59G-1.045 : Medicaid Forms - Florida Administrative Rules, Law, Code, Register

Florida Department of State and Division of Library and Information Services

Rule: 59G-1.045 Prev Up Next

Rule Title: Medicaid Forms
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:	2/8/2018
	History Notes:	Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.912 FS. History–New 9-28-15, Amended 7-11-16, 4-5-17, 2-8-18.
	References in this version:	Ref-07012 Medical Certification for Medicaid Long-term Care Services and Patient Transfer, AHCA Form 5000-3008 Ref-07013 State of Florida Abortion Certification Form, AHCA MedServ Form 011 Ref-07014 State of Florida Exception to Hysterectomy Acknowledgment Requirement, ETA-5001 Ref-07015 State of Florida Hysterectomy Acknowledgment Form, HAF-5000 Ref-07915 Unborn Activation Form, AHCA Form 5240-006, February 2017 Ref-07926 The United States Department of Health and Human Services’ Consent for Sterilization Form - HHS-687 (10/12) (Consent for Sterilization Form) Ref-09057 Acquired Immune Deficiency Syndrome (AIDS) Physician Referral for Individuals at Risk of Hospitalization, AHCA Form 5000-0607, January 2018 Ref-09058 Adults with Cystic Fibrosis Physician Referral for Individuals at Risk of Hospitalization, AHCA Form 5000-0608, January 2018 Ref-09059 Consent for Voluntary Suspension of Authorized Services for Florida Medicaid State Plan Recipients, AHCA Form 5000-0123, August 2017 Ref-09060 Model Waiver Physician Referral for Individuals at Risk of Hospitalization, AHCA Form 5000-0025, January 2018

History of this Rule since Jan. 6, 2006

Section	Description	ID	Publish Date

Final 59G-1.045	Medicaid Forms	19983084	Effective: 02/08/2018
Proposed 59G-1.045	The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code, is to include new Florida Medicaid forms in the Rule.	19783846	11/29/2017 Vol. 43/229
Development 59G-1.045	The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code (F.A.C.), is to include new Florida Medicaid forms in the Rule. The amendment incorporates by reference the Consent for Voluntary Suspension of ....	19606918	10/25/2017 Vol. 43/207
Final 59G-1.045	Medicaid Forms	18753415	Effective: 04/05/2017
Proposed 59G-1.045	The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code, is to update forms required by Florida Medicaid that impact multiple services.	18520809	1/24/2017 Vol. 43/15
Development 59G-1.045	The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code, is to update certain forms required under the Florida Medicaid Program. The amendment updates existing forms and incorporates by reference additional ....	18044151	9/23/2016 Vol. 42/186
Final 59G-1.045	Medicaid Forms	17691265	Effective: 07/11/2016
Change 59G-1.045	Medicaid Forms	17581267	5/27/2016 Vol. 42/104
Proposed 59G-1.045	The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code, is to update forms required by Florida Medicaid that impact multiple services.	17418986	4/21/2016 Vol. 42/78
Development 59G-1.045	The purpose of the amendment to Rule 59G-1.045 is to update forms incorporated by reference within the rule, and to incorporate by reference additional forms specified throughout Florida Medicaid rules.	17033411	1/14/2016 Vol. 42/09
Final 59G-1.045	Medicaid Forms	16479347	Effective: 09/28/2015
Change 59G-1.045	Medicaid Forms	16332877	8/12/2015 Vol. 41/156
Proposed 59G-1.045	The purpose of new Rule 59G-1.045 is to incorporate by reference Florida Medicaid forms.	16123745	6/18/2015 Vol. 41/118
Development 59G-1.045	The purpose of Rule 59G-1.045 is to incorporate by reference Florida Medicaid forms. The Medical Certification for Medicaid Long-term Care Services and Patient Transfer Form is used to determine the medical eligibility for ....	15725948	3/2/2015 Vol. 41/41

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