Florida Senate - 2026 SB 1560
By Senator Simon
3-01208-26 20261560__
1 A bill to be entitled
2 An act relating to medical placement for high-acuity
3 children; amending s. 39.01, F.S.; providing
4 definitions; amending s. 39.01375, F.S.; requiring
5 that specific needs of a high-acuity child be
6 considered when determining a child’s best interest;
7 amending s. 39.302, F.S.; conforming a cross
8 reference; amending s. 39.303, F.S.; revising the role
9 of and services provided by a Child Protection Team;
10 requiring that reports involving a high-acuity child
11 be referred to a Child Protection Team; requiring
12 certain agencies and departments to avoid duplicating
13 the provision of certain services; authorizing a Child
14 Protection Team to prioritize the placement of a high
15 acuity child and to require certain services for a
16 high-acuity child; revising membership of the
17 Children’s Medical Services task force; amending s.
18 39.4021, F.S.; providing for the placement of a high
19 acuity child; amending s. 39.4022, F.S.; revising the
20 definition of the term “multidisciplinary team”;
21 revising the goals of multidisciplinary teams;
22 revising the participants in a multidisciplinary team;
23 requiring that a multidisciplinary team staffing be
24 held for placement decisions for a high-acuity child;
25 providing the process for instances when the
26 multidisciplinary team cannot reach a consensus on a
27 plan for the placement of a high-acuity child;
28 amending s. 39.407, F.S.; requiring a licensed health
29 care professional to perform a medical screening for
30 certain conditions on a child who is removed from the
31 home and maintained in an out-of-home placement;
32 requiring a judge to order the placement of a high
33 acuity child in a medical placement after he or she is
34 evaluated even if there are other placement options
35 available; authorizing the placement of a high-acuity
36 child in a setting that best meets the needs of the
37 high-acuity child; revising definitions; requiring
38 that a specified examination and suitability
39 assessment be conducted on a high-acuity child;
40 requiring a high-acuity child’s guardian ad litem to
41 notify the court within a specified timeframe if a
42 suitable placement is not identified after an
43 evaluation and suitability assessment within a
44 specified timeframe; requiring the court to set an
45 emergency evidentiary hearing within a specified
46 timeframe to determine a suitable placement;
47 authorizing the court to prioritize certain
48 placements; creating s. 39.4078, F.S.; providing a
49 short title; providing legislative findings and
50 intent; providing definitions; providing
51 applicability; providing for medical placements;
52 providing requirements for a medical placement;
53 requiring a comprehensive clinical assessment of a
54 high-acuity child by a qualified licensed professional
55 under certain circumstances; providing requirements
56 for such clinical assessment and admission to a
57 medical placement; requiring the court to hold an
58 emergency evidentiary hearing under certain
59 circumstances; requiring the Department of Children
60 and Families to petition the court within a specified
61 timeframe after a multidisciplinary team staffing;
62 requiring the court to conduct an evidentiary hearing
63 and provide specified written findings; requiring that
64 certain consent and authorization be obtained and
65 documented; requiring the court to maintain certain
66 services and contacts for a high-acuity child;
67 requiring the court to conduct certain periodic
68 reviews during the duration of a medical placement;
69 requiring the department to file a certain report at a
70 specified time before each review hearing; authorizing
71 the court to immediately order that a high-acuity
72 child be moved to a less or more restrictive licensed
73 placement under certain circumstances; authorizing the
74 department to implement certain emergency procedures;
75 requiring a transition plan; requiring that a high
76 acuity child’s case plan be updated within a specified
77 timeframe; prohibiting a medical placement from
78 exceeding a specified number of days except under
79 certain circumstances; providing that a high-acuity
80 child maintains certain rights; requiring the
81 department to collect certain data; requiring the
82 department to submit to the Legislature a specified
83 annual report; providing construction; authorizing the
84 department and the Department of Health to adopt
85 rules; amending s. 39.523, F.S.; revising legislative
86 findings and intent; requiring that a comprehensive
87 placement assessment for a high-acuity child be used
88 to determine the medical necessity of such child;
89 requiring that certain procedures be followed for
90 high-acuity children; requiring appropriate agencies
91 and departments to prioritize the placement of a high
92 acuity child; amending s. 39.6012, F.S.; requiring
93 that a high-acuity child’s case plan include a
94 specific description of the child’s needs; requiring
95 that certain tasks and descriptions be included in the
96 high-acuity child’s case plan; amending s. 39.6013,
97 F.S.; requiring that a high-acuity child’s case plan
98 reflect certain goals, services, and requirements;
99 amending s. 391.025, F.S.; providing that the
100 Children’s Medical Services program includes the
101 Medical Placement for High-acuity Children Act;
102 amending s. 391.029, F.S.; providing that a high
103 acuity child is eligible for the Children’s Medical
104 Services program and the Children’s Medical Services
105 Safety Net program; amending s. 393.065, F.S.;
106 requiring that a high-acuity child be placed in
107 category 1 for priority purposes of Medicaid waiver
108 services; conforming a cross-reference; amending s.
109 394.495, F.S.; providing that certain services include
110 placement of a high-acuity child in a medical bed in a
111 medical placement; revising the list of who a
112 community action treatment team serves to include a
113 high-acuity child; revising the list of who certain
114 mobile response teams serve to include a high-acuity
115 child; conforming a cross-reference; amending s.
116 409.145, F.S.; revising the goals of a system of care;
117 defining the term “high-acuity child”; requiring that
118 the medical necessity of a high-acuity child take
119 priority over the reasonable and prudent parent
120 standard; amending s. 409.166, F.S.; revising the
121 definition of the term “difficult-to-place child”;
122 amending s. 409.906, F.S.; authorizing the Agency for
123 Health Care Administration to pay for a medical bed in
124 a medical placement and certain services for a high
125 acuity child; amending s. 409.986, F.S.; revising
126 goals of the Department of Children and Families;
127 defining the term “high-acuity child”; amending ss.
128 934.255, 960.065, and 984.03, F.S.; conforming cross
129 references; providing an effective date.
130
131 Be It Enacted by the Legislature of the State of Florida:
132
133 Section 1. Present subsections (38) through (49), (50), and
134 (51) through (91) of section 39.01, Florida Statutes, are
135 redesignated as subsections (39) through (50), (52), and (54)
136 through (94), respectively, new subsections (38), (51), and (53)
137 are added to that section, and subsection (10) and present
138 subsection (39) of that section are amended, to read:
139 39.01 Definitions.—When used in this chapter, unless the
140 context otherwise requires:
141 (10) “Caregiver” means the parent, legal custodian,
142 permanent guardian, adult household member, or other person
143 responsible for a child’s welfare as defined in subsection (60)
144 (57).
145 (38) “High-acuity child” means a child age birth to 18 who
146 presents with intensive and complex medical, developmental,
147 behavioral health, or disability needs across multiple areas of
148 functioning and who requires immediate clinical assessment and
149 specialized care, services, and medical placement. The term
150 includes a child who is reasonably presumed to meet the criteria
151 for high acuity.
152 (40)(39) “Institutional child abuse or neglect” means
153 situations of known or suspected child abuse or neglect in which
154 the person allegedly perpetrating the child abuse or neglect is
155 an employee of a public or private school, public or private day
156 care center, residential home, institution, facility, or agency
157 or any other person at such institution responsible for the
158 child’s welfare as defined in subsection (60) (57).
159 (51) “Medical bed” means a licensed placement that meets
160 the criteria of a medical placement and is approved by the
161 applicable licensing authority, such as the Department of
162 Health, the Agency for Persons with Disabilities, the Agency for
163 Health Care Administration, or the department.
164 (53) “Medical placement” means a residential setting that
165 provides clinical oversight, licensed nursing care, and
166 therapeutic supports 24 hours a day, 7 days a week to adequately
167 address the immediate needs of a high-acuity child being placed
168 who requires intensive, specialized medical care consistent with
169 the standards of the Affordable Care Act and the Centers for
170 Medicare and Medicaid Services guidelines for pediatric medical
171 necessity.
172 Section 2. Present subsection (15) of section 39.01375,
173 Florida Statutes, is redesignated as subsection (16), and a new
174 subsection (15) is added to that section, to read:
175 39.01375 Best interest determination for placement.—The
176 department, community-based care lead agency, or court shall
177 consider all of the following factors when determining whether a
178 proposed placement under this chapter is in the child’s best
179 interest:
180 (15) The intensive and complex medical, developmental,
181 behavioral health, or disability needs of a high-acuity child
182 and the need for medical placement under s. 39.4078 to address
183 the high-acuity child’s needs.
