HB 475 — Out-of-home Placement Providers and Treatment Facilities

39.4078, F.S.;

providing a short title;

providing legislative findings and intent;

providing definitions;

providing applicability;

providing for medical placements;

providing requirements for a medical placement;

requiring a comprehensive clinical assessment of a Page 2 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 high-acuity child by a qualified licensed professional;

providing requirements for such clinical assessment and admission to a medical placement;

requiring the court to hold an emergency evidentiary hearing under certain circumstances;

requiring the Department of Children and Families to petition the court within a specified timeframe after a multidisciplinary team staffing;

requiring the court make specified written findings;

requiring certain consent and authorization be obtained and documented;

requiring the court to maintain certain services and contacts for a high-acuity child;

requiring the court to conduct certain reviews during the duration of a medical placement;

authorizing the court to immediately order a high-acuity child be moved to a less or more restrictive licensed placement under certain circumstances;

requiring a transition plan;

requiring a high-acuity child's case plan be updated within a specified timeframe;

prohibiting a medical placement from exceeding a specified number of days except under certain circumstances;

providing that a high-acuity child maintains certain rights;

requiring the department collect certain data;

requiring the department submit to the Legislature a specified annual report;

authorizing the department and the Page 3 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 Department of Health to adopt rules;

amending s.

revisingrequiring legislativethe intent;Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, and the Agency for Health Care Administration to provide certain data to community- based care lead agencies on a specified schedule;

requiring athe comprehensiveOffice placementof assessmentProgram forPolicy aAnalysis high-acuityand childGovernment Accountability to determineconduct thean medicalanalysis necessity of suchthis child;state's capacity to care for high-acuity children in out-of-home placements and treatment facilities;

requiringproviding certaindefinitions; procedures be followed for high-acuity children;

requiringspecifying appropriaterequirements agenciesfor and departments to prioritize the placementanalysis; of a high- acuity child;

amendingrequiring s.the office to submit to the Legislature, by specified dates, interim and final reports of its findings and recommendations;

39.6012, F.S.;

requiring a high-acuity child's case plan to include a specific description of the child's needs;

requiring certain tasks and descriptions be included in the high-acuity child's case plan;

amending s.

39.6013, F.S.;

requiring a high-acuity child's case plan to reflect certain goals, services, and requirements;

amending s.

391.025, F.S.;

providing that the Children's Medical Services program includes the Medical Placement Act for high-acuity children;

amending s.

391.029, F.S.;

providing that a high-acuity child is eligible for the Children's Medical Services program and the Children's Medical Services Safety Net program;

amending s.

393.065, F.S.;

requiring a high-acuity child be placed in category 1 for priority purposes of Medicaid waiver services;

amending s.

394.495, F.S.;

providing that certain services include placement of a high-acuity child in a medical bed in a medical placement;

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 amending s.

409.145, F.S.;

revising the goals of a system of care;

defining the term "high-acuity child";

requiring that the medical necessity of a high-acuity child takes priority over the reasonable and prudent parent standard;

amending s.

409.166, F.S.;

revising the definition of the term "difficult-to-place child";

amending s.

409.906, F.S.;

authorizing the Agency for Health Care Administration to pay for a medical bed in a medical placement and certain services for a high- acuity child;

amending s.

409.986, F.S.;

revising the goals of the department;

defining the term "high- acuity child";

amending ss.

934.255, 960.065, and 984.03, F.S.;

conforming cross-references;

SubsectionsParagraph (38)(g) throughis (50)added andto (51)subsection through(2) (91) of section 39.01,39.523, Florida Statutes, are renumbered as subsections (39) through (51) and (53) through (94), respectively, subsections (10) and (39) are amended, and new subsections (38), (51), and (52) are added to that section, to read:

39.0139.523 Definitions.—WhenPlacement usedin out-of-home care.— (2) ASSESSMENT AND PLACEMENT.—When any child is removed from a home and placed in thisout-of-home chapter,care, unlessa thecomprehensive contextPage otherwise1 requires:of 7 CODING:

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hb475-00hb475-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 475 2026 (10)placement "Caregiver"assessment meansprocess theshall parent,be legalcompleted custodian, permanent guardian, adult household member, or other person responsible for a child's welfare as defined in subsectionaccordance (60)with (57).s.

