Agency for Health Care Administration ASPEN: Regulation Set (RS) Page 1 of 92 Printed 10/15/2015 Aspen State Regulation Set: D 2.01 Adult Day Care (Licensure) ST - D0000 - INITIAL COMMENTS Type Memo Tag Statute or Rule Title INITIAL COMMENTS Interpretive Guideline Regulation Definition These guidelines are meant solely to provide guidance to surveyors in the survey process. ST - D0001 - GENERAL LICENSURE STANDARD Type Rule Statute or Rule 429.907(1-4) Title GENERAL LICENSURE STANDARD Interpretive Guideline Regulation Definition 429.907 (1) The requirements of part II of chapter 408 apply to the provision of services that require licensure pursuant to this part and part II of chapter 408 and to entities licensed by or applying for such licensure from the Agency for Health Care Administration pursuant to this part. A license issued by the agency is required in order to operate an adult day care center in this state. (2)(a) Except as otherwise provided in this subsection, separate licenses are required for centers operated on separate premises, even though operated under the same management. Separate licenses are not required for separate buildings on the same premises. (b) If a licensed center becomes wholly or substantially unusable due to a disaster or due to an emergency as those terms are defined in s. 252.34: 1. The licensee may continue to operate under its current license in premises separate from that authorized under the license if the licensee has: Surveyor Probes: Examine the center license: 1. Is it current? 2. Is the license displayed in a conspicuous place? NOTE: Shared areas between assisted living facility and ADCC are surveyed with assisted living facility . If the center is not licensed, notify the center operator that operating without a license is a 2nd degree misdemeanor. Failure to apply for a license within 10 days notification will result in the Agency obtaining an injunction to close the center. oRegSet.rpt
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Agency for Health Care Administration
ASPEN: Regulation Set (RS)
Page 1 of 92Printed 10/15/2015
Aspen State Regulation Set: D 2.01 Adult Day Care (Licensure)
ST - D0000 - INITIAL COMMENTS
Type Memo Tag
Statute or Rule
Title INITIAL COMMENTS
Interpretive GuidelineRegulation Definition
These guidelines are meant solely to provide guidance to surveyors in the survey process.
ST - D0001 - GENERAL LICENSURE STANDARD
Type Rule
Statute or Rule 429.907(1-4)
Title GENERAL LICENSURE STANDARD
Interpretive GuidelineRegulation Definition
429.907 (1) The requirements of part II of chapter 408
apply to the provision of services that require licensure
pursuant to this part and part II of chapter 408 and to
entities licensed by or applying for such licensure from
the Agency for Health Care Administration pursuant to
this part. A license issued by the agency is required in
order to operate an adult day care center in this state.
(2)(a) Except as otherwise provided in this subsection,
separate licenses are required for centers operated on
separate premises, even though operated under the
same management. Separate licenses are not required
for separate buildings on the same premises.
(b) If a licensed center becomes wholly or substantially
unusable due to a disaster or due to an emergency as
those terms are defined in s. 252.34:
1. The licensee may continue to operate under its
current license in premises separate from that
authorized under the license if the licensee has:
Surveyor Probes:
Examine the center license:
1. Is it current?
2. Is the license displayed in a conspicuous place?
NOTE: Shared areas between assisted living facility and ADCC are surveyed with assisted living facility .
If the center is not licensed, notify the center operator that operating without a license is a 2nd degree
misdemeanor. Failure to apply for a license within 10 days notification will result in the Agency obtaining
an injunction to close the center.
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a. Specified the location of the premises in its
comprehensive emergency management plan submitted
to and approved by the applicable county emergency
management authority; and
b. Notified the agency and the county emergency
management authority within 24 hours of operating in
the separate premises.
2. The licensee shall operate the separate premises only
while the licensed center ' s original location is
substantially unusable and for up to 180 days. The
agency may extend use of the alternate premises
beyond the initial 180 days. The agency may also review
the operation of the disaster premises quarterly.
(3) In accordance with s. 408.805, an applicant or
licensee shall pay a fee for each license application
submitted under this part and part II of chapter 408. The
amount of the fee shall be established by rule and may
not exceed $150.
(4) County-operated or municipally operated centers
applying for licensure under this part are exempt from
the payment of license fees.
ST - D0002 - Governing Body
Type Rule
Statute or Rule 58A-6.006(1)
Title Governing Body
Interpretive GuidelineRegulation Definition
(1) The Center shall have a Governing Authority which
shall establish policies in compliance with this rule
chapter. Governing Authority, as defined in this rule
chapter, may consist of one or more people, and
designation of its membership or composition shall be
determined by the owner or operator. The Governing
Authority shall be responsible for ensuring compliance
with standards requiring that:
(a) Admission criteria shall be determined by the Owner,
Surveyor Probes:
Surveyor should ask to see center's written policies and procedures.
Review governing body by-laws for documentation of governing body responsibility to the center.
Review governing body minutes for documentation of governing body involvement in the organization and
operations of the center.
