Florida Regulations 64W-4.003: Documentation Requirements
Current as of: 2024 | Check for updates
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(1) Applications are to be completed and documents uploaded to the FRAMEworks portal or mailed to the Florida Department of Health, Division of Public Health Statistics and Performance Management, State Primary Care Office, FRAME Program, 4052 Bald Cypress Way, Bin #A05, Tallahassee, Florida 32399-1720. Hand-delivered application packets will not be accepted.
(2) Submit a completed Florida Reimbursement Assistance for Medical Education (FRAME) Application, DH8013-PHSPM-01/2023, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-15268.
(3) Based on employment type, one of the following must be either submitted to the Department in the physical application packet or uploaded to the FRAMEworks portal:
(a) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Employment Verification Form for each employer if the applicant is an employee. The Employment Verification Form, DH8015-PHSPM-01/2023, is incorporated by reference and available https://www.flrules.org/Gateway/reference.asp?No=Ref-15271,
or
(b) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Solo Practitioner Attestation, if the applicant is not an employee. If the application is completed in the FRAMEworks portal, the information in this form may be completed in the portal, without the need to upload the form. The Solo Practitioner Attestation, DH8016-PHSPM-01/2023, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-15270.
(4) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Loan Certification Form for each educational loan must be either submitted to the Department in the application packet or uploaded to the FRAMEworks portal. The Loan Certification Form, DH8014-PHSPM-01/2023, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15269.
(5) The following FRAME program documents should be either submitted to the Department in the application packet or uploaded to the FRAMEworks portal, as applicable:
(a) For all practice locations that are in a primary care HPSA, submit documentation of primary care shortage designation status. A copy of the HRSA “”Find Shortage Areas by Address”” query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address) is considered acceptable documentation.
(b) For all practice locations that are not in a primary care HPSA but are in a designated rural health area or rural hospital, submit documentation of the rural health status. A copy of the query result for each practice site location from the Federal Office of Rural Health Policy (https://data.hrsa.gov/tools/rural-health) is considered acceptable documentation.
(c) If requested by the Department, documentation of status as a United States citizen (U.S. born or naturalized) or United States national, as defined by 8 U.S.C. § 1401 – 1440, shall be provided by the applicant within five (5) business days.
(6) All Department forms for the FRAME program will also be made available on the Department’s website at https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/FRAMEProgram/index.html.
(7) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.
Rulemaking Authority 1009.65 FS. Law Implemented Florida Statutes § 1009.65. History-New 4-20-23.
(3) Based on employment type, one of the following must be either submitted to the Department in the physical application packet or uploaded to the FRAMEworks portal:
(a) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Employment Verification Form for each employer if the applicant is an employee. The Employment Verification Form, DH8015-PHSPM-01/2023, is incorporated by reference and available https://www.flrules.org/Gateway/reference.asp?No=Ref-15271,
or
(b) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Solo Practitioner Attestation, if the applicant is not an employee. If the application is completed in the FRAMEworks portal, the information in this form may be completed in the portal, without the need to upload the form. The Solo Practitioner Attestation, DH8016-PHSPM-01/2023, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-15270.
(4) A completed Florida Reimbursement Assistance for Medical Education (FRAME) Loan Certification Form for each educational loan must be either submitted to the Department in the application packet or uploaded to the FRAMEworks portal. The Loan Certification Form, DH8014-PHSPM-01/2023, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15269.
(5) The following FRAME program documents should be either submitted to the Department in the application packet or uploaded to the FRAMEworks portal, as applicable:
(a) For all practice locations that are in a primary care HPSA, submit documentation of primary care shortage designation status. A copy of the HRSA “”Find Shortage Areas by Address”” query result for each practice site location (https://data.hrsa.gov/tools/shortage-area/by-address) is considered acceptable documentation.
(b) For all practice locations that are not in a primary care HPSA but are in a designated rural health area or rural hospital, submit documentation of the rural health status. A copy of the query result for each practice site location from the Federal Office of Rural Health Policy (https://data.hrsa.gov/tools/rural-health) is considered acceptable documentation.
(c) If requested by the Department, documentation of status as a United States citizen (U.S. born or naturalized) or United States national, as defined by 8 U.S.C. § 1401 – 1440, shall be provided by the applicant within five (5) business days.
(6) All Department forms for the FRAME program will also be made available on the Department’s website at https://www.floridahealth.gov/provider-and-partner-resources/community-health-workers/HealthResourcesandAccess/FRAMEProgram/index.html.
(7) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.
Rulemaking Authority 1009.65 FS. Law Implemented Florida Statutes § 1009.65. History-New 4-20-23.