184 Section 3. Subsection (1) of section 39.302, Florida
185 Statutes, is amended to read:
186 39.302 Protective investigations of institutional child
187 abuse, abandonment, or neglect.—
188 (1) The department shall conduct a child protective
189 investigation of each report of institutional child abuse,
190 abandonment, or neglect. Upon receipt of a report that alleges
191 that an employee or agent of the department, or any other entity
192 or person covered by s. 39.01(40) or (60) s. 39.01(39) or (57),
193 acting in an official capacity, has committed an act of child
194 abuse, abandonment, or neglect, the department shall initiate a
195 child protective investigation within the timeframe established
196 under s. 39.101(2) and notify the appropriate state attorney,
197 law enforcement agency, and licensing agency, which shall
198 immediately conduct a joint investigation, unless independent
199 investigations are more feasible. When conducting investigations
200 or having face-to-face interviews with the child, investigation
201 visits shall be unannounced unless it is determined by the
202 department or its agent that unannounced visits threaten the
203 safety of the child. If a facility is exempt from licensing, the
204 department shall inform the owner or operator of the facility of
205 the report. Each agency conducting a joint investigation is
206 entitled to full access to the information gathered by the
207 department in the course of the investigation. A protective
208 investigation must include an interview with the child’s parent
209 or legal guardian. The department shall make a full written
210 report to the state attorney within 3 business days after making
211 the oral report. A criminal investigation shall be coordinated,
212 whenever possible, with the child protective investigation of
213 the department. Any interested person who has information
214 regarding the offenses described in this subsection may forward
215 a statement to the state attorney as to whether prosecution is
216 warranted and appropriate. Within 15 days after the completion
217 of the investigation, the state attorney shall report the
218 findings to the department and shall include in the report a
219 determination of whether or not prosecution is justified and
220 appropriate in view of the circumstances of the specific case.
221 Section 4. Subsections (3) and (7) and paragraph (a) of
222 subsection (9) of section 39.303, Florida Statutes, are amended,
223 and paragraph (j) is added to subsection (4) of that section, to
224 read:
225 39.303 Child Protection Teams and sexual abuse treatment
226 programs; services; eligible cases.—
227 (3) The Department of Health shall use and convene the
228 Child Protection Teams to supplement the assessment and
229 protective supervision activities of the family safety and
230 preservation program of the Department of Children and Families.
231 This section does not remove or reduce the duty and
232 responsibility of any person to report pursuant to this chapter
233 all suspected or actual cases of child abuse, abandonment, or
234 neglect or sexual abuse of a child. The role of the Child
235 Protection Teams is to support activities of the program and to
236 provide services, including services necessary and appropriate
237 to address the needs of a high-acuity child, deemed by the Child
238 Protection Teams to be necessary and appropriate to abused,
239 abandoned, and neglected children upon referral. The specialized
240 diagnostic assessment, evaluation, coordination, consultation,
241 and other supportive services that a Child Protection Team must
242 be capable of providing include, but are not limited to, the
243 following:
244 (a) Medical diagnosis and evaluation services, including
245 provision or interpretation of X rays and laboratory tests, and
246 related services, as needed, and documentation of related
247 findings.
248 (b) Telephone consultation services in emergencies and in
249 other situations.
250 (c) Medical evaluation related to abuse, abandonment, or
251 neglect, as defined by policy or rule of the Department of
252 Health.
253 (d) Such psychological and psychiatric diagnosis and
254 evaluation services for the child or the child’s parent or
255 parents, legal custodian or custodians, or other caregivers, or
256 any other individual involved in a child abuse, abandonment, or
257 neglect case, as the team may determine to be needed.
258 (e) Expert medical, psychological, and related professional
259 testimony in court cases.
260 (f) Case staffings to develop treatment plans for children
261 whose cases have been referred to the team. A Child Protection
262 Team may provide consultation with respect to a child who is
263 alleged or is shown to be abused, abandoned, or neglected, which
264 consultation shall be provided at the request of a
265 representative of the family safety and preservation program or
266 at the request of any other professional involved with a child
267 or the child’s parent or parents, legal custodian or custodians,
268 or other caregivers. In every such Child Protection Team case
269 staffing, consultation, or staff activity involving a child, a
270 family safety and preservation program representative shall
271 attend and participate.
272 (g) Case service coordination and assistance, including the
273 location of services available from other public and private
274 agencies in the community.
275 (h) Such training services for program and other employees
276 of the Department of Children and Families, employees of the
277 Department of Health, and other medical professionals as is
278 deemed appropriate to enable them to develop and maintain their
279 professional skills and abilities in handling child abuse,
280 abandonment, and neglect cases. The training service must
281 include training in the recognition of and appropriate responses
282 to head trauma and brain injury in a child under 6 years of age
283 as required by ss. 402.402(2) and 409.988.
284 (i) Educational and community awareness campaigns on child
285 abuse, abandonment, and neglect in an effort to enable citizens
286 more successfully to prevent, identify, and treat child abuse,
287 abandonment, and neglect in the community.
288 (j) Child Protection Team assessments that include, as
289 appropriate, medical evaluations, medical consultations, family
290 psychosocial interviews, specialized clinical interviews, or
291 forensic interviews.
292 (k) Identification of a child who meets the criteria for a
293 high-acuity child and the basis for the determination of the
294 Child Protection Team.
295
296 A Child Protection Team that is evaluating a report of medical
297 neglect and assessing the health care needs of a medically
298 complex child shall consult with a physician who has experience
299 in treating children with the same condition.
300 (4) The child abuse, abandonment, and neglect reports that
301 must be referred by the department to Child Protection Teams of
302 the Department of Health for an assessment and other appropriate
303 available support services as set forth in subsection (3) must
304 include cases involving:
305 (j) A report involving a high-acuity child or a child
306 believed to meet the criteria of a high-acuity child.
307 (7)(a) In all instances in which a Child Protection Team is
308 providing certain services to abused, abandoned, or neglected
309 children, other offices and units of the Department of Health,
310 and offices and units of the Department of Children and
311 Families, the Agency for Persons with Disabilities, and the
312 Agency for Health Care Administration must shall avoid
313 duplicating the provision of those services.
314 (b) A Child Protection Team may:
315 1. Prioritize the placement of a high-acuity child into a
316 specialized and appropriate placement in accordance with s.
317 39.4078, including, but not limited to, a medical bed or group
318 home in a facility licensed or maintained by the department, the
319 Agency for Persons with Disabilities, the Department of Health,
320 or the Agency for Health Care Administration, even if such
321 placement is outside of the normal services of the Child
322 Protection Team.
323 2. Require the provision of services to the high-acuity
324 child by an entity deemed appropriate and necessary by the Child
325 Protection Team for the stabilization, treatment, or safety of
326 the high-acuity child, even if such services are outside of the
327 normal services of the Child Protection Team.
328 (9)(a) Children’s Medical Services shall convene a task
329 force to develop a standardized protocol for forensic
330 interviewing of children suspected of having been abused. The
331 Department of Health shall provide staff to the task force as
332 necessary. The task force shall include:
333 1. A representative from the Florida Prosecuting Attorneys
334 Association.
335 2. A representative from the Florida Psychological
336 Association.
337 3. The Statewide Medical Director for Child Protection.
338 4. A representative from the Florida Public Defender
339 Association.
340 5. The executive director of the Statewide Guardian ad
341 Litem Office.
342 6. A representative from a community-based care lead
343 agency.
344 7. A representative from Children’s Medical Services.
345 8. A representative from the Florida Sheriffs Association.
346 9. A representative from the Florida Chapter of the
347 American Academy of Pediatrics.
348 10. A representative from the Florida Network of Children’s
349 Advocacy Centers.
350 11. Other representatives designated by Children’s Medical
351 Services.
352 12. An expert or a direct care provider who has experience
353 in serving high-acuity children.
354 Section 5. Paragraph (a) of subsection (2) of section
355 39.4021, Florida Statutes, is amended, and subsection (3) is
356 added to that section, to read:
357 39.4021 Priority placement for out-of-home placements.—
358 (2) PLACEMENT PRIORITY.—
359 (a) Except as provided in subsection (3), when a child
360 cannot safely remain at home with a parent, out-of-home
361 placement options must be considered in the following order:
362 1. Nonoffending parent.
363 2. Relative caregiver.
364 3. Adoptive parent of the child’s sibling, when the
365 department or community-based care lead agency is aware of such
366 sibling.
367 4. Fictive kin with a close existing relationship to the
368 child.
369 5. Nonrelative caregiver that does not have an existing
370 relationship with the child.
371 6. Licensed foster care.
372 7. Group or congregate care.
