Florida Regulations 59A-35.060: Licensure Application Process.
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(1) The applicant must apply for licensure using the program specific forms listed below and the Health Care Licensing Application Addendum, AHCA Form 3110-1024, October 2009, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05363. All forms are incorporated by reference and available online at: http://ahca.myflorida.com/HQAlicensureforms.
(a) Drug Free Workplace Laboratories as provided under Sections 112.0455 and 440.102, F.S.; AHCA Form 3170-5001, Rev. July 2009.
(b) Crisis Stabilization Units, as provided under Parts I and IV of Florida Statutes Chapter 394; AHCA Form 3180-5003, Rev. July 2009.
(c) Short Term Residential Treatment Units, as provided under Parts I and IV of Florida Statutes Chapter 394; AHCA Form 3180-5003, Rev. July 2009.
(d) Residential Treatment Facilities, as provided under Florida Statutes Chapter 394, Part IV; AHCA Form 3180-5003, Rev. July 2009.
(e) Residential Treatment Centers for Children and Adolescents, as provided under Florida Statutes Chapter 394, Part IV; AHCA Form 3180-5004, Rev. July 2009.
(f) Health Care Risk Managers, as provided under Florida Statutes Chapter 395, Part I; AHCA Form RM-001, Rev. July 2009.
(g) Nursing Homes, as provided under Florida Statutes Chapter 400, Part II; AHCA Form 3110-6001, Rev. July 2009.
(h) Home Health Agencies, as provided under Florida Statutes Chapter 400, Part III; AHCA Form 3110-1011, Rev. July 2009.
(i) Nurse Registries, as provided under Florida Statutes Chapter 400, Part III; AHCA Form 3110-7004, Rev. July 2009.
(j) Companion Services or Homemaker Services, as provided under Florida Statutes Chapter 400, Part III; AHCA Form 3110-1003, Rev. July 2009.
(k) Hospices, as provided under Florida Statutes Chapter 400, Part IV; AHCA Form 3110-4001, Rev. July 2009.
(l) Home for Special Services as provided under Florida Statutes Chapter 400, Part V; AHCA Form 3110-3001, July 2014, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05202.
(m) Home Medical Equipment Providers, as provided under Florida Statutes Chapter 400, Part VII; AHCA Form 3110-1005, Rev. July 2009.
(n) Intermediate Care Facilities for the Developmentally Disabled, as provided under Florida Statutes Chapter 400, Part VIII; AHCA Form 3110-5003, Rev. July 2009.
(o) Assisted Living Facilities, as provided under Florida Statutes Chapter 429, Part I; AHCA Form 3110-1008, Rev. July 2009.
(p) Adult Family-Care Homes, as provided under Florida Statutes Chapter 429, Part II; AHCA Form 3180-1022, Rev. July 2009.
(q) Adult Day Care Centers, as provided under Florida Statutes Chapter 429, Part III; AHCA Form 3180-1004, Rev. July 2009.
(r) Clinical Laboratories, as provided under Florida Statutes Chapter 483, Part I; AHCA Form 3170-2004 (renewal), B (initial) or C (change of ownership), Rev. July 2009 or AHCA Form 3170-2004D, September 2009 (addition of specialty, or subspecialty or change in specialty).
(s) Organ and Tissue Procurement Agencies, as provided under Florida Statutes Chapter 381; AHCA Form 3140-2001, July 2009.
(2) The licensure fee must be included with any application. Applications will be returned to the applicant unprocessed if the fee does not accompany the application. Applications from state agencies must include a copy of the posted journal transactions by State Wide Document Number (SWDN) within benefiting Operating Level Organization (OLO) and site.
(3) Applications received more than 120 days prior to the date of license expiration or the effective date will be returned to the applicant unprocessed.
(4) If an applicant, licensee, or controlling interest is required to register or file with the Florida Secretary of State, Division of Corporations, the principal, fictitious name and mailing addresses submitted with the licensure application for the applicant, licensee and controlling interests must be the same as the information registered with the Division of Corporations.
(5) Unresponsive applicant. If certified mail sent to the provider’s address of record, or mailing address if applicable, is returned as unclaimed or undeliverable, the Agency will send a copy of the letter by regular mail to the provider’s address of record, or mailing address if applicable, with a copy to the applicant’s address if different from the provider. The applicant must respond to the request within 21 days of the date of the letter sent by regular mail. If timely response is not received, the application will be subject to withdrawal or denial.
(6) An application is considered complete upon receipt of:
(a) All required documents and information and appropriate fee;
(b) All required background screening results; and,
(c) Completion of a satisfactory inspection if required by authorizing statutes or rules. Satisfactory inspection means no regulatory violations exist, or all prior violations found have been determined by the Agency to be corrected.
(7) A licensure inspection will not be authorized until paragraphs (6)(a) and (6)(b) of this section have been satisfied.
(8) An application for license renewal may only be filed by the licensee.