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Operator, or Governing Authority and it may limit
Participant eligibility to adults with Functional
Impairments, in need of a protective environment or a
program of therapeutic social and health activities and
services as defined in this rule chapter. The Owner or
Operator will assure that the admission of each
Participant shall be review within the confines of
specific requirements set forth below:
1. Within forty-five days prior to admission to the center,
each person applying to be a participant shall provide a
statement signed by a physician, a Florida licensed
health care provider under the direct supervision of a
physician, physician or a county public health unit
documenting freedom from tuberculosis in the
communicable form and documenting freedom from
signs and symptoms of other communicable disease.
Any participant who is diagnosed as having a
communicable disease shall be excluded from
participation until deemed non-infectious. However,
participants who have Human Immunodeficiency Virus
(HIV) infection may be admitted to the center, provided
that they would otherwise be eligible according to this
rule.
2. No participant shall be admitted or retained in a
center if the required services from the center are
beyond those that the center is licensed to provide.
3. No participant who requires medication during the
time spent at the center and who is incapable of
self-administration of medications shall be admitted or
retained unless there is a person licensed according to
Florida law to administer medications who will provide
this service. A person licensed according to Florida law
includes a physician licensed under Chapters 458 and
459, F.S., an advanced registered nurse practitioner, a
dentist, a registered nurse, licensed practical nurse, or a
physician ' s assistant.
(b) Provision is made for a safe physical plant equipped
and staffed to maintain the center and services provided
as defined in this rule chapter.
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ST - D0003 - Owner/Oper/Designee on Premises
Type Rule
Statute or Rule 58A-6.006(2)
Title Owner/Oper/Designee on Premises
Interpretive GuidelineRegulation Definition
The governing authority shall ascertain that the owner or
operator or the designated responsible person shall be
on the premises during the center's hours of operation.
If the operator is away from the center, there is a designated responsible person who is on the premises
and in charge of center operations.
Surveyor Probes:
Review governing body by-laws for documentation of designation of an operator who is responsible for
the daily operation of the center.
Review organizational charts for documentation of line authority, with the operator in charge of center
operation.
Review operators job description for verification that roles and responsibilities are included.
Is the owner/operator or designated responsible person at the center during the visit?
ST - D0005 - Closure-Notification(s)
Type Rule
Statute or Rule 429.925
Title Closure-Notification(s)
Interpretive GuidelineRegulation Definition
When a center voluntarily discontinues operation, the
Agency is notified in writing at least 60 days prior to the
discontinuance of operation. The center also informs
each participant, guardian or responsible person of the
fact and the proposed time of such a discontinuance.
The center should have written proof of notification to the Agency and participants .
Surveyor Probes:
Review Agency and participant notifications.
ST - D0006 - AdvertisingoRegSet.rpt
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Type Rule
Statute or Rule 429.917(2)
Title Advertising
Interpretive GuidelineRegulation Definition
A center licensed under this part which claims that it
provides special care for persons who have Alzheimer '
s disease or other related disorders must disclose in its
advertisements or in a separate document those
services that distinguish the care as being especially
applicable to, or suitable for, such persons. The center
must give a copy of all such advertisements or a copy of
the document to each person who requests information
about the center and must maintain a copy of all such
advertisements and documents in its records. The
agency shall examine all such advertisements and
documents in the center ' s records as part of the
license renewal procedure. An adult day care center
may not claim to be licensed or designated to provide
specialized Alzheimer ' s services unless the adult day
care center ' s license has been designated as such
pursuant to s. 429.918
Applicable advertising may include brochures, highway signs (billboards), newspaper ads, internet, and
listing or ads under adult day care centers in the telephone yellow pages, radio, and television
announcements.
Licensed hospitals, nursing homes or assisted living facilities that do not hold themselves out to the public
as an adult day care center may provide services such as social, health, therapeutic, recreational,
nutritional, or respite services during the day to non-residents.
Surveyor Probes:
Review the latest telephone directory, area newspaper, center brochures, etc. to determine compliance.
ST - D0007 - Definitions
Type Memo Tag
Statute or Rule 429.901; 429.918(2)(a & c & d) 58A-6.002
Title Definitions
Interpretive GuidelineRegulation Definition
429.901 Definitions.-As used in this part, the term:
(1) "Adult day care center" or "center" means any
building, buildings, or part of a building, whether
operated for profit or not, in which is provided through its
ownership or management, for a part of a day, basic
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services to three or more persons who are 18 years of
age or older, who are not related to the owner or
operator by blood or marriage, and who require such
services.
(2) "Agency" means the Agency for Health Care
Administration.
(3) "Basic services" include, but are not limited to,
providing a protective setting that is as noninstitutional
as possible; therapeutic programs of social and health
activities and services; leisure activities; self-care
training; rest; nutritional services; and respite care.
(4) "Department" means the Department of Elderly
Affairs.
(6) "Operator" means the licensee or person having
general administrative charge of an adult day care
center.
(7) "Owner" means the licensee of an adult day care
center.
(8) "Participant" means a recipient of basic services or
of supportive and optional services provided by an adult
day care center.
(9) "Supportive and optional services" include, but are
not limited to, speech, occupational, and physical
therapy; direct transportation; legal consultation;
consumer education; and referrals for followup services.