373 (3) MEDICAL PLACEMENT FOR A HIGH-ACUITY CHILD.—In cases in
374 which a child is identified or assessed as a high-acuity child,
375 the department or any contractor or subcontractor of the
376 department must follow the procedures and requirements in s.
377 39.4078 and place the high-acuity child in a medical placement
378 if he or she meets the eligibility criteria in order to ensure
379 the high-acuity child’s complex medical, behavioral, and
380 developmental needs are addressed in an appropriate medical
381 setting.
382 Section 6. Paragraph (c) of subsection (2), paragraph (b)
383 of subsection (3), paragraph (a) of subsection (4), paragraph
384 (a) of subsection (5), and paragraph (d) of subsection (6) of
385 section 39.4022, Florida Statutes, are amended to read:
386 39.4022 Multidisciplinary teams; staffings; assessments;
387 report.—
388 (2) DEFINITIONS.—For purposes of this section, the term:
389 (c) “Multidisciplinary team” means an integrated group of
390 individuals which meets to collaboratively develop and attempt
391 to reach a consensus decision on the most suitable out-of-home
392 placement or the appropriateness of a medical placement under s.
393 39.4078, educational placement, or other specified important
394 life decision that is in the best interest of the child.
395 (3) CREATION AND GOALS.—
396 (b) The multidisciplinary teams must adhere to all of the
397 following goals:
398 1. Secure a child’s safety in the least restrictive and
399 intrusive placement that can meet his or her needs.;
400 2. Minimize the trauma associated with separation from the
401 child’s family and help the child to maintain meaningful
402 connections with family members and others who are important to
403 him or her.;
404 3. Provide input into the proposed placement decision made
405 by the community-based care lead agency and the proposed
406 services to be provided in order to support the child.;
407 4. Provide input into the decision to preserve or maintain
408 the placement, including necessary placement preservation
409 strategies.;
410 5. Contribute to an ongoing assessment of the child and the
411 family’s strengths and needs.;
412 6. Ensure that plans are monitored for progress and that
413 such plans are revised or updated as the child’s or family’s
414 circumstances change.; and
415 7. Ensure that the child and family always remain the
416 primary focus of each multidisciplinary team meeting.
417 8. Ensure that if the child meets the classification of a
418 high-acuity child, the multidisciplinary team considers such
419 classification when determining the appropriate placement for
420 the child. The multidisciplinary team must prioritize the
421 placement of a high-acuity child in appropriate specialized
422 placements within the department, the Agency for Persons with
423 Disabilities, the Department of Health, or the Agency for Health
424 Care Administration.
425 (4) PARTICIPANTS.—
426 (a) Collaboration among diverse individuals who are part of
427 the child’s network is necessary to make the most informed
428 decisions possible for the child. A diverse team is preferable
429 to ensure that the necessary combination of technical skills,
430 cultural knowledge, community resources, and personal
431 relationships is developed and maintained for the child and
432 family. The participants necessary to achieve an appropriately
433 diverse team for a child may vary by child and may include
434 extended family, friends, neighbors, coaches, clergy, coworkers,
435 or others the family identifies as potential sources of support.
436 1. Each multidisciplinary team staffing must invite all of
437 the following members:
438 a. The child, unless he or she is not of an age or capacity
439 to participate in the team, and the child’s guardian ad litem.;
440 b. The child’s family members and other individuals
441 identified by the family as being important to the child,
442 provided that a parent who has a no contact order or injunction,
443 is alleged to have sexually abused the child, or is subject to a
444 termination of parental rights may not participate.;
445 c. The current caregiver, provided the caregiver is not a
446 parent who meets the criteria of one of the exceptions under
447 sub-subparagraph b.;
448 d. A representative from the department other than the
449 Children’s Legal Services attorney, when the department is
450 directly involved in the goal identified by the staffing.;
451 e. A representative from the community-based care lead
452 agency, when the lead agency is directly involved in the goal
453 identified by the staffing.;
454 f. The case manager for the child, or his or her case
455 manager supervisor.; and
456 g. A representative from the Department of Juvenile
457 Justice, if the child is dually involved with both the
458 department and the Department of Juvenile Justice. The
459 representative must have the authority to make a same-day
460 placement of a high-acuity child in an appropriate medical
461 placement in the Department of Juvenile Justice if necessary.
462 h. A representative from the Agency for Persons with
463 Disabilities who has the authority to make a same-day placement
464 of a high-acuity child in an appropriate medical placement in
465 the agency if such child meets the eligibility criteria under s.
466 393.065 and is in a preenrollment category.
467 2. The multidisciplinary team must make reasonable efforts
468 to have all mandatory invitees attend. However, the
469 multidisciplinary team staffing may not be delayed if the
470 invitees in subparagraph 1. fail to attend after being provided
471 reasonable opportunities.
472 (5) SCOPE OF MULTIDISCIPLINARY TEAM.—
473 (a) A multidisciplinary team staffing must be held when an
474 important decision is required to be made about a child’s life,
475 including all of the following:
476 1. Initial placement decisions for a child who is placed in
477 out-of-home care. A multidisciplinary team staffing required
478 under this subparagraph may occur before the initial placement
479 or, if a staffing is not possible before the initial placement,
480 must occur as soon as possible after initial removal and
481 placement to evaluate the appropriateness of the initial
482 placement and to ensure that any adjustments to the placement,
483 if necessary, are promptly handled.
484 2. Changes in physical custody after the child is placed in
485 out-of-home care by a court and, if necessary, determination of
486 an appropriate mandatory transition plan in accordance with s.
487 39.4023.
488 3. Changes in a child’s educational placement and, if
489 necessary, determination of an appropriate mandatory transition
490 plan in accordance with s. 39.4023.
491 4. Initial placement decisions or a change in placement for
492 a high-acuity child in a medical placement under s. 39.4078, as
493 appropriate, to stabilize such child.
494 5.4. Placement decisions for a child as required by
495 subparagraph 1., subparagraph 2., or subparagraph 3., or
496 subparagraph 4. which involve sibling groups that require
497 placement in accordance with s. 39.4024.
498 6.5. Any other important decisions in the child’s life
499 which are so complex that the department or appropriate
500 community-based care lead agency determines convening a
501 multidisciplinary team staffing is necessary to ensure the best
502 interest of the child is maintained.
503 (6) ASSESSMENTS.—
504 (d)1. If the participants of a multidisciplinary team
505 staffing reach a unanimous consensus decision, it becomes the
506 official position of the community-based care lead agency
507 regarding the decision under subsection (5) for which the team
508 convened. Such decision is binding upon all department and lead
509 agency participants, who are obligated to support it.
510 2.a. If the participants of a multidisciplinary team
511 staffing cannot reach a unanimous consensus decision on a plan
512 to address the identified goal of a child who has not been
513 classified as a high-acuity child, the trained professional
514 acting as the facilitator shall notify the court and the
515 department within 48 hours after the conclusion of the staffing.
516 The department shall then determine how to address the
517 identified goal of the staffing by what is in the child’s best
518 interest.
519 b. If the participants of a multidisciplinary team staffing
520 cannot reach a unanimous consensus decision on a plan to address
521 the appropriate initial placement or change in placement of a
522 high-acuity child, the trained professional acting as the
523 facilitator must notify the court and the department within 48
524 hours after the conclusion of the staffing. The court must set
525 an emergency evidentiary hearing within 10 days after such
526 notification to address the appropriate initial placement or
527 change in placement of the high-acuity child and determine if
528 the high-acuity child should be placed in a medical placement in
529 accordance with s. 39.4078. The court may require the
530 representative from a community-based care lead agency or the
531 department who was required to attend the multidisciplinary team
532 staffing to attend the evidentiary hearing.
533 Section 7. Subsection (1), paragraph (b) of subsection (4),
534 and subsection (6) of section 39.407, Florida Statutes, are
535 amended to read:
536 39.407 Medical, psychiatric, and psychological examination
537 and treatment of child; physical, mental, or substance abuse
538 examination of person with or requesting child custody.—
539 (1) When any child is removed from the home and maintained
540 in an out-of-home placement, the department is authorized to
541 have a medical screening performed on the child without
542 authorization from the court and without consent from a parent
543 or legal custodian. Such medical screening shall be performed by
544 A licensed health care professional must perform such medical
545 screening and shall be to examine the child, in part, for
546 injury;, illness; mental, disability, or behavioral health
547 conditions;, and communicable diseases and to determine the need
548 for immunization. The department shall by rule establish the
549 invasiveness of the medical procedures authorized to be
550 performed under this subsection. In no case does This subsection
551 does not:
552 (a) Authorize the department to consent to medical
553 treatment for such children; or
554 (b) Limit the procedures for a medical placement of a high
555 acuity child established under s. 39.4078.
