Florida Administrative Code

(1) Purpose. The purpose of this rule is to establish penalty categories that specify varying ranges of monetary fines for willful and nonwillful violations of applicable provisions of the Florida Insurance Code, or rules promulgated thereunder, that are committed by HMOs. (2) Sc…

Rulemaking Authority 624.4431 FS. Law Implemented 624.436 FS. History-New 7-15-90, Formerly 4-116.001, Amended 11-16-92, Formerly 4-192.001, Repealed 9-28-22.

(1) All terms defined in the Florida Nonprofit Multiple Employer Welfare Arrangement Act, Chapter 624, F.S., which are used in these rules shall have the same meaning as in the Act. (2) "Accounting Period" as used in Section 624.4415, F.S., means the time period for which financi…

Rulemaking Authority 624.439, 624.4431 FS. Law Implemented 624.438, 624.439 FS. History-New 7-28-94, Formerly 4-192.008, Amended 9-28-22, 1-4-24 Tranferred to 69O-136.041.

(1) Cash management systems. The arrangement may participate in a cash management program as long as the arrangement has direct access to its funds at all times and the depository or custodian maintains a separate accounting for each account. The depository must also be one which…

Each covered employee shall receive a policy, contract, certificate, summary arrangement description, or evidence of the benefits and coverages provided. Each document shall have on the first page inside the cover of the document, or if the document does not have a cover, on the …

Any agreement between the arrangement and any administrator or service company which is to be made available for review rather than filed with the Office shall be subject to the following: (1) The document shall be made available to the Office at a location in Tallahassee or at s…

(1) Arrangements are prohibited from paying any fees, other than for reimbursement of specific expenses, to its sponsoring association unless the services rendered to the arrangement are available to the arrangement from persons, or companies other than the sponsoring association…

(1) Each employer application to participate in the arrangement shall disclose in the same manner as described in Rule 69O-192.028, F.A.C., the following disclaimer: "The benefits and coverages described herein are provided through a self insured trust fund established and funded…

(1) Each Multiple Employer Welfare Arrangement ("MEWA") shall file with the Office a full and true report of its financial condition, transactions, and affairs. (a) An annual report covering the preceding fiscal year shall be filed within 3 months after the end of the fiscal year…

If the Office makes a determination that the records of the arrangement are not adequate to make a determination of solvency or insolvency the Office may take any action (administrative or otherwise) available to the Office as if the arrangement were insolvent. Rulemaking Authori…

Rulemaking Authority 624.4431 FS. Law Implemented 624.424, 624.439, 624.442, 628.4615 FS. History-New 7-15-90, Formerly 4-116.015, Amended 7-28-94, Formerly 4-192.058, Amended 7-30-17, Repealed 9-28-22.

Rulemaking Authority 651.015 FS. Law Implemented 651 FS. History-New 6-25-90, Formerly 4-45.010, 4-193.001, Repealed 3-12-20.

(1) All terms defined in Chapter 651, F.S., which are used in these rules shall have the same meaning as in Chapter 651, F.S. (2) "Administrator or executive director" means a natural person who has the general day-to-day administrative charge of a facility. (3) "Affiliate" means…

Rulemaking Authority 651.015(3), 651.021(2), 651.022(2), 651.0245(3), (5), (6), 651.0246(1), 651.043 FS. Law Implemented 651.0215, 651.022, 651.023, 651.024, 651.0245, 651.0246 FS. History-New 7-16-92, Formerly 4-193.003, Amended 3-12-20, 7-21-22, 1-17-24, Transferred to 69O-136.…

(1) Monthly Statements. If required by the Office pursuant to Section 651.0261(3), F.S., a provider shall file Form OIR-A3-973 within 25 days after the end of each month. Form OIR-A3-973, "Monthly Financial Report," effective 7/20, is hereby incorporated by reference and availabl…

(1) In addition to days cash on hand, debt service coverage ratio, and occupancy as defined in Section 651.011, F.S., the Office may utilize measures set forth in this rule to assess the financial viability of a provider. (2) The Office may analyze trends in performance of a prov…

Rulemaking Authority 651.015(3) FS. Law Implemented 651.022, 651.023, 651.026, 651.1151 FS. History-New 7-16-92, Formerly 4-193.007, Repealed 3-12-20.