429.918 Licensure designation as a specialized
Alzheimer ' s services adult day care center.-
(2) As used in this section, the term:
(a) "ADRD participant" means a participant who has a
documented diagnosis of Alzheimer ' s disease or a
dementia-related disorder (ADRD) from a licensed
physician, licensed physician assistant, or a licensed
advanced registered nurse practitioner.
(c) "Specialized Alzheimer' s services" means
therapeutic, behavioral, health, safety, and security
interventions; clinical care; support services; and
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educational services that are customized for the
specialized needs of a participant ' s caregiver and the
participant who is affected by Alzheimer ' s disease or an
irreversible, degenerative condition resulting in
dementia.
(d) "Therapeutic activity" means an individual or group
activity that is intended to promote, maintain, or enhance
the ADRD participant' s physical, cognitive, social,
spiritual, or emotional health.
58A-6.002 Definitions.
(1) The following terms are defined in Section 429.901,
F.S., and are applicable to this rule chapter: adult day
care center or center, agency, basic services,
department, multiple or repeated violations, operator,
owner, participant, and supportive and optional services.
(2) Additional definitions applicable in this rule chapter
are as follows:
(a) "Activities of Daily Living" or "ADL" shall mean the
functions or tasks for self-care and shall include:
ambulation, bathing, dressing, eating, grooming,
transferring, and toileting, self-administration of
medications, and other personal hygiene activities.
(e) "Participant Capacity" shall mean the number of
Participants for which a Center is licensed to provide
care to at any given time and shall be based upon
required net floor space.
(g) "Congregate Space" shall mean climatically
controlled living rooms, dining rooms, specialized activity
rooms, or other rooms to be commonly used by all
Participants.
(h) "Daily Attendance" shall mean the number of
Participants who, during any one calendar day, attend
the Center. This count is not dependent upon, nor does
it include, the number of types of services a Participant
receives, but is an actual, individual, and unduplicated
census count.
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(i) "Functional impairment" means a physical, mental, or
social condition or cognitive deficit which restricts an
individual' s ability to perform the tasks and activities of
daily living and which impedes the individual' s capability
for self-care and independent living without assistance
or supervision from others on a recurring or continuous
basis for extended periods of time.
(k) "Major Incident" shall mean any incident for which
the Agency, Center, Staff member or other person
associated with the Center may be liable, or which has
resulted in serious injury, death or extensive property
damage. Major Incidents include, but are not limited to,
the following:
1. Death of a Participant from other than natural causes,
while in the care of the Center;
2. Threats or occurrences of riots, bombings, or other
extreme violence,;
3. Disappearance of a Participant, from the Center;
4. Assaults or batteries on or by a Participant, resulting
in severe injury or death, including, but not limited to,
sexual assaults or rape;
5. Property damage from any cause that would interrupt
routine operations or disrupt service delivery,;
6. Auto accidents with injuries involving participants;
7. Involuntary Center closure;
8. Incidents of abuse, neglect, exploitation or fraud,;
9. Employee work conduct which results in a criminal
law violation;
10. Attempted suicide by a participant while under
Center supervision.
(m) "Operator" shall mean an individual who has daily
administrative charge of an Adult Day Care Center and
who shall be designated in writing as such by the owner
or Governing Authority. An Operator of a Specialized
Alzheimer ' s Services Adult Day Care Center must meet
the educational or experiential requirements in Section
429.918(5), F.S.
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(n) "Orientation and Training Plan" shall mean a written
plan developed and reviewed at least annually, and
implemented throughout the year, which describes a
coordinated program for Staff training for each service
and for orientation of each new Staff member on Center
policies, procedures, assigned duties and
responsibilities,. The orientation and training provided
for by the Orientation and Training Plan shall begin no
later than the first day of employment.
(o) "Over the Counter Products" or "OTC Products"
shall mean medications and related products that can
be purchased legally without a prescription, including,
but not limited to, medications, vitamins, nutritional
supplements and nutraceuticals.
(p) "Participant Care Plan" shall mean a written record
documenting adult day health services, as required by
paragraph 58A-6.010(6)(d), F.A.C.
(q) "Participant File" shall mean a record, prepared and
kept by the Center which shall include: a Participant
Care Plan, documenting adult day health services
provided to the Participant, if any; medical and social
history or copies of an examination completed by a
physician; diagnosis; disabilities and limitations;
rehabilitation potential; short and long-term goals;
recommended activities; orders for medication or
modified diet, including Supervision of Self-administered
Medication; special needs for health or safety; permitted
levels of physical activity; frequency of attendance at the
Center; and notes as required in this rule chapter.
(s) "Respite Care" or "Respite" in an Adult Day Care
Center is defined as a service provided to relieve the
caregiver.
(t) "Responsible Person" shall mean any person who
has assumed the responsibility to manage the affairs
and protect the rights of any Participant of a Center. The
Responsible Person is not a legal entity, but may be a
caregiver or friend and shall in no case be affiliated with
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the facility, its operations, or its personnel, unless so
ordered by a court.
(u) "Significant Change" shall mean: a deterioration or
improvement in ability to carry out Activities of Daily
Living; a deterioration in behavior or mood to the point
where daily problems arise, or an improvement to the
point that these problems are eliminated; or a
substantial deterioration in health status or reversal of
such condition. Ordinary day-to-day fluctuations in
functioning and behavior and acute short-term illness
such as a cold are not considered Significant Changes
unless such fluctuations persist to the extent that a trend
is established.