(39)39.4022 "Institutionalto childdetermine abusethe orlevel neglect" means situations of knowncare orneeded suspectedby child abuse or neglect in which the personchild allegedlyand perpetratingmatch the child abusewith or neglect is an employee of a public or private school, public or private day care center, residential home, institution, facility, or agency or any other person at such institution responsible for the child'smost welfareappropriate asplacement. defined in subsection (60) (57).

(38)(g) "High-acuityThe child"department, meansthe aDepartment childof ageHealth, birththe toAgency 18for whoPersons presents with intensiveDisabilities, and complexthe medical,Agency developmental,for behavioralHealth health,Care orAdministration disabilitymust needsprovide acrossto multipleeach areascommunity-based ofcare functioninglead andagency, whoas requiresdefined immediatein clinicals. assessment and specialized care, services, and medical placement.

The409.986(3): term includes a child who is reasonably presumed to meet the criteria for high-acuity.

(51) "Medical bed" means a licensed placement that meets the criteria of a medical placement and is approved by the applicable licensing authority, such as the Department of Health, the Agency for Persons with Disabilities, the Agency for Health Care Administration, or the department.

(52) "Medical placement" means a residential setting that provides clinical oversight, licensed nursing care, and Page 6 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 therapeutic supports 24 hours a day, 7 days a week to address the immediate and adequate needs of a high-acuity child being placed who requires intensive, specialized medical care consistent with the standards of the Affordable Care Act and the Centers for Medicare and Medicaid guidelines for pediatric medical necessity.

Section 2.

Subsection (15) of section 39.01375, Florida Statutes, is renumbered as subsection (16), and a new subsection (15) is added to that section, to read:

39.01375 Best interest determination for placement.—The department, community-based care lead agency, or court shall consider all of the following factors when determining whether a proposed placement under this chapter is in the child's best interest:

(15) The intensive and complex medical, developmental, behavioral health, or disability needs of a high-acuity child and the need for medical placement under s.

39.4078 to address the high-acuity child's needs.

Section 3.

Subsection (1) of section 39.302, Florida Statutes, is amended to read:

39.302 Protective investigations of institutional child abuse, abandonment, or neglect.— (1) The department shall conduct a child protective investigation of each report of institutional child abuse, abandonment, or neglect.

Upon receipt of a report that alleges Page 7 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 that an employee or agent of the department, or any other entity or person covered by s.

39.01(40) or (60) s.

39.01(39) or (57), acting in an official capacity, has committed an act of child abuse, abandonment, or neglect, the department shall initiate a child protective investigation within the timeframe established under s.

39.101(2) and notify the appropriate state attorney, law enforcement agency, and licensing agency, which shall immediately conduct a joint investigation, unless independent investigations are more feasible.

When conducting investigations or having face-to-face interviews with the child, investigation visits shall be unannounced unless it is determined by the department or its agent that unannounced visits threaten the safety of the child.

If a facility is exempt from licensing, the department shall inform the owner or operator of the facility of the report.

Each agency conducting a joint investigation is entitled to full access to the information gathered by the department in the course of the investigation.

A protective investigation must include an interview with the child's parent or legal guardian.

The department shall make a full written report to the state attorney within 3 business days after making the oral report.

A criminal investigation shall be coordinated, whenever possible, with the child protective investigation of the department.

Any interested person who has information regarding the offenses described in this subsection may forward a statement to the state attorney as to whether prosecution is Page 8 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 warranted and appropriate.

Within 15 days after the completion of the investigation, the state attorney shall report the findings to the department and shall include in the report a determination of whether or not prosecution is justified and appropriate in view of the circumstances of the specific case.

Section 4.

