Medicaid Nursing Facility Provider Information
Requirements to Notify the Department of Children and Families (DCF) of Nursing Facility Admissions and Discharges
The Florida Department of Children and Families (DCF) must be notified of a Florida Medicaid recipient’s admission to a nursing facility or discharge from a nursing facility.
Upon notification of a nursing facility admission or discharge, DCF updates the recipient’s demographic information in the DCF computer system and makes any necessary changes in the recipient’s Medicaid eligibility aid category and patient responsibility.
Forms to Notify DCF of Nursing Facility Admission
Within 10 working days of the Medicaid recipient’s admission to a nursing facility, DCF must receive a completed DCF #2506A Form (Client Referral/Change).
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DCF #2506A Form
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117.5 kB
]
(Client Referral/Change) -
DCF #2506A Form Instructions
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136.1 kB
]
Forms to Notify DCF of Nursing Facility Discharge
Within 10 working days of the Medicaid recipient’s discharge from a nursing facility, DCF must receive a completed DCF #2506 Form (Client Discharge/Change Notice).
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DCF #2506 Form
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186.5 kB
]
(Client Discharge/Change Notice)
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DCF #2515 Form
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131 kB
]
(Certification of Enrollment Status (HCBS))
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DCF #2515 Form Instructions
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615.3 kB
]
Copies of these forms are also available from the Department of Children and Families, Office of Economic Self Sufficiency.
Pre-Admission Screening and Resident Review (PASRR)
Rule 59G-1.040, Florida Administrative Code
Florida Medicaid Forms
Rule 59G-1.045, Florida Administrative Code
- AHCA MedServ Form 004 Part A Preadmission Screen and Resident Review (PASRR) Level I Form and AHCA MedServ Form 004 Part A1 Preadmission Screen and Resident Review (PASRR) Resident Review – Evaluation Request Form
- AHCA Form 5000-3008 Medical Certification for Medicaid Long-term Care Services and Patient Transfer, and AHCA Form 5000-3008 Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Instructions
