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 medically dependent or technologically dependent children 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 inspection. 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 rules must also specify advance notice
224 requirements.
225 (12) Admission and assessment of children.
226 (13) Establishment of necessary procedures, identification
227 of forms, specification of required documentation, and
228 clarification 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.