OPPAGA text logo with graphic of FL historic capitol
OPPAGA text logo with graphic of FL historic capitol

Agency for Health Care Administration

Health Quality Assurance

What is the purpose of the program?

The purpose of Health Quality Assurance (HQA) is to protect Floridians through licensing and certification of health care facilities and providers, regulating commercial managed care organizations' provider network requirements, responding to consumer complaints against facilities, determining the need for select health care facilities and services, providing transparency in health care, and promoting integrity in the Medicaid Program.

How is the program administered?

The program's functions are administered through six entities as described below.
  • Bureau of Health Facility Regulation handles health care licensure, Medicare and Medicaid certification, and regulation for hospitals, ambulatory surgical centers, home health agencies, hospices, clinical laboratories, nursing homes, assisted living facilities, adult daycare and adult family-care homes, and many other types of health care providers. The bureau also oversees commercial managed care programs and administers the certificate of need (CON) program, which reviews applications for new facilities at nursing homes, hospices, and intermediate care facilities for the developmentally disabled.
  • Bureau of Field Operations completes onsite surveys to determine compliance with state licensure and federal certification requirements. In addition, this bureau handles consumer complaints.
  • Office of Plans and Construction reviews and approves health care facilities' plans and specifications; trained specialists also conduct surveys of facilities under construction.
  • Florida Center for Health Information and Transparency (Florida Center) is responsible for administering the Medicaid Electronic Health Record (EHR) Incentive Program; providing governance of the Florida Health Information Exchange (Florida HIE); and providing research and analytic support to the agency; collecting adverse incident reports from hospitals, ambulatory surgery centers, health maintenance organizations, nursing homes, and assisted living facilities; and ensuring the transparency of consumer health information by collecting, compiling, analyzing, and disseminating health related data for public policy and consumer information thorough FloridaHealthFinder.gov.
  • Medicaid Program Integrity operates the statutorily mandated fraud, abuse, and waste prevention and detection program that oversees Medicaid provider activities to ensure that fraudulent and abusive behavior occurs to the minimum extent possible in the Medicaid program.
  • Bureau of Central Services provides services and support to the other five bureaus within the Division of Health Quality Assurance and the Division of Medicaid. The bureau is comprised of four units: the Background Screening Unit, the Financial Analysis Unit, the Central Intake Unit, and the Training and Support Unit. These units are responsible for the receipt and distribution of all health care facility paper 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 of Health Quality Assurance.

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

For Fiscal Year 2018-19, the agency met its standard for investigating within two business days 100% of the Priority 1 consumer complaints about licensed facilities and programs. The agency designates a complaint as Priority 1 when the alleged complaint or noncompliance indicates that there is or could be serious injury, harm, impairment or death to a patient or resident in any health facility.

How are these activities funded?

Fiscal Year: 2020-21
Fund Dollars Positions
PROGRAM: HEALTH CARE REGULATION
HEALTH CARE REGULATION
95,797,170
653.50
TOTAL
95,797,170
653.50

Updates

Scope of Practice Expansion for Certain Practitioners The 2020 Legislature enacted Ch. 2020-9, Laws of Florida, that expands scope of practice for advanced practice registered nurses (APRNs), certified nursing assistants (CNAs) and home health aides (HHAs).  The law allows APRNs who meet certain criteria to practice primary care or midwifery without physician supervision and authorizes CNAs and HHAs to administer medications and assist with preventative skin care, and applying bandages and nebulizer treatments as delegated by a registered nurse.

Certificate of Need Exemption for Intermediate Care Facilities for the Developmentally Disabled.  The 2020 Legislature enacted Ch. 2020-60, Laws of Florida, that establishes a new certificate of need exemption for intermediate care facilities for the developmentally disabled for use by clients exhibiting severe maladaptive behaviors and co-occurring psychiatric diagnoses that require increased levels of behavioral, medical, and therapeutic oversight.

Assisted Living Facility Regulatory Amendments.  The 2020 Legislature enacted Ch. 2020-68, Laws of Florida, that makes several changes to assisted living facility (ALF) regulations.  The law allows ALFs to admit or retain residents including residents that require the use of assistive devices, require 24-hour nursing care, receive hospice services, are bedridden for no more than seven days, or in the case of an ALF licensed to provide extended congregate care, are bedridden for no more than 14 days.  The law also allows ALFs to use certain physical restraints such as full bed rails and geriatric chairs while authorizing AHCA to develop rules to address the technological advances in the provision of care, safety and security; and changing how staff communicate with residents regarding self-administration of medications.  In addition, the law requires that AHCA conduct a full inspection to review key quality-of-care standards for facilities that have a history of Class I, Class II, or uncorrected Class III violations resulting from complaints referred by the State Long-Term Care Ombudsman Program and amends the Resident Bill of Rights to allow the State Long-Term Care Ombudsman Program to provide assistance to a resident who needs to be relocated due to closure of a facility.

Amended Facility and Provider Licensure Requirements. The 2020 Legislature enacted Ch. 2020-157, Laws of Florida, that changes the licensing and regulation over certain health care facilities and providers including

  • repealing multiphasic health testing center licensure;  
  • reinstating AHCA's authority to require hospital adult cardiac programs to participate in the American College of Cardiology or the American Heart Association national reporting and quality registries and requiring that level III adult cardiovascular services participate in the clinical outcome reporting systems operated by the Society of Thoracic Surgeons;
  • extending the rural hospital designation from 2021 to 2025 for a hospital licensed as a rural hospital during Fiscal Years 2010-11 or 2011-12;
  • modifying the inspection requirements for nursing homes, hospices, adult day care centers, health care clinics, home medical equipment providers, and nurse registries;
  • modifying birth centers' reporting requirements and requiring centers to immediately report each maternal death, newborn death, or stillbirth;
  • revising comprehensive emergency management plan approval requirements for newly-licensed facilities; 
  • removing unenforceable annual assessments from ambulatory surgery centers;
  • allowing AHCA to issue provisional initial licenses for all regulated providers;
  • providing exemptions from additional disqualifications to provider background screening requirements; and 
  • revising the definitions and licensure requirements related to home health agencies.

Where can I find related OPPAGA reports?

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 State's Efforts to Control Medicaid Fraud and Abuse Fiscal Year 2017-18, Agency for Health Care Administration, December 2018.
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 2014, Agency for Health Care Administration.
The Auditor General reports on agency operations are available on its website.
Crisis Stabilization Units, Florida Senate, Interim Report 2012-109, September 2011.
Review Regulatory Oversight of Assisted Living Facilities in Florida, Florida Senate, Interim Report 2012-128, September 2011.
Review the Moratorium on Nursing Home Certificates of Need, Florida Senate, Interim Report 2011-125, October 2010.
Websites of Interest
Agency for Health Care Administration, Facility/Provider Locator
Agency for Health Care Administration, Nursing Home Information
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 GL 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 Chs395, 400, 408, and 429, Florida Statutes.

Whom do I contact for help?

Deputy Secretary, Health Quality Assurance, 850-412-4400
Consumer Complaint Call Center and Medicaid fraud hotline, 1-888-419-3456, or complete the Health Care Facility Complaint Form

Website