(v) "Staff " shall mean any employee, independent
contractor, or volunteer included in the minimum Staff
ratio, who provides direct or indirect services to the
Participants and volunteers who are included in the
minimum staff ratio.
(w) "Staff Providing Direct Care for ADRD Participants"
means Staff providing personal or Specialized
Alzheimer' s Services to ADRD Participants or
Participants with dementia-related disorders, including,
but not limited to, Owners, Operators, and Assistant
Operators providing such services.
(x) "Staff in Direct Contact with ADRD Participants"
means all Staff who are not Staff Providing Direct Care
to ADRD Participants or Participants with
dementia-related disorders, but whose duties may
require them to interact with ADRD Participants or
Participants with dementia-related disorders on a daily
basis.
(y) "Supervision of Self-administered Medication" shall
mean the performance of the following tasks: reminding
Participants to take medication at the time indicated on
the prescription; opening or closing medication
container(s) or assisting in the opening of prepackaged
medication; reading the medication label to Participants;
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observing Participants while they take medication;
checking the self-administered dosage against the label
of the container; reassuring Participants that they have
obtained and are taking the dosage as prescribed;
keeping daily records of when Participants received
supervision pursuant to this subsection; and immediately
reporting apparent adverse effects on a Participant ' s
condition to the Participant' s physician and responsible
person. No Center is required to provide Supervision of
Self-administered Medication to Participants who are
capable of administering their own medication.
(z) "Supervision of Staff" shall mean guidance by a
qualified person for a Staff member' s performance of
job-related functions and activities, with initial direction
and periodic on-site inspection of the performance.
Supervision of Participants shall mean guidance and
care necessary for the health, safety and well-being of
Participants.
(aa) "Supportive and Optional Services" shall mean
optional activities and services provided by a Center, in
accordance with Rule 58A-6.010, F.A.C.
(bb) "Transportation Services" shall mean the
conveyance of Participants between the Center and a
designated location, as well as to and from services
provided directly or indirectly by the Center. No
Participant' s transportation to and from a designated
location and the Center shall exceed two hours if the
transportation is provided or arranged by the Center.
(cc) "Volunteer" shall mean an individual not on the
payroll of the Adult Day Care Center, whose
qualifications shall be determined by the Center, for
whom a written job description and Orientation and
Training Plan shall be provided and implemented.
ST - D0100 - Fiscal Standard - Participant Funds
Statute or Rule 58A-6.012(1-3)
Title Fiscal Standard - Participant Funds
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Type Rule
Interpretive GuidelineRegulation Definition
(1) The center shall establish and maintain a record of
all funds held in trust, if any, and the participant funds
shall be kept separate from the center funds. Such
funds shall be used or expended only at the request of
the participant, the participant ' s representative,
designee, surrogate, guardian, or attorney-in-fact, if
applicable.
(2) The center shall furnish at least annually, a complete
verified statement of such funds or property to the
participant or to the guardian or responsible person,
detailing the amount and items received with sources
and disposition. Such a report also shall be made at
termination or transfer from the center.
(3) Any agency, governmental or private, contributing
funds or property to the account of a participant, shall,
upon request, be entitled to receive such a statement
annually and upon termination or transfer.
The word verified as it pertains to statements would mean that the center has a copy of the statement
that was given/sent to the participant, guardian, or responsible person.
Any agency, governmental or private, contributing funds or property to the account of a participant, is
entitled to receive the annual statement upon request.
58A-6.012(3), F.A.C.
Surveyor Probes:
Surveyors should question the center operator, staff, and participants concerning the handling of
participants' funds/property, and ask to see applicable accounting records.
Contact may also be made with any guardians to see if the center handles monies for their clients.
Interview participants to determine if the facility is providing satisfactory reporting.
ST - D0101 - Fiscal Std- Current Signed Agreement On File
Type Rule
Statute or Rule 58A-6.011(6)
Title Fiscal Std- Current Signed Agreement On File
Interpretive GuidelineRegulation Definition
If the Center accepts fee-for-service Participants, there
shall be a signed agreement documenting the amount of
fee, hours and days of attendance, services to be
provided, and frequency of payment. This agreement
shall be signed by the Owner, Operator, or the Owner or
Operator ' s designee, the Participant or Responsible
Person, and recorded in the Participant ' s File. Financial
records shall be maintained and shall be current through
the last payment period.
The fee-for-service agreement must be current through the last payment period. The agreement is signed
by the owner or operator, participant, or responsible person. 58A-6. 011(6), F.A.C. Make sure all
agreements contain items a through d.
Surveyor Probes:
Review fee-for-service participants' records for documentation that the required information is included
and ask for fee-for-service fee schedule.
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ST - D0102 - Fiscal Std - Liability Insurance Coverage
Type Rule
Statute or Rule 429.909(2)(c), 58A-6.003(2)(b), -6.012(4
Title Fiscal Std - Liability Insurance Coverage
Interpretive GuidelineRegulation Definition
429.909 Application for license.-In addition to all
provisions of part II of chapter 408, the applicant for
licensure must furnish a description of the physical and
mental capabilities and needs of the participants to be
served and the availability, frequency, and intensity of
basic services and of supportive and optional services to
be provided and proof of adequate liability insurance
coverage.