556 (4)
557 (b) The judge may also order such child to be evaluated by
558 a psychiatrist or a psychologist or, if a developmental
559 disability is suspected or alleged, by the developmental
560 disability diagnostic and evaluation team of the department. If
561 it is necessary to place a child in a residential facility for
562 such evaluation, the criteria and procedure established in s.
563 394.463(2) or chapter 393 must shall be used, whichever is
564 applicable. If, after the evaluation is conducted under this
565 paragraph, the psychiatrist, psychologist, or developmental
566 disability diagnostic and evaluation team determines that the
567 child meets the criteria to be classified as a high-acuity child
568 under s. 39.4078, the judge must immediately order the high
569 acuity child to be placed in a medical placement to address the
570 basis for the child’s high-acuity needs, even if there are other
571 placement options available under s. 39.4021.
572 (6) Children in the legal custody of the department may be
573 placed by the department, without prior approval of the court,
574 in a residential treatment center licensed under s. 394.875 or a
575 hospital licensed under chapter 395 for residential mental
576 health treatment only pursuant to this section or may be placed
577 by the court in accordance with an order of involuntary
578 examination or involuntary placement entered pursuant to s.
579 394.463 or s. 394.467. A high-acuity child may be placed in a
580 residential treatment program or medical placement, as
581 appropriate, which best meets the needs of the high-acuity child
582 based on the high-acuity child’s complex medical, developmental,
583 behavioral health, or disability needs. All children placed in a
584 residential treatment program under this subsection must have a
585 guardian ad litem appointed.
586 (a) As used in this subsection, the term:
587 1. “Least restrictive alternative” means the treatment and
588 conditions of treatment that, separately and in combination, are
589 no more intrusive or restrictive of freedom than reasonably
590 necessary to achieve a substantial therapeutic benefit or to
591 protect the child or adolescent or others from physical injury.
592 2. “Residential treatment” or “residential treatment
593 program” means a placement for observation, diagnosis, or
594 treatment of an emotional disturbance in a residential treatment
595 center licensed under s. 394.875 or a hospital licensed under
596 chapter 395. The term includes a medical placement under s.
597 39.4078 for a high-acuity child who presents with needs that are
598 not suitable for treatment in a standard foster care or
599 therapeutic group home environment due to the complexity of the
600 needs or the potential for harm to others in the same care
601 setting.
602 3. “Suitable for residential treatment” or “suitability”
603 means a determination concerning a child or adolescent who is
604 classified as a high-acuity child or a child or adolescent with
605 an emotional disturbance as defined in s. 394.492(5) or a
606 serious emotional disturbance as defined in s. 394.492(6) that
607 each of the following criteria is met:
608 a. The child requires residential treatment.
609 b. The child is in need of a residential treatment program
610 and is expected to benefit from mental or behavioral health
611 treatment, or a combination of treatment.
612 c. An appropriate, less restrictive alternative to
613 residential treatment is unavailable.
614 4. “Therapeutic group home” means a residential treatment
615 center that offers a 24-hour residential program providing
616 community-based mental health treatment and mental health
617 support services to children who meet the criteria in s.
618 394.492(5) or (6) in a nonsecure, homelike setting.
619 (b) If Whenever the department believes that a child in its
620 legal custody is emotionally disturbed or is classified or
621 likely to be classified as a high-acuity child under s. 39.4078
622 and may need residential treatment, an examination and
623 suitability assessment must be conducted by a qualified
624 evaluator appointed by the department. This suitability
625 assessment must be completed before the placement of the child
626 in a residential treatment program.
627 1. The qualified evaluator for placement in a residential
628 treatment center, other than a therapeutic group home, or a
629 hospital must be a psychiatrist or a psychologist licensed in
630 this state who has at least 3 years of experience in the
631 diagnosis and treatment of serious emotional disturbances in
632 children and adolescents and who has no actual or perceived
633 conflict of interest with any inpatient facility or residential
634 treatment center or program.
635 2. The qualified evaluator for placement in a therapeutic
636 group home must be a psychiatrist licensed under chapter 458 or
637 chapter 459, a psychologist licensed under chapter 490, or a
638 mental health counselor licensed under chapter 491 who has at
639 least 2 years of experience in the diagnosis and treatment of
640 serious emotional, medical, developmental, or behavioral
641 disturbances disturbance in children, including high-acuity
642 children, and adolescents and who has no actual or perceived
643 conflict of interest with any residential treatment center or
644 program.
645 (c)1. Consistent with the requirements of this section, the
646 child shall be assessed for suitability for residential
647 treatment by a qualified evaluator who has conducted an
648 examination and assessment of the child and has made written
649 findings that:
650 a.1. The child appears to have an emotional disturbance
651 serious enough to require treatment in a residential treatment
652 program and is reasonably likely to benefit from the treatment.
653 b.2. The child has been provided with a clinically
654 appropriate explanation of the nature and purpose of the
655 treatment.
656 c.3. All available modalities of treatment less restrictive
657 than residential treatment have been considered, and a less
658 restrictive alternative that would offer comparable benefits to
659 the child is unavailable.
660 2. A copy of the written findings of the evaluation and
661 suitability assessment must be provided to the department, to
662 the guardian ad litem, and, if the child is a member of a
663 Medicaid managed care plan, to the plan that is financially
664 responsible for the child’s care in residential treatment, all
665 of whom must be provided with the opportunity to discuss the
666 findings with the evaluator.
667 3. If the written findings of the evaluation and
668 suitability assessment state that the child meets the criteria
669 of a high-acuity child and there is not a suitable residential
670 treatment program or medical placement for the high-acuity child
671 identified within 5 business days after the written findings are
672 provided to the department and guardian ad litem, the high
673 acuity child’s guardian ad litem must notify the court within 24
674 hours after the expiration of the 5-day time period that there
675 is a failure to identify a suitable placement. Within 5 business
676 days after receiving such notification, the court must set an
677 emergency evidentiary hearing to determine the most suitable
678 placement for the high-acuity child in accordance with s.
679 39.4078. The court may prioritize the placement of a high-acuity
680 child who is being placed or currently residing in foster care
681 to a specialized and appropriate placement, including, but not
682 limited to, a medical bed or group home in a facility licensed
683 or maintained by the department, the Agency for Persons with
684 Disabilities, the Department of Health, or the Agency for Health
685 Care Administration.
686 (d) Immediately upon placing a child in a residential
687 treatment program under this section, the department must notify
688 the guardian ad litem and the court having jurisdiction over the
689 child. Within 5 days after the department’s receipt of the
690 assessment, the department shall provide the guardian ad litem
691 and the court with a copy of the assessment by the qualified
692 evaluator.
693 (e) Within 10 days after the admission of a child to a
694 residential treatment program, the director of the residential
695 treatment program or the director’s designee must ensure that an
696 individualized plan of treatment has been prepared by the
697 program and has been explained to the child, to the department,
698 and to the guardian ad litem, and submitted to the department.
699 The child must be involved in the preparation of the plan to the
700 maximum feasible extent consistent with his or her ability to
701 understand and participate, and the guardian ad litem and the
702 child’s foster parents must be involved to the maximum extent
703 consistent with the child’s treatment needs. The plan must
704 include a preliminary plan for residential treatment and
705 aftercare upon completion of residential treatment. The plan
706 must include specific behavioral and emotional goals against
707 which the success of the residential treatment may be measured.
708 A copy of the plan must be provided to the child, to the
709 guardian ad litem, and to the department.
710 (f) Within 30 days after admission, the residential
711 treatment program must review the appropriateness and
712 suitability of the child’s placement in the program. The
713 residential treatment program must determine whether the child
714 is receiving benefit toward the treatment goals and whether the
715 child could be treated in a less restrictive treatment program.
716 The residential treatment program shall prepare a written report
717 of its findings and submit the report to the guardian ad litem
718 and to the department. The department must submit the report to
719 the court. The report must include a discharge plan for the
720 child. The residential treatment program must continue to
721 evaluate the child’s treatment progress every 30 days thereafter
722 and must include its findings in a written report submitted to
723 the department. The department may not reimburse a facility
724 until the facility has submitted every written report that is
725 due.
726 (g)1. The department must submit, at the beginning of each
727 month, to the court having jurisdiction over the child, a
728 written report regarding the child’s progress toward achieving
729 the goals specified in the individualized plan of treatment.
730 2. The court must conduct a hearing to review the status of
731 the child’s residential treatment plan no later than 60 days
732 after the child’s admission to the residential treatment
733 program. An independent review of the child’s progress toward
734 achieving the goals and objectives of the treatment plan must be
735 completed by a qualified evaluator and submitted to the court
736 before its 60-day review.
