Florida’s appeal isn’t just the sunshine and sandy beaches—it’s the vibrant, livable haven for older adults that makes it a top retirement destination.
By 2030, more than a quarter (25.5 percent) of Florida’s residents will be aged 65 and over. – Newsweek
This means your agency is operating in a booming market—where demand for quality in-home care has never been higher.
But thriving here also means mastering a maze of home care laws in Florida. From securing a Florida home care license to implementing mandatory electronic visit verification in Florida, the compliance bar is set high.
Whether you’re just starting off or a seasoned Medicaid operator, the key to success lies in navigating these complex rules seamlessly.
That’s where this article comes in. We’ll unpack licensing, caregiver checks, Medicaid billing nuances, and the must-know about EVV in Florida—all in clear, actionable terms.
And if compliance ever feels overwhelming, know that CareSmartz360’s here with modern workflows and integrated EVV support to help you stay ahead. Ready? Let’s jump in.
To operate a home care agency in Florida, you must obtain a Florida home care license through the state’s Agency for Health Care Administration (AHCA).
The licensing process involves a formal application, home care license requirements like passing Level 2 background checks for owners and staff, and meeting certain staffing and policy standards. For example, agencies need an administrator and perhaps a Director of Nursing (if providing any nursing or personal care services) meeting experience qualifications.
You’ll also need to show proof of liability insurance and may need a surety bond to protect clients – measures aimed at ensuring home care compliance with financial and safety standards.
To legally operate a non-medical home care agency in Florida, here’s what your agency needs to prepare:
Full home health agency license: Required if offering any personal care, hands-on assistance, or health-related tasks
Homemaker/companion registration: Valid if offering non-hands-on services like companionship, meal prep, or light housekeeping
Create and maintain a comprehensive emergency management plan
It boils down to fulfilling the above licensing steps and requirements. This means registering your business entity with the state, completing the AHCA licensure application, hiring qualified staff, and preparing to operate under Florida’s home care rules.
Note that the initial licensure application can take a couple of months to process, so new agencies should plan timelines accordingly. Once licensed, you must display your license at your office and renew it biennially, keeping up with any new home care laws in Florida that may emerge.
Many home care agencies plan to serve clients through Florida’s Medicaid programs, so it’s crucial to understand those rules.
Yes – Florida’s Medicaid program (called the Statewide Medicaid Managed Care, SMMC) does pay for in-home care services for eligible individuals. Low-income seniors or adults with disabilities who meet medical and financial criteria can receive services like personal care assistance, homemaker services, skilled nursing visits, and therapy at home under Medicaid.
Please note that:
Medicaid reimburses personal care, homemaker, and home health services under different coverage types.
Non-medical home care agencies generally do not provide skilled services unless they also hold an HHA license and appropriate staffing.
These services are often provided through managed long-term care plans that the client enrolls in. In fact, Medicaid home care is a lifeline for many Florida seniors who wish to age in place rather than in nursing facilities.
However, Medicaid’s coverage has its limits and special requirements.
Medicaid can cover 24/7 care in certain cases – specifically when a doctor documents a medical necessity for round-the-clock supervision or nursing.
Under Florida’s long-term care Medicaid waivers, if an individual’s condition warrants continuous care to remain safely at home, the program may authorize 24-hour caregiving by splitting shifts among multiple providers.
Round-the-clock care under Medicaid is rare and must meet strict medical necessity documentation, usually approved only for high-acuity individuals under long-term care waivers.
Most Medicaid recipients receive a set number of hours per week based on their assessed needs.
Agencies should be prepared to coordinate with Medicaid case managers who authorize hours and to ensure caregivers log the time accurately.
Beyond obtaining the state license, agencies must enroll as Medicaid providers. Agencies must first enroll with Florida Medicaid via the Florida Medicaid Provider Enrollment Portal. For long-term care services, they may also contract directly with Managed Care Organizations (MCOs) after enrollment.
You’ll need to meet Medicaid-specific home care agency requirements such as having a Medicaid provider agreement, ensuring caregivers have any additional training required by Medicaid, and, crucially, using the required reporting systems.
One major federal requirement affecting Florida Medicaid providers is Electronic Visit Verification.
Florida has implemented electronic visit verification mandates to comply with the 21st Century Cures Act. EVV Florida requirements apply to all Medicaid-funded personal care and home health services.
What does this mean for agencies? Caregivers must electronically log each visit with details like type of service, client served, date, time in/out, and location.
Florida uses an open EVV model, which allows agencies to integrate their EVV vendor with the state-approved aggregator.
Agencies billing Medicaid must capture visits via an approved EVV solution – such as a GPS-enabled mobile app, telephony system from the client’s landline, or fixed device in the home—depending on agency workflows and caregiver accessibility.
Compliance with EVV is closely monitored. Florida’s AHCA has set strict benchmarks: managed care plans must ensure at least 85% of all home care visits are verified through EVV technology (without manual overrides) in order for those claims to be paid. – Florida Agency for Health Care Administration
In practice, that means agencies need to train staff on using EVV and promptly address any exceptions or missed check-ins so that the vast majority of visits register properly.
Failing to meet EVV usage thresholds could lead to claims denials or sanctions. EVV may sound like extra paperwork, but it greatly enhances home care compliance by preventing fraud and ensuring clients receive the scheduled care.
It’s effectively a digital audit trail. When setting up your agency’s processes, plan for EVV from day one – choose compliant software and instill the habit in your caregivers to avoid headaches later.
Tune in as we welcome Robert Markette, the legal lifeline for home health, hospice, and private duty home care providers! As Of Counsel at Hall Render, Robert is your go-to expert for all things compliance—whether it’s Medicaid, HIPAA, or navigating audits and investigations.
Operating a home care agency in Florida means juggling multiple compliance responsibilities: licensing rules, caregiver background screenings, insurance and bonding, Medicaid billing rules, EVV, client rights, and more.
It can feel overwhelming, especially for new agency owners. Fortunately, technology and good operational practices can ease the burden of compliance. Many agencies (1000+) turn to our all-in-one, AI-powered home care management software–CareSmartz360–to stay on top of regulations.
The platform integrates scheduling with EVV so that every visit is automatically verified and documented in accordance with Florida’s requirements. Caregiver credentials and background check renewals can be tracked through the software’s licensing workflows, alerting you before anything lapses.
Moreover, digital care records and reports make it easier to demonstrate compliance during AHCA audits or Medicaid reviews.
In short, leveraging a modern home care software not only improves efficiency but also acts as a safety net for regulatory compliance – an invaluable asset in a heavily regulated environment like Florida.
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