AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.: RULE TITLE:
59G-1.060: Provider Enrollment Policy
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 47 No. 179, September 15, 2021 issue of the Florida Administrative Register.
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 47 No. 179, September 15, 2021 issue of the Florida Administrative Register.
The rule text has been changed as follows:
(1) through (2) No change.
(3) The following forms are incorporated by reference and available on the Florida Medicaid Web portal at http://portal.flmmis.com/flpublic, and as follows:
(a) through (h) No change.
(i) Group Membership Authorization, AHCA Form 5000-1061, June 2019, http://www.flrules.org/Gateway/reference.asp?No=Ref-_________.
(i) through (v) renumbered as (j) through (w).
(x) No change.
(4) No change.
Following changes have been made to the Florida Medicaid Provider Enrollment Policy, incorporated by reference in the Rule:
1.0 through 3.9, No change.
3.10 National Provider Identifier
Introductory paragraph, No change.
First bullet, No change.
Providers designated as an Organizational provider entity type and signing an Institutional Provider Agreement must enter a unique NPI for each service location (if the provider has more than one service address).
Providers designated as an Organizational provider entity type and signing a Non-Institutional Provider Agreement are not required to designate one NPI per service location.
3.11 through 3.14, No change.
4.0 through 4.1, No change.
4.2 Screening Categories
4.2.1 Providers and suppliers designated as “limited” categorical risk:
Alphabetized bulleted list, No change until the following:
Medical foster care
Occupational, respiratory or speech therapists, enrolling as individuals
Pharmacies
No change to remainder of list.
4.2.2 Providers and suppliers designated as “moderate” categorical risk:
Alphabetized bulleted list, No change until the following:
- Occupational, physical, respiratory, or speech therapists, enrolling as individuals
or as group practices
No change to remainder of list.
4.2.3 Providers and suppliers designated as “high” categorical risk:
Alphabetized bulleted list, No change until the following:
- Mental health targeted case management providers
- Physical therapists, enrolling as individuals
- Prospective (newly enrolling) home health agencies and other home health
service providers
No change to remainder of list.
4.3 through 8.3, No change.
9.0 Appendices
9.1 Appendix A through 9.2 Appendix B, No change.
9.3 Appendix C: Provider Specific Documents
Alphabetized Provider Type list.
Provider Type: Advanced Practice Registered Nurse through Provider Type: Home and Community-Based Services, No change.
Provider Type: Home Health Services
Enrollment Types, No change.
Application Types, No change.
Specialties
Personal Care, Unlicensed
Independent Nurse, Licensed Practical Nurse (LPN)
Independent Nurse, RN
Home Health Agency
Practice Type, No change.
Required Documents, No change.
Additional Required Documents for Independent Nurse, LPN and Independent Nurse, RN, No change.
Additional Required Documents for Sole Proprietor Personal Care Providers Exempt from Home Health Agency Licensure under 400.464(5), F.S., No change.
Additional Required Documents for Home Health Agencies that Provide Skilled Services
State of Florida Agency for Health Care Administration Florida Medicaid Provider Surety Bond, AHCA Form 5000-1064, June 2019, incorporated by reference in Rule 59G-1.060, F.A.C.
Home Health Agencies must complete a pre-certification survey by the Health Quality Assurance licensing unit
Medicare Certification Letter*
Additional Information
*Home health providers must be either Medicare certified or meet the standards for certification. These providers must meet one of the following requirements to qualify for limited or full enrollment in Florida Medicaid:
- Have Medicare certification
- Meet the requirements for Medicare certification by demonstrating compliance during a survey conducted by the Division of Health Quality Assurance
- Be accredited and surveyed for deemed status by The Joint Commission (TJC), the Community Health Accreditation Partner (CHAP), or the Accreditation Commission for Health Care (ACHC) as meeting the Medicare Conditions of Participation. These are the current organizations approved by Medicare. Florida Medicaid would accept these and others designated by the Centers for Medicare and Medicaid Services.
Provider Type: Hospice through Provider Type: Transportation, No change.
