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Health Care Licensing Application, Mental Health Services, AHCA Form 3180-5003. Please make check or money order payable to the Agency for Health Care Administration (AHCA). The biennial licensure fee (CSU/SRT = $195.00 per bed RTF = $189.00 per bed). The principal and mailing addresses submitted with any application must be the same as the addresses that appear as registered with the Department of State, Division of Corporations. Ahca health care licensing application registration#Initials, Renewals and Change of Ownership Applications must include: NOTE TO ALL APPLICANTS: The Agency will verify that all applicants, licensees and controlling interests subject to Chapters 607, 608 or 617, Florida Statutes related to Business Organizations have complied with applicable Department of State registration and filing requirements. Send completed applications to: Agency for Health Care Administration, Hospital and Outpatient Services Unit, 2727 Mahan Drive, Mail Stop 31, Tallahassee, FL 32308. All forms listed below may be obtained from the website. The application will be withdrawn from review if all the required documents and fees are not included with this application or received within 21 days of an omission notice. The applicant will receive notice of the amount of the late fee as part of the application process or by separate notice. If the renewal application is received by the Agency less than 60 days prior to the expiration date, it is subject to a late fee as set forth in statute. Ahca health care licensing application license#Applications must be received at least 60 days prior to the expiration of the current license or effective date of a change of ownership to avoid a late fine. Ahca health care licensing application code#flu image by Vladimirs Koskins from Fotolia.Applicants must include the following attachments as stated in Chapters 408, Part II and 394, Florida Statutes (F.S.), and Chapters 59A-35, 65E-4, 65E-5, and 65E-12, Florida Administrative Code (F.A.C).Pay the licensing fee of $1,705 when you submit your application. Respond to any follow-up questions or notices from AHCA to help the process move along properly.ĪHCA will not approve a home care business in Florida that is within 10 miles of another home health agency. ![]() Submit these to AHCA with your application. Gather your insurance coverage documents. Ahca health care licensing application professional#Other items include zoning qualifications from your municipality, licenses for professional nurses and Employee Identification Number (EIN) from the IRS. For example, if the administrator or financial officer has done a level 2 background check with fingerprints within the past five years, you must submit an Affidavit of Compliance with Background Screening (AHCA Form 3100-0008, Oct 09) to AHCA. Submit any other forms AHCA requires of your agency. These include the application for licensure (AHCA form 3110-1011 revised Oct 09), Financial Schedules (AHCA form 3110-0009 revised Oct 09), Affidavit of Good Moral Character for the Alternate Administrator (AHCA form 3110-0001 Oct 09) and Health Care Licensing Application Addendum (see Resources). ![]() Thus, there is a high demand for home care services in Florida due to the fact that the state is home to many retirees.įill out and file the applications required by the Florida Agency for Health Care Administration (AHCA). Home nursing care agencies provide necessary services to patients after a hospital discharge or for elderly, homebound clients. You may receive reimbursement from both private and public insurance while keeping expenses relatively low. Providing home health care services to patients in Florida has the potential for high profits. ![]()
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