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

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Rule: 59G-1.060 Prev Up Next

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:	4/30/2025
	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, 4-30-25.
	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

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

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