Agency for Health Care Administration

Florida Senate
-
2026

SB 1438

By
Senator Harrell

31-01451A-26 20261438__
1 A bill to be entitled
2 An act relating to the Agency for Health Care
3 Administration; creating part XII of ch. 400, F.S.,
4 entitled “Medically Complex Children’s Homes”;
5 creating s. 400.9991, F.S.; providing legislative
6 intent; creating s. 400.9992, F.S.; defining the terms
7 “agency” and “medically complex children’s home”;
8 creating s. 400.9993, F.S.; providing licensure
9 requirements; providing an exception; creating s.
10 400.9994, F.S.; providing application requirements;
11 requiring the Agency for Health Care Administration to
12 require certain background screening for certain
13 persons; requiring that a medically complex children’s
14 home be accessible at reasonable times for certain
15 persons; providing for provisional and conditional
16 licensure; requiring the agency to conduct inspections
17 at a specified frequency; creating s. 400.9995, F.S.;
18 authorizing the agency to adopt certain rules;
19 creating s. 400.9996, F.S.; providing eligibility
20 requirements for admission to a medically complex
21 children’s home; creating s. 400.9997, F.S.; providing
22 uniform firesafety standards, emergency preparedness
23 requirements, and construction standards; creating s.
24 400.9998, F.S.; providing for the denial, suspension,
25 and revocation of a license; providing for
26 administrative fines; specifying classification of
27 fines; amending s. 435.12, F.S.; requiring the agency,
28 by a specified date, to review and determine
29 eligibility for specified criminal history checks;
30 requiring the Care Provider Background Screening
31 Clearinghouse to share eligibility determinations with
32 specified agencies; amending ss. 400.051, 408.802,
33 408.820, and 408.823, F.S.; conforming provisions to
34 changes made by the act; providing an effective date.
35
36 Be It Enacted by the Legislature of the State of Florida:
37
38 Section 1.
Part XII of chapter 400, Florida Statutes,

39
consisting of ss. 400.9991-400.9998, is created and entitled

40
“Medically Complex Children’s Homes.”

41 Section 2. Section 400.9991, Florida Statutes, is created
42 to read:
43
400.9991

Legislative intent.—It is the intent of the

44
Legislature to develop, establish, and enforce licensure

45
requirements and basic standards for medically complex

46
children’s homes in order to ensure that the homes are family

47
centered and that the medical, developmental, physiological,

48
nutritional, and psychosocial needs of medically complex

49
children residing in such homes are met. Medically complex

50
children’s homes shall serve as a safe home-like setting with

51
clinical oversight for children with complex medical needs as an

52
alternative to institutional care. This setting is intended to

53
meet the needs of children and families in this state, offering

54
smaller homes geographically close to parents and guardians to

55
maintain family connections for the medically complex children

56
served. Medically complex children’s homes are not intended to

57
serve children whose parents and guardians live outside of this

58
state, as out-of-state residency does not support family

59
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
children who are medically dependent or technologically

69
dependent upon medical equipment or procedures and who are not

70
related to the owner or operator
of the home
by blood, marriage,

71
or adoption. A medically complex children’s home
serves

72
m
edically dependent or technologically dependent child
ren
as

73
defined in s. 400.902
(6)
.

74 Section 4. Section 400.9993, Florida Statutes, is created
75 to read:
76
400.9993

Licensure required; exemptions.—

77
(1)

The requirements of part II of chapter 408 apply to the

78
provision of services that require licensure pursuant to this

79
part and part II of chapter 408 and to entities licensed by or

80
applying for such licensure from the agency pursuant to this

81
part. A license issued by the agency is required for the

82
operation of a medically complex children’s home in this state.

83
(2)

Separate licenses are required for homes maintained in

84
separate premises which are operated under the same 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 which provides residential care for medically

89
complex children is deemed to satisfy the requirements for

90
initial licensure under this part if the home meets each of the

91
following criteria:

92
1.

The home held a license in good standing under chapter

93
393 as of 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
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) must 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 this part and

117
part II of chapter 408.

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, which 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
(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 no more than 6 months

to an applicant for initial

137
licensure which meets all of the licensure requirements of this

138
part and part II of chapter 408.

139
1.

The licensee shall notify the agency in writing when at

140
least one child has been admitted to the home, after which an

141
unannounced inspection shall be made to determine compliance

142
with the requirements of a medically complex children’s home.

143
2.

A provisional licensee that demonstrates compliance with

144
all the requirements of a medically complex children’s home

145
license during the inspection must be issued a medically complex

146
children’s home license.

147
3.

In addition to sanctions authorized under this part, if

148
violations are found during the inspection and the licensee

149
fails to demonstrate compliance with all medically complex

150
children’s home requirements during a follow-up inspection, the

151
licensee may not admit any new children for medically complex

152
children’s home services. The agency may extend the provisional

153
license for not more than 1 month
after
verification of

154
correction of violations through the second, follow-up

155
inspectio
n. If violations are found during the second
,
follow-up

156
inspection, the agency may not extend the provisional license

157
any further. The licensee shall promptly create and implement a

158
plan for the safe and orderly discharge of the children being

159
cared for under the medically complex children’s home license.

160
(b)

The agency may issue a conditional license to a

161
facility if, at the time of license renewal, the facility is

162
found to have any uncorrected violation that the facility had an

163
opportunity to correct. A conditional license must be limited to

164
a specified period not exceeding 6 months.

165
(6)

The agency shall conduct licensure inspections of

166
medically complex children’s homes and quarterly monitor visits.

167 Section 6. Section 400.9995, Florida Statutes, is created
168 to read:
169
400.9995

Rules establishing minimum standards.—
The agency

170
may adopt rules to administer this part and part II of chapter

171
408, which
rules
must include reasonable and fair minimum

172
standards in relation to
all of the following
:

173
(
1
)

A safe and sanitary environment that is residential and

174
noninstitutional in design or nature and
allows
for

175
technological advances in the provision of care, safety, and

176
security, including the use of devices, equipment, and other

177
security measures related to the general safety and security of

178
residents, staff, and the home.

179
(
2
)

Accommodation of the needs and preferences of residents

180
to enhance the quality of life in a
medically complex children’s

181
home.

182
(
3
) The provision of individualized medical, developmental,

183
and family training services.

184
(
4
) The number and qualifications of all personnel

185
responsible
for the care of the children served
,
based on the

186
age and acuity of the children.
A
medically complex children’s

187
home
must have licensed nursing staff on duty in the home at all

188
times.

189
(
5
) All sanitary conditions within the medically complex

190
children’s home and its surroundings, including water supply,

191
sewage disposal, food handling, and general hygiene, and

192
maintenance thereof, which will ensure the health and comfort of

193
the
children served.

194
(
6
) Programs and basic services promoting and maintaining a

195
homelike environment and the health and development of the

196
children served
,
including facilitating school services. Such

197
programs and services
must
include development, implementation,

198
and monitoring of a comprehensive protocol of care, developed in

199
conjunction with the parent or guardian, which specifies the

200
medical, nursing, psychosocial, and developmental therapies

201
required by the medically dependent or technologically dependent

202
child served.

203
(
7
) Requirements for assisting with supportive services
,

204
including
,
but not limited to, speech therapy, occupational

205
therapy, physical therapy, social work,
child development and

206
psychological services
,
and transportation.

207
(
8
) Maintenance of appropriate medical records, data, and

208
information relative to the children and programs. Such records

209
must
be accessible to the agency for inspection during onsite

210
visits.

211
(
9
)

The use of video cameras and electronic monitoring

212
within the
medically complex children’s

home to include areas

213
where monitoring is required and areas where monitoring is

214
permitted
only
with the
consent of the
resident’s parent or

215
guardian.

216
(
10
)

Requirements for child bedrooms
,
including criteria

217
for a private room and the permissible circumstances for a

218
shared room.

219
(
11
)

Discharge and transfer planning for a child
,
including

220
a child
who
becomes ineligible for services from the home.

221
Discharge planning must be initiated at least 18 months
before

222
the resident’s 21st birthday to enable a smooth transition to an

223
appropriate setting.
The r
ules
must
also specify advance notice

224
requirements.

225
(
12
)

Admission and assessment of children
.

226
(
13
)

Establishment of necessary
procedures,
identification

227
of
forms, specif
ication of required
documentation, and

228
clarif
ication of
terms, as necessary, to administer this part.

229 Section 7. Section 400.9996, Florida Statutes, is created
230 to read:
231
400.9996

Resident eligibility and admission.—To qualify for

232
admission to a medically complex children’s home, a child must:

233
(1)

Be admitted from a higher level of care in an in-state

234
facility, such as a hospital or skilled nursing facility, or

235
from the home of a parent or guardian whose primary residence is

236
in this state.

237
(2)

Have a chronic debilitating disease or condition of one

238
or more physiological or organ systems which generally makes the

239
child dependent upon 24-hour medical, nursing, or health

240
supervision or intervention. Medically fragile children are

241
medically complex, and their medical condition is such that they

242
are technologically dependent upon medical equipment or

243
procedures to sustain life and can expire without warning unless

244
continually under observation.

245
(3)

Have a written order by the child’s attending physician

246
in consultation with the parent or legal guardian. The

247
recommendations for placement of a Medicaid applicant or

248
recipient in the medically complex children’s home must be made

249
by the Children’s Multidisciplinary Assessment Team of the

250
Department of Health under s. 391.025. Consideration must be

251
given to relevant medical, emotional, psychosocial, and

252
environmental factors.

253 Section 8. Section 400.9997, Florida Statutes, is created
254 to read:
255
400.9997

Uniform firesafety requirements; emergency

256
preparedness; construction standards.—

257
(1)

Uniform firesafety standards for medically complex

258
children’s homes, which are residential board and care

259
occupancies, shall be established by the State Fire Marshal

260
pursuant to s. 633.206.

261
(2)

Permanent onsite generators must be installed and

262
maintained.

263
(3)

An automatic fire sprinkler system must be installed

264
and maintained.

265
(4)

A firesafety evacuation capability determination must

266
be conducted within 6 months after the date of initial licensure

267
of a medically complex children’s home.

268
(5)

Comprehensive emergency management plans required by s.

269
408.821 must be submitted for review and approval to the local

270
emergency management agency.

271
(6)

All medically complex children’s homes must have an

272
annual fire inspection conducted by the local fire marshal or

273
authority having jurisdiction.

274
(7)

The requirements for the construction or renovation of

275
a medically complex children’s home must comply with all of the

276
following:

277
(a)

The provisions of chapter 553 pertaining to building

278
construction standards, including plumbing, electrical codes,

279
glass, manufactured buildings, and accessibility for the

280
physically disabled.

281
(b)

Section 633.206 and applicable rules pertaining to

282
physical standards for community residential care facilities.

283
(c)

The standards or rules adopted pursuant to this part

284
and part II of chapter 408.

285
(8)

The agency may adopt rules to implement this section.

286 Section 9. Section 400.9998, Florida Statutes, is created
287 to read:
288
400.9998

Denial, suspension, and revocation of licensure;

289
violations; administrative fines.—

290
(1)

In accordance with part II of chapter 408, the agency

291
may deny, revoke, and suspend a license and impose an

292
administrative fine for the violation of any provision of this

293
part, part II of chapter 408, or applicable rules.

294
(2)

A violation of this part, part II of chapter 408, or

295
applicable rules is subject to fines specified in s. 408.813. A

296
violation must be classified according to the nature of the

297
violation and the gravity of its probable effect on residents.

298
The agency shall indicate the classification on the written

299
notice of the violation as follows:

300
(a)

Class I violations as described in s. 408.813. The

301
agency shall issue a citation regardless of correction and

302
impose an administrative fine of $500 for an isolated violation,

303
$750 for a patterned violation, or $1,000 for a widespread

304
violation.

305
(b)

Class II violations as described in s. 408.813. The

306
agency shall impose an administrative fine of $400 for an

307
isolated violation, $600 for a patterned violation, or $800 for

308
a widespread violation.

309
(c)

Class III violations as described in s. 408.813. The

310
agency shall impose an administrative fine of $200 for an

311
isolated violation, $300 for a patterned violation, or $400 for

312
a widespread violation. If a deficiency giving rise to a class

313
III violation is corrected within the time specified by the

314
agency, the fine may not be imposed.

315
(d)

Class IV violations as described in s. 408.813. The

316
agency shall impose for a cited class IV violation an

317
administrative fine of at least $100 but not exceeding $200 for

318
each violation. If a deficiency giving rise to a class IV

319
violation is corrected within the time specified by the agency,

320
the fine may not be imposed.

321
(3)

The agency may impose an administrative fine for an

322
unclassified violation pursuant to s. 408.813(3).
The agency may

323
impose an administrative fine of $500 if a licensee is found not

324
to
be in compliance with the background screening requirements

325
as provided in s. 408.809
.

326 Section 10. Subsection (1) of section 435.12, Florida
327 Statutes, is amended to read:
328 435.12 Care Provider Background Screening Clearinghouse.—
329 (1) The Agency for Health Care Administration in
330 consultation with the Department of Law Enforcement shall create
331 a secure web-based system, which shall be known as the “Care
332 Provider Background Screening Clearinghouse” or “clearinghouse.”
333 The clearinghouse must allow the results of criminal history
334 checks provided to the specified agencies and, beginning January
335 1, 2026, or a later date as determined by the Agency for Health
336 Care Administration, to qualified entities participating in the
337 clearinghouse for screening of persons qualified as care
338 providers under s. 943.0542 to be shared among the specified
339 agencies and qualified entities when a person has applied to
340 volunteer, be employed, be licensed, enter into a contract, or
341 has an affiliation that allows or requires a state and national
342 fingerprint-based criminal history check. Beginning January 1,
343 2025, or a later date as determined by the Agency for Health
344 Care Administration, the Agency for Health Care Administration
345 shall review and determine eligibility for all criminal history
346 checks submitted to the clearinghouse for the Department of
347 Education. The clearinghouse shall share eligibility
348 determinations with the Department of Education and the
349 qualified entities.
Beginning July 1, 2028, or a later date as

350
determined by the Agency for Health Care Administration, the

351
agency shall review and determine eligibility for all criminal

352
history checks submitted to the clearinghouse for specified

353
agencies as defined in s. 435.02. The clearinghouse shall share

354
eligibility determinations with the specified agencies.
The
355 Agency for Health Care Administration and the Department of Law
356 Enforcement may adopt rules to create forms or implement
357 procedures needed to carry out this section.
358 Section 11. Paragraph (d) is added to subsection (1) of
359 section 400.051, Florida Statutes, to read:
360 400.051 Homes or institutions exempt from the provisions of
361 this part.—
362 (1) The following shall be exempt from the provisions of
363 this part:
364
(d)

Any medically complex children’s home licensed under

365
part XII of this chapter.

366 Section 12. Subsection (26) is added to section 408.802,
367 Florida Statutes, to read:
368 408.802 Applicability.—This part applies to the provision
369 of services that require licensure as defined in this part and
370 to the following entities licensed, registered, or certified by
371 the agency, as described in chapters 112, 383, 390, 394, 395,
372 400, 429, 440, and 765:
373
(26)

Medically complex children’s homes, as provided under

374
part XII of chapter 400.

375 Section 13. Subsection (25) is added to section 408.820,
376 Florida Statutes, to read:
377 408.820 Exemptions.—Except as prescribed in authorizing
378 statutes, the following exemptions shall apply to specified
379 requirements of this part:
380
(25)

Medically complex children’s homes, as provided under

381
part XII of chapter 400, are exempt from s. 408.810(10).

382 Section 14. Subsection (1) of section 408.823, Florida
383 Statutes, is amended to read:
384 408.823 In-person visitation.—
385 (1) This section applies to developmental disabilities
386 centers as defined in s. 393.063, hospitals licensed under
387 chapter 395, nursing home facilities licensed under part II of
388 chapter 400, hospice facilities licensed under part IV of
389 chapter 400, intermediate care facilities for the
390 developmentally disabled licensed and certified under part VIII
391 of chapter 400,
medically complex children’s homes licensed

392
under part XII of chapter 400,
and assisted living facilities
393 licensed under part I of chapter 429.
394 Section 15. This act shall take effect July 1, 2026.