CS/HB 1229 full text · Session Watch

1 A bill to be entitled

2 An act relating to residential homes for medically or

3 technologically dependent children; creating part XII

4 of ch. 400, F.S., entitled "Medically Complex

5 Children's Homes"; creating s. 400.9991, F.S.;

6 providing legislative intent; creating s. 400.9992,

7 F.S.; defining the terms "agency" and "medically

8 complex children's home"; creating s. 400.9993, F.S.;

9 providing licensure requirements; 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 access to a medically complex

14 children's home at reasonable times for certain

15 persons; requiring the agency to issue a provisional

16 license to a newly licensed provider for a specified

17 timeframe under certain circumstances; requiring

18 issuance of a standard license to a provisionally

19 licensed provider under certain circumstances;

20 authorizing the agency to issue a conditional license

21 for a specified timeframe to a licensed provider for

22 specified reasons; requiring the agency to conduct

23 inspections; creating s. 400.9995, F.S.; providing

24 rulemaking authority and requirements; creating s.

25 400.9996, F.S.; providing eligibility requirements for

26 admission to a medically complex children's home;

27 creating s. 400.9997, F.S.; providing uniform

28 firesafety standards, emergency preparedness

29 requirements, and construction standards; creating s.

30 400.9998, F.S.; providing for the denial, suspension,

31 and revocation of a license; providing for

32 administrative fines; amending ss. 400.051, 408.802,

33 408.820, and 408.823, F.S.; conforming provisions to

34 changes made by the act; requiring the agency to

35 implement certain changes by a specified date;

36 providing an effective date.

38 Be It Enacted by the Legislature of the State of Florida:

40 Part XII of chapter 400, Florida Statutes, Section 1.

41 consisting of ss. 400.9991 through 400.9998, is created and

42 entitled "Medically Complex Children's Homes."

43 Section 2. Section 400.9991, Florida Statutes, is created

44 to read:

45 400.9991 Legislative intent.—It is the intent of the

46 Legislature to develop, establish, and enforce licensure and

47 basic standards for medically complex children's homes in order

48 to ensure that the homes are family-centered and that the

49 medical, developmental, physiological, nutritional, and

50 psychosocial needs of medically complex children are met.

51 Medically complex children's homes shall serve as a safe home-

52 like setting with clinical oversight for children with complex

53 medical needs as an alternative to institutional care. This

54 setting is intended to meet the needs of children and families

55 in this state, offering smaller homes geographically close to

56 parents and guardians to maintain family connections for the

57 fragile children served. Medically complex children's homes are

58 not intended to serve children whose parents and guardians live

59 outside of this state, as out-of-state residency does not

60 support family involvement with the child.

61 Section 3. Section 400.9992, Florida Statutes, is created

62 to read:

63 400.9992 Definitions.—As used in this part, the term:

64 (1) "Agency" means the Agency for Health Care

65 Administration.

66 (2) "Medically complex children's home" means any

67 residential home that undertakes through its ownership or

68 management to provide residential services for up to six

69 medically dependent or technologically dependent children who

70 are not related to the owner or operator by blood, marriage, or

71 adoption. A medically complex children's home serves children

72 who are medically or technologically dependent as defined in s.

73 400.902(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

78 the provision of services that require licensure pursuant to

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

80 or 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 shall be required for homes

84 maintained in separate premises that are operated under the same

85 management.

86 (3) A medical foster home licensed by the Department of

87 Children and Families is exempt from licensure under this part.

88 (4)(a) A community residential group home licensed under

89 chapter 393 providing residential care for medically complex

90 children is deemed to satisfy the requirements for initial

91 licensure under this part if the home meets all of the following

92 criteria:

93 1. The home held a license in good standing under chapter

94 393 on June 30, 2026.

95 2. The home shares common ownership with all of the

96 following:

97 a. A health agency licensed under part III of chapter 400

98 providing private duty nursing services by registered nurses or

99 licensed practical nurses.