Subsections (3) and (7) and paragraph (a) of subsection (9) of section 39.303, Florida Statutes, are amended, and paragraph (j) is added to subsection (4) of that section, to read:

39.303 Child Protection Teams and sexual abuse treatment programs;

services;

eligible cases.— (3) The Department of Health shall use and convene the Child Protection Teams to supplement the assessment and protective supervision activities of the family safety and preservation program of the Department of Children and Families.

This section does not remove or reduce the duty and responsibility of any person to report pursuant to this chapter all suspected or actual cases of child abuse, abandonment, or neglect or sexual abuse of a child.

The role of the Child Protection Teams is to support activities of the program and to provide services, including services necessary and appropriate to address the needs of a high-acuity child, deemed by the Child Protection Teams to be necessary and appropriate to abused, abandoned, and neglected children upon referral.

The specialized diagnostic assessment, evaluation, coordination, consultation, Page 9 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 and other supportive services that a Child Protection Team must be capable of providing include, but are not limited to, the following:

(a) Medical diagnosis and evaluation services, including provision or interpretation of X rays and laboratory tests, and related services, as needed, and documentation of related findings.

(b) Telephone consultation services in emergencies and in other situations.

(c) Medical evaluation related to abuse, abandonment, or neglect, as defined by policy or rule of the Department of Health.

(d) Such psychological and psychiatric diagnosis and evaluation services for the child or the child's parent or parents, legal custodian or custodians, or other caregivers, or any other individual involved in a child abuse, abandonment, or neglect case, as the team may determine to be needed.

(e) Expert medical, psychological, and related professional testimony in court cases.

(f) Case staffings to develop treatment plans for children whose cases have been referred to the team.

A Child Protection Team may provide consultation with respect to a child who is alleged or is shown to be abused, abandoned, or neglected, which consultation shall be provided at the request of a representative of the family safety and preservation program or Page 10 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 at the request of any other professional involved with a child or the child's parent or parents, legal custodian or custodians, or other caregivers.

In every such Child Protection Team case staffing, consultation, or staff activity involving a child, a family safety and preservation program representative shall attend and participate.

(g) Case service coordination and assistance, including the location of services available from other public and private agencies in the community.

(h) Such training services for program and other employees of the Department of Children and Families, employees of the Department of Health, and other medical professionals as is deemed appropriate to enable them to develop and maintain their professional skills and abilities in handling child abuse, abandonment, and neglect cases.

The training service must include training in the recognition of and appropriate responses to head trauma and brain injury in a child under 6 years of age as required by ss.

402.402(2) and 409.988.

(i) Educational and community awareness campaigns on child abuse, abandonment, and neglect in an effort to enable citizens more successfully to prevent, identify, and treat child abuse, abandonment, and neglect in the community.

(j) Child Protection Team assessments that include, as appropriate, medical evaluations, medical consultations, family psychosocial interviews, specialized clinical interviews, or Page 11 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 forensic interviews.

(k) Identifying a child who meets the criteria for a high- acuity child and the basis for the determination of the Child Protection Team.

A Child Protection Team that is evaluating a report of medical neglect and assessing the health care needs of a medically complex child shall consult with a physician who has experience in treating children with the same condition.

(4) The child abuse, abandonment, and neglect reports that must be referred by the department to Child Protection Teams of the Department of Health for an assessment and other appropriate available support services as set forth in subsection (3) must include cases involving:

(j) A report involving a high-acuity child or a child believed to meet the criteria of a high-acuity child.

(7)(a) In all instances in which a Child Protection Team is providing certain services to abused, abandoned, or neglected children, other offices and units of the Department of Health, and offices and units of the Department of Children and Families, the Agency for Persons with Disabilities, and the Agency for Health Care Administration must shall avoid duplicating the provision of those services.

(b) A Child Protection Team may:

PrioritizeA thedetailed placementlist of aeach high-acuitylicensed childout-of-home intoplacement aprovider Pageand 12treatment offacility 55within CODING:the lead agency's respective region, including, but not limited to:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 specialized and appropriate placement in accordance with s.

