59G-1.060 : Provider Enrollment Policy - Florida Administrative Rules, Law, Code, Register

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Rule Title: Provider Enrollment Policy
Department:	AGENCY FOR HEALTH CARE ADMINISTRATION	Add to MyFLRules Favorites
Division:	Medicaid
Chapter:	GENERAL MEDICAID

Latest version of the final adopted rule presented in Florida Administrative Code (FAC):

	Effective Date:	2/9/2022
	History Notes:	Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.907, 409.973 FS. History–New 12-25-19, Amended 2-9-22.
	References in this version:	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 Ref-13974 Florida Medicaid Provider Enrollment Policy, January 2022 Ref-13975 Florida Medicaid Provider Enrollment Application Out of State Fee for Service, AHCA Form 5000-1260, (JAN 2021) Ref-13976 Florida Medicaid Provider Enrollment Change of Ownership (CHOW) Disclosure Form-Hospital, Institutional Care (ICF) and Skilled Nursing Facility ONLY, AHCA Form 5000-1264, (JAN 2021) Ref-13977 Group Membership Authorization, AHCA Form 5000-1061, June 2019 Ref-13978 Non-profit Organization Certification-Fingerprinting Exemption, AHCA Form 5000-1261, (JAN 2021) Ref-13979 Special Exempt Entity Certification-Fingerprinting Exemption, AHCA Form 5000-1262, (JAN 2021)

History of this Rule since Jan. 6, 2006

Section	Description	ID	Publish Date

Proposed 59G-1.060	The purpose of this amendment is to remove the sunset provision from the rule text. This change is pursuant to the Joint Administrative Procedures Committee's objection dated February 4, 2025 and to the requirements in s. ....	29341353	3/6/2025 Vol. 51/45
Final 59G-1.060	Provider Enrollment Policy	25495012	Effective: 02/09/2022
Change 59G-1.060	Provider Enrollment Policy	25340297	12/13/2021 Vol. 47/239
Proposed 59G-1.060	The purpose of the amendment to Rule 59G-1.060, Florida Administrative Code (F.A.C.), is to revise provider enrollment requirements and update the rule text.	25012437	9/15/2021 Vol. 47/179
Correction 59G-1.060	Provider Enrollment Policy	24551105	5/17/2021 Vol. 47/95
Public Meeting 59G-1.060	The Agency is scheduling the meeting for the purpose of discussing the draft Florida Medicaid Provider Enrollment Policy which is available .... May 27, 2021, 2:00 to 2:30 p.m. Remote Listeners: Attendees may register for the meeting at: ....	24551202	5/17/2021 Vol. 47/95
Public Meeting 59G-1.060	The Agency is scheduling the meeting for the purpose of discussing the draft Florida Medicaid Provider Enrollment Policy which is available .... May 14, 2021, 2:30-3:00 p.m. Remote Listeners: Attendees may register for the meeting at: ....	24540338	5/14/2021 Vol. 47/94
Public Meeting 59G-1.060	The Agency is rescheduling the original January 27, 2021 workshop published in Vol. 47, No. 8 on January 13, 2021, for the purpose of discussing .... February 5, 2021 from 2:30 p.m. – 3:00 p.m. Remote Listeners: Attendees may register for the workshop at: ....	24155248	1/29/2021 Vol. 47/19
Development 59G-1.060	The purpose of the amendment to Rule 59G-1.060, Florida Administrative Code (F.A.C.), is to revise provider enrollment requirements and update the rule text.	24093944	1/13/2021 Vol. 47/08
Final 59G-1.060	Provider Enrollment Policy	22691518	Effective: 12/25/2019
Correction 59G-1.060	Enrollment Policy	22584236	11/8/2019 Vol. 45/219
Change 59G-1.060	Enrollment Policy	22517694	10/23/2019 Vol. 45/207
Change 59G-1.060	Enrollment Policy	22414777	9/26/2019 Vol. 45/188
Public Hearing 59G-1.060	The Agency is scheduling a hearing for discussing the Florida Medicaid Provider Enrollment process and policy. August 14, 2019 from 1:30 p.m. to 2:30 p.m. Agency for Health Care Administration, 2727 Mahan Drive, Building ....	22212823	8/2/2019 Vol. 45/150
Proposed 59G-1.060	The purpose of Rule 59G-1.060, Florida Administrative Code, is to incorporate by reference the Florida Medicaid Provider Enrollment Policy, __________.	21815802	5/6/2019 Vol. 45/88
Public Meeting 59G-1.060	The Agency is holding a public meeting to discuss the Florida Medicaid Enrollment Policy. April 12, 2019; 10:00 a.m. - 11:00 a.m. Agency for Health Care Administration, 2727 Mahan Drive, Building ....	21703767	4/5/2019 Vol. 45/67
Development 59G-1.060	The purpose of rule 59G-1.060 is to incorporate by reference the Florida Medicaid Enrollment Policy, __________. The incorporated policy will specify enrollment requirements for individuals, groups, and entities seeking ....	17098110	2/2/2016 Vol. 42/21

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