					 FS.
New 6-25-13.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.001 - Purpose (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.034(5), 408.15(8) FS. Law
					 Implemented 408.031-.045 FS.
New 1-1-77, Amended 11-1-77, 6-5-79, 4-25-80, 2-1-81,
					 Formerly 10-5.01, Amended 11-17-87, Formerly 10-5.001, Repealed
					 10-31-96.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.002 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) "Applicant" means any individual,
				partnership, corporation, or governmental entity which has filed an application
				for a Certificate of Need with the Agency.
(2) "Application" means the forms supplied by
				the Agency to an applicant which are to be completed in order to be eligible to
				be considered for a Certificate of Need.
(3) "Audited financial statement" means all
				pages of the financial statements of the applicant that have been examined by
				an independent certified public accountant in accordance with generally
				accepted auditing standards as set forth in Statements on Auditing Standards
				published by the American Institute of Certified Public Accountants, on which
				the certified public accountant expresses an opinion as to the fairness with
				which the financial statements present financial position, results of
				operations, and changes in financial position in conformity with generally
				accepted accounting principles as established by the American Institute of
				Certified Public Accountants and the Financial Accounting Standards
				Board.
(4) "Batching Cycle" means
				the grouping for comparative review of Certificate of Need applications
				submitted for beds, services or programs having a like Certificate of Need need
				methodology or licensing category in the same planning horizon and the same
				applicable District or subdistrict.
(5) "By or on behalf of" means any action
				taken directly or indirectly by a health care facility or health maintenance
				organization which will result in any leasehold or ownership interest for the
				health care facility or health maintenance organization.
(6) "Capital project" means a project,
				whether subject to or not subject to Certificate of Need review, which involves
				a capital expenditure as defined in Section
				408.032(2),
				F.S., and which the applicant has approved via authorization to execute. For
				projects subject to Certificate of Need review, a capital project approved by
				the applicant also means:
(a) A project
				involving a capital expenditure for which a notice of intent to grant a
				Certificate of Need has been issued; or
(b) A project involving a capital expenditure
				for which a notice of intent to deny a Certificate of Need is in litigation, or
				could still be litigated within any remaining part of the 21-day period
				provided by Section 408.039(5)(a),
				F.S.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.0025 - Threshold Adjustment Methodology (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.034(5), 408.15(8) FS. Law
					 Implemented 408.032(1), (15) FS.
New 1-31-91, Formerly 10-5.0025, Amended 11-11-93, 1-31-94,
					 2-8-95, 2-12-96, 2-27-97, Repealed
					 10-8-97.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.003 - Applicability of Projects for Review (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.034(5), 408.15(8) FS. Law
					 Implemented 408.036 FS.
New 1-1-77, Amended 6-5-79, 2-1-81, Formerly 10-5.03,
					 Amended 11-17-87, 1-31-91, Formerly 10-5.003, Repealed
					 10-18-95.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.004 - Projects Subject to Review

Current through Reg. 50, No. 138; July 16, 2024
(1) Projects
				Subject to a Comparative Review. Unless subject to expedited review under
				Section 408.036(2),
				F.S., and subsection (2) of this rule, or exempted under Section
				408.036(3),
				F.S. and Rule 59C-1.005, F.A.C., the following
				projects are subject to comparative review and the batching cycle procedures
				specified in Rule 59C-1.008, F.A.C., and will be
				reviewed in accordance with procedures set forth in subsection
				59C-1.010(3),
				F.A.C.:
(a) The addition of beds in community
				nursing homes or intermediate care facilities for the developmentally disabled
				(ICF/DD) by new construction or alteration, unless exempt pursuant to Section
				408.036(3)(m),
				F.S.
(b) The new construction or
				establishment of additional health care facilities, including a replacement
				health care facility when the proposed project site is not located on the same
				site or within one mile of the existing health care facility, if the number of
				beds in each licensed bed category will not increase and unless exempt pursuant
				to Section 408.036(3)(j),
				F.S.
(c) The conversion from one
				type of health care facility to another that requires a certificate to
				establish.