39.4078, including, but not limited to, a medical bed or group home in a facility licensed or maintained by the department, Agency for Persons with Disabilities, Department of Health, or Agency for Health Care Administration, even if such placement is outside of the normal services of the Child Protection Team.

2.

Require the provision of services to the high-acuity child by an entity deemed appropriate and necessary by the Child Protection Team for the stabilization, treatment, or safety of the high-acuity child, even if such services are outside of the normal services of the Child Protection Team.

(9)(a) Children's Medical Services shall convene a task force to develop a standardized protocol for forensic interviewing of children suspected of having been abused.

The Department of Health shall provide staff to the task force as necessary.

The task force shall include:

1.

A representative from the Florida Prosecuting Attorneys Association.

2.

A representative from the Florida Psychological Association.

3.

The Statewide Medical Director for Child Protection.

4.

A representative from the Florida Public Defender Association.

5.

The executive director of the Statewide Guardian ad Litem Office.

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 6.

A representative from a community-based care lead agency.

7.

A representative from Children's Medical Services.

8.

A representative from the Florida Sheriffs Association.

9.

A representative from the Florida Chapter of the American Academy of Pediatrics.

10.

A representative from the Florida Network of Children's Advocacy Centers.

11.

Other representatives designated by Children's Medical Services.

12.

An expert or a direct care provider who has experience in serving high-acuity children.

Section 5.

Paragraph (a) of subsection (2) of section 39.4021, Florida Statutes, is amended, and subsection (3) is added to that section, to read:

39.4021 Priority placement for out-of-home placements.— (2) PLACEMENT PRIORITY.— (a) Except as provided in subsection (3), when a child cannot safely remain at home with a parent, out-of-home placement options must be considered in the following order:

1.

Nonoffending parent.

2.

Relative caregiver.

3.

Adoptive parent of the child's sibling, when the department or community-based care lead agency is aware of such sibling.

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 4.

Fictive kin with a close existing relationship to the child.

5.

Nonrelative caregiver that does not have an existing relationship with the child.

6.

Licensed foster care.

7.

Group or congregate care.

(3) MEDICAL PLACEMENT FOR A HIGH-ACUITY CHILD.—In cases in which a child is identified or assessed as a high-acuity child, the department or any contractor or subcontractor of the department must follow the procedures and requirements in s.

39.4078 and place the high-acuity child in a medical placement if he or she meets the eligibility criteria in order to ensure the high-acuity child's complex medical, behavioral, and developmental needs are addressed in an appropriate medical setting.

Section 6.

Paragraph (c) of subsection (2), paragraph (b) of subsection (3), paragraph (a) of subsection (4), paragraph (a) of subsection (5), and paragraph (d) of subsection (6) of section 39.4022, Florida Statutes, are amended to read:

39.4022 Multidisciplinary teams;

staffings;

assessments;

report.— (2) DEFINITIONS.—For purposes of this section, the term:

(c) "Multidisciplinary team" means an integrated group of individuals which meets to collaboratively develop and attempt to reach a consensus decision on the most suitable out-of-home Page 15 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 placement or the appropriateness of a medical placement under s.

39.4078, educational placement, or other specified important life decision that is in the best interest of the child.

(3) CREATION AND GOALS.— (b) The multidisciplinary teams must adhere to all of the following goals:

1.

Secure a child's safety in the least restrictive and intrusive placement that can meet his or her needs.;

2.

Minimize the trauma associated with separation from the child's family and help the child to maintain meaningful connections with family members and others who are important to him or her.;

3.

Provide input into the proposed placement decision made by the community-based care lead agency and the proposed services to be provided in order to support the child.;

4.

Provide input into the decision to preserve or maintain the placement, including necessary placement preservation strategies.;

5.

Contribute to an ongoing assessment of the child and the family's strengths and needs.;

6.

Ensure that plans are monitored for progress and that such plans are revised or updated as the child's or family's circumstances change.;

and 7.

Ensure that the child and family always remain the primary focus of each multidisciplinary team meeting.

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 8.