737 3. For any child in residential treatment at the time a
738 judicial review is held pursuant to s. 39.701, the child’s
739 continued placement in residential treatment must be a subject
740 of the judicial review.
741 4. If at any time the court determines that the child is
742 not suitable for continued residential treatment, the court
743 shall order the department to place the child in the least
744 restrictive setting that is best suited to meet his or her
745 needs.
746 (h) After the initial 60-day review, the court must conduct
747 a review of the child’s residential treatment plan every 90
748 days.
749 Section 8. Section 39.4078, Florida Statutes, is created to
750 read:
751 39.4078 Medical Placement for High-acuity Children Act.—
752 (1) SHORT TITLE.—This section may be cited as the “Medical
753 Placement for High-acuity Children Act.”
754 (2) LEGISLATIVE FINDINGS AND INTENT.—
755 (a) The Legislature finds that high-acuity children,
756 particularly those with disabilities, who are entering or
757 currently involved in the child protection system in this state
758 require prompt and specialized medical health assessments, as
759 well as appropriate medical placements.
760 (b) It is the intent of the Legislature to establish a
761 time-limited, court-supervised process for the medical placement
762 of high-acuity children which:
763 1. Ensures the high-acuity child receives medically
764 necessary treatment and stabilization in the least restrictive
765 setting that can safely meet the child’s needs.
766 2. Coordinates judicial oversight with clinical assessment,
767 case planning, and transition planning.
768 3. Promotes a prompt transfer to a less restrictive setting
769 as acute symptoms resolve, while preserving the high-acuity
770 child’s rights to education, visitation, and normalcy.
771 (3) DEFINITIONS.—As used in this section, the term:
772 (a) “Community-based care lead agency” has the same meaning
773 as in s. 409.986(3).
774 (b) “Multidisciplinary team” has the same meaning as in s.
775 39.4022(2).
776 (4) APPLICABILITY.—This section applies to the assessment,
777 eligibility, placement, case plan tasks, transfers to more or
778 less restrictive settings, and discharge of high-acuity children
779 in medical placements. This section operates in accordance with
780 ss. 39.4022, 39.407, 39.523, and 39.6013; however, if this
781 section conflicts with another section of law, this section
782 prevails to the extent necessary to address the needs of a high
783 acuity child.
784 (5) MEDICAL PLACEMENT.—A medical placement may include all
785 of the following, as clinically appropriate and subject to
786 applicable licensure under chapter 394, chapter 395, chapter
787 400, or chapter 409:
788 (a) Acute care beds for short-term intensive medical or
789 psychiatric treatment.
790 (b) Subacute beds for continued clinical support after
791 acute care.
792 (c) Therapeutic medical foster care providing in-home
793 medical services directed by a licensed health care
794 professional.
795 (d) Specialized residential treatment programs for children
796 with significant co-occurring medical and behavioral health
797 conditions.
798 (e) Placements that meet the requirements of the pilot
799 program of treatment foster care under s. 409.996(27).
800 (f) Other licensed settings capable of delivering
801 equivalent medically necessary services to a high-acuity child
802 in the least restrictive environment.
803 (6) REQUIREMENTS OF A MEDICAL PLACEMENT.—A medical
804 placement must do all of the following:
805 (a) Stabilize the high-acuity child’s acute symptoms and
806 address any immediate safety risks.
807 (b) Initiate or continue evidence-based treatment and
808 medication management, consistent with s. 39.407.
809 (c) Maintain the high-acuity child’s educational services
810 and reasonable family and sibling contact.
811 (d) Develop clear, time-limited clinical and functional
812 goals that determine when the high-acuity child is ready for a
813 less restrictive setting.
814 (e) Create a plan for placement and services that address
815 the range of needs of the high-acuity child from his or her
816 admission to a medical bed until he or she transitions to a less
817 restrictive setting and eventually reaches permanency.
818 (f) Ensure that high-acuity children in the custody of the
819 department under this chapter are given priority for placements
820 in the most appropriate facilities licensed or maintained by the
821 Agency for Persons with Disabilities, the Agency for Health Care
822 Administration, the Department of Health, or the department, as
823 applicable.
824 (7) ASSESSMENT AND ADMISSION.—
825 (a) Before admission to a medical placement, or within 24
826 hours after an emergency admission, a Child Protection Team must
827 collaborate with the department or community-based care lead
828 agency to obtain a comprehensive clinical assessment conducted
829 by a qualified licensed professional which identifies a high
830 acuity child’s needs, recommended level of care, and anticipated
831 length of stay.
832 (b) In accordance with s. 39.4022, a multidisciplinary team
833 staffing must occur within 72 hours after a child is classified
834 as a high-acuity child, and the staffing must include all
835 necessary participants who can appropriately address the basis
836 for classifying the child as a high-acuity child.
837 (c) The multidisciplinary team staffing must recommend the
838 least restrictive medical bed placement that is capable of
839 meeting the needs of the high-acuity child and identify
840 measurable goals and criteria for less restrictive placement.
841 The recommendations of the multidisciplinary team staffing must
842 be filed with a court pursuant to subsection (8).
843 (d) If the multidisciplinary team staffing cannot reach a
844 consensus on the placement of a high-acuity child, a designated
845 person present at the staffing must notify the court and, within
846 10 days after such notification, the court must hold an
847 emergency evidentiary hearing in accordance with s.
848 39.4022(6)(d)2.b.
849 (8) COURT APPROVAL AND WRITTEN FINDINGS.—
850 (a) Within 72 hours after a multidisciplinary team staffing
851 at which a consensus is reached to place a high-acuity child in
852 a medical placement, the department shall petition the court for
853 approval of such placement. The petition must include a copy of
854 the comprehensive clinical assessment and recommendations of the
855 multidisciplinary team staffing.
856 (b) The court shall conduct an evidentiary hearing and
857 provide written findings on all of the following:
858 1. The medical, behavioral, or complex conditions of the
859 child which are the basis for classifying the child as a high
860 acuity child.
861 2. Whether the medical bed suggested by the
862 multidisciplinary team staffing is the least restrictive setting
863 available for the high-acuity child.
864 3. Clearly defined goals and criteria for the high-acuity
865 child to enter a less restrictive placement.
866 4. The appropriate timeframe in which the case plan must be
867 updated to address the written findings of the court.
868 (c) Consent and authorization for medical, psychiatric, and
869 behavioral health services must be obtained and documented in
870 accordance with s. 39.407.
871 (d) The court must ensure that a high-acuity child’s
872 educational services, including any individualized education
873 program services if applicable, continue without interruption
874 and that reasonable family and sibling contact occurs unless
875 such contact is against clinical judgment and court order.
876 (9) PERIODIC REVIEWS.—Within 30 days after the court
877 provides its written findings under subsection (8), and every 30
878 days thereafter for as long as the high-acuity child remains in
879 a medical placement, the court must review the high-acuity
880 child’s progress through acute presentation of complex
881 behaviors. Each review must include updated clinical reports,
882 the progress of the high-acuity child toward defined goals that
883 address the stabilization and treatment of any identified high
884 acuity behaviors, educational progress, family and sibling
885 contact, and a recommendation regarding whether the high-acuity
886 child is ready for a less restrictive setting. Within 5 days
887 before each review hearing, the department must file with the
888 court an updated report that includes a recommendation for
889 maintaining the medical placement or, if appropriate,
890 transferring the high-acuity child to a less restrictive
891 setting. The multidisciplinary team staffing shall reconvene
892 before each review unless such requirement is waived by the
893 court.
894 (10) PLACEMENT PROCEDURES.—
895 (a) Upon motion of any party or on the court’s own motion,
896 and based on competent substantial evidence of the high-acuity
897 child’s clinical status, the court may immediately order the
898 high-acuity child to be moved to a less or more restrictive
899 licensed placement as indicated by the presence or resolution of
900 acute symptoms without having to wait for a regularly scheduled
901 review.
902 (b) The department may implement emergency procedures for
903 moving a high-acuity child to a more restrictive setting for the
904 safety of the high-acuity child or based on medical necessity.
905 The department shall notify the court and all parties within 24
906 hours after implementation of emergency procedures. The court
907 shall set the matter for a hearing within 3 days after being
908 notified of the implementation of emergency procedures.
909 (c) The transition between placements of a high-acuity
910 child must comply with s. 39.523 and include a written
911 transition plan that addresses medication continuity, treatment
912 hand-offs, education, and family and sibling contact of the
913 high-acuity child.
914 (11) CASE PLAN.—A high-acuity child’s case plan must be
915 updated within 7 days after court approval under subsection (8)
916 and after each review under subsection (9) to reflect placement
917 goals and transition planning.
