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CS/HB 1229 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to residential homes for medically or 2
technologically dependent children; creating part XII 3
of ch. 400, F.S., entitled "Medically Complex 4
Children's Homes"; creating s. 400.9991, F.S.; 5
providing legislative intent; creating s. 400.9992, 6
F.S.; defining the terms "agency" and "medically 7
complex children's home"; creating s. 400.9993, F.S.; 8
providing licensure requirements; creating s. 9
400.9994, F.S.; providing application requirements; 10
requiring the Agency for Health Care Administration to 11
require certain background screening for certain 12
persons; requiring access to a medically complex 13
children's home at reasonable times for certain 14
persons; requiring the agency to issue a provisional 15
license to a newly licensed provider for a specified 16
timeframe under certain circumstances; requiring 17
issuance of a standard license to a provisionally 18
licensed provider under certain circumstances; 19
authorizing the agency to issue a conditional license 20
for a specified timeframe to a licensed provider for 21
specified reasons; requiring the agency to conduct 22
inspections; creating s. 400.9995, F.S.; providing 23
rulemaking authority and requirements; creating s. 24
400.9996, F.S.; providing eligibility requirements for 25
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
admission to a medically complex children's home; 26
creating s. 400.9997, F.S.; providing uniform 27
firesafety standards, emergency preparedness 28
requirements, and construction standards; creating s. 29
400.9998, F.S.; providing for the denial, suspension, 30
and revocation of a license; providing for 31
administrative fines; amending ss. 400.051, 408.802, 32
408.820, and 408.823, F.S.; conforming provisions to 33
changes made by the act; requiring the agency to 34
implement certain changes by a specified date; 35
providing an effective date. 36
37
Be It Enacted by the Legislature of the State of Florida: 38
39
Section 1. Part XII of chapter 400, Florida Statutes, 40
consisting of ss. 400.9991 through 400.9998, is created and 41
entitled "Medically Complex Children's Homes." 42
Section 2. Section 400.9991, Florida Statutes, is created 43
to read: 44
400.9991 Legislative intent.—It is the intent of the 45
Legislature to develop, establish, and enforce licensure and 46
basic standards for medically complex children's homes in order 47
to ensure that the homes are family-centered and that the 48
medical, developmental, physiological, nutritional, and 49
psychosocial needs of medically complex children are met. 50
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Medically complex children's homes shall serve as a safe home-51
like setting with clinical oversight for children with complex 52
medical needs as an alternative to institutional care. This 53
setting is intended to meet the needs of children and families 54
in this state, offering smaller homes geographically close to 55
parents and guardians to maintain family connections for the 56
fragile children served. Medically complex children's homes are 57
not intended to serve children whose parents and guardians live 58
outside of this state, as out-of-state residency does not 59
support family involvement with the child. 60
Section 3. Section 400.9992, Florida Statutes, is created 61
to read: 62
400.9992 Definitions.—As used in this part, the term: 63
(1) "Agency" means the Agency for Health Care 64
Administration. 65
(2) "Medically complex children's home" means any 66
residential home that undertakes through its ownership or 67
management to provide residential services for up to six 68
medically dependent or technologically dependent children who 69
are not related to the owner or operator by blood, marriage, or 70
adoption. A medically complex children's home serves children 71
who are medically or technologically dependent as defined in s. 72
400.902(6). 73
Section 4. Section 400.9993, Florida Statutes, is created 74
to read: 75
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400.9993 Licensure required; exemptions.— 76
(1) The requirements of part II of chapter 408 apply to 77
the provision of services that require licensure pursuant to 78
this part and part II of chapter 408 and to entities licensed by 79
or applying for such licensure from the agency pursuant to this 80
part. A license issued by the agency is required for the 81
operation of a medically complex children's home in this state. 82
(2) Separate licenses shall be required for homes 83
maintained in separate premises that are operated under the same 84
management. 85
(3) A medical foster home licensed by the Department of 86
Children and Families is exempt from licensure under this part. 87
(4)(a) A community residential group home licensed under 88
chapter 393 providing residential care for medically complex 89
children is deemed to satisfy the requirements for initial 90
licensure under this part if the home meets all of the following 91
criteria: 92
1. The home held a license in good standing under chapter 93
393 on June 30, 2026. 94
2. The home shares common ownership with all of the 95
following: 96
a. A health agency licensed under part III of chapter 400 97
providing private duty nursing services by registered nurses or 98
licensed practical nurses. 99
b. A prescribed pediatric extended care center licensed 100
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under part VI of chapter 400. 101
c. A home medical equipment provider licensed under part 102
VII of chapter 400. 103
d. A health care clinic licensed under part X of chapter 104
400 providing speech-language therapy, physical therapy, or 105
occupational therapy. 106
(b) A community residential group home that meets the 107
requirements in paragraph (a) shall submit an application for 108
licensure to the agency within 60 days after the adoption of 109
agency licensure rules and must comply with the minimum 110
standards and requirements to maintain licensure pursuant to 111
this part. 112
Section 5. Section 400.9994, Florida Statutes, is created 113
to read: 114
400.9994 Licensure application requirements.— 115
(1) Each application for initial licensure or license 116
renewal must meet the requirements specified in part II of 117
chapter 408 and this part. 118
(2) The initial application must contain the location of 119
the medically complex children's home for which a license is 120
sought and documentation, signed by the appropriate local 121
government official, that states that the applicant has met 122
local zoning requirements. 123
(3) The agency shall require level 2 background screening 124
for personnel pursuant to s. 408.809(1)(e) and chapter 435. 125
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(4) In addition to the requirements of s. 408.811, access 126
to a medically complex children's home must be provided at 127
reasonable times for the appropriate officials of the agency, 128
the Department of Health, the Department of Children and 129
Families, and the State Fire Marshal, who are responsible for 130
the development and maintenance of fire, health, sanitary, and 131
safety standards, and Medicaid requirements, to inspect the home 132
to ensure compliance with these standards. 133
(5) In addition to the license categories available in s. 134
408.808: 135
(a) The agency shall issue a provisional license for a 136
period of up to 6 months to an applicant for initial licensure 137
which meets the licensure criteria pursuant to this part and 138
part II of chapter 408. 139
1. The licensed provider shall notify the agency, in 140
writing, when at least one resident has been admitted to the 141
home, after which an unannounced inspection shall be made to 142
determine compliance with the requirements of a medically 143
complex children's home. 144
2. In addition to sanctions authorized under this part, if 145
violations are found during the inspection and the licensee 146
fails to demonstrate compliance with all medically complex 147
children's home requirements during a followup inspection, the 148
licensee may not admit any new children for medically complex 149
children's home services. The agency may extend the provisional 150
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license for not more than 1 month pending verification of 151
correction of violations through a second followup inspection. 152
If violations are found during the second followup inspection, 153
the agency may not extend the provisional license any further. 154
The licensee shall promptly create and implement a plan for the 155
safe and orderly discharge of the children being cared for under 156
the medically complex children's home license. 157
3. A provisionally licensed provider that demonstrates 158
compliance with all the requirements of a medically complex 159
children's home license during the inspection shall be issued a 160
standard medically complex children's home license. 161
(b) The agency may issue a conditional license to a 162
facility if, at the time of license renewal, the facility is 163
found to have uncorrected violations that the facility has had 164
an opportunity to correct. A conditional license must be limited 165
to a specific period of not more than 6 months. 166
(6) The agency shall conduct licensure inspections of 167
medically complex children's homes and quarterly monitor visits. 168
Section 6. Section 400.9995, Florida Statutes, is created 169
to read: 170
400.9995 Rules establishing minimum standards.—The agency 171
may adopt rules to administer this part and part II of chapter 172
408, which must include reasonable and fair minimum standards in 173
relation to: 174
(1) A safe and sanitary environment that is residential 175
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and noninstitutional in design or nature and may allow for 176
technological advances in the provision of care, safety, and 177
security, including the use of devices, equipment, and other 178
security measures related to the general safety and security of 179
residents, staff, and the home. 180
(2) Accommodation of the needs and preferences of 181
residents to enhance the quality of life in the home. 182