Ensure that if the child meets the classification of a high-acuity child that the multidisciplinary team considers such classification when determining the appropriate placement for the child.

The multidisciplinary team must prioritize the placement of a high-acuity child in appropriate specialized placements within the department, the Agency for Persons with Disabilities, the Department of Health, or the Agency for Health Care Administration.

(4) PARTICIPANTS.— (a) Collaboration among diverse individuals who are part of the child's network is necessary to make the most informed decisions possible for the child.

A diverse team is preferable to ensure that the necessary combination of technical skills, cultural knowledge, community resources, and personal relationships is developed and maintained for the child and family.

The participants necessary to achieve an appropriately diverse team for a child may vary by child and may include extended family, friends, neighbors, coaches, clergy, coworkers, or others the family identifies as potential sources of support.

1.

Each multidisciplinary team staffing must invite all of the following members:

TheTherapeutic child, unless he or she is not of an age or capacity to participate in the team, and themedical child'sfoster guardianhomes adlicensed litem.;under s.

409.175.

TheResidential child'streatment familycenters membersfor children and otheradolescents individualsas Pageprovided 17in ofs. 55 CODING:

Words394.875. stricken are deletions;

words underlined are additions.

hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 identified by the family as being important to the child, provided that a parent who has a no contact order or injunction, is alleged to have sexually abused the child, or is subject to a termination of parental rights may not participate.;

TheTherapeutic currentgroup caregiver,homes providedas thedefined caregiverin iss. not a parent who meets the criteria of one of the exceptions under sub-subparagraph b.;

39.407(6)(a).

AQualified representativeresidential fromtreatment theprograms departmentlicensed otherby than the Children'sAgency Legalfor ServicesHealth attorney,Care whenAdministration. the department is directly involved in the goal identified by the staffing.;

ABehavioral representativequalified fromresidential thetreatment community-basedprograms carelicensed lead agency, when the lead agency is directly involved in the goal identified by the staffing.;department.

TheProfessional casefoster managercare forprograms theas child,provided orin hiss. or her case manager supervisor.;

and409.996. g.

Ag. representative from the Department of Juvenile Justice, if the child is dually involved with both the department and the Department of Juvenile Justice.

TheGroup representativehomes mustand havefoster thecare authorityfacilities tolicensed makeby a same-day placement of a high-acuity child in an appropriate medical placement in the DepartmentAgency offor JuvenilePersons Justicewith ifDisabilities. necessary.

AStatewide representativeinpatient frompsychiatric theprograms Agencylicensed forby Persons with Disabilities who has the authorityAgency tofor makeHealth aCare same-dayAdministration. placement of a high-acuity child in an appropriate medical placement in the agency if such child meets the eligibility criteria under s.

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hb475-00hb475-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 475 2026 393.0652. and is in a preenrollment category.

2.On a weekly basis, the current number of available beds in each licensed out-of-home placement provider and treatment facility listed under subparagraph 1.

TheSection multidisciplinary2. team must make reasonable efforts to have all mandatory invitees attend.

However,Out-of-home theplacement multidisciplinaryprovider teamand staffingtreatment mayfacility notanalysis.— be(1) delayedThe ifOffice theof inviteesProgram Policy Analysis and Government Accountability shall conduct a comprehensive analysis of this state's capacity to care for high-acuity children in subparagraphout-of-home 1.placements and treatment facilities.

fail(2) toFor attendpurposes afterof beingthis providedmultipart reasonableanalysis, opportunities.the term:

(5)(a) SCOPE"High-acuity" OFmeans MULTIDISCIPLINARYa TEAM.—child (a)from Abirth multidisciplinaryto team18 staffingyears mustof beage heldwho whenpresents anwith importantintensive decisionand iscomplex requiredmedical, todevelopmental, bebehavioral madehealth, aboutor adisability child'sneeds life,across includingmultiple allareas of thefunctioning. following:

1.(b) "Specialized placement" means licensed out-of-home care settings, including, but not limited to, family foster homes licensed as level IV or level V, qualified residential treatment programs, behavioral qualified residential treatment programs, therapeutic group homes, residential treatment centers for children and adolescents, and professional foster care programs, as well as foster care facilities and group homes licensed by the Agency for Persons with Disabilities.

