(1) Application for licensure to operate an Intermediate Care Facility for the Developmentally Disabled (ICF/DD) must be submitted on the Health Care Licensing Application, Intermediate Care Facilities for the Developmentally Disabled, AHCA Form 3110-5003, April 2021 which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13996 and must be accompanied by the Health Care Licensing Application Addendum referenced in subsection 59A-35.060(1), F.A.C. Applicants for renewal of an ICF/DD license or for a change during the licensure period can submit the Health Care Licensing Online Application, Intermediate Care Facilities for the Developmentally Disabled. AHCA Form 3110-5003OL, April 2021, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13997. These forms are available at: http://ahca.myflorida.com/HQAlicensureforms or, for online submissions at http://apps.ahca.myflorida.com/SingleSignOn Portal.

Terms Used In Florida Regulations 59A-26.002

  • Deed: The legal instrument used to transfer title in real property from one person to another.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
    (a) Successful completion of a licensure survey by the Agency to determine compliance with the requirements of Chapter 400, Part VIII, Florida Statutes Chapter 408, Part II, Fl. Admin. Code Chapter 59A-35, and this rule chapter must occur prior to issuing a license.
    (b) A license will not be issued until the application fee has been received by the Agency and all monies owed to the Agency have been paid as specified in Florida Statutes § 408.831(1)
    (2) Applicants for initial licensure must submit to the Agency:
    (a) An approved plan review and on-site construction survey conducted by the Agency showing compliance with Florida Statutes Chapter 400, Part VIII and this rule chapter, and a certificate of occupancy from the local building authority;
    (b) A completed licensure application using the forms referenced in subsection (1) of this rule;
    (c) If the facility is managed by an entity other than the licensee, a copy of any and all letters of intent, agreements, memoranda of understanding, or contracts between licensee and management company;
    (d) An approved fire inspection report from the local fire authority completed no more than three months prior to the date of receipt by the Agency of the initial licensure application;
    (e) Documentation of compliance with the community residential home requirements as required by Florida Statutes Chapter 419, if applicable;
    (f) Satisfactory current proof that the applicant possesses the financial ability to operate the facility as required by Florida Statutes § 408.810
    (g) A copy of the Certificate of Need issued by the Agency for the facility to be licensed; and,
    (h) Proof of the licensee’s current right to occupy the ICF/DD building, such as, a copy of a lease, sublease agreement or deed.
    (3) Applicants applying for renewal of a license must submit a completed licensure application using the forms referenced in subsection (1) of this rule.
    (4) Applicants applying for a change of ownership must submit:
    (a) A completed application for licensure using the forms referenced in subsection (1) of this rule; and,
    (b) All documents and fees required for initial licensure in subsection (1) of this rule, with the exception of paragraphs (2)(a), (d), (e), and (g).
    (5) In addition to the provisions of Chapter 400, Part VIII, Chapter 408, Part II, Florida Statutes Chapter 409 and rule Fl. Admin. Code Chapter 59G-4, a license may be suspended, revoked or denied in any case where the Agency finds that there has been failure to comply with certification or re-certification requirements as a Medicaid provider.
    (6) This rule is in effect for five years from its effective date.
Rulemaking Authority 400.967, 408.819 FS. Law Implemented 400.962, 400.967, 408.804, 408.805, 408.806, 408.807, 408.809, 408.810, 408.811, FS. History-New 12-21-15, Amended 2-27-22.