Office of Program Policy Analysis and Government Accountability
Office of Program Policy Analysis and Government Accountability

Agency for Health Care Administration

Health Quality Assurance

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For assistance, call 850-412-4400 or visit http://ahca.myflorida.com/MCHQ/index.shtml

What is the purpose of the program?

The Division of Health Care Policy and Oversight protects Floridians through oversight of health care providers. The division licenses, certifies, and regulates over 30 different types of health care providers, including hospitals, nursing homes, assisted living facilities, and home health agencies. In total, the division licenses, certifies, regulates or provides exemptions for more than 50,000 providers.

How is the program administered?

The program's functions are administered through six entities as described below.
  • Bureau of Health Facility Regulation regulates facilities such as ambulatory surgical centers, rehabilitation agencies, home health agencies, organ procurement, and hospice. The bureau is comprised of five units that are regulated by the state: Assisted Living; Certificate of Need and Commercial Managed Care; Hospital and Outpatient Services; Laboratory and In-Home Services; and Long-Term Care Services. The bureau also maintains a database (Health Facility Reporting System) of licensees who provide residential or inpatient services for reporting emergency status, planning, or operations.
  • Bureau of Field Operations directs facility inspections, evaluating factors such as management and administration; nursing services; social services; dietary services; laboratory services; and compliance with state and federal fire safety codes. In addition, field operations maintains records of deficiencies and issues a corrective action report to the facility. It also helps develop facility regulations and procedures and implements quality assurance initiatives.
  • Office of Plans and Construction (OPC) approves all proposed construction of new facilities and any and all additions, modifications, renovations, or refurbishment of the site, building, equipment or systems of all existing facilities prior to commencing any construction activity.
  • Florida Center for Health Information and Transparency (Florida Center) collects, compiles, analyzes and disseminates health related data for the purpose of developing public policy and promoting the transparency of consumer health care information through FloridaHealthFinder.gov. The Florida Center administers the Medicaid Electronic Health Record (EHR) Incentive Program, provides governance of the Florida Health Information Exchange (Florida HIE) as well as research and analytic support to the Agency. The Florida Center is also responsible for collecting patient safety culture reports from hospitals and ambulatory surgery centers.
  • Medicaid Program Integrity audits and investigates providers suspected of overbilling or defrauding Florida's Medicaid program, recovers overpayments, issues administrative sanctions, and refers cases of suspected fraud for criminal investigation.  
  • Bureau of Central Services provides service and support to the bureaus within the Division of Health Care Policy and Oversight. The bureau is comprised of four units: the Background Screening Unit, the Financial Analysis Unit, the Central Intake Unit, and the Systems Management/Training and Support Unit. These units are responsible for the receipt and distribution of all health care facility applications and associated fees; the background screening of facility owners, administrators, and personnel; the financial analysis of health care facilities; and the data support and training within the division.

How effective is the agency at investigating access to care issues and Priority 1 consumer complaints received by the agency?

For Fiscal Year 2021-22, the agency investigated 99.82% of Priority 1 complaints about licensed facilities and programs within two business days, which fell below its standard for investigating 100% of the Priority 1 consumer complaints by investigating within two business days. AHCA, through the Office of Risk Management and Patient Safety, administers serious patient injury, reporting, tracking trending and problem resolution programs in hospitals, ambulatory surgical centers, assisted living facilities, nursing homes, and certain HMOs as directed by the Florida Statutes.

How are these activities funded?

Fiscal Year: 2023-24
Fund Dollars Positions
PROGRAM: HEALTH CARE REGULATION
HEALTH CARE REGULATION
85,368,322
659.50
TOTAL
85,368,322
659.50

Updates

Home Health Aides for Medically Fragile Children. The 2023 Legislature enacted Ch. 2023-183, Laws of Florida, creates the Home Health Aides for Medically Fragile Children program to help ameliorate the impact of the shortage of health care workers on medically fragile children. The law requires the AHCA, in consultation with the Board of Nursing, to approve any training program created by a home health agency that meets the federal standards for a nurse aide training program and which is meant to train family caregivers as home health aides for medically fragile children.

Where can I find related OPPAGA reports?

Biennial Review of AHCAs Oversight of Fraud, Waste, and Abuse in Florida's Medicaid Program, Report 22-03, January 2022
AHCA Continues to Improve Medicaid Program Data Quality and Oversight; Additional Improvements Needed in Use of Data, Report 20-04, January 2020
OPPAGA Review of Tertiary Health Services Licensing Standards, Report 19-11, November 2019

Where can I get more information?

Other Reports
The Auditor General reports on agency operations are available on its website
Florida's Efforts to Control Medicaid Fraud and Abuse, Fiscal Year 2019-20, Agency for Health Care Administration, January 2021
Florida Report on Telehealth Unitization and Accessibility, Agency for Health Care Administration, December 2016
Emergency Department Utilization Report 2017, Agency for Health Care Administration
Florida Center for Health Information and Transparency Annual Report 2017, Agency for Health Care Administration
Florida Health Care Expenditure Report 2015, Agency for Health Care Administration

Websites of Interest
Agency for Health Care Administration Publications
Agency for Health Care Administration, Facility/Provider Locator
Agency for Health Care Administration, Nursing Home Information
Utilization Review Accreditation Commission (URAC)
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality
Community Health Accreditation Program (CHAP)
Accreditation Association for Ambulatory Health Care
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
National Committee for Quality Assurance (NCQA)
DNV Healthcare

Performance Information


Performance measures and standards for the department may be found in its Long Range Program Plan.

What are the applicable statutes?

Sections 20.42, 409.913, and 409.9131, and Chs. 395, 400, 408, and 429, Florida Statutes

Whom do I contact for help?

Deputy Secretary, Health Care Policy and Oversight, 850-412-4516

To file a complaint against a licensed or unlicensed healthcare facility, contact AHCA at 1-888-419-3456 or 1-800-955-8771 Florida Relay Services (TDD number).

You may also submit a Licensed Health Care Facility Complaint Form or an Unlicensed Health Care Facility Complaint Form.

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