Initial(c) placement"Treatment decisionsfacility" formeans a medical facility that treats a child whoand isdoes placednot inconstitute an out-of-home care.placement, including, but not limited to, the statewide inpatient Page 3 of 7 CODING:

A multidisciplinary team staffing required under this subparagraph may occur before the initial placement or, if a staffing is not possible before the initial placement, must occur as soon as possible after initial removal and placement to evaluate the appropriateness of the initial placement and to ensure that any adjustments to the placement, if necessary, are promptly handled.

2.

Changes in physical custody after the child is placed in out-of-home care by a court and, if necessary, determination of an appropriate mandatory transition plan in accordance with s.

39.4023.

3.

Changes in a child's educational placement and, if necessary, determination of an appropriate mandatory transition plan in accordance with s.

39.4023.

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hb475-00hb475-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 475 2026 4.psychiatric program.

Initial(3) placementThe decisionsOffice orof aProgram changePolicy inAnalysis placementand Government Accountability shall review the roles and responsibilities of the Department of Children and Families, the Department of Health, the Agency for aPersons high-acuitywith childDisabilities, inthe aAgency medicalfor placementHealth underCare s.Administration, and community-based care lead agencies regarding recruitment and retention at all specialized placements and treatment facilities.

39.4078,(4) The Office of Program Policy Analysis and Government Accountability shall conduct a comprehensive review and gap analysis of the use of specialized placements and treatment facilities by the Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, and the Agency for Health Care Administration for children in out-of-home care who are identified as appropriate,high toacuity stabilizeor suchdiagnosed child.with co-occurring disorders.

5.4.Specifically, the office shall compile data for the last 3 fiscal years and evaluate the sufficiency of current bed capacity relative to the demonstrated need across all community-based care lead agency regions, sorted by community-based care lead agency, as follows:

Placement(a) decisionsThe fortotal anumber childof aslicensed requiredbeds, bythe subparagraphaverage 1.,daily subparagraphcensus, 2.,and orthe subparagraphpercentage 3.,of orcapacity subparagraphused 4.each month for each specialized placement and treatment facility that is reviewed;

whichany involveidentified siblingneed groupsfor thatincreased requirebed placementcapacity in accordanceany withof s.such specialized placements and treatment facilities;

39.4024.and, for Page 4 of 7 CODING:

6.5.

Any other important decisions in the child's life which are so complex that the department or appropriate community-based care lead agency determines convening a multidisciplinary team staffing is necessary to ensure the best interest of the child is maintained.

(6) ASSESSMENTS.— (d)1.

If the participants of a multidisciplinary team staffing reach a unanimous consensus decision, it becomes the official position of the community-based care lead agency regarding the decision under subsection (5) for which the team convened.

Such decision is binding upon all department and lead agency participants, who are obligated to support it.

2.a.

If the participants of a multidisciplinary team staffing cannot reach a unanimous consensus decision on a plan to address the identified goal of a child who has not been classified as high-acuity, the trained professional acting as the facilitator shall notify the court and the department within 48 hours after the conclusion of the staffing.

The department Page 20 of 55 CODING:

hb475-00hb475-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 475 2026 shallspecialized thenplacements determineand howtreatment tofacilities addressthat thealso identifiedcare goalfor ofnonchild thewelfare staffingchildren, bydata whaton is in the child'scase bestmix. interest.

b.(b) An aggregate list of referred diagnoses, ranked in descending order from most common to least common, associated with children referred to or placed in each specialized placement or treatment facility.

If(c) theThe participantstotal number of arequests, multidisciplinaryorders, team staffing cannot reach a unanimous consensus decision on a plan to address the appropriate initial placement or changereferrals infor placementspecialized ofplacements a high-acuity child, the trained professional acting as the facilitator must notify the court and thetreatment departmentfacilities; within 48 hours after the conclusion of the staffing.

