AHCA Announces Changes to the Quarterly Report Effective July 1

Following HCAF’s successful efforts to reform the AHCA Home Health Quarterly Report, the Agency has announced changes to the reporting requirement that will go into effect on July 1. The report originated with the 2008 legislative session as a measure to combat health care fraud and abuse. The changes affect the amount of the fine owed for late submissions and which home health agencies are required to report.

Fines Reduced

The fine amounts have been reduced to $200 per day for each day the report is late up to a maximum of $5,000.

HHAs Required to Complete the Quarterly Report

A home health agency is required to submit the Quarterly Report if it:

  • is a Medicaid provider,
  • is a Medicare provider,  or
  • shares a controlling interest with a licensee, as defined in s. 408.803, F.S., which bills the Florida Medicaid program or the Medicare program.

If the home health agency has any one of the criteria listed above, that agency must continue to submit the Quarterly Report.

Home health agencies that do not meet one or more of the above stated conditions are exempt from submitting the Quarterly Report.

Important Terms

A “Medicaid provider” as defined in s. 409.901, F.S., means a person or entity that has a Medicaid provider agreement in effect with the agency and is in good standing with the agency.

A “Controlling interest” as defined in s. 408.803, F.S., means:

(a) The applicant or licensee:

(b) A person or entity that serves as an officer of , is on the board of directors of , or has a 5-percent or greater ownership interest in the applicant or licensee; or

(c) A person or entity that serves as an officer of, is on the board of directors of, or has a 5- percent or greater ownership interests in the management company or other entity, related or unrelated with which the applicant or licensee contracts to manage the provider.

The term does not include a voluntary board member.

A “Licensee” as defined in s. 408.803, F.S., means an individual, corporation, partnership, firm, association, governmental entity, or other entity that is issued a permit, registration, certificate, or license by the agency. The licensee is legally responsible for all aspects of the provider operation.

Examples of Who Reports and Who is Exempt

(a) Home health agency is a Medicaid or Medicare provider. The home health agency must continue to submit the Quarterly Report because it is a Medicaid or Medicare provider.

(b) Home health agency has two controlling interests. The home health agency is not a Medicaid or Medicare provider. One of the controlling interests is also a controlling interest of another licensee that bills the Florida Medicaid program or the Medicare program. The home health agency must continue to submit the Quarterly Report because the home health agency shares a controlling interest with a licensee which bills the Florida Medicaid program or the Medicare program. 

(c) Home health agency has two controlling interests. The home health agency is not a Medicaid or Medicare provider. One of the controlling interests is also a controlling interest of another licensee that does not bill the Florida Medicaid program or the Medicare program. The home health agency is exempt from submitting the Quarterly Report because the home health agency is not a Medicaid or Medicare provider and it does not share a controlling interest with a licensee which bills the Florida Medicaid program or the Medicare program.

Next Steps

Providers are encouraged to check with the owners/officers/board of directors for your agency to determine if your agency shares a controlling interest with a licensee which bills the Florida Medicaid program or the Medicare program. If you are uncertain about whether your agency is required to file a quarterly report, you are encouraged to submit a report within the reporting period.

Questions?

Please call the Home Care Unit at (850) 412-4403 and speak to a home health specialist or e-mail HQAHOMEHEALTH@ahca.myflorida.com.

Tags: , ,


%d bloggers like this: