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Florida Senate
-
2026
SB 648
By
Senator Bradley
6-00438A-26 2026648__
1 A bill to be entitled
2 An act relating to Medicaid reimbursement for private
3 duty nursing services; amending s. 409.962, F.S.;
4 defining the term “pediatric continuing care
5 integrated community” for purposes of the state
6 Medicaid program; amending s. 409.975, F.S.; defining
7 the terms “geographic area” and “prevailing hourly
8 rate”; requiring Medicaid managed care plans to
9 reimburse licensed home health agencies for private
10 duty nursing services provided in a community
11 residential group home at a certain rate; prohibiting
12 Medicaid managed care plans from reducing
13 reimbursement for such services under certain
14 circumstances; requiring Medicaid managed care plans
15 to negotiate rates with affiliated businesses at least
16 annually; requiring the Agency for Health Care
17 Administration to seek federal approval within a
18 specified timeframe; requiring the agency to implement
19 the changes made by the act upon federal approval;
20 providing effective dates.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
24 Section 1. Effective July 1, 2026, present subsections (13)
25 through (18) of section 409.962, Florida Statutes, are
26 redesignated as subsections (14) through (19), respectively, and
27 a new subsection (13) is added to that section, to read:
28 409.962 Definitions.—As used in this part, except as
29 otherwise specifically provided, the term:
30
(13) “Pediatric continuing care integrated community” means
31
a group of affiliated and integrated businesses
that,
as of
July
32
1, 2026, are
licensed or certified by the
agency
or the Agency
33
for Persons with Disabilities
and
collectively provide
34
coordinated care for Medicaid-eligible persons
younger than
21
35
years of age
who are medically fragile, including those who are
36
technology dependent.
The term includes all of the following
37
entities
under common ownership:
38
(a)
A
c
ommunity
r
esidential
g
roup
h
ome licensed under
39
chapter 393 providing residential care for medically complex
40
children
.
41
(b)
A
h
ome
he
alth
a
gency licensed under part III of chapter
42
400 providing private duty nursing services by registered nurses
43
or licensed practical nurses
.
44
(c)
A
p
rescribed
p
ediatric
e
xtended
c
are
c
enter licensed
45
under part VI of chapter 400
.
46
(d)
A
h
ome
m
edical
e
quipment provider licensed under part
47
VII of chapter 400
.
48
(e)
A
h
ealth
c
are
c
linic licensed under part X of chapter
49
400 providing speech
-language therapy
, physical
therapy
,
or
50
occupational therapy.
51 Section 2. Subsection (7) is added to section 409.975,
52 Florida Statutes, to read:
53 409.975 Managed care plan accountability.—In addition to
54 the requirements of s. 409.967, plans and providers
55 participating in the managed medical assistance program shall
56 comply with the requirements of this section.
57
(7) REIMBURSEMENT FOR SERVICES IN
P
EDIATRIC
C
ONTINUING
C
ARE
58
I
NTEGRATED
C
OMMUNITIES.
—
59
(
a
)
As used
in
this subsection
, the term
:
60
1
.
“Geographic area” means the region or metropolitan
61
statistical area in which the pediatric continuing care
62
integrated community is located.
63
2
.
“Prevailing hourly rate” means the usual and customary
64
contracted hourly rate paid by Medicaid managed care plans to
65
providers for private duty nursing services in the same
66
geographic area during the current calendar year
, which rate
is
67
negotiated
at least annually
between the Medicaid managed care
68
plans and the provider of private duty nursing within the
69
community residential group home.
70
(
b
)
Medicaid managed care plans shall reimburse home health
71
agencies licensed under
p
art III of chapter 400 for private duty
72
nursing services, including services provided by registered
73
nurses and licensed practical nurses, provided in a community
74
residential group home at 100 percent of the prevailing hourly
75
rate paid for private duty nursing services in the geographic
76
area, regardless of the number of plan members who share a
77
dwelling space within the community residential group home.
78
(c)
Reimbursement
may
not be reduced based on the number of
79
Medicaid-eligible persons receiving private duty nursing
80
services in the same dwelling space, or on the same day, within
81
the community residential group home.
82
(d)
M
anaged care plans and the affiliated businesses shall
83
negotiate rates
at least annually
for medical services provided
84
within the pediatric continuing care integrated community.
85 Section 3.
Within 30 days after the effective date of this
86
act
, the Agency for Health Care Administration shall seek
any
87
necessary
federal approval, including through any necessary
88
state plan amendment or Medicaid waiver, to implement the
89
changes made
by
this act. The agency shall implement this act
90
upon receipt of federal approval.
91 Section 4. Except as otherwise provided in this act, this
92 act shall take effect upon becoming a law.