918 (12) DURATION OF A MEDICAL PLACEMENT.—
919 (a) A medical placement may not exceed 90 consecutive days
920 without express written consent by the court, supported by clear
921 and convincing evidence that the medical placement remains
922 medically necessary and is the least restrictive setting
923 available to safely meet the needs of the high-acuity child.
924 (b) This section does not authorize the placement of a
925 high-acuity child in a setting prohibited by federal or state
926 law or rule.
927 (13) RIGHTS OF HIGH-ACUITY CHILDREN.—Unless otherwise
928 ordered by the court, a high-acuity child who is in a medical
929 placement retains all rights under this chapter, including, but
930 not limited to, access to an attorney ad litem and a guardian ad
931 litem, reasonable visitation with family and siblings,
932 individualized education program services, and participation in
933 case plan development based on the age and capacity of the high
934 acuity child.
935 (14) ANNUAL REPORT.—
936 (a) The department shall collect data relating to the
937 Medical Placement for High-acuity Children Act, including
938 admissions, placement types, lengths of stay, goals achieved,
939 outcomes of less restrictive settings, recidivism, education
940 continuity, family and sibling contact, and time to permanency.
941 Community-based care lead agencies and providers must furnish to
942 the department any data required to comply with this subsection.
943 (b) By January 31, 2027, and annually thereafter, the
944 department shall submit to the President of the Senate and the
945 Speaker of the House of Representatives a report relating to
946 utilization, outcomes, and service gaps of and recommendations
947 regarding the Medical Placement for High-acuity Children Act.
948 (15) CONSTRUCTION.—This section may not be construed to
949 limit the requirements of medical consent under s. 39.407 or the
950 court’s authority under s. 39.522.
951 (16) RULEMAKING.—The department and the Department of
952 Health may adopt rules to implement this section.
953 Section 9. Paragraphs (c) and (d) of subsection (1) and
954 subsection (2) of section 39.523, Florida Statutes, are amended,
955 and paragraph (e) is added to subsection (1) of that section, to
956 read:
957 39.523 Placement in out-of-home care.—
958 (1) LEGISLATIVE FINDINGS AND INTENT.—
959 (c) The Legislature also finds that the timely
960 identification of and therapeutic response to acute presentation
961 of symptoms indicative of trauma or high-acuity complex needs
962 can reduce adverse outcomes for a child, aid in the
963 identification of services to enhance initial placement
964 stability and of supports to caregivers, and reduce placement
965 disruption.
966 (d) It is the intent of the Legislature that whenever a
967 child is unable to safely remain at home with a parent, the most
968 appropriate available out-of-home placement must shall be chosen
969 after an assessment of the child’s needs and the availability of
970 caregivers qualified to meet the child’s needs, including
971 certain group or treatment settings that are appropriate for
972 addressing the needs of a high-acuity child.
973 (e) It is the intent of the Legislature that this section
974 applies to transitions between all out-of-home placements,
975 including, but not limited to, medical placements under s.
976 39.4078.
977 (2) ASSESSMENT AND PLACEMENT.—When any child is removed
978 from a home and placed in out-of-home care, a comprehensive
979 placement assessment process shall be completed in accordance
980 with s. 39.4022 or s. 39.4078, as applicable, to determine the
981 level of care needed by the child and match the child with the
982 most appropriate placement.
983 (a) In accordance with rules adopted by the department, the
984 department, or community-based care lead agency, or Child
985 Protection Team, if the child being evaluated has been
986 identified as a high-acuity child under s. 39.4078, must:
987 1. Coordinate a multidisciplinary team staffing as
988 established in s. 39.4022 with the necessary participants for
989 the stated purpose of the staffing.
990 2. Conduct a trauma screening as soon as practicable after
991 the child’s removal from his or her home but no later than 21
992 days after the shelter hearing. If indicated as appropriate or
993 necessary by the screening, the department or community-based
994 care lead agency must, at a minimum:
995 a. Promptly refer the child to appropriate trauma
996 assessment, which must be completed within 30 days, and if
997 appropriate, services and intervention as needed. To the extent
998 possible, the trauma screening, the assessment, and the services
999 and intervention must be integrated into the child’s overall
1000 behavioral health treatment planning and services.
1001 b. In accordance with s. 409.1415(2)(b)3.f., provide
1002 information and support, which may include, but need not be
1003 limited to, consultation, coaching, training, and referrals to
1004 services, to the caregiver of the child to help the caregiver
1005 respond to and care for the child in a trauma-informed and
1006 therapeutic manner.
1007 (b) The comprehensive placement assessment process may also
1008 include the use of an assessment instrument or tool that is best
1009 suited for the individual child and is able to identify a high
1010 acuity child.
1011 (c) The most appropriate available out-of-home placement
1012 shall be chosen after consideration by all members of the
1013 multidisciplinary team of all of the information and data
1014 gathered, including the results and recommendations of any
1015 evaluations conducted and considering the most appropriate
1016 placement of each child under ss. 39.4021 and 39.4022.
1017 (d) Placement decisions for each child in out-of-home
1018 placement shall be reviewed as often as necessary to ensure
1019 permanency for that child and address special issues related to
1020 this population of children.
1021 (e) The department, a community-based care lead agency, or
1022 a case management organization must document all placement
1023 assessments and placement decisions in the Florida Safe Families
1024 Network.
1025 (f) If it is determined during the comprehensive placement
1026 assessment process that:
1027 1. Residential treatment as defined in s. 39.407 would be
1028 suitable for the child, the procedures in that section must be
1029 followed.
1030 2. A child is classified as a high-acuity child, the
1031 procedures in s. 39.4078 must be followed.
1032 (g) The appropriate agencies and departments shall
1033 prioritize the placement of a high-acuity child who is taken
1034 into or currently in out-of-home care under this chapter into a
1035 specialized and appropriate placement, including, but not
1036 limited to, a medical bed or group home placement in a facility
1037 licensed or maintained by the department, the Department of
1038 Health, the Agency for Persons with Disabilities, or the Agency
1039 for Health Care Administration.
1040 Section 10. Subsection (2) and paragraph (a) of subsection
1041 (3) of section 39.6012, Florida Statutes, are amended to read:
1042 39.6012 Case plan tasks; services.—
1043 (2) The case plan must include all available information
1044 that is relevant to the child’s care including, at a minimum:
1045 (a) A description of the identified needs of the child
1046 while in care, including the needs of a child who has been
1047 evaluated and meets the criteria of a high-acuity child. The
1048 description of such needs must be specific enough for the parent
1049 or caregiver to sufficiently understand how to properly address
1050 any high-acuity medical conditions and the provision of care for
1051 such conditions to ensure the safe placement and care of the
1052 high-acuity child in compliance with s. 39.4078.
1053 (b) A description of the plan for ensuring that the child
1054 receives safe and proper care and that services are provided to
1055 the child in order to address the child’s needs. To the extent
1056 available and accessible, all of the following health, mental
1057 health, and education information and records of the child must
1058 be attached to the case plan and updated throughout the judicial
1059 review process:
1060 1. The names and addresses of the child’s health, mental
1061 health, and educational providers.;
1062 2. The child’s grade level performance.;
1063 3. The child’s school record or, if the child is under the
1064 age of school entry, any records from a child care program,
1065 early education program, or preschool program.;
1066 4. Documentation of compliance or noncompliance with the
1067 attendance requirements under s. 39.604, if the child is
1068 enrolled in a child care program, early education program, or
1069 preschool program.;
1070 5. Assurances that the child’s placement takes into account
1071 proximity to the school in which the child is enrolled at the
1072 time of placement.;
1073 6. The child’s immunizations.;
1074 7. The child’s known medical history, including any known
1075 health problems.;
1076 8. The child’s medications, if any.; and
1077 9. Any other relevant health, mental health, and education
1078 information concerning the child.
1079 10. Any other tasks that the Child Protection Team deems
1080 appropriate for a case plan prepared in accordance with s.
1081 39.4078 for a high-acuity child which are specific to addressing
1082 the child’s high-acuity needs and appropriate transition plans
1083 to more restrictive and less restrictive settings, regardless of
1084 whether the high-acuity designation is based on the child’s
1085 mental health, behavioral health, disability, or involvement
1086 with the juvenile justice system.
1087 (3) In addition to any other requirement, if the child is
1088 in an out-of-home placement, the case plan must include:
1089 (a) A description of the type of placement in which the
1090 child is to be living, including if such placement is a medical
1091 bed in a medical placement for a high-acuity child.
1092 Section 11. Subsections (1) and (2) of section 39.6013,
1093 Florida Statutes, are amended to read:
1094 39.6013 Case plan amendments.—
1095 (1) After the case plan has been developed under s.