58A-6.003(5)(b)
(b) Documentation of adequate liability insurance
coverage, as defined in Section 624.605, F.S., that
remains in force at all times. Such documentation must
be issued by the insurance company and must include
the name and street address of the Center, a reference
that the facility is an Adult Day Care Center, the Center '
s licensed capacity, and the dates of coverage.
58A-6.012(4)
Centers shall maintain liability insurance coverage in
force at all times. On the renewal date of the center ' s
policy or whenever a center changes policies, the center
shall file documentation with the AHCA, ADC Program,
2727 Mahan Drive, Tallahassee, FL 32308. Such
documentation shall be issued by the insurance
company, shall include the name of the center, dates of
coverage and shall meet the criteria of this chapter.
Surveyor Probes:
Review the centers liability insurance policy or certificate and verify dates of coverage to ensure the
center maintains current liability insurance coverage.
Contact the insurance agent if there is a question regarding whether or not the policy is current.
ST - D0201 - Center Record Standard
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Type Rule
Statute or Rule 58A-6.011(3)
Title Center Record Standard
Interpretive GuidelineRegulation Definition
(3) The Operator shall be responsible for the recording,
reporting and availability of Participant data, including
those records required for each Center Participant, and
program data, including those records required for
services made available to and provided to Participants
by the Adult Day Care Center. Such records shall
include:
(a) Number of Participants enrolled to current date;
(b) Average Daily Attendance as defined in this rule
chapter, based upon attendance through the end of the
preceding month;
(c) Hours of travel time current through the previous
month, if Transportation Services are provided or
arranged by the Center.
(d) Business hours of operation shall be posted in a
conspicuous place. Business hours shall mean a time
period established by the Center, as defined in its
policies, and shall be no less than five hours per day on
week days of Center operation and may include a
reduced schedule of weekend hours.
Surveyor Probes:
Review centers' participant data records as identified in items a through d.
Ascertain whether business hours are clearly posted.
ST - D0202 - Record of Staff Assignments
Type Rule
Statute or Rule 58A-6.011(5)
Title Record of Staff Assignments
Interpretive GuidelineRegulation Definition
A record shall be kept of staff assignments. Surveyor Probes:
Review governing authority policies and procedures for documentation of staff assignments .
Review personnel records for verification of staff assignments .
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ST - D0203 - Record of Major Incidents
Type Rule
Statute or Rule 58A-6.011(7-8)
Title Record of Major Incidents
Interpretive GuidelineRegulation Definition
(7) A written record shall be kept of Major Incidents
affecting Participants, Staff, Volunteers or the program
of the Center.
(8) Major Incidents, as defined in this rule chapter shall
be reported immediately to the Agency ' s Complaint
05435>, and an informal teleconference, during which
the individual must present clear and convincing
evidence to support a reasonable belief that he or she
has been rehabilitated and does not present a danger to
the health, safety, and welfare of the patient or individual
as described in Section 435.07, F.S.
(e) "FBI" means the Federal Bureau of Investigation.
(f) "FDLE" means the Florida Department of Law
Enforcement.
(g) "Level 2 Screening" means an assessment of the
criminal history record obtained through a fingerprint
search through the FDLE and FBI to determine whether
screened individuals have any disqualifying offenses
pursuant to Section 435.04 or 408.809(5), F.S. An
analysis and review of court dispositions and arrest
reports may be required to make a final determination.
(h) "Livescan Service Provider" means an entity that
scans fingerprints electronically and submits them to
FDLE.
ST - DZ802 - License or Application Denial; Revocation
Type Rule
Statute or Rule 408.815 FS
Title License or Application Denial; Revocation
Interpretive GuidelineRegulation Definition
408.815 License or application denial; revocation.- The program unit is responsible for issuing notification of enforcement action for licensure actions.oRegSet.rpt
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(1) In addition to the grounds provided in authorizing
statutes, grounds that may be used by the agency for
denying and revoking a license or change of ownership
application include any of the following actions by a
controlling interest:
(a) False representation of a material fact in the license
application or omission of any material fact from the
application.
(b) An intentional or negligent act materially affecting the
health or safety of a client of the provider.
(c) A violation of this part, authorizing statutes, or
applicable rules.
(d) A demonstrated pattern of deficient performance.
(e) The applicant, licensee, or controlling interest has
been or is currently excluded, suspended, or terminated
from participation in the state Medicaid program, the
Medicaid program of any other state, or the Medicare
program.
(2) If a licensee lawfully continues to operate while a
denial or revocation is pending in litigation, the licensee
must continue to meet all other requirements of this part,
authorizing statutes, and applicable rules and file
subsequent renewal applications for licensure and pay
all licensure fees. The provisions of ss. 120.60(1) and
408.806(3)(c) do not apply to renewal applications filed
during the time period in which the litigation of the denial
or revocation is pending until that litigation is final.
(3) An action under s. 408.814 or denial of the license of
the transferor may be grounds for denial of a change of
ownership application of the transferee.
