Florida HB 1261: Medicaid Reimbursement for Private Duty Nursing Services

Bill Text

HB 1261 2026

CODING: Words stricken are deletions; words underlined are additions.
hb1261-00
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A bill to be entitled 1
An act relating to Medicaid reimbursement for private 2
duty nursing services; amending s. 409.962, F.S.; 3
defining the term "pediatric continuing care 4
integrated community" for purposes of the state 5
Medicaid program; amending s. 409.975, F.S.; defining 6
the term "Medicaid region"; requiring Medicaid managed 7
care plans to reimburse licensed home health agencies 8
for private duty nursing services provided in a 9
community residential group home at a certain rate; 10
prohibiting Medicaid managed care plans from reducing 11
reimbursement for such services under certain 12
circumstances; requiring Medicaid managed care plans 13
to negotiate rates with affiliated businesses at least 14
annually; requiring Medicaid managed care plans, upon 15
request by a provider, to provide certain written 16
certification; 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. 21
22
Be It Enacted by the Legislature of the State of Florida: 23
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Section 1. Effective July 1, 2026, present subsections 25

HB 1261 2026

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(13) 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" 31
means a group of affiliated and integrated businesses that, as 32
of July 1, 2026, are licensed or certified by the agency or the 33
Agency 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 42
chapter 400 providing private duty nursing services by 43
registered nurses 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

HB 1261 2026

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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 58
CARE INTEGRATED COMMUNITIES.— 59
(a) As used in this subsection, the term "Medicaid region" 60
means any of the regions established by the agency for the 61
purpose of managed medical assistance. 62
(b) Medicaid managed care plans shall reimburse home 63
health agencies licensed under part III of chapter 400 for 64
private duty nursing services, including services provided by 65
registered nurses and licensed practical nurses, provided in a 66
community residential group home at an amount no less than the 67
Private Duty Nursing Fee Schedule set by the agency, regardless 68
of the number of plan members who share a dwelling space within 69
the community residential group home. However, mutually 70
acceptable higher rates may be negotiated for medically complex 71
care. 72
(c) Reimbursement may not be reduced based on the number 73
of Medicaid-eligible persons receiving private duty nursing 74
services in the same dwelling space, or on the same day, within 75

HB 1261 2026

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the community residential group home. 76
(d) Managed care plans and the affiliated businesses shall 77
negotiate rates at least annually for medical services provided 78
within the pediatric continuing care integrated community. 79
(e) Upon request by a provider, a Medicaid managed care 80
plan must provide a written certification that the reimbursement 81
rate offered for s