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THE BILL ITSELF

SB 648

Medicaid Reimbursement for Private Duty Nursing Services

VERSION S 648 Filed · BACK TO THE SUMMARY · OFFICIAL RECORD

underlined language is being added; struck language is being deleted. Line numbers are the Legislature's own — the same ones amendments cite.

Florida Senate - 2026 SB 648 By Senator Bradley 6-00438A-26 2026648__
1 A bill to be entitled
2 An act relating to Medicaid reimbursement for private
3 duty nursing services; amending s. 409.962, F.S.;
4 defining the term “pediatric continuing care
5 integrated community” for purposes of the state
6 Medicaid program; amending s. 409.975, F.S.; defining
7 the terms “geographic area” and “prevailing hourly
8 rate”; requiring Medicaid managed care plans to
9 reimburse licensed home health agencies for private
10 duty nursing services provided in a community
11 residential group home at a certain rate; prohibiting
12 Medicaid managed care plans from reducing
13 reimbursement for such services under certain
14 circumstances; requiring Medicaid managed care plans
15 to negotiate rates with affiliated businesses at least
16 annually; requiring the Agency for Health Care
17 Administration to seek federal approval within a
18 specified timeframe; requiring the agency to implement
19 the changes made by the act upon federal approval;
20 providing effective dates.
22 Be It Enacted by the Legislature of the State of Florida:
24 Section 1. Effective July 1, 2026, present subsections (13)
25 through (18) of section 409.962, Florida Statutes, are
26 redesignated as subsections (14) through (19), respectively, and
27 a new subsection (13) is added to that section, to read:
28 409.962 Definitions.—As used in this part, except as
29 otherwise specifically provided, the term:
30 (13) “Pediatric continuing care integrated community” means
31 a group of affiliated and integrated businesses that, as of July
32 1, 2026, are licensed or certified by the agency or the Agency
33 for Persons with Disabilities and collectively provide
34 coordinated care for Medicaid-eligible persons younger than 21
35 years of age who are medically fragile, including those who are
36 technology dependent. The term includes all of the following
37 entities under common ownership:
38 (a) A community residential group home licensed under
39 chapter 393 providing residential care for medically complex
40 children.
41 (b) A home health agency licensed under part III of chapter
42 400 providing private duty nursing services by registered nurses
43 or licensed practical nurses.
44 (c) A prescribed pediatric extended care center licensed
45 under part VI of chapter 400.
46 (d) A home medical equipment provider licensed under part
47 VII of chapter 400.
48 (e) A health care clinic licensed under part X of chapter
49 400 providing speech-language therapy, physical therapy, or
50 occupational therapy.
51 Section 2. Subsection (7) is added to section 409.975,
52 Florida Statutes, to read:
53 409.975 Managed care plan accountability.—In addition to
54 the requirements of s. 409.967, plans and providers
55 participating in the managed medical assistance program shall
56 comply with the requirements of this section.
57 (7) REIMBURSEMENT FOR SERVICES IN PEDIATRIC CONTINUING CARE
58 INTEGRATED COMMUNITIES.—
59 (a) As used in this subsection, the term:
60 1. “Geographic area” means the region or metropolitan
61 statistical area in which the pediatric continuing care
62 integrated community is located.
63 2. “Prevailing hourly rate” means the usual and customary
64 contracted hourly rate paid by Medicaid managed care plans to
65 providers for private duty nursing services in the same
66 geographic area during the current calendar year, which rate is
67 negotiated at least annually between the Medicaid managed care
68 plans and the provider of private duty nursing within the
69 community residential group home.
70 (b) Medicaid managed care plans shall reimburse home health
71 agencies licensed under part III of chapter 400 for private duty
72 nursing services, including services provided by registered
73 nurses and licensed practical nurses, provided in a community
74 residential group home at 100 percent of the prevailing hourly
75 rate paid for private duty nursing services in the geographic
76 area, regardless of the number of plan members who share a
77 dwelling space within the community residential group home.
78 (c) Reimbursement may not be reduced based on the number of
79 Medicaid-eligible persons receiving private duty nursing
80 services in the same dwelling space, or on the same day, within
81 the community residential group home.
82 (d) Managed care plans and the affiliated businesses shall
83 negotiate rates at least annually for medical services provided
84 within the pediatric continuing care integrated community.
85 Section 3. Within 30 days after the effective date of this
86 act, the Agency for Health Care Administration shall seek any
87 necessary federal approval, including through any necessary
88 state plan amendment or Medicaid waiver, to implement the
89 changes made by this act. The agency shall implement this act
90 upon receipt of federal approval.
91 Section 4. Except as otherwise provided in this act, this
92 act shall take effect upon becoming a law.