No. HB 1261
Filed under Healthcare.
Medicaid Reimbursement for Private Duty Nursing Services; Defines "pediatric continuing care integrated community" for purposes of state Medicaid program; defines "geographic area" & "prevailing hourly rate"; requires Medicaid managed care plans to reimburse licensed home health agencies for private duty nursing services provided in community residential group home at certain rate; prohibits Medicaid managed care plans from reducing reimbursement for such services; requires Medicaid managed care plans to negotiate rates with affiliated businesses at least annually & upon request by provider, to provide certain written certification; requires AHCA to seek federal approval within specified timeframe; requires agency to implement changes made by act upon federal approval.
Plain English Summary
AI-GENERATEDMedicaid managed care plans must pay home health agencies the full private duty nursing fee schedule rate for care given in a community residential group home. That floor holds no matter how many Medicaid children share the dwelling or receive care the same day.
Plans and these providers must renegotiate rates at least once a year. Providers can also demand written proof that group-home nursing pays no less than the same plan's rate for nursing in a private home in that region.
The floor is written into a new subsection about a 'pediatric continuing care integrated community': a group home, home health agency, therapy clinic, medical-equipment supplier, and pediatric day center all under one owner as of July 1, 2026, serving medically fragile children under 21.
The substantive changes don't take hold until the state secures federal approval for them, which the agency must pursue within 30 days. The law does not say what happens if that approval is delayed or denied.
AIManaged care plans must pay home health agencies at least the Private Duty Nursing Fee Schedule rate for nursing given in a community residential group home, no matter how many plan members share the dwelling.
AIPlans cannot reduce reimbursement because multiple Medicaid-eligible patients receive private duty nursing in the same dwelling space or on the same day within the group home.
AIA 'pediatric continuing care integrated community' is a group home, home health agency, pediatric extended care center, home medical equipment provider, and therapy clinic all under common ownership, serving medically fragile Medicaid patients under 21.
AIManaged care plans and the affiliated businesses in the integrated community must sit down and renegotiate rates for medical services at least once every year.
AIOn request, a plan must certify in writing that what it pays for nursing inside the integrated community is not less than what it pays for the same nursing in private homes in that Medicaid region.