Rulemaking Authority 651.015(3) FS. Law Implemented 651.011(5) FS. History-New 7-16-92, Formerly 4-193.010, Repealed 3-12-20.

(1)(a) A provider intending to develop a facility in phases shall submit a feasibility study as required by Chapter 651, F.S., which contains all information required by law for each phase of the proposed project, as well as the project as it will exist upon completion of all con…

Rulemaking Authority 651.015(3) FS. Law Implemented 651.021 FS. History-New 7-16-92, Formerly 4-193.015, Repealed 3-12-20.

Any fee in excess of $1,500 paid by a prospective resident to secure a priority right to subscribe to a continuing care agreement shall be escrowed in an escrow account governed by an escrow agreement as prescribed by Section 651.033, F.S., and shall not be released except as pro…

All continuing care contracts shall be written in plain language customarily used and understood by people in the conduct of their personal affairs. Rulemaking Authority 651.015(3) FS. Law Implemented 651.011, 651.055 FS. History-New 7-16-92, Formerly 4-193.020.

(1) Each escrow agreement or amendment required by Chapter 651, F.S., shall be filed and approved by the Office prior to its use in this state. (2) Each escrow agreement or amendment must be signed by: (a) The provider; (b) The escrow agent, which must be a financial institution …

Rulemaking Authority 651.015(3) FS. Law Implemented 651.021, 651.022, 651.023 FS. History-New 7-16-92, Formerly 4-193.028, Repealed 3-12-20.

(1) Definitions of terms as used in this rule. (a) An "extraordinary or unusual change" means a material change to the market conditions upon which the feasibility study was based that may cause an adverse impact to the facility. (b) A "material deviation" includes, but is not li…

Hazardous or injurious transactions, methods, or practices, may include but are not limited to, the following: (1) Repeated violations of Part IX of Chapter 626, F.S., entitled "Unfair Insurance Trade Practices"; (2) Payment or distribution of funds, other than salaries and wages…

(1) Where a certificate of occupancy is required by Chapter 651, F.S., a temporary certificate of occupancy may be acceptable if it does not conditionally preclude the residents from occupying a structure. (2) A provider shall not require a resident to occupy a unit before the pr…

(1)(a) Advertising must be truthful and not misleading in fact or implication. (b) Words or phrases shall be clear and understandable without reliance upon technical terminology. (2) Testimonials or Endorsements by Third Parties. (a) If the person making a testimonial, endorsemen…

(1) Each provider shall maintain at its home or principal office in this state a complete file containing every printed, published, or prepared advertisement it has used in this state, with a notation attached to each indicating the manner and extent of distribution and the form …

(1) All sales people or representatives of the provider who are engaged in soliciting prospective residents are bound by these rules, Section 651.095, and Part IX, Chapter 626, F.S. (2) A provider holding a provisional certificate of authority or a certificate of authority is res…

Rulemaking Authority 651.015(3) FS. Law Implemented 651.018 FS. History-New 7-16-92, Formerly 4-193.045, Repealed 3-12-20.

Rulemaking Authority 651.015(3) FS. Law Implemented 651.035 FS. History-New 7-16-92, Formerly 4-193.048, Repealed 3-12-20.