(d) The establishment of
				a Hospice or Hospice inpatient facility.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.005 - Certificate of Need Exemption Procedure

Current through Reg. 50, No. 138; July 16, 2024
(1) Request for Exemption. Certain projects
				are subject to exemption from batched or expedited Certificate of Need review
				pursuant to Sections 408.036(3) and
				(4), F.S., provided the conditions specified
				in this rule are met. To receive an exemption, the applicant shall file a
				Certificate of Need exemption request with the Agency and provide documentation
				to justify the request. A request for exemption may be submitted at any time,
				and must be submitted to:
Agency for Health Care Administration
Certificate of Need
2727 Mahan Drive, Mail Stop #28
Tallahassee, Florida 32308
(2) General Requirements. In the case of any
				applicant filing a Certificate of Need exemption request, the request shall
				include:
(a) The type of exemption requested,
				with reference to the authorizing paragraph in Section
				408.036(3),
				F.S. Except as provided in paragraph (6)(a) or (b) of this rule, an exemption
				request must be limited to a single type of exemption.
(b) The name of the health care facility
				involved, and the name of the licensee. A request for exemption affecting an
				existing licensed health care facility must be submitted by the current
				licensee.
(c) The location and
				service area of the project.
(d)
				The costs of the project.
(e) The
				gross square footage of the project, if applicable.
(f) The proposed licensed bed capacity of the
				health care facility, if applicable.
(g) A non-refundable fee of two hundred and
				fifty dollars ($250) payable to the Agency for Health Care Administration in
				accordance with Section
				408.036(4),
				F.S. Exemption requests shall not be accepted by the Agency at the time of
				receipt unless accompanied by the $250 fee. Checks that are returned by the
				bank for insufficient funds will be processed consistent with the procedures
				for expedited review applications specified in subparagraph
				59C-1.008(3)(c)
				1., F.A.C.
(h) The applicable
				project specific information required by subsection (6) of this
				rule.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.008 - Certificate of Need Application Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) Letters of Intent and applications
				subject to comparative review shall be accepted in two batching cycles annually
				each for hospice programs and freestanding inpatient hospice facilities and for
				nursing homes and intermediate care facilities for the developmentally disabled
				(ICF/DD), as specified in paragraph (g) of this subsection. The category
				"hospice" includes proposals for new hospice programs and hospice inpatient
				facilities. The category "nursing homes and ICF/DDs" includes proposals for
				community nursing home projects unless the project meets criteria in Section
				408.036(2) or Section
				408.036(3),
				F.S., and intermediate care facilities for the developmentally disabled.
(a) Letter of Intent. A letter of intent
				shall state with specificity the type of project proposed with sufficient
				clarity to notify the public of the intention to file a Certificate of Need
				application. A separate letter of intent is required for each type of project
				and for each type of bed, program or facility having a separate need
				methodology or licensing category. At least 30 days prior to the applicable
				batching cycle application due date, an applicant shall file a letter of intent
				respecting the development of a proposal in the following manner:
1. The letter of intent must be actually
				received by the Agency by 5:00 p.m. (local time). The original of the letter of
				intent must be submitted to the Agency at the address in paragraph
				59C-1.008(1)(f),
				F.A.C.
2. A letter of intent is for
				a specific project within a specific geographic planning area as defined by
				rule or statute for an established planning horizon. When no planning area is
				defined, the District should be specified.
3. A prospective applicant submitting a
				letter of intent is solely responsible for its conformity with any and all
				statutory and rule criteria.
4. If
				an application is not filed on or before the earliest subsequent due date for
				filing applications of the same type as that specified in the letter of intent,
				the letter of intent will be considered invalid and a new letter of intent must
				be timely filed in a subsequent batching cycle before an application may be
				filed.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.010 - Certificate of Need Application Review Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) The Agency shall review all applications
				in the context of the review criteria specified in Section
				408.035, F.S. and Chapters 59C-1
				and 59C-2, F.A.C., and all information relevant to the criteria contained
				therein.
(2) General Provisions.
(a) Applications subject to comparative or
				expedited review shall be submitted to the Agency on AHCA Form 3150-0001,
				August 2020 "Application For A Certificate of Need" or 3150-0003, August 2020
				"Transfer of A Certificate of Need" as referenced in paragraph
				59C-1.008(1)(f),
				F.A.C.
