Medicaid Provider Agreement QRG

Quick Reference Guide

MPA Requirement

Providers located both in-state and out-of-state who are applying or renewing the Fully Enrollment type must submit a Master Provider Agreement (MPA). This document must be signed, dated, and include the title of the individual signing it. Institutional providers are required to submit an institutional MPA, which must be renewed every three years. Non-institutional providers must complete a Non-Institutional MPA, with renewal required every five years.

Acceptable Versions of the MPA

The MPAs are available on the Enrollment Forms page.

Verifying MPA Requirements

Providers are encouraged to utilize the Interactive Enrollment Checklist to verify which Medicaid Provider Agreement is required. Interactive Enrollment Checklist is located on the New Medicaid Providers page.

Authorized Signers

The legibly printed name of signatory, title of signatory, signature, and date must be completed on the MPA.

The signatory’s name and title must match the information provided in the Owner and Operator section of the enrollment or renewal application.

Non-Institutional MPA

Sole proprietors and sole proprietors enrolling as a member of a group:

• Sole proprietor must personally sign the MPA.
• An agent may not sign in lieu of the sole proprietor.

Groups and other business entities:

• All persons with five percent or greater ownership or controlling interest must sign the MPA.
• A chief executive officer (CEO) or President may sign the agreement in lieu of all required persons; the signature is binding to all persons disclosed on the application.
• An administrator is not permitted to sign the agreement in lieu of all required persons.

Institutional MPA

• All persons with five percent or greater ownership or controlling interest must sign the MPA.
• A chief executive officer (CEO), President, or Administrator may sign the agreement in lieu of all required persons; the signature is binding to all persons disclosed on the application.

Expiring MPA

Providers will receive a notification letter within 90, 60, and then 30 days of their MPA expiration date. The expiration date of the current agreement is the deadline for completing the renewal application.

See Provider Renewal for more information regarding the renewal application process.

Additional Resources
AHCA Adopted Rules
Adopted Rules - Florida Medicaid Forms
Adopted Rules - Provider Enrollment Policy
Florida Medicaid Contact Information Sheet
Support
Training

TIP: Download Adobe Acrobat Reader to open or save PDF documents.