Florida - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Florida Agency for Health Care Administration (AHCA) licenses Home Health Agencies under Chapter 400, Part III, Florida Statutes, to deliver intermittent skilled nursing and therapy services. Applicants must secure an AHCA Home Health Agency license using Form 3110-1011 and post a $500,000 surety bond before the state will accept a Medicaid provider enrollment application through the FLMMIS portal.

Medicaid reimburses these skilled services primarily through the Statewide Medicaid Managed Care (SMMC) program, requiring agencies to contract directly with managed care plans after obtaining their active Medicaid ID. Medicare certification is strongly recommended and often required by SMMC plans for skilled nursing and therapy reimbursement.

1. Service Definition and Scope

Florida Medicaid defines Home Health Services as medically necessary, intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, and home health aide services provided to recipients in their place of residence. These services must be ordered by a physician and provided under a written plan of care.

The scope of this service is strictly limited to intermittent visits rather than continuous private duty nursing. Agencies must be licensed to provide skilled care, distinguishing them from nurse registries or homemaker/companion services which handle unskilled personal care.

• Service Location: Recipient's permanent or temporary residence, excluding hospitals or nursing facilities.
• Skilled Nursing: Provided by an RN or LPN under RN supervision, limited to intermittent visits.
• Therapy Services: Includes physical, occupational, and speech-language pathology services.
• Home Health Aide: Permitted only when provided in conjunction with skilled nursing or therapy services.
• Plan of Care: Must be established and periodically reviewed by the recipient's attending physician.
• Exclusions: Does not cover continuous shift nursing or purely custodial care.

2. Regulatory and Oversight Agencies

The Agency for Health Care Administration (AHCA) (https://ahca.myflorida.com) is the primary regulatory body for Home Health Agencies in Florida. AHCA's Bureau of Health Facility Regulation handles the physical licensure, while AHCA's Medicaid division oversees the provider enrollment process.

Medicaid enrollment is processed through the Florida Medicaid Management Information System (FLMMIS) portal (https://portal.flmmis.com). Background screening compliance is managed through the Care Provider Background Screening Clearinghouse (https://info.flclearinghouse.com).

• Agency for Health Care Administration (AHCA): Issues the state Home Health Agency license (https://ahca.myflorida.com).
• AHCA Bureau of Health Facility Regulation: Conducts initial and renewal licensure surveys (https://ahca.myflorida.com/health-quality-assurance).
• FLMMIS Provider Portal: Processes Medicaid enrollment applications and claims (https://portal.flmmis.com).
• Care Provider Background Screening Clearinghouse: Maintains Level 2 background screening records (https://info.flclearinghouse.com).
• Florida Department of Health (DOH): Reviews and approves Comprehensive Emergency Management Plans (CEMPs) (https://www.floridahealth.gov).
• Statewide Medicaid Managed Care (SMMC) Plans: Contract with enrolled providers to authorize and pay for services (https://flmedicaidmanagedcare.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Florida requires applicants to obtain a Home Health Agency license from AHCA before applying for Medicaid enrollment. A Certificate of Need (CON) is no longer required for Medicare-certified home health agencies in Florida, but the licensure process itself requires a detailed application, zoning approvals, and an approved emergency management plan.

To enroll in Florida Medicaid, Home Health Agencies must secure and maintain a $500,000 surety bond payable to AHCA. This bond must be maintained for three consecutive years without adverse actions before the requirement is lifted.

• AHCA Licensure: Must hold an active Home Health Agency license from AHCA before Medicaid enrollment.
• Surety Bond: A $500,000 surety bond payable to AHCA is required for Medicaid enrollment.
• Medicare Certification: While not strictly required for state licensure, it is practically required by most SMMC plans for skilled service reimbursement.
• CEMP Approval: Must have a Comprehensive Emergency Management Plan approved by the local county health department or DOH.
• Zoning Approval: Must provide proof of local zoning approval for the agency's physical office location.
• Operational Status: Must be fully operational at the service location in Florida prior to Medicaid application.