(b) Applications for
				projects involving an existing health care facility shall be filed by the
				current license holder as listed on the current Agency license in effect at the
				time of the applicant omission deadline specified in subparagraphs (3)(a)3. or
				(4)(d)3. of this rule, or the application shall be withdrawn from
				consideration. Applications submitted by corporations required to have filed
				incorporation papers or foreign corporation papers in order to do business in
				Florida must be able to do business in Florida prior to notifying the Agency of
				its intentions in a comparative review cycle or by the time it files an
				expedited application, if the project is subject to expedited review.
(c) An application shall not be deemed
				complete by the Agency unless all information required by statute and rule has
				been submitted by the applicant.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.0105 - Certificate of Need Post Application Review Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) Batched Reviews. The following procedure
				will be utilized in issuance of letters of intent to grant or deny a
				Certificate of Need in a batched review:
(a)
				Upon signature of the State Agency Action Report by the Agency Director or
				designee, a letter of intent to grant or deny will be sent to the
				applicant.
(b) A notice of the
				Agency's Intent to Issue or Deny will be published in the Florida
				Administrative Register. This notice will report initial Agency action and
				include: the Certificate of Need number, type of project, District and, if
				applicable, subdistrict location.
(c) If the initial Agency action is to issue
				a Certificate of Need and there is no valid request for an Administrative
				Hearing or timely appeal, a Certificate of Need will be prepared no later than
				35 days following the publication in paragraph (1)(b) above. The issuance date
				of the Certificate of Need will be the 22nd day following the publication in
				paragraph (1)(b) above.
(d) If the
				initial Agency action is appealed, the issuance or denial of the Certificate of
				Need is dependent upon the method of resolution.
(e) If the initial Agency action is to deny a
				Certificate of Need and no valid request for an Administrative Hearing has been
				filed, a letter advising the applicant that the initial decision has become the
				final decision by the operation of law will be prepared no later than 35 days
				following publication in paragraph (1)(b) above. The effective date of the
				denial will be the 22nd day following the publication in paragraph (1)(b)
				above.
(f) If the initial Agency
				action is to approve an identifiable portion of an application, then this
				action also contains an initial Agency action to deny the full application. If
				there is no valid request for an Administrative Hearing, a Certificate of Need
				will be issued for the identifiable portion, a letter recognizing the operation
				of law will be prepared no later than 35 days following publication in
				paragraph (1)(b) above. The effective date of the denial will be the 22nd day
				following the publication in paragraph (1)(b) above.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.013 - Monitoring Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) General
				Provisions. The Agency, with the assistance of the local health councils, shall
				monitor the Certificate of Need holder's progress in meeting the approved
				timetable for project development. In addition, the Agency shall monitor the
				holder's compliance with conditions as specified on the Certificate of Need. A
				condition is defined as a specific requirement expressed on the face of a
				Certificate of Need under the heading "conditions".
(2) Project Status Reports.
(a) The Agency shall require the Certificate
				of Need holder to provide periodic status reports regarding progress in meeting
				the timetable. The timetable submitted with the application or otherwise
				modified by agreement between the Certificate of Need holder and the Agency is
				binding for the following steps:
1. Commence
				construction;
2. Construction
				completed;
3. Survey for
				certificate of occupancy;
4.
				Licensure of project; and,
5.
				Facility in use.
Prior to commencing construction, the Certificate of Need
				  holder will submit a revised project timetable, if necessary, which specifies
				  the month, day, and year for completion of each of the five steps identified
				  above.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.017 - Local Health Councils (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.033(1)(a) FS.
New 7-15-82, Amended 10-1-83, Formerly 10-5.17, Amended
					 11-24-86, Formerly 10-5.017, Repealed
					 10-18-95.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.018 - Termination of Certificate of Need

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Validity Period of Certificate of Need. A Certificate of Need shall terminate
				18 months from the date of issuance unless the holder meets the applicable
				conditions for an extension set forth in Section
				408.040(2),
				F.S., and this rule.