(3) The provision of individualized medical, 183
developmental, and family training services. 184
(4) The number and qualifications of all personnel who 185
have responsibility for the care of the children served based on 186
the age and acuity of the children. The home must have licensed 187
nursing staff who are on duty in the home at all times. 188
(5) All sanitary conditions within the medically complex 189
children's home and its surroundings, including water supply, 190
sewage disposal, food handling, and general hygiene, and 191
maintenance staff thereof, which will ensure the health and 192
comfort of children served. 193
(6) Programs and basic services promoting and maintaining 194
a homelike environment and the health and development of the 195
children served, including facilitating school services. Such 196
programs and services include development, implementation, and 197
monitoring of a comprehensive protocol of care, developed in 198
conjunction with the parent or guardian, which specifies the 199
medical, nursing, psychosocial, and developmental therapies 200
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required by the medically dependent or technologically dependent 201
child served. 202
(7) Requirements for assisting with supportive services, 203
including, but not limited to, speech therapy, occupational 204
therapy, physical therapy, social work, developmental services, 205
child life services, psychological services, and transportation. 206
(8) Maintenance of appropriate medical records, data, and 207
information relative to the children and programs. Such records 208
shall be accessible to the agency for inspection during onsite 209
visits. 210
(9) The use of video cameras and electronic monitoring 211
within the home to include areas where monitoring is required 212
and areas where monitoring is permitted with the consent of the 213
parent or guardian of the child. 214
(10) Requirements for child bedrooms, including criteria 215
for a private room and the permissible circumstances for a 216
shared room. 217
(11) Discharge and transfer planning for a child, 218
including a child who becomes ineligible for services from the 219
home. Discharge planning must be initiated at least 18 months 220
before the child reaches 21 years of age to enable a smooth 221
transition to an appropriate setting. The rules shall also 222
specify advance notice requirements. 223
(12) Establishing procedures, identifying forms, 224
specifying documentation, and clarifying terms, as necessary, to 225
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administer this part. 226
(13) Admission and assessment of children. 227
Section 7. Section 400.9996, Florida Statutes, is created 228
to read: 229
400.9996 Resident eligibility and admission.— 230
To qualify for admission to a medically complex children's home, 231
a child must: 232
(1) Be admitted from a higher level of care in a Florida 233
facility such as a hospital or skilled nursing facility, or must 234
be admitted from a family home of a parent or guardian whose 235
primary residence is in Florida. 236
(2) Have a chronic debilitating disease or condition of 237
one or more physiological or organ systems which generally makes 238
the child dependent upon 24-hour-per-day medical, nursing, or 239
health supervision or intervention. Medically fragile children 240
are medically complex and the medical condition is such that 241
they are technologically dependent upon medical equipment or 242
procedures to sustain life and can expire without warning unless 243
continually under observation. 244
(3) Have a written order by the child's attending 245
physician in consultation with the parents or legal guardians. 246
For Medicaid recipients, the recommendations for placement of a 247
Medicaid applicant or recipient in the medically complex 248
children's home must be made by the Children's Multidisciplinary 249
Assessment Team of the Department of Health under s. 391.025. 250
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Consideration must be given to relevant medical, emotional, 251
psychosocial, and environmental factors. 252
Section 8. Section 400.9997, Florida Statutes, is created 253
to read: 254
400.9997 Uniform firesafety requirements; emergency 255
preparedness; construction standards.— 256
(1) Uniform firesafety standards for medically complex 257
children's homes, which are residential board and care 258
occupancies, shall be established by the State Fire Marshal 259
pursuant to s. 633.206. 260
(2) Permanent onsite generators must be installed and 261
maintained. 262
(3) An automatic fire sprinkler system must be installed 263
and maintained. 264
(4) A firesafety evacuation capability determination shall 265
be conducted within 6 months after the date of initial licensure 266
of a medically complex children's home. 267
(5) Comprehensive emergency management plans required by 268
s. 408.821 shall be submitted for review and approval to the 269
local emergency management agency. 270
(6) All medically complex children's homes must have an 271