100 b. A prescribed pediatric extended care center licensed

101 under part VI of chapter 400.

102 c. A home medical equipment provider licensed under part

103 VII of chapter 400.

104 d. A health care clinic licensed under part X of chapter

105 400 providing speech-language therapy, physical therapy, or

106 occupational therapy.

107 (b) A community residential group home that meets the

108 requirements in paragraph (a) shall submit an application for

109 licensure to the agency within 60 days after the adoption of

110 agency licensure rules and must comply with the minimum

111 standards and requirements to maintain licensure pursuant to

112 this part.

113 Section 5. Section 400.9994, Florida Statutes, is created

114 to read:

115 400.9994 Licensure application requirements.—

116 (1) Each application for initial licensure or license

117 renewal must meet the requirements specified in part II of

118 chapter 408 and this part.

119 (2) The initial application must contain the location of

120 the medically complex children's home for which a license is

121 sought and documentation, signed by the appropriate local

122 government official, that states that the applicant has met

123 local zoning requirements.

124 (3) The agency shall require level 2 background screening

125 for personnel pursuant to s. 408.809(1)(e) and chapter 435.

126 (4) In addition to the requirements of s. 408.811, access

127 to a medically complex children's home must be provided at

128 reasonable times for the appropriate officials of the agency,

129 the Department of Health, the Department of Children and

130 Families, and the State Fire Marshal, who are responsible for

131 the development and maintenance of fire, health, sanitary, and

132 safety standards, and Medicaid requirements, to inspect the home

133 to ensure compliance with these standards.

134 (5) In addition to the license categories available in s.

135 408.808:

136 (a) The agency shall issue a provisional license for a

137 period of up to 6 months to an applicant for initial licensure

138 which meets the licensure criteria pursuant to this part and

139 part II of chapter 408.

140 1. The licensed provider shall notify the agency, in

141 writing, when at least one resident has been admitted to the

142 home, after which an unannounced inspection shall be made to

143 determine compliance with the requirements of a medically

144 complex children's home.

145 2. In addition to sanctions authorized under this part, if

146 violations are found during the inspection and the licensee

147 fails to demonstrate compliance with all medically complex

148 children's home requirements during a followup inspection, the

149 licensee may not admit any new children for medically complex

150 children's home services. The agency may extend the provisional

151 license for not more than 1 month pending verification of

152 correction of violations through a second followup inspection.

153 If violations are found during the second followup inspection,

154 the agency may not extend the provisional license any further.

155 The licensee shall promptly create and implement a plan for the

156 safe and orderly discharge of the children being cared for under

157 the medically complex children's home license.

158 3. A provisionally licensed provider that demonstrates

159 compliance with all the requirements of a medically complex

160 children's home license during the inspection shall be issued a

161 standard medically complex children's home license.

162 (b) The agency may issue a conditional license to a

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

164 found to have uncorrected violations that the facility has had

165 an opportunity to correct. A conditional license must be limited

166 to a specific period of not more than 6 months.

167 (6) The agency shall conduct licensure inspections of

168 medically complex children's homes and quarterly monitor visits.

169 Section 6. Section 400.9995, Florida Statutes, is created

170 to read:

171 400.9995 Rules establishing minimum standards.—The agency

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

173 408, which must include reasonable and fair minimum standards in

174 relation to:

175 (1) A safe and sanitary environment that is residential

176 and noninstitutional in design or nature and may allow for

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

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

179 security measures related to the general safety and security of

180 residents, staff, and the home.

181 (2) Accommodation of the needs and preferences of

182 residents to enhance the quality of life in the home.

183 (3) The provision of individualized medical,

184 developmental, and family training services.

185 (4) The number and qualifications of all personnel who

186 have responsibility for the care of the children served based on

187 the age and acuity of the children. The home must have licensed

188 nursing staff who are on duty in the home at all 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 staff thereof, which will ensure the health and

193 comfort of children served.