(4) Unless an applicant is determined by the agency to
satisfy the provisions of subsection (5) for the action in
question, the agency shall deny an application for a
license or license renewal based upon any of the
following actions of an applicant, a controlling interest of
the applicant, or any entity in which a controlling interest
of the applicant was an owner or officer when the
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following actions occurred:
(a) A conviction or a plea of guilty or nolo contendere to ,
regardless of adjudication, a felony under chapter 409,
chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or 42
subsequent period of probation for such convictions or
plea ended more than 15 years before the date of the
application; or
(b) Termination for cause from the Medicare program or
a state Medicaid program, unless the applicant has been
in good standing with the Medicare program or a state
Medicaid program for the most recent 5 years and the
termination occurred at least 20 years before the date of
the application.
ST - DZ803 - License Required; Display
Type Rule
Statute or Rule 408.804 FS
Title License Required; Display
Interpretive GuidelineRegulation Definition
408.804 License required; display.-
(1) It is unlawful to provide services that require
licensure, or operate or maintain a provider that offers or
provides services that require licensure, without first
obtaining from the agency a license authorizing the
provision of such services or the operation or
maintenance of such provider.
(2) A license must be displayed in a conspicuous place
readily visible to clients who enter at the address that
appears on the license and is valid only in the hands of
the licensee to whom it is issued and may not be sold,
assigned, or otherwise transferred, voluntarily or
involuntarily. The license is valid only for the licensee,
provider, and location for which the license is issued.
(3) Any person who knowingly alters, defaces, or
- Check to see that the license is for the facility and location where it is displayed. Contact the appropriate
licensure unit if there are questions about the license.
- During tour determine if the license is displayed in a consipicuous location.
- If applicable, check to make sure the category of testing being done is reflected on the license, the
ownership given on the face of the license is accurate, that the location of the facility is the address
printed on the license, and that the license is properly displayed. Look at Z0827 Unlicensed Activity-
408.12, F.S. as unlicensed activity should be cited if there has been a change of ownership, or for clinical
laboratories, testing outside of the specialty/subspecialties printed on the license are being performed.
- Regarding Nursing Homes, refer to 400.062(2) which states:
Separate licenses shall be required for facilities maintained in separate premises, even though operated
under the same management. However, a separate license shall not be required for separate buildings
on the same grounds.
- Regarding Labs, refer to 59A-7.021(3) which states:
Separate licensure shall be required for all laboratories maintained on separate premises, as defined
under subsection 59A-7.020(27), F.A.C., including mobile laboratory units, even though operated under oRegSet.rpt
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falsifies a license certificate issued by the agency, or
causes or procures any person to commit such an
offense, commits a misdemeanor of the second degree,
punishable as provided in s. 775.082 or s. 775.083. Any
licensee or provider who displays an altered, defaced, or
falsified license certificate is subject to the penalties set
forth in s. 408.815 and an administrative fine of $1,000
for each day of illegal display.
the same management. Separate licensure shall not be required for separate buildings on the same or
adjoining grounds.
ST - DZ806 - Change of Address
Type Rule
Statute or Rule 59A-35.040(2-5), FAC
Title Change of Address
Interpretive GuidelineRegulation Definition
(2) Any request to amend a license must be received by
the Agency in advance of the requested effective date as
detailed below. Requests to amend a license are not
authorized until the license is issued.
(a) Requests to change the address of record must be
received by the Agency 60 to 120 days in advance of the
requested effective date for the following provider types :
1. Birth Centers, as provided under Chapter 383, F.S.;
2. Abortion Clinics, as provided under Chapter 390, F.S.;
3. Crisis Stabilization Units, as provided under Parts I
and IV of Chapter 394, F.S.;
4. Short Term Residential Treatment Units, as provided
under Parts I and IV of Chapter 394, F.S.
5. Residential Treatment Facilities, as provided under
Part IV of Chapter 394, F.S.;
6. Residential Treatment Centers for Children and
Adolescents, as provided under Part IV of Chapter 394,
F.S.;
7. Hospitals, as provided under Part I of Chapter 395,
F.S.;
8. Ambulatory Surgical Centers, as provided under Part I
of Chapter 395, F.S.;
- The licensure unit handles change of address, but surveyors may find that the provider has moved and
therefore could cite this.
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9. Nursing Homes, as provided under Part II of Chapter
400, F.S.;
10. Hospices, as provided under Part IV of Chapter 400,
F.S.;
11. Homes for Special Services as provided under Part
V of Chapter 400, F.S.;
12. Transitional Living Facilities, as provided under Part
V of Chapter 400, F.S.;
13. Prescribed Pediatric Extended Care Centers, as
provided under Part VI of Chapter 400, F.S.;
14. Intermediate Care Facilities for the Developmentally
Disabled, as provided under Part VIII of Chapter 400,
F.S.;
15. Assisted Living Facilities, as provided under Part I of
Chapter 429, F.S.;
16. Adult Family-Care Homes, as provided under Part II
of Chapter 429, F.S.;
17. Adult Day Care Centers, as provided under Part III of
Chapter 429, F.S.