(1) A Minimum Liquid Reserve (MLR) Calculation shall be filed with the Office, on or before May 1 of each year if the provider's fiscal year end is December 31 or within 120 days of the last day of the fiscal year of the provider if the provider has declared a fiscal year other t…

(1) If principal and interest payments are paid to a trust that is beneficially held by residents as described in Section 651.023(7), F.S., the Office may waive all or any portion of the escrow requirements for mortgage principal and interest if the Office finds that such waiver …

(1) A provider or facility is accredited for the purposes of Sections 400.235(5)(b)1., and 651.105(1), F.S., if it is accredited without stipulations or conditions by Commission on Accreditation of Rehabilitation Facilities International ("CARF International"). (2) The provider w…

Each provider shall immediately notify the Office and file pertinent documents within five business days regarding: (1) Any litigation alleging a felonious act by a provider or any person affiliated with or controlled by a provider; (2) Any proceeding for denial, suspension, or r…

Rulemaking Authority 651.015(3) FS. Law Implemented 651.022(2)(c), 651.023, 651.0235, 651.026 FS. History-New 7-16-92, Formerly 4-193.060, Repealed 3-12-20.

(1) Scope of Rule. This rule implements Section 651.123, F.S., and applies to a dispute between a resident and a provider except a dispute over increases in monthly maintenance fees. (2) Definitions. The following definitions shall apply for purposes of this rule: (a) "Administra…

(1) Scope of Rule. Any portion of a dispute which is not resolved in mediation under Rule 69O-193.062, F.A.C., may be submitted by a party to binding arbitration under this rule if all parties agree in advance to be bound by the arbitrated result. (2) Definitions. The following d…

Rulemaking Authority 624.308(1), 651.013, 651.015(1), (3) FS. Law Implemented 624.307(1), 651.021, 651.022, 651.023, 651.024, 651.026, 651.033, 651.035 FS. History-New 6-25-90, Formerly 4-45.035, Amended 7-16-92, 11-29-98, 12-24-03, Formerly 4-193.065, Repealed 3-12-20.

(1) The Office shall approve a corrective action plan submitted pursuant to Section 651.034, F.S., if the plan includes: (a) A statement of the fundamental problems causing the regulatory action level event to occur; (b) A description of the pricing, operational, or other changes…

Rulemaking Authority 641.403 FS. Law Implemented 641.403 FS. History-New 5-9-85, Formerly 4-69.01, 4-69.001, 4-194.001, Repealed 9-28-22.

(1) All terms defined in the Prepaid Health Clinic Act which are used in these rules shall have the same meaning as in the Act. (2) PHC. Prepaid health clinics shall be abbreviated as PHC in these rules. (3) Basic Services. Basic services include any of the following services whi…

Rulemaking Authority 641.403, 641.405(2) FS. Law Implemented 641.405, 641.406, 641.407, 641.409, 641.412, 641.42, 641427, 641.43, 641.441 FS. History-New 5-9-85, Formerly 4-69.03, 4-69.003, 4-194.003, Amended 9-28-22, 1-4-24, Transferred to 69O-136.043.

Evidence of the existence of insurance or a plan for self-insurance approved by the Office must be submitted at least 30 days prior to the expiration date of the policy and with each annual report. The Office shall consider the potential general liability and potential malpractic…

(1)(a) "Prepaid health clinic" or "PHC contract" means the certificate or contract provided to the subscriber which describes the health care services provided and the amount to be charged. Every subscriber shall be given a PHC contract unless subsection (2) of this rule applies.…

(1) For new rates under new prepaid health clinic contracts, the PHC must submit a copy of the new rates, and a full explanation of how the rates were calculated, including utilization assumptions, signed by the preparer. (2) For new rates under existing prepaid health clinic con…

(1) Advertising includes printed and published material, descriptive literature and sales aids, sales talks and sales materials, booklets, forms and pamphlets, illustrations, depictions and form letters, and newspaper, radio, television and direct mail advertising, and any other …

The manner of merchandising subscriber contracts must be fully explained by the PHC prior to certification. All salesmen or representatives of the PHC engaged in soliciting subscribers are bound by these rules. The PHC is responsible for the acts of its representatives in solicit…