194 (6) Programs and basic services promoting and maintaining

195 a homelike environment and the health and development of the

196 children served, including facilitating school services. Such

197 programs and services include development, implementation, and

198 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, developmental services,

206 child life services, psychological services, and transportation.

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

208 information relative to the children and programs. Such records

209 shall be accessible to the agency for inspection during onsite

210 visits.

211 (9) The use of video cameras and electronic monitoring

212 within the home to include areas where monitoring is required

213 and areas where monitoring is permitted with the consent of the

214 parent or guardian of the child.

215 (10) Requirements for child bedrooms, including criteria

216 for a private room and the permissible circumstances for a

217 shared room.

218 (11) Discharge and transfer planning for a child,

219 including a child who becomes ineligible for services from the

220 home. Discharge planning must be initiated at least 18 months

221 before the child reaches 21 years of age to enable a smooth

222 transition to an appropriate setting. The rules shall also

223 specify advance notice requirements.

224 (12) Establishing procedures, identifying forms,

225 specifying documentation, and clarifying terms, as necessary, to

226 administer this part.

227 (13) Admission and assessment of children.

228 Section 7. Section 400.9996, Florida Statutes, is created

229 to read:

230 400.9996 Resident eligibility and admission.—

231 To qualify for admission to a medically complex children's home,

232 a child must:

233 (1) Be admitted from a higher level of care in a Florida

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

235 be admitted from a family home of a parent or guardian whose

236 primary residence is in Florida.

237 (2) Have a chronic debilitating disease or condition of

238 one or more physiological or organ systems which generally makes

239 the child dependent upon 24-hour-per-day medical, nursing, or

240 health supervision or intervention. Medically fragile children

241 are medically complex and the medical condition is such that

242 they 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

246 physician in consultation with the parents or legal guardians.

247 For Medicaid recipients, the recommendations for placement of a

248 Medicaid applicant or recipient in the medically complex

249 children's home must be made by the Children's Multidisciplinary

250 Assessment Team of the Department of Health under s. 391.025.

251 Consideration must be given to relevant medical, emotional,

252 psychosocial, and 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 shall

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

269 s. 408.821 shall be submitted for review and approval to the

270 local 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 shall comply with all of the

276 following:

277 (a) The provisions of chapter 553, which pertain to

278 building construction standards, including plumbing, electrical

279 code, 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 shall 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. Paragraph (d) is added to subsection (1) of

327 section 400.051, Florida Statutes, to read:

328 400.051 Homes or institutions exempt from the provisions

329 of this part.—

330 (1) The following shall be exempt from the provisions of

331 this part:

332 (d) Any medically complex children's home licensed under

333 part XII of this chapter.

334 Section 11. Subsection (26) is added to section 408.802,

335 Florida Statutes, to read:

336 408.802 Applicability.—This part applies to the provision

337 of services that require licensure as defined in this part and

338 to the following entities licensed, registered, or certified by

339 the agency, as described in chapters 112, 383, 390, 394, 395,

340 400, 429, 440, and 765:

341 (26) Medically complex children's homes, as provided under

342 part XII of chapter 400.

343 Section 12. Subsection (25) is added to section 408.820,

344 Florida Statutes, to read:

345 408.820 Exemptions.—Except as prescribed in authorizing

346 statutes, the following exemptions shall apply to specified

347 requirements of this part:

348 (25) Medically complex children's homes, as provided under

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

350 Section 13. Subsection (1) of section 408.823, Florida

351 Statutes, is amended to read:

352 408.823 In-person visitation.—

353 (1) This section applies to developmental disabilities

354 centers as defined in s. 393.063, hospitals licensed under

355 chapter 395, nursing home facilities licensed under part II of

356 chapter 400, hospice facilities licensed under part IV of

357 chapter 400, intermediate care facilities for the

358 developmentally disabled licensed and certified under part VIII

359 of chapter 400, medically complex children's homes licensed

360 under part XII of chapter 400, and assisted living facilities

361 licensed under part I of chapter 429.

362 Section 14. This act shall take effect July 1, 2026.