Florida SB 648: Continuing Education for Dentists

Bill Text

648 
Medicaid Reimbursement for Private Duty Nursing Services 
2025-11-21T09:34:10Z 
Defining the term “pediatric continuing care integrated community” for purposes of the state Medicaid program; requiring Medicaid managed care plans to reimburse licensed home health agencies for private duty nursing services provided in a community residential group home at a certain rate; requiring Medicaid managed care plans to negotiate rates with affiliated businesses at least annually, etc. 
Original Filed Version 
2026 
S 
GB 
General Bill 
__ 

 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. 
 21 
 22 Be It Enacted by the Legislature of the State of Florida: 
 23 
 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