The court must set an emergency evidentiary hearing within 10 days after such notification to address the appropriatenumber initial placement or change in placement of aplacements high-acuitymade; child and determine if the high-acuity child should be placed in a medical placement in accordance with s.

39.4078.the specific reasons placements were not made;

Thethe courtnumber mayof requirealternative theservices representativeprovided, fromsuch aas community-basedstep-down lead agency or thein-lieu-of-services; department who was required to attend the multidisciplinary team staffing to attend the evidentiary hearing.

Sectionand, 7.for placements made in a county other than the county in which the child's residence is located, the distance between the placement and the child's residence.

Subsection(d) (1),The paragraphnumber (b) of subsectionout-of-state (4),specialized andplacements, paragraphsthe (a),reasons (b),for andsuch (c)out-of-state ofplacements, subsectionand (6)the ofcommunity- sectionbased 39.407,care Floridalead Statutes,agency areregion amendedof toorigin. read:

39.407(e) Medical,The psychiatric,average andnumber psychologicalof examinationdays required for qualified evaluators to complete suitability assessments and treatmentwhether there is a shortage of child;qualified evaluators.

physical,(f) mental,The oraverage substancenumber abuse examination of persondays with or requesting child custody.— (1) When any child is removed from the homedetermination andof maintainedclinical inneed anuntil out-of-home placement, the departmentactual isadmission authorizedor toplacement haveof a medical screening performed on the childchild. without Page 21 of 55 CODING:

(g) The average length of stay per specialized placement and treatment facility type, sorted by the primary behavioral or medical condition treated.

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hb475-00hb475-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 475 2026 authorization(h) fromThe theprevalence courtof andcourts withoutdisregarding consentspecialized fromplacement aor parenttreatment orfacility legalrecommendations custodian.made by the Department of Children and Families and the reasons therefor.

Such(5) medicalThe screeningOffice of Program Policy Analysis and Government Accountability shall bereview performedthe byDepartment Aof licensedHealth's healthprocess carefor professionalestablishing, mustscreening, performand suchplacing children into medical screeningfoster andhomes, shallincluding, bebut tonot examinelimited to, the child,involvement inof part,a forChild injury;,Protection illness;Team.

mental,(6) disability,The orOffice behavioralof healthProgram conditions;,Policy Analysis and communicableGovernment diseasesAccountability shall review the methods the Department of Children and toFamilies, determinethe Department of Health, the needAgency for immunization.Persons with Disabilities, and the Agency for Health Care Administration use to communicate the availability of beds in specialized placements and treatment facilities to community- based care lead agencies.

(7) The departmentOffice shallof byProgram rulePolicy establishAnalysis and Government Accountability shall assess the invasivenessquality and uniformity of thetraining medicalprovided proceduresto authorizedcase managers by community-based care lead agencies to besupport performedhigh-acuity underchildren, thisspecialized subsection.placements, and treatment facilities and shall identify a model training if one is identified through the review of existing community-based care lead agency case manager trainings.

In(8) noThe caseOffice doesof ThisProgram subsectionPolicy doesAnalysis not:and Government Accountability shall submit an interim report of its findings and recommendations to the President of the Senate and the Page 6 of 7 CODING:

(a) Authorize the department to consent to medical treatment for such children;

or (b) Limit the procedures for a medical placement of a high-acuity child established under s.

39.4078.

(4) (b) The judge may also order such child to be evaluated by a psychiatrist or a psychologist or, if a developmental disability is suspected or alleged, by the developmental disability diagnostic and evaluation team of the department.

If it is necessary to place a child in a residential facility for such evaluation, the criteria and procedure established in s.

394.463(2) or chapter 393 must shall be used, whichever is applicable.

If, after the evaluation is conducted under this paragraph, the psychiatrist, psychologist, or developmental disability diagnostic and evaluation team determines that the Page 22 of 55 CODING:

hb475-00hb475-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HBCS/HB 475 2026 childSpeaker meetsof the criteriaHouse toof beRepresentatives classifiedby asOctober 1, 2026, and a high-acuityfinal childreport underof s.its findings and recommendations by December 1, 2026.

