Florida Department of State and Division of Library and Information Services
Notice: 22691518
Final Adopted Version in F.A.C.
Department: AGENCY FOR HEALTH CARE ADMINISTRATION
Division: Medicaid
Chapter: GENERAL MEDICAID

VIEW NOTICE

Overview
RULE:
59G-1.060   Provider Enrollment Policy
RULE FILE DATE: 12/5/2019
RULE EFFECTIVE DATE: 12/25/2019
HISTORY NOTES: Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.907, 409.973 FS. History–New 12-25-19.
OVERSIGHT COMMITTEE: Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)
RELATED COURT CASES: Division of Administrative Hearings
FEDERAL RULES
AND REGULATIONS: 		Electronic Code of Federal Regulations
HOW TO LINK TO
THIS NOTICE: 		http://flrules.org/gateway/ruleno.asp?id=59G-1.060&Section=0
REFERENCE MATERIALS: Ref-11331 Florida Medicaid Provider Enrollment Policy, December 2019
Ref-11332 Case Manager Certification, AHCA Form 5000-3537, May 2014
Ref-11333 Case Manager Supervisor Certification Targeted Case Management for Children at Risk of Abuse and Neglect, AHCA Form 5000-3536, May 2014
Ref-11334 Comprehensive Behavioral Health Assessment Agency and Practitioner Self-Certification, AHCA Form 5000-3512, May 2014
Ref-11335 Contractor Certification for Children’s Services Council, AHCA Form 5000-3535, May 2014
Ref-11336 County Health Department Agreement Provider Credentialing of Behavioral Health Providers and Social Workers, AHCA Form 5000-1066, June 2019
Ref-11337 Medical Foster Care Children’s Medical Services Local Medical Foster Care (MFC) Program Care Coordinator Attestation Checklist, AHCA Form 5000-1069, June 2019
Ref-11338 Physician Group Certificate of Ownership, AHCA Form 5000-1068, June 2019
Ref-11339 Practitioner Collaborative Agreement, AHCA Form 5000-1067, June 2019
Ref-11340 Provider Agency Certification for Children’s Services Council, AHCA Form 5000-3539, May 2014
Ref-11341 School District Assurance Agreement Provider Credentialing of Behavior Analysts, AHCA Form 5000-1162, June 2019
Ref-11342 School District Assurance Agreement Provider Credentialing of Behavioral Sciences Staff, AHCA Form 5000-1160, June 2019
Ref-11343 School District Assurance Agreement Provider Credentialing of Mental Health Counselors and Family Therapists, AHCA Form 5000-1161, June 2019
Ref-11344 School District Assurance Agreement Provider Credentialing of Psychologists, Behavior Analysts, and Social Workers, AHCA Form 5000-1163, June 2019
Ref-11345 School District Assurance Agreement Provider Credentialing of Registered Nurses and Licensed Practical Nurses, AHCA Form 5000-1164, June 2019
Ref-11346 School District Assurance Agreement Provider Credentialing of School Health Aides, AHCA Form 5000-1165, June 2019
Ref-11347 School District Assurance Agreement Provider Credentialing of Therapists and Therapy Assistants, AHCA Form 5000-1166, June 2019
Ref-11348 State of Florida Agency for Health Care Administration Florida Medicaid Provider Surety Bond, AHCA Form 5000-1064, June 2019
Ref-11349 Therapeutic Foster Care Provider Agency Self-Certification, AHCA Form 5000-3513, March 2014
Ref-11350 Electronic Data Interchange Agreement, AHCA Form 5000-1062, June 2019


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