annual fire inspection conducted by the local fire marshal or 272
authority having jurisdiction. 273
(7) The requirements for the construction or renovation of 274
a medically complex children's home shall comply with all of the 275
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following: 276
(a) The provisions of chapter 553, which pertain to 277
building construction standards, including plumbing, electrical 278
code, glass, manufactured buildings, and accessibility for the 279
physically disabled. 280
(b) Section 633.206 and applicable rules pertaining to 281
physical standards for community residential care facilities. 282
(c) The standards or rules adopted pursuant to this part 283
and part II of chapter 408. 284
(8) The agency may adopt rules to implement this section. 285
Section 9. Section 400.9998, Florida Statutes, is created 286
to read: 287
400.9998 Denial, suspension, and revocation of licensure; 288
violations; administrative fines.— 289
(1) In accordance with part II of chapter 408, the agency 290
may deny, revoke, and suspend a license and impose an 291
administrative fine for the violation of any provision of this 292
part, part II of chapter 408, or applicable rules. 293
(2) A violation of this part, part II of chapter 408, or 294
applicable rules is subject to fines specified in s. 408.813. A 295
violation shall be classified according to the nature of the 296
violation and the gravity of its probable effect on residents. 297
The agency shall indicate the classification on the written 298
notice of the violation as follows: 299
(a) Class "I" violations as described in s. 408.813. The 300
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agency shall issue a citation regardless of correction and 301
impose an administrative fine of $500 for an isolated violation, 302
$750 for a patterned violation, or $1,000 for a widespread 303
violation. 304
(b) Class "II" violations as described in s. 408.813. The 305
agency shall impose an administrative fine of $400 for an 306
isolated violation, $600 for a patterned violation, or $800 for 307
a widespread violation. 308
(c) Class "III" violations as described in s. 408.813. The 309
agency shall impose an administrative fine of $200 for an 310
isolated violation, $300 for a patterned violation, or $400 for 311
a widespread violation. If a deficiency giving rise to a class 312
III violation is corrected within the time specified by the 313
agency, the fine may not be imposed. 314
(d) Class "IV" violations as described in s. 408.813. The 315
agency shall impose for a cited class IV violation an 316
administrative fine of at least $100 but not exceeding $200 for 317
each violation. If a deficiency giving rise to a class IV 318
violation is corrected within the time specified by the agency, 319
the fine may not be imposed. 320
(3) The agency may impose an administrative fine for an 321
unclassified violation pursuant to s. 408.813(3). The agency may 322
impose an administrative fine of $500 if a licensee is found not 323
to be in compliance with the background screening requirements 324
as provided in s. 408.809. 325
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Section 10. Paragraph (d) is added to subsection (1) of 326
section 400.051, Florida Statutes, to read: 327
400.051 Homes or institutions exempt from the provisions 328
of this part.— 329
(1) The following shall be exempt from the provisions of 330
this part: 331
(d) Any medically complex children's home licensed under 332
part XII of this chapter. 333
Section 11. Subsection (26) is added to section 408.802, 334
Florida Statutes, to read: 335
408.802 Applicability.—This part applies to the provision 336
of services that require licensure as defined in this part and 337
to the following entities licensed, registered, or certified by 338
the agency, as described in chapters 112, 383, 390, 394, 395, 339
400, 429, 440, and 765: 340
(26) Medically complex children's homes, as provided under 341
part XII of chapter 400. 342
Section 12. Subsection (25) is added to section 408.820, 343
Florida Statutes, to read: 344
408.820 Exemptions.—Except as prescribed in authorizing 345
statutes, the following exemptions shall apply to specified 346
requirements of this part: 347
(25) Medically complex children's homes, as provided under 348
part XII of chapter 400, are exempt from s. 408.810(10). 349
Section 13. Subsection (1) of section 408.823, Florida 350
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Statutes, is amended to read: 351
408.823 In-person visitation.— 352
(1) This section applies to developmental disabilities 353
centers as defined in s. 393.063, hospitals licensed under 354
chapter 395, nursing home facilities licensed under part II of 355
chapter 400, hospice facilities licensed under part IV of 356
chapter 400, intermediate care facilities for the 357
developmentally disabled licensed and certified under part VIII 358
of chapter 400, medically complex children's homes licensed 359
under part XII of chapter 400, and assisted living facilities 360
licensed under part I of chapter 429. 361
Section 14. This act shall take effect July 1, 2026. 362