4. Licensure and Certification Requirements

Applicants must submit the Health Care Licensing Application for Home Health Agencies (AHCA Form 3110-1011) to the Bureau of Health Facility Regulation. The application requires disclosure of all owners, a projected operating budget, and proof of commercial general liability and malpractice insurance.

Following application approval, AHCA conducts an initial on-site survey to verify compliance with Chapter 400, Part III, F.S., and Rule 59A-8, F.A.C. Agencies seeking Medicare certification must undergo a separate initial certification survey by an approved accrediting organization or AHCA.

• Application Form: AHCA Form 3110-1011, Health Care Licensing Application Home Health Agencies.
• Licensure Fee: $1,705 biennial licensure fee submitted with the application.
• Insurance: Proof of commercial general liability and professional malpractice insurance.
• Financial Viability: Submission of a projected operating budget demonstrating financial stability.
• Administrator Qualifications: Must designate a qualified administrator meeting state experience and training requirements.
• Director of Nursing: Must employ a registered nurse as the Director of Nursing to oversee skilled services.

5. Medicaid Provider Enrollment

Once licensed, the agency must apply for Medicaid enrollment via the FLMMIS Enrollment Wizard (https://portal.flmmis.com). The agency enrolls under Provider Type 65 (Home Health Agency).

The enrollment process requires uploading the AHCA license, the $500,000 surety bond, and proof of Level 2 background screening for all owners and managing employees. Out-of-state providers are generally not permitted unless located within 50 miles of the Florida border.

• Provider Portal: Applications must be submitted through the FLMMIS Enrollment Wizard (https://portal.flmmis.com).
• Provider Type: Enroll as Provider Type 65 (Home Health Agency).
• Application Fee: Payment of the institutional provider application fee (varies annually, aligns with Medicare fee).
• Surety Bond Upload: Must attach the $500,000 surety bond document to the FLMMIS application.
• Ownership Disclosure: Complete disclosure of all individuals or entities with 5% or more ownership.
• Reenrollment: Institutional providers must renew their Medicaid enrollment every three years.

6. Staffing, Training and Background Checks

All agency personnel, including owners, administrators, and direct care staff, must undergo Level 2 background screening through the Care Provider Background Screening Clearinghouse (https://info.flclearinghouse.com) prior to employment. Staff must also complete required training, including Alzheimer's Disease and Related Disorders training if applicable.

Skilled staff must hold active, unencumbered Florida licenses (RN, LPN, PT, OT, SLP). Home health aides must have completed a minimum 75-hour training program and possess a valid certificate.

• Background Screening: Level 2 screening required via the Clearinghouse (https://info.flclearinghouse.com).
• Professional Licensure: RNs, LPNs, and therapists must hold active Florida Department of Health licenses.
• Home Health Aides: Must complete a 75-hour training course or hold an active Florida CNA certificate.
• CPR Certification: All direct care staff must maintain current CPR certification.
• In-Service Training: Home health aides require 12 hours of in-service training annually.
• Administrator Training: Administrators must complete specific training on state and federal home health regulations.

7. Documentation, Policies and Records

Agencies must maintain comprehensive clinical records for each patient, including the physician-ordered plan of care, clinical notes for every visit, and discharge summaries. Records must be retained for a minimum of five years following the patient's discharge.

State rules require agencies to maintain written policies covering patient rights, infection control, emergency management, and quality assurance. The Comprehensive Emergency Management Plan (CEMP) must be updated and reviewed annually.

• Plan of Care: Must be signed by the attending physician and updated at least every 60 days.
• Clinical Notes: Must be written and incorporated into the patient's record within 7 days of the visit.
• Record Retention: Patient records must be kept for at least 5 years from the date of discharge.
• CEMP: Annual update and approval of the Comprehensive Emergency Management Plan.
• Quality Assurance: Must have a documented quality assurance program reviewing clinical records quarterly.
• Patient Rights: Written notice of patient rights must be provided prior to the initiation of care.