1096 39.6011, the tasks and services agreed upon in the plan may not
1097 be changed or altered in any way except as provided in this
1098 section. If a high-acuity child is placed in a medical
1099 placement, the case plan must reflect the goals, services, and
1100 transition requirements identified in s. 39.4078.
1101 (2) The case plan may be amended at any time in order to
1102 change the goal of the plan, employ the use of concurrent
1103 planning, add or remove tasks the parent must complete to
1104 substantially comply with the plan, provide appropriate services
1105 for the child, and update the child’s health, mental health, and
1106 education records as required by s. 39.4078 or s. 39.6012.
1107 Section 12. Paragraph (k) is added to subsection (1) of
1108 section 391.025, Florida Statutes, to read:
1109 391.025 Applicability and scope.—
1110 (1) The Children’s Medical Services program consists of the
1111 following components:
1112 (k) The Medical Placement for High-acuity Children Act
1113 established under s. 39.4078.
1114 Section 13. Subsection (1) of section 391.029, Florida
1115 Statutes, is amended, and paragraph (d) is added to subsection
1116 (2) and paragraph (d) is added to subsection (3) of that
1117 section, to read:
1118 391.029 Program eligibility.—
1119 (1) Eligibility for the Children’s Medical Services program
1120 is based on the diagnosis of one or more chronic and serious
1121 medical conditions or meeting the criteria for a high-acuity
1122 child as defined in s. 39.01 and the family’s need for
1123 specialized services.
1124 (2) The following individuals are eligible to receive
1125 services through the program:
1126 (d) Children or youth with complex behavioral or mental
1127 health needs from birth to 18 years of age who meet the criteria
1128 of a high-acuity child as defined in s. 39.01 or who are placed
1129 in a medical bed in a medical placement under s. 39.4078.
1130 (3) Subject to the availability of funds, the following
1131 individuals may receive services through the Children’s Medical
1132 Services Safety Net program:
1133 (d) Children or youth with complex behavioral or mental
1134 health needs from birth to 18 years of age who meet the criteria
1135 of a high-acuity child as defined in s. 39.01 or who are placed
1136 in a medical bed in a medical placement under s. 39.4078.
1137 Section 14. Subsection (5) of section 393.065, Florida
1138 Statutes, is amended to read:
1139 393.065 Application and eligibility determination.—
1140 (5) Except as provided in subsections (6) and (7), if a
1141 client seeking enrollment in the developmental disabilities home
1142 and community-based services Medicaid waiver program meets the
1143 level of care requirement for an intermediate care facility for
1144 individuals with intellectual disabilities pursuant to 42 C.F.R.
1145 ss. 435.217(b)(1) and 440.150, the agency must assign the client
1146 to an appropriate preenrollment category pursuant to this
1147 subsection and must provide priority to clients waiting for
1148 waiver services in the following order:
1149 (a) Category 1, which includes clients deemed to be in
1150 crisis as described in rule and clients who meet the criteria of
1151 a high-acuity child as defined in s. 39.01, must be given first
1152 priority in moving from the preenrollment categories to the
1153 waiver.
1154 (b) Category 2, which includes clients in the preenrollment
1155 categories who are:
1156 1. From the child welfare system with an open case in the
1157 Department of Children and Families’ statewide automated child
1158 welfare information system and who are either:
1159 a. Transitioning out of the child welfare system into
1160 permanency; or
1161 b. At least 18 years but not yet 22 years of age and who
1162 need both waiver services and extended foster care services; or
1163 2. At least 18 years but not yet 22 years of age and who
1164 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the
1165 extended foster care system.
1166
1167 For individuals who are at least 18 years but not yet 22 years
1168 of age and who are eligible under sub-subparagraph 1.b., the
1169 agency must provide waiver services, including residential
1170 habilitation, and must actively participate in transition
1171 planning activities, including, but not limited to,
1172 individualized service coordination, case management support,
1173 and ensuring continuity of care pursuant to s. 39.6035. The
1174 community-based care lead agency must fund room and board at the
1175 rate established in s. 409.145(3) and provide case management
1176 and related services as defined in s. 409.986(3)(f) s.
1177 409.986(3)(e). Individuals may receive both waiver services and
1178 services under s. 39.6251. Services may not duplicate services
1179 available through the Medicaid state plan.
1180 (c) Category 3, which includes, but is not required to be
1181 limited to, clients:
1182 1. Whose caregiver has a documented condition that is
1183 expected to render the caregiver unable to provide care within
1184 the next 12 months and for whom a caregiver is required but no
1185 alternate caregiver is available;
1186 2. At substantial risk of incarceration or court commitment
1187 without supports;
1188 3. Whose documented behaviors or physical needs place them
1189 or their caregiver at risk of serious harm and other supports
1190 are not currently available to alleviate the situation; or
1191 4. Who are identified as ready for discharge within the
1192 next year from a state mental health hospital or skilled nursing
1193 facility and who require a caregiver but for whom no caregiver
1194 is available or whose caregiver is unable to provide the care
1195 needed.
1196 (d) Category 4, which includes, but is not required to be
1197 limited to, clients whose caregivers are 60 years of age or
1198 older and for whom a caregiver is required but no alternate
1199 caregiver is available.
1200 (e) Category 5, which includes, but is not required to be
1201 limited to, clients who are expected to graduate within the next
1202 12 months from secondary school and need support to obtain a
1203 meaningful day activity, maintain competitive employment, or
1204 pursue an accredited program of postsecondary education to which
1205 they have been accepted.
1206 (f) Category 6, which includes clients 21 years of age or
1207 older who do not meet the criteria for category 1, category 2,
1208 category 3, category 4, or category 5.
1209 (g) Category 7, which includes clients younger than 21
1210 years of age who do not meet the criteria for category 1,
1211 category 2, category 3, or category 4.
1212
1213 Within preenrollment categories 3, 4, 5, 6, and 7, the agency
1214 shall prioritize clients in the order of the date that the
1215 client is determined eligible for waiver services. A client
1216 within any preenrollment category who meets the criteria of a
1217 high-acuity child as defined in s. 39.01 whose high-acuity
1218 designation is related to a disability that otherwise makes the
1219 child eligible for services under this chapter must be placed in
1220 category 1 for priority placement in an appropriate medical bed
1221 in a medical placement in accordance with s. 39.4078 if the
1222 child is taken into or is currently in the custody of the
1223 Department of Children and Families under chapter 39.
1224 Section 15. Paragraph (p) of subsection (4), paragraph (a)
1225 of subsection (6), and paragraph (a) of subsection (7) of
1226 section 394.495, Florida Statutes, are amended, and paragraph
1227 (r) is added to subsection (4) of that section, to read:
1228 394.495 Child and adolescent mental health system of care;
1229 programs and services.—
1230 (4) The array of services may include, but is not limited
1231 to:
1232 (p) Trauma-informed services for children who have suffered
1233 sexual exploitation as defined in s. 39.01(83)(g) s.
1234 39.01(80)(g).
1235 (r) Placement in a medical bed in a medical placement under
1236 s. 39.4078.
1237 (6) The department shall contract for community action
1238 treatment teams throughout the state with the managing entities.
1239 A community action treatment team shall:
1240 (a) Provide community-based behavioral health and support
1241 services to children from 11 to 13 years of age, adolescents,
1242 and young adults from 18 to 21 years of age with serious
1243 behavioral health conditions who are at risk of out-of-home
1244 placement as demonstrated by:
1245 1. Repeated failures at less intensive levels of care;
1246 2. Two or more behavioral health hospitalizations;
1247 3. Involvement with the Department of Juvenile Justice;
1248 4. A history of multiple episodes involving law
1249 enforcement; or
1250 5. A record of poor academic performance or suspensions; or
1251 6. A designation as a high-acuity child as defined in s.
1252 39.01 or placement in a medical bed in a medical placement under
1253 s. 39.4078.
1254
1255 Children younger than 11 years of age who otherwise meet the
1256 criteria in this paragraph may be candidates for such services
1257 if they demonstrate two or more of the characteristics listed in
1258 subparagraphs 1.-5.
1259 (7)(a) The department shall contract with managing entities
1260 for mobile response teams throughout the state to provide
1261 immediate, onsite behavioral health crisis services to children,
1262 adolescents, and young adults ages 18 to 25, inclusive, who:
1263 1. Have an emotional disturbance;
1264 2. Are experiencing an acute mental or emotional crisis;
1265 3. Are experiencing escalating emotional or behavioral
1266 reactions and symptoms that impact their ability to function
1267 typically within the family, living situation, or community
1268 environment; or
1269 4. Are served by the child welfare system and are
1270 experiencing or are at high risk of placement instability; or
1271 5. Have been evaluated and meet the criteria of a high
1272 acuity child as defined in s. 39.01 or who are placed in a
1273 medical bed in a medical placement under s. 39.4078.