Rulemaking Authority 408.819 FS. Law Implemented 400.801, 408.805, 408.806, 408.809, 408.810, 408.811 FS. History-New 7-14-10, Amended 5-4-15.
(a) Drug Free Workplace Laboratories as provided under Sections 112.0455 and 440.102, F.S.; AHCA Form 3170-5001, Rev. July 2009.
(b) Crisis Stabilization Units, as provided under Parts I and IV of Florida Statutes Chapter 394; AHCA Form 3180-5003, Rev. July 2009.
(c) Short Term Residential Treatment Units, as provided under Parts I and IV of Florida Statutes Chapter 394; AHCA Form 3180-5003, Rev. July 2009.
(d) Residential Treatment Facilities, as provided under Florida Statutes Chapter 394, Part IV; AHCA Form 3180-5003, Rev. July 2009.
(e) Residential Treatment Centers for Children and Adolescents, as provided under Florida Statutes Chapter 394, Part IV; AHCA Form 3180-5004, Rev. July 2009.
(f) Health Care Risk Managers, as provided under Florida Statutes Chapter 395, Part I; AHCA Form RM-001, Rev. July 2009.
(g) Nursing Homes, as provided under Florida Statutes Chapter 400, Part II; AHCA Form 3110-6001, Rev. July 2009.
(h) Home Health Agencies, as provided under Florida Statutes Chapter 400, Part III; AHCA Form 3110-1011, Rev. July 2009.
(i) Nurse Registries, as provided under Florida Statutes Chapter 400, Part III; AHCA Form 3110-7004, Rev. July 2009.
(j) Companion Services or Homemaker Services, as provided under Florida Statutes Chapter 400, Part III; AHCA Form 3110-1003, Rev. July 2009.
(k) Hospices, as provided under Florida Statutes Chapter 400, Part IV; AHCA Form 3110-4001, Rev. July 2009.
(l) Home for Special Services as provided under Florida Statutes Chapter 400, Part V; AHCA Form 3110-3001, July 2014, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05202.
(m) Home Medical Equipment Providers, as provided under Florida Statutes Chapter 400, Part VII; AHCA Form 3110-1005, Rev. July 2009.
(n) Intermediate Care Facilities for the Developmentally Disabled, as provided under Florida Statutes Chapter 400, Part VIII; AHCA Form 3110-5003, Rev. July 2009.
(o) Assisted Living Facilities, as provided under Florida Statutes Chapter 429, Part I; AHCA Form 3110-1008, Rev. July 2009.
(p) Adult Family-Care Homes, as provided under Florida Statutes Chapter 429, Part II; AHCA Form 3180-1022, Rev. July 2009.
(q) Adult Day Care Centers, as provided under Florida Statutes Chapter 429, Part III; AHCA Form 3180-1004, Rev. July 2009.
(r) Clinical Laboratories, as provided under Florida Statutes Chapter 483, Part I; AHCA Form 3170-2004 (renewal), B (initial) or C (change of ownership), Rev. July 2009 or AHCA Form 3170-2004D, September 2009 (addition of specialty, or subspecialty or change in specialty).
(s) Organ and Tissue Procurement Agencies, as provided under Florida Statutes Chapter 381; AHCA Form 3140-2001, July 2009.
(2) The licensure fee must be included with any application. Applications will be returned to the applicant unprocessed if the fee does not accompany the application. Applications from state agencies must include a copy of the posted journal transactions by State Wide Document Number (SWDN) within benefiting Operating Level Organization (OLO) and site.
(3) Applications received more than 120 days prior to the date of license expiration or the effective date will be returned to the applicant unprocessed.
(4) If an applicant, licensee, or controlling interest is required to register or file with the Florida Secretary of State, Division of Corporations, the principal, fictitious name and mailing addresses submitted with the licensure application for the applicant, licensee and controlling interests must be the same as the information registered with the Division of Corporations.
(5) Unresponsive applicant. If certified mail sent to the provider’s address of record, or mailing address if applicable, is returned as unclaimed or undeliverable, the Agency will send a copy of the letter by regular mail to the provider’s address of record, or mailing address if applicable, with a copy to the applicant’s address if different from the provider. The applicant must respond to the request within 21 days of the date of the letter sent by regular mail. If timely response is not received, the application will be subject to withdrawal or denial.
(6) An application is considered complete upon receipt of:
(a) All required documents and information and appropriate fee;
(b) All required background screening results; and,
(c) Completion of a satisfactory inspection if required by authorizing statutes or rules. Satisfactory inspection means no regulatory violations exist, or all prior violations found have been determined by the Agency to be corrected.
(7) A licensure inspection will not be authorized until paragraphs (6)(a) and (6)(b) of this section have been satisfied.
(8) An application for license renewal may only be filed by the licensee.
Rulemaking Authority 408.819 FS. Law Implemented 400.801, 408.805, 408.806, 408.809, 408.810, 408.811 FS. History-New 7-14-10, Amended 5-4-15.