(2)
				Undertaking a Project Authorized by a Certificate of Need. A Certificate of
				Need will terminate after the 18-month time frame set forth in subsection (1)
				unless the applicant meets one of the minimum requirements described below:
(a) Certificates of Need for New Construction
				or Renovation Projects.
1. A holder of a
				Certificate of Need with a project for new construction must, by the date of
				termination of the Certificate of Need, be deemed to have commenced continuous
				construction as defined in Section
				408.032(4),
				F.S. For purposes of compliance, site preparation must be completed as defined
				below:
a. Completion of site preparation
				activities which include clearing of land, removal of soil, placement and
				compacting of fill dirt, and grading and leveling of the site for that portion
				of the site which will contain the foundation;
b. Foundation permit;
c. Completion of footprint of the
				certificated portion of the building, unless the contractor is building a
				hospital using the fast-track method of construction and the agreement between
				the contractor and the Certificate of Need holder provides for the use of that
				method; and,
d. Foundation forming
				with placement of concrete and steel which will become an integral part of the
				final facility to be constructed.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.019 - Modification of Certificate of Need

Current through Reg. 50, No. 138; July 16, 2024
(1) A
				modification is defined as an alteration to an issued, valid Certificate of
				Need, or an alteration to the condition or conditions on the face of a
				Certificate of Need for a health facility or service that has been licensed,
				where such an alteration does not result in a project subject to review as
				specified in either Sections
				408.036(1) or
				(2), F.S.
(2) A Certificate of Need holder desiring
				modification of a Certificate of Need shall submit a written request to the
				Agency documenting good cause for modification. A request to reduce the number
				of beds granted in a Certificate of Need prior to licensure of the beds shall
				show the financial impact of the reduction by revising Schedules 1 and 3 and 7
				and 8 or 7a and 8a that were submitted with the application for a Certificate
				of Need, as found in AHCA Form 3150-0001, August 2020 and incorporated by
				reference in paragraph
				59C-1.008(1)(f),
				F.A.C.
(3) Good cause includes, for
				example:
(a) Changes in the adequacy of
				reimbursement, or
(b) Changes in
				the overall ability of the health care facility or Hospice for which the
				Certificate of Need was issued to cover its costs if such changes are of such a
				degree that the continued viability of the health care facility or Hospice is
				seriously threatened, or
(c)
				Changes in Agency rules and regulations substantially affecting the
				project.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.020 - Effect on Licensure (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.034(8), 408.15(8) FS. Law
					 Implemented 408.034(2) FS.
New 11-24-86, Amended 7-25-89, 1-31-91, Formerly 10-5.020,
					 Amended 12-12-00, Repealed 8-8-21.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59C - Certificate of Need › Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT › Section 59C-1.021 - Certificate of Need Penalties

Current through Reg. 50, No. 138; July 16, 2024
(1) General
				Provisions. The Agency shall initiate administrative proceedings for revocation
				of a Certificate of Need for violation of Sections
				408.040(2)(a) and
				(b), F.S., or the assessment of
				administrative fines for failure to comply with conditions placed on a
				Certificate of Need as specified under Rule
				59C-1.013, F.A.C.
(2) Certificate of Need Revocation. The
				Agency shall issue an administrative complaint seeking revocation of a
				Certificate of Need if the Agency determines that the Certificate of Need
				holder has not made a good faith effort to undertake the project as approved or
				to meet the approved project timetables. A holder shall be deemed to have made
				a "good faith effort" if the following requirements are met.
(a) Projects which cease continuous
				construction for a period in excess of 30 calendar days shall perform the
				following steps:
1. Within 35 calendar days of
				work stoppage, notify the Agency in writing of a break in construction and
				submit for approval, documentation verifying the holder's inability to control
				the break in construction.
2.
				Within 45 calendar days of work stoppage, submit to the Agency for approval, a
				plan for recommencement of construction not to exceed 90 calendar days. The
				revised dates may increase the amount of time elapsed within and among the
				steps set forth in the original application for completion of the
				project.
3. Within 15 calendar days
				of the projected restart time, the holder shall submit to the Agency a letter
				from the project's architect certifying that the project has restarted
				construction in accordance with the approved plan submitted under this
				paragraph.