Florida Regulations 59A-12.003: Administration, Forms, Fees
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(1) Application. “”Application for Health Care Provider Certificate””, AHCA Form 3002, Feb. 1998, obtained from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308, which forms are incorporated herein by reference, must be completed in the manner specified within the application in order for each individual item to be considered complete for the purpose of determining that a properly completed application has been filed. The application shall be accompanied by a filing fee of $1,000.00 payable to AHCA and shall be completed by each entity desiring to obtain a Health Care Provider Certificate as an HMO or PHC. The application shall specify the contact person or persons for the HMO or PHC. During the review of the entity only contact persons specified within the application shall be allowed access to the application materials submitted.
(2) Application Review Process for Health Care Provider Certificate. Upon receipt of the Application for Health Care Provider Certificate from a proposed HMO or PHC, AHCA shall review the application within 30 days of receipt. AHCA shall provide notification to the proposed HMO or PHC of deficiencies in the application within this 30-day period. The applicant has 90 days from the date of the filing of the application to file any additional information requested by AHCA. By the end of the 90-day period if the additional information has not been received the application will be denied in accordance with Florida Statutes Chapter 120 Within 90 days after the application has been completed AHCA shall approve or deny the application.
(3) Certificate of Authority. The application for a Health Care Provider Certificate must include a copy of the letter from the Department of Financial Services accepting the receipt of an application for a Certificate of Authority submitted by the organization.
(4) Geographic Area Expansions. The HMO or PHC may not change its geographic area unless it follows the applicable requirements set forth in Florida Statutes § 641.495(2) Each HMO or PHC shall submit the required notarized “”Affidavit by HMO for Expansion of Service Area””, AHCA Form 3160-1005, April 2002, which is hereby adopted and incorporated by reference. Copies may be obtained by writing AHCA, 2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308.
(5) Annual Assessment. The Agency for Health Care Administration shall determine the regulatory assessment percentage necessary to be imposed for each calendar year. AHCA Form “”Regulatory Assessment Worksheet for Health Maintenance Organizations, Prepaid Health Clinics, and Exclusive Provider Organizations””, AHCA Form 3160-1004, July 1995, which is hereby adopted and incorporated by reference, will be provided to the organization for calculating the annual regulatory assessment percentage and premium volume. Copies may be obtained by writing the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308. The annual regulatory assessment shall not exceed the statutory limitations and must be paid by the date specified in the Administrative Assessment Order.
Rulemaking Authority 641.36, 641.41, 641.56, 641.58 FS. Law Implemented 120.60(2), 641.21, 641.22, 641.47, 641.495 FS. History-New 1-28-88, Formerly 10D-100.003, Amended 4-10-03.
(2) Application Review Process for Health Care Provider Certificate. Upon receipt of the Application for Health Care Provider Certificate from a proposed HMO or PHC, AHCA shall review the application within 30 days of receipt. AHCA shall provide notification to the proposed HMO or PHC of deficiencies in the application within this 30-day period. The applicant has 90 days from the date of the filing of the application to file any additional information requested by AHCA. By the end of the 90-day period if the additional information has not been received the application will be denied in accordance with Florida Statutes Chapter 120 Within 90 days after the application has been completed AHCA shall approve or deny the application.
(3) Certificate of Authority. The application for a Health Care Provider Certificate must include a copy of the letter from the Department of Financial Services accepting the receipt of an application for a Certificate of Authority submitted by the organization.
(4) Geographic Area Expansions. The HMO or PHC may not change its geographic area unless it follows the applicable requirements set forth in Florida Statutes § 641.495(2) Each HMO or PHC shall submit the required notarized “”Affidavit by HMO for Expansion of Service Area””, AHCA Form 3160-1005, April 2002, which is hereby adopted and incorporated by reference. Copies may be obtained by writing AHCA, 2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308.
(5) Annual Assessment. The Agency for Health Care Administration shall determine the regulatory assessment percentage necessary to be imposed for each calendar year. AHCA Form “”Regulatory Assessment Worksheet for Health Maintenance Organizations, Prepaid Health Clinics, and Exclusive Provider Organizations””, AHCA Form 3160-1004, July 1995, which is hereby adopted and incorporated by reference, will be provided to the organization for calculating the annual regulatory assessment percentage and premium volume. Copies may be obtained by writing the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop #26, Tallahassee, Florida 32308. The annual regulatory assessment shall not exceed the statutory limitations and must be paid by the date specified in the Administrative Assessment Order.
Rulemaking Authority 641.36, 641.41, 641.56, 641.58 FS. Law Implemented 120.60(2), 641.21, 641.22, 641.47, 641.495 FS. History-New 1-28-88, Formerly 10D-100.003, Amended 4-10-03.