Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.
The Agency for Health Care Administration(AHCA) in Florida was created by Chapter 20 of the Florida Statutes and serves as the primary health policy and planning institution for all of Florida.
Florida’s Medicaid program is worth $25.2 billion. The more than 4 million Floridians served by that program and the licensure of the almost 50,000 health care facilities in Florida all fall under the jurisdiction of the AHCA in Florida.
What Does the AHCA Do in Florida?
Essentially, the AHCA regulates and coordinates the Medicaid system and the healthcare providers that offer medical services through that program to Floridians, so there is sharing of healthcare data and resources across the state through the Florida Center for Health Information and Policy Analysis.
As much as the AHCA is a regulatory agency in Florida, they have ongoing goals to get more Floridians the health insurance they need, identify and eliminate fraudulent providers that are raising costs for everyone, and cut back on regulations that aren’t valuable or productive.
What Are Florida AHCA Regulations?
It may be easier to list what Florida AHCA does NOT regulate rather than all it does, but here are just a few of the primary things that ACHA regulates:
Fraud and abuse of billing and services
Licensure of healthcare professionals, healthcare clinics and other facilities, including hospitals and long-term care programs
Quality of care and civil rights complaints in all healthcare facilities
Compilations of healthcare data
Background screenings for those who work as administrators or employees in nursing homes
Health plan enrollment, rates, contracts, and related information
What Do I Need to Be in Compliance With ACHA in Florida?
Every healthcare provider and facility will have a different list of regulations, licensure, and other compliance tools to address with the ACHA. Contact us at the Florida Healthcare Law Firmto set up an appointment. We can help you discover what you and your business need to remain compliant.
Providers licensed or regulated by the Agency for Health Care Administration must make certain that their employees and/or contracted personnel have had Level 2 Background Screening (criminal history background check) pursuant to Florida Statutes and Administrative Code within 10 business days of being hired. Also, if a potential employee or contractor has not been employed within the previous 90 days, even if that individual previously had level 2 background screening, the individual will need to go through submitting fingerprints again. Further, each employee or contracted individual that is subject to Level 2 Background Screening must renew the background screening every 5 years to be eligible for employment or continued employment with an AHCA licensed or regulated provider.
Fingerprint Retention Period
The 5 year expiration from the date of retention of fingerprints is the date that the Florida Department of Law Enforcement (“FDLE”) will purge fingerprints from storage, meaning if fingerprint retention renewal has not occurred prior to this date, the whole screening process, that is fingerprinting, etc., starts over. There is no “grace period” if fingerprints have been purged, which means the individual is no longer “technically” eligible for employment with an AHCA licensed provider (and perhaps other providers licensed and regulated by other state agencies such as Department of Health, Department of Children and Families, or Department of Elder Affairs). Further if the provider is in the process of an AHCA survey, accreditation survey, or renewal licensure application, not having a current Level 2 Background Screening for an employee or contractor might subject the provider to a statement of deficiency, assessment of administrative fines or fees, or denial of a licensure renewal application. read more
As many know, out-of-network providers have much different appeal rights with commercial plans than in-network providers. It is important to understand each health plan’s appeal procedure as well as time requirements for an appeal may vary. However, the appeal process is still one of the most important tools providers have to get paid in the current environment of reduced reimbursements, caps on the number and frequency of services, bundled payments based on specific codes, delayed payments, daily errors in claims processing leading to denied claims, claw backs, and the list goes on. read more
Lately we’ve noticed an uptick in criticism of toxicology labs that are owned by the substance abuse treatment programs and recovery residences that refer to them. Sadly, this criticism seems to be coming from within the addiction and recovery industry itself. In addition to being absolutely necessary for substance abuse treatment, toxicology screens have become a meaningful source of revenue that helps to fund treatment programs and scholarships for those who cannot afford to pay the full cost of treatment. We cannot understand why the substance abuse treatment industry would want to help pull the rug out from under itself, but that seems to be what is occurring. Under the current state of Florida law, toxicology labs can be owned by their referral sources without much risk if that arrangement is properly structured. read more
In a recent Alert, Florida’s Agency for Health Care Administration announced that Florida Medicaid is in the throes of updating its Provider General Handbook, and will soon require new enrollees to provide either a copy of their Health Care Clinic License or a Certificate of Exemption from the clinic licensure requirement. Once Handbook changes have been adopted, Florida Medicaid will roll-out similar requirements for existing providers to produce either Licenses or Certificates of Exemptions.
Up until now there really has not been a compelling reason for an exempt provider to obtain a Certificate of Exemption. We urge our clients to file for their Certificates of Exemption in an effort to avoid what is likely to be an onslaught at AHCA’s licensing bureau.”
Followers & Friends – BIG Announcement coming out today! If you haven’t seen our new NATIONAL platform, check it out here at www.nationalhealthcarelawfirm.com and stay tuned for our #healthcare #legal news at 2pm EST !!!
(Delray Beach, FL) June 21st, 2012 – The Florida Healthcare Law Firm, one of Florida’s leading healthcare law firms, today announced a major increase in their legal practice capabilities with the official launch of the National Healthcare Law Firm, a d/b/a and new portal of the firm. The expansion to a national platform providing healthcare legal services to physicians and healthcare businesses is one that significantly increases resources for clients who lack qualified local healthcare counsel. While the Florida Healthcare Law Firm has for years assisted clients outside the state of Florida*, this new development further cements the firm’s commitment to providing ethical legal counsel in the healthcare industry.
“We are very excited about it. The fact that we serve clients all over the country has been a small secret for a while but we realized there’s a huge demand and decided to just go for it,” said Jeffrey L. Cohen, Esq. Founder and President of Florida Healthcare Law Firm.
According to Cohen, “It’s just a strange area of the law. Nearly everything in healthcare business is regulated; leases, employment agreements, compensation. Things you wouldn’t think are regulated are strongly regulated. And there are large fines and criminal penalties for getting it wrong! Our clients understand that healthcare business of any kind has serious legal risks and that they need uniquely qualified help.”
Acknowledged throughout the country for its service and excellence, Florida Healthcare Law Firm is one of the nation’s leading providers of healthcare legal services. Founded by Jeffrey L. Cohen, Esq and headquartered in South Florida, FHLF provides legal services to physicians and healthcare businesses with the right pricing responsiveness and ethics. From healthcare clinic regulation, home health agency representation and physician contracting to medical practice formation/representation and federal and state compliance matters, the Florida Healthcare Law Firm is committed to bringing knowledge and experience to a diverse group of clients.
When the text of the new PIP law became public, our jaws went slack. The new law imposed incongruous effective dates that would seemingly put many providers out of the PIP business for six months. How could the insurance industry’s best and brightest have screwed this up?
The new law requires providers to be licensed as “clinics” in order to receive PIP payments, unless an exclusion to that licensing requirement applies. The incongruity arises because the provision requiring licensure seems to become effective July 1, 2012; but the provision creating the exclusions from that licensure requirement do not seem to become effective until January 1, 2013. Many providers are rightly concerned that they must either: become licensed as a clinic in order to receive PIP payments, or stop treating PIP patients from July 1, 2012 through January 1, 2013 when an appropriate exclusion will exist.
Thank goodness for Stuart Williams, AHCA’s General Counsel. In his May 8, 2012 memorandum, Mr. Williams artfully reasons that the statute could and should be interpreted so that both the licensure requirement and its applicable exclusions become effective January 1, 2013. Now most providers can continue to treat PIP patients without interruption. Whew!!!
We hope and expect that Florida’s Office of Insurance Regulation will adopt Mr. Williams’ reasoning and educate the PIP insurers.