Services Provided - All documents are PDF files less than 544KB.  All open in a new window.

Each provider is required to utilize Medicaid and all other applicable funding sources prior to billing this Waiver.

1. How to Apply

• Provider Application Instructions(pdf-36KB)- 1st Time Applicants
• TBI/SCI Medicaid Waiver Application(pdf-2MB)
• Non-Institutional Provider Agreement Form(pdf-185KB)
• NPI Registration(pdf-544KB)

          Note: A fingerprint card must be submitted with each application along with payment of $43.25 per card per principals or shareholds with five percent (5%) or more ownership.  each check per person must be payable to AHCA.  One fingerprint card and one check per person. For more information, see contact below. 

2. Information for Providers Already Enrolled in Another Medicaid Waiver

• Application for a New Location Code(pdf-28KB)
• Payment Authorization Form(pdf-109KB) (Please sign Option #2 only!)

• Non-Institutional Provider Agreement(pdf-185KB)

• NPI Registration(pdf-544KB)

Important

• Copies of Certification, Licenses and credentials for specific service areas are required at the time of application submission!

• All individual providers are required to hand write a note describing familiarity and experience in working with individuals who have sustained a traumatic brain and/or spinal cord injury.

For more information regarding enrollment or to check on your status, please contact the Medicaid Waiver Section by calling Toll Free at (866) 875-5660 or direct at (850) 245-4045.

Please Mail Applications to address below:

Florida Department of Health
Brain and Spinal Cord Injury Program
4052 Bald Cypress Way, Bin C-25
Tallahassee, FL 32399-1744
Phone: (850) 245-4045
Toll Free: 1-866-875-5660
Fax: (850) 921-0499

BSCIP Staff | BSCIP Home | DOH Contacts

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