(b) Requests to change the address of record must be
received by the Agency 21 to 120 days in advance of the
requested effective date for the following provider types :
1. Drug Free Workplace Laboratories as provided under
Sections 112.0455 and 440.102, F.S.;
2. Mobile Surgical Facilities, as provided under Part I of
Chapter 395, F.S.;
3. Health Care Risk Managers, as provided under Part I
of Chapter 395, F.S.;
4. Home Health Agencies, as provided under Part III of
Chapter 400, F.S.;
5. Nurse Registries, as provided under Part III of
Chapter 400, F.S.;
6. Companion Services or Homemaker Services
Providers, as provided under Part III of Chapter 400,
F.S.;
7. Home Medical Equipment Providers, as provided
under Part VII of Chapter 400, F.S.;
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8. Health Care Services Pools, as provided under Part
IX of Chapter 400, F.S.;
9. Health Care Clinics, as provided under Part X of
Chapter 400, F.S., including certificate of exemption;
10. Clinical Laboratories, as provided under Part I of
Chapter 483, F.S.;
11. Multiphasic Health Testing Centers, as provided
under Part II of Chapter 483, F.S.;
12. Organ and Tissue Procurement Agencies, as
provided under Chapter 381, F.S.
(c) All other requests to amend a license including but
not limited to services, licensed capacity, and other
specifications which are required to be displayed on the
license by authorizing statutes or applicable rules must
be received by the Agency 60 to 120 days in advance of
the requested effective date. This deadline does not
apply to a request to amend hospital emergency
services defined in Section 395.1041(2), F.S.
(3) Failure to submit a timely request shall result in a
$500 fine.
(4) A licensee is not authorized to operate in a new
location until a license is obtained which specifies the
new location. Failure to amend a license prior to a
change of the address of record constitutes unlicensed
activity.
(5) The licensee shall return the license certificate to the
Agency upon the rendition of a final order revoking,
cancelling or denying a license, and upon the voluntary
discontinuance of operation.
ST - DZ809 - Proof of Financial Ability to Operate
Type Rule
Statute or Rule 59A-35.062(3)(e)&(7);408.803(7);408.810(
Title Proof of Financial Ability to Operate
Interpretive GuidelineRegulation Definition
59A-35.062(3)(e) FAC Proof of Financial Ability to - This standard would be used by surveyors if evidence of financial instability is found and the licensee or oRegSet.rpt
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Operate.
"Financial instability" means the provider cannot meet its
financial obligations. Evidence such as the issuance of
bad checks, an accumulation of delinquent bills, or
inability to meet current payroll needs shall constitute
prima facie evidence that the ownership of the provider
lacks the financial ability to operate. Evidence shall also
include the Medicare or Medicaid program's indications
or determination of financial instability or fraudulent
handling of government funds by the provider.
408.803(7) FS Definitions.
"Controlling interest" means:
(a) The applicant or licensee;
(b) A person or entity that serves as an officer of, is on
the board of directors of, or has a 5-percent or greater
ownership interest in the applicant or licensee; or
(c) A person or entity that serves as an officer of, is on
the board of directors of, or has a 5-percent or greater
ownership interest in the management company or other
entity, related or unrelated, with which the applicant or
licensee contracts to manage the provider.
The term does not include a voluntary board member.
408.810 FS
(8) Upon application for initial licensure or change of
ownership licensure, the applicant shall furnish
satisfactory proof of the applicant's financial ability to
operate in accordance with the requirements of this part,
authorizing statutes, and applicable rules. The agency
shall establish standards for this purpose, including
information concerning the applicant's controlling
interests. The agency shall also establish documentation
requirements, to be completed by each applicant, that
show anticipated provider revenues and expenditures,
the basis for financing the anticipated cash-flow
requirements of the provider, and an applicant's access
any controlling interest in the licensee withholds information from the surveyor.
- The financial schedules and documentation of correction of the financial instability are submitted to the
AHCA Home Care Unit in the state office and reviewed by AHCA state office financial reviewers in the
Financial Analysis Unit. Further administrative action may be taken by the state office .
- This standard applies to the following provider types:
· Nursing Home Facilities, as specified in Part II, Chapter 400, F.S.;
· Assisted Living Facilities, as specified in Part I, Chapter 429, F.S.;
· Home Health Agencies, as specified in Part III, Chapter 400, F.S.;
· Hospices, as specified in Part IV, Chapter 400, F.S.;
· Adult Day Care Centers, as specified in Part III, Chapter 429, F.S.;
· Prescribed Pediatric Extended Care Centers, as specified in Part VI, Chapter 400, F.S.;
· Home Medical Equipment Providers, as specified in Part VII, Chapter 400, F.S.;
· Intermediate Care Facilities for the Developmentally Disabled, as specified in Part VIII, Chapter 400,
F.S.;
· Health Care Clinics, as specified in Part X, Chapter 400, F.S.;
- The standard applies to Nurse Registries as specified in 59A-18.004(7) which states:
- An application for renewal of a license shall not be required to provide proof of financial ability to
operate, unless the applicant has demonstrated financial instability at any time, pursuant to Section
408.810, F.S., in which case AHCA shall require the applicant for renewal to provide proof of financial
ability to operate by submitting information as described in 59A-35.062(7)(b), F.A.C. and documentation
of correction of the financial instability, to include evidence of the payment in full of any bad checks,
delinquent bills or liens and all associated fees, costs, and changes related to the instability. If complete
payment cannot be made, evidence must be submitted of partial payment along with a plan for payment
of any liens or delinquent bills. If the lien is with a government agency or repayment is ordered by a
federal, state, or district court, an accepted plan of repayment must be provided. If the licensed nurse
registry has demonstrated financial instability as outlined above at any time the AHCA will request proof of
financial ability to operate.
