Florida legislation · 2026 Regular Session
Florida H1261: Medicaid Reimbursement for Private Duty Nursing Services
Status: Failed, March 13, 2026
Defines "pediatric continuing care integrated community" for purposes of state Medicaid program; defines "geographic area" & "prevailing hourly rate"; requires Medicaid managed care plans to reimburse licensed home health agencies for private duty nursing services provided in community residential group home at certain rate; prohibits Medicaid managed care plans from reducing reimbursement for such services; requires Medicaid managed care plans to negotiate rates with affiliated businesses at least annually & upon request by provider, to provide certain written certification; requires AHCA to seek federal approval within specified timeframe; requires agency to implement changes made by act upon federal approval.
What the bill says
An act relating to Medicaid reimbursement for private duty nursing services; amending s. 409.962, F.S.; defining the term "pediatric continuing care integrated community" for purposes of the state Medicaid program; amending s. 409.975, F.S.; defining the term "Medicaid region"; 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; prohibiting Medicaid managed care plans from reducing reimbursement for such services under certain circumstances…
From the introduced text, January 8, 2026:
An act relating to Medicaid reimbursement for private duty nursing services; amending s. 409.962, F.S.; defining the term "pediatric continuing care integrated community" for purposes of the state Medicaid program; amending s. 409.975, F.S.; defining the term "Medicaid region"; 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; prohibiting Medicaid managed care plans from reducing reimbursement for such services under certain circumstances; requiring Medicaid managed care plans to negotiate rates with affiliated businesses at least annually; requiring Medicaid managed care plans, upon request by a provider, to provide certain written certification; requiring the Agency for Health Care Administration to seek federal approval within a specified timeframe; requiring the agency to implement the changes made by the act upon federal approval; providing effective dates. Be It Enacted by the Legislature of the State of Florida: Section 1. Effective July 1, 2026, present subsections HB 1261 2026 CODING: Words stricken are deletions; words underlined are additions. hb1261-00 Page 2 of FLORIDAHOUSEOFREPRESENTATIVES (13) through (18) of section 409.962, Florida Statutes, are redesignated as subsections (14) through (19), respectively, and a new subsection (13) is added to that section, to read: 409.962 Definitions.—As used in this part, except as otherwise specifically provided, the term: (13) "Pediatric …