SB 1560 full text · Session Watch

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.

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

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.

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.

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.

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 .

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.

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.