- None of the Hospital Unit Programs nor the Lab Unit Programs would have this requirement.
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to contingency financing. A current certificate of
authority, pursuant to chapter 651, may be provided as
proof of financial ability to operate. The agency may
require a licensee to provide proof of financial ability to
operate at any time if there is evidence of financial
instability, including, but not limited to, unpaid expenses
necessary for the basic operations of the provider.
59A-35.062 FS
(7) An applicant for renewal of a license shall not be
required to provide proof of financial ability to operate,
unless the licensee or applicant has demonstrated
financial instability. If an applicant or licensee has shown
signs of financial instability, as provided in Section
408.810(9), F.S., at any time, the Agency may require
the applicant or licensee to provide proof of financial
ability to operate by submission of:
(a) AHCA Form 3100-0009, July 2009, Proof of Financial
Ability Form, that includes a balance sheet and income
and expense statement for the next 2 years of operation
which provide evidence of having sufficient assets,
credit, and projected revenues to cover liabilities and
expenses, and
(b) Documentation of correction of the financial
instability, including but not limited to, evidence of the
payment of any bad checks, delinquent bills or liens. If
complete payment cannot be made, evidence must be
submitted of partial payment along with a plan for
payment of any liens or delinquent bills. If the lien is with
a government agency or repayment is ordered by a
federal or state court, an accepted plan of repayment
must be provided.
ST - DZ812 - Change of Ownership
Type Rule
Statute or Rule 408.803(5); 408.807 FS
Title Change of Ownership
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Interpretive GuidelineRegulation Definition
408.803(5) FS
"Change of ownership" means:
(a) An event in which the licensee sells or otherwise
transfers its ownership to a different individual or entity
as evidenced by a change in federal employer
identification number or taxpayer identification number;
or
(b) An event in which 51 percent or more of the
ownership, shares, membership, or controlling interest
of a licensee is in any manner transferred or otherwise
assigned. This paragraph does not apply to a licensee
that is publicly traded on a recognized stock exchange.
A change solely in the management company or board
of directors is not a change of ownership.
408.807 Change of ownership.-Whenever a change of
ownership occurs:
(1) The transferor shall notify the agency in writing at
least 60 days before the anticipated date of the change
of ownership.
(2) The transferee shall make application to the agency
for a license within the timeframes required in s.
408.806.
(3) The transferor shall be responsible and liable for:
(a) The lawful operation of the provider and the welfare
of the clients served until the date the transferee is
licensed by the agency.
(b) Any and all penalties imposed against the transferor
for violations occurring before the date of change of
ownership.
(4) Any restriction on licensure, including a conditional
license existing at the time of a change of ownership,
shall remain in effect until the agency determines that
the grounds for the restriction are corrected.
(5) The transferee shall maintain records of the
transferor as required in this part, authorizing statutes,
- This tag may be cited for unreported changes of ownership.
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and applicable rules, including:
(a) All client records.
(b) Inspection reports.
(c) All records required to be maintained pursuant to s.
409.913, if applicable.
ST - DZ813 - esults of Screening & Notification In File
Type Rule
Statute or Rule 59A-35.090(3)(c), FAC
Title esults of Screening & Notification In File
Interpretive GuidelineRegulation Definition
59A-35.090(3) Results of Screening and Notification.
(c) The eligibility results of employee screening and the
signed Attestation referenced in subsection
59A-35.090(2), F.A.C., must be in the employee's
personnel file, maintained by the provider.
ST - DZ814 - Background Screening Clearinghouse
Type Rule
Statute or Rule 435.12(2)(b-d), FS
Title Background Screening Clearinghouse
Interpretive GuidelineRegulation Definition
435.12(2) Care Provider Background Screening
Clearinghouse.-
(b) Until such time as the fingerprints are enrolled in the
national retained print arrest notification program at the
Federal Bureau of Investigation, an employee with a
break in service of more than 90 days from a position
that requires screening by a specified agency must
submit to a national screening if the person returns to a
position that requires screening by a specified agency.
(c) An employer of persons subject to screening by a
Review employee files for verification that any break in service was less than 90 days or a new screening
was completed.
Verify that the facility has an updated employee roster listed in the clearinghouse .
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specified agency must register with the clearinghouse
and maintain the employment status of all employees
within the clearinghouse. Initial employment status and
any changes in status must be reported within 10
business days.
(d) An employer must register with and initiate all
criminal history checks through the clearinghouse before
referring an employee or potential employee for
electronic fingerprint submission to the Department of
Law Enforcement. The registration must include the
employee's full first name, middle initial, and last name;
social security number; date of birth; mailing address;
sex; and race. Individuals, persons, applicants, and
controlling interests that cannot legally obtain a social
security number must provide an individual taxpayer
identification number.
ST - DZ815 - Background Screening; Prohibited Offenses