Florida Administrative Code
59 - AGENCY FOR HEALTH CARE ADMINISTRATION
59A - Health Facility and Agency Licensing
Chapter 59A-12 - HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH CLINICS
Section 59A-12.0071 - Accreditation
Current through Reg. 50, No. 187; September 24, 2024
As a condition of doing business in the state, each HMO or PHC shall apply for accreditation within 1 year and be accredited within 2 years of the organization's receipt of its Certificate of Authority. HMOs and PHCs with existing Certificates of Authority must apply for accreditation within 1 year and be accredited within 2 years of the effective date of this rule. All HMOs and PHCs must undergo reaccreditation not less than once every 3 years. Accreditation and reaccreditation must be awarded by an accreditation organization approved by the agency pursuant to Rule 59A-12.0072, F.A.C.
(1) The agency will provide technical assistance, upon request by an HMO or PHC, in order to assist new or existing organizations to develop and maintain quality assurance systems.
(2) The agency will monitor and determine the accreditation status of all existing HMOs and PHCs on an ongoing basis and group them into the following categories:
(3) The agency shall verify the compliance of HMOs and PHCs with the accreditation requirement with the accreditation organizations and shall initiate action for HMOs and PHCs classified under paragraphs (2)(c), (d) and (f) above. For those HMOs and PHCs under paragraph (2)(e) above, the agency shall not take administrative action until receipt of the final determination of accreditation from either the HMO, PHC or the accrediting body.
(4) The agency shall file an administrative order to show cause against those HMOs and PHCs under paragraphs (2)(c), (d) and (f) which are not in compliance with the accreditation requirement.
(5) The penalties to be assessed against organizations not achieving accreditation will be as follows:
|
ACCREDITATION STATUS |
PENALTY |
|
Not applied for accreditation |
Suspension of enrollment for a period not to exceed one year or until |
|
within the time frames of this rule |
accreditation is received if less than one year; Two counts of willful |
|
violation as specified under Section 641.52(5), F.S. |
|
|
Applied, not surveyed within the time |
Suspension of enrollment for a period not to exceed one year or until |
|
frames of this rule |
accreditation is received if less than one year; One count of willful violation |
|
as specified under Section 641.52(5), F.S. |
|
|
Failed initial or renewal accreditation survey |
No fine; Suspension of enrollment beyond the current enrollment level for a |
|
Failed follow-up accreditation survey conducted |
period not to exceed one year or until accreditation is received if less than |
|
subsequent to a failed accreditation survey. |
one year; Revocation of the Health Provider Certificate |
(6) For those HMOs and PHCs failing an accreditation survey the agency shall assess the need to mitigate the penalties specified under subsection (5) based upon:
(7) Those HMOs and PHCs classified under paragraphs (2)(c), (d) or (f) will be surveyed by the agency to ensure compliance with minimum standards for a Health Provider Certificate specified in Chapter 59A-12, F.A.C.
(8) For those HMOs and PHCs failing the initial accreditation survey the agency shall require the HMO or PHC to enter into a corrective action process for the purpose of achieving accreditation.
(9) The agency shall monitor the progress of those organizations not in compliance in cooperation with the accreditation organization to ensure that HMOs and PHCs come into compliance with the accreditation requirement.
(10) Those HMOs and PHCs failing an initial or renewal accreditation survey must receive at least accreditation under paragraph (2)(b) during a subsequent accreditation survey by the original accrediting organization. Accreditation must be received within one year of the final accreditation decision by the accrediting agency or within a time frame mutually agreeable to the agency, the accreditation organization, and the HMO or PHC. An HMO or PHC may, at any time, seek accreditation from another accreditation organization provided that the HMO or PHC enters into a corrective action process under subsection (8) to achieve accreditation with the original accreditation organization.
Rulemaking Authority 641.56 FS. Law Implemented 641.495, 641.512, 641.515(1), 641.52(1)(e), (g) FS.
New 3-11-92, Formerly 10D-100.0071, Amended 11-21-94, 4-10-03.