8. Billing, Rates and Claims

Florida Medicaid reimburses Home Health Services primarily through the Statewide Medicaid Managed Care (SMMC) program. Providers must negotiate rates and submit claims directly to the SMMC plans (e.g., Sunshine Health, Humana) rather than billing fee-for-service Medicaid.

For the limited fee-for-service population, claims are submitted via the FLMMIS portal using standard CMS-1500 or UB-04 formats, utilizing specific HCPCS codes (e.g., G0154 for skilled nursing, G0151 for physical therapy) as outlined in the AHCA Provider Reimbursement Schedules.

• SMMC Contracting: Must contract with SMMC plans for authorization and payment (https://flmedicaidmanagedcare.com).
• Fee-for-Service Claims: Submitted via FLMMIS portal for non-managed care recipients.
• Prior Authorization: Most skilled services require prior authorization from the SMMC plan.
• Billing Codes: Utilize standard HCPCS codes (e.g., G0154, G0151) per the AHCA fee schedule.
• Electronic Visit Verification (EVV): Required for home health visits to verify service delivery.
• Timely Filing: Fee-for-service claims must generally be submitted within 6 months of the date of service.

9. Approval Sequence and Timeline

The approval process begins with local zoning and CEMP approval, followed by the submission of the AHCA licensure application. AHCA typically reviews the application within 30 days and schedules an initial survey within 60 days of application completeness.

After obtaining the AHCA license, the provider submits the Medicaid enrollment application via FLMMIS. Medicaid enrollment processing can take 30 to 90 days, after which the provider must spend several months credentialing and contracting with SMMC plans.

• Local Approvals: Obtain zoning and CEMP approval (1-2 months).
• AHCA Application: Submit Form 3110-1011; AHCA reviews within 30 days.
• Initial Survey: Conducted by AHCA within 60 days of a complete application.
• Medicaid Enrollment: Submit via FLMMIS; processing takes 30-90 days.
• SMMC Contracting: Credentialing with managed care plans typically takes 90-120 days.
• Total Timeline: Expect 6 to 9 months from initial application to billing first claims.

10. Common Denials and Survey Findings

Licensure applications are frequently delayed or denied due to incomplete ownership disclosures, failure to secure the $500,000 surety bond, or discrepancies between the application and local zoning approvals. Medicaid enrollment will be rejected if the information in FLMMIS does not perfectly match the AHCA license.

During initial and routine surveys, AHCA commonly cites agencies for incomplete personnel files (missing background screenings or CPR cards), failure to update the plan of care every 60 days, and inadequate documentation of home health aide supervision by a registered nurse.

• Surety Bond Issues: Failure to obtain or properly format the $500,000 surety bond.
• Data Mismatch: Discrepancies between AHCA license data and FLMMIS application data.
• Background Screening: Allowing staff to work before Clearinghouse approval is verified.
• Plan of Care: Missing physician signatures or failure to recertify every 60 days.
• Aide Supervision: Lack of documented RN supervisory visits for home health aides.
• CEMP Lapses: Failure to maintain an annually approved emergency management plan.

11. Key Contacts and Resources

The primary contact for licensure is the AHCA Bureau of Health Facility Regulation, Laboratory and In-Home Services Unit. For Medicaid enrollment issues, providers should utilize the FLMMIS Provider Services contact center.

Providers must regularly check the AHCA website and the FLMMIS portal for updates to service-specific policies, fee schedules, and SMMC plan contact information.

• AHCA Laboratory and In-Home Services Unit: (850) 412-4500, [email protected] (https://ahca.myflorida.com).
• FLMMIS Provider Enrollment: Accessed via the provider portal (https://portal.flmmis.com).
• Background Screening Clearinghouse: (https://info.flclearinghouse.com).
• Florida Medicaid Managed Care: Plan directories and contacts (https://flmedicaidmanagedcare.com).
• Florida Department of Health: For CEMP guidelines and professional licensing (https://www.floridahealth.gov).
• AHCA Public Meetings and Alerts: For policy updates (https://apps.ahca.myflorida.com/public-meetings).

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