1274 Section 16. Paragraphs (a) and (b) of subsection (2) of
1275 section 409.145, Florida Statutes, are amended, and paragraph
1276 (h) is added to subsection (1) of that section, to read:
1277 409.145 Care of children; “reasonable and prudent parent”
1278 standard.—The child welfare system of the department shall
1279 operate as a coordinated community-based system of care which
1280 empowers all caregivers for children in foster care to provide
1281 quality parenting, including approving or disapproving a child’s
1282 participation in activities based on the caregiver’s assessment
1283 using the “reasonable and prudent parent” standard.
1284 (1) SYSTEM OF CARE.—The department shall develop,
1285 implement, and administer a coordinated community-based system
1286 of care for children who are found to be dependent and their
1287 families. This system of care must be directed toward the
1288 following goals:
1289 (h) Ensure that a child who has been designated as a high
1290 acuity child after an assessment for such purpose has the most
1291 appropriate medical placement and necessary services, including
1292 transitions to more restrictive and less restrictive settings,
1293 to address the acute or chronic expression of the medical
1294 conditions that are the reason for the high-acuity designation.
1295 (2) REASONABLE AND PRUDENT PARENT STANDARD.—
1296 (a) Definitions.—As used in this subsection, the term:
1297 1. “Age-appropriate” means an activity or item that is
1298 generally accepted as suitable for a child of the same
1299 chronological age or level of maturity. Age appropriateness is
1300 based on the development of cognitive, emotional, physical, and
1301 behavioral capacity which is typical for an age or age group.
1302 2. “Caregiver” means a person with whom the child is placed
1303 in out-of-home care, or a designated official for a group care
1304 facility licensed by the department under s. 409.175.
1305 3. “High-acuity child” has the same meaning as in s. 39.01.
1306 4.3. “Reasonable and prudent parent” standard means the
1307 standard of care used by a caregiver in determining whether to
1308 allow a child in his or her care to participate in
1309 extracurricular, enrichment, and social activities. This
1310 standard is characterized by careful and thoughtful parental
1311 decisionmaking that is intended to maintain a child’s health,
1312 safety, and best interest while encouraging the child’s
1313 emotional and developmental growth.
1314 (b) Application of standard of care.—
1315 1. Every child who comes into out-of-home care pursuant to
1316 this chapter is entitled to participate in age-appropriate
1317 extracurricular, enrichment, and social activities.
1318 2. Each caregiver shall use the reasonable and prudent
1319 parent standard in determining whether to give permission for a
1320 child living in out-of-home care to participate in
1321 extracurricular, enrichment, or social activities. When using
1322 the reasonable and prudent parent standard, the caregiver must
1323 consider:
1324 a. The child’s age, maturity, and developmental level to
1325 maintain the overall health and safety of the child.
1326 b. The potential risk factors and the appropriateness of
1327 the extracurricular, enrichment, or social activity.
1328 c. The best interest of the child, based on information
1329 known by the caregiver.
1330 d. The importance of encouraging the child’s emotional and
1331 developmental growth.
1332 e. The importance of providing the child with the most
1333 family-like living experience possible.
1334 f. The behavioral history of the child and the child’s
1335 ability to safely participate in the proposed activity.
1336
1337 For a high-acuity child, the medical necessity of such child and
1338 the need for medical placement or transitions to more
1339 restrictive and less restrictive settings take priority over the
1340 reasonable and prudent parent standard until such time as the
1341 court determines that the acute or chronic expression of the
1342 medical conditions that are the reason for the high-acuity
1343 designation have been stabilized.
1344 Section 17. Paragraph (d) of subsection (2) of section
1345 409.166, Florida Statutes, is amended to read:
1346 409.166 Children within the child welfare system; adoption
1347 assistance program.—
1348 (2) DEFINITIONS.—As used in this section, the term:
1349 (d) “Difficult-to-place child” means:
1350 1. A child whose permanent custody has been awarded to the
1351 department or to a licensed child-placing agency;
1352 2. A child who has established significant emotional ties
1353 with his or her foster parents or is not likely to be adopted
1354 because he or she is:
1355 a. Eight years of age or older;
1356 b. Developmentally disabled;
1357 c. Physically or emotionally handicapped;
1358 d. A member of a racial group that is disproportionately
1359 represented among children described in subparagraph 1.; or
1360 e. A member of a sibling group of any age, provided two or
1361 more members of a sibling group remain together for purposes of
1362 adoption; or
1363 f. A high-acuity child as defined in s. 39.01; and
1364 3. Except when the child is being adopted by the child’s
1365 foster parents or relative caregivers, a child for whom a
1366 reasonable but unsuccessful effort has been made to place the
1367 child without providing a maintenance subsidy.
1368 Section 18. Subsection (30) is added to section 409.906,
1369 Florida Statutes, to read:
1370 409.906 Optional Medicaid services.—Subject to specific
1371 appropriations, the agency may make payments for services which
1372 are optional to the state under Title XIX of the Social Security
1373 Act and are furnished by Medicaid providers to recipients who
1374 are determined to be eligible on the dates on which the services
1375 were provided. Any optional service that is provided shall be
1376 provided only when medically necessary and in accordance with
1377 state and federal law. Optional services rendered by providers
1378 in mobile units to Medicaid recipients may be restricted or
1379 prohibited by the agency. Nothing in this section shall be
1380 construed to prevent or limit the agency from adjusting fees,
1381 reimbursement rates, lengths of stay, number of visits, or
1382 number of services, or making any other adjustments necessary to
1383 comply with the availability of moneys and any limitations or
1384 directions provided for in the General Appropriations Act or
1385 chapter 216. If necessary to safeguard the state’s systems of
1386 providing services to elderly and disabled persons and subject
1387 to the notice and review provisions of s. 216.177, the Governor
1388 may direct the Agency for Health Care Administration to amend
1389 the Medicaid state plan to delete the optional Medicaid service
1390 known as “Intermediate Care Facilities for the Developmentally
1391 Disabled.” Optional services may include:
1392 (30) HIGH-ACUITY CHILD SERVICES.—The agency may pay for a
1393 medical bed in a medical placement and any transitions to more
1394 restrictive and less restrictive settings that are required to
1395 appropriately serve a high-acuity child as defined in s. 39.01
1396 to ensure that a child designated as a high-acuity child has the
1397 most appropriate placement and services necessary to address the
1398 acute or chronic expression of the medical conditions that are
1399 the reason for the high-acuity designation. The agency may seek
1400 federal approval if necessary to implement this subsection.
1401 Section 19. Present paragraph (e) of subsection (3) of
1402 section 409.986, Florida Statutes, is redesignated as paragraph
1403 (f), and paragraph (j) is added to subsection (2) and a new
1404 paragraph (e) is added to subsection (3) of that section, to
1405 read:
1406 409.986 Legislative findings and intent; child protection
1407 and child welfare outcomes; definitions.—
1408 (2) CHILD PROTECTION AND CHILD WELFARE OUTCOMES.—It is the
1409 goal of the department to protect the best interest of children
1410 by achieving the following outcomes in conjunction with the
1411 community-based care lead agency, community-based
1412 subcontractors, and the community alliance:
1413 (j) If applicable, the needs of a high-acuity child are
1414 stabilized and the child is provided the most appropriate
1415 services and placements.
1416 (3) DEFINITIONS.—As used in this part, except as otherwise
1417 provided, the term:
1418 (e) “High-acuity child” has the same meaning as in s.
1419 39.01.
1420 Section 20. Paragraph (c) of subsection (1) of section
1421 934.255, Florida Statutes, is amended to read:
1422 934.255 Subpoenas in investigations of sexual offenses.—
1423 (1) As used in this section, the term:
1424 (c) “Sexual abuse of a child” means a criminal offense
1425 based on any conduct described in s. 39.01(83) s. 39.01(80).
1426 Section 21. Subsection (5) of section 960.065, Florida
1427 Statutes, is amended to read:
1428 960.065 Eligibility for awards.—
1429 (5) A person is not ineligible for an award pursuant to
1430 paragraph (2)(a), paragraph (2)(b), or paragraph (2)(c) if that
1431 person is a victim of sexual exploitation of a child as defined
1432 in s. 39.01(83)(g) s. 39.01(80)(g).
1433 Section 22. Subsection (24) of section 984.03, Florida
1434 Statutes, is amended to read:
1435 984.03 Definitions.—When used in this chapter, the term:
1436 (24) “Neglect” has the same meaning as in s. 39.01 s.
1437 39.01(53).
1438 Section 23. This act shall take effect July 1, 2026.