39.4078,Section the3. judge must immediately order the high- acuity child to be placed in a medical placement to address the basis for the child's high-acuity needs, even if there are other placement options available under s.

39.4021.

(6) Children in the legal custody of the department may be placed by the department, without prior approval of the court, in a residential treatment center licensed under s.

394.875 or a hospital licensed under chapter 395 for residential mental health treatment only pursuant to this section or may be placed by the court in accordance with an order of involuntary examination or involuntary placement entered pursuant to s.

394.463 or s.

394.467.

A high-acuity child may be placed in a residential treatment program or medical placement, as appropriate, which best meets the needs of the high-acuity child based on the high-acuity child's complex medical, developmental, behavioral health, or disability needs.

All children placed in a residential treatment program under this subsection must have a guardian ad litem appointed.

(a) As used in this subsection, the term:

1.

"Least restrictive alternative" means the treatment and conditions of treatment that, separately and in combination, are no more intrusive or restrictive of freedom than reasonably necessary to achieve a substantial therapeutic benefit or to protect the child or adolescent or others from physical injury.

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 2.

"Residential treatment" or "residential treatment program" means a placement for observation, diagnosis, or treatment of an emotional disturbance in a residential treatment center licensed under s.

394.875 or a hospital licensed under chapter 395.

The term includes a medical placement under s.

39.4078 for a high-acuity child who presents with needs that are not suitable for treatment in a standard foster care or therapeutic group home environment due to the complexity of the needs of the high-acuity child or the potential for harm to others in the same care setting.

3.

"Suitable for residential treatment" or "suitability" means a determination concerning a child or adolescent who is classified as a high-acuity child or a child or adolescent with an emotional disturbance as defined in s.

394.492(5) or a serious emotional disturbance as defined in s.

394.492(6) that each of the following criteria is met:

a.

The child requires residential treatment.

b.

The child is in need of a residential treatment program and is expected to benefit from mental or behavioral health treatment, or a combination of treatment.

c.

An appropriate, less restrictive alternative to residential treatment is unavailable.

4.

"Therapeutic group home" means a residential treatment center that offers a 24-hour residential program providing community-based mental health treatment and mental health Page 24 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 support services to children who meet the criteria in s.

394.492(5) or (6) in a nonsecure, homelike setting.

(b) If Whenever the department believes that a child in its legal custody is emotionally disturbed or is classified or likely to be classified as a high-acuity child under s.

39.4078 and may need residential treatment, an examination and suitability assessment must be conducted by a qualified evaluator appointed by the department.

This suitability assessment must be completed before the placement of the child in a residential treatment program.

1.

The qualified evaluator for placement in a residential treatment center, other than a therapeutic group home, or a hospital must be a psychiatrist or a psychologist licensed in this state who has at least 3 years of experience in the diagnosis and treatment of serious emotional disturbances in children and adolescents and who has no actual or perceived conflict of interest with any inpatient facility or residential treatment center or program.

2.

The qualified evaluator for placement in a therapeutic group home must be a psychiatrist licensed under chapter 458 or chapter 459, a psychologist licensed under chapter 490, or a mental health counselor licensed under chapter 491 who has at least 2 years of experience in the diagnosis and treatment of serious emotional, medical, developmental, or behavioral disturbances disturbance in children, including high-acuity Page 25 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 children, and adolescents and who has no actual or perceived conflict of interest with any residential treatment center or program.

(c)1.

Consistent with the requirements of this section, the child shall be assessed for suitability for residential treatment by a qualified evaluator who has conducted an examination and assessment of the child and has made written findings that:

a.1.

The child appears to have an emotional disturbance serious enough to require treatment in a residential treatment program and is reasonably likely to benefit from the treatment.

b.2.

The child has been provided with a clinically appropriate explanation of the nature and purpose of the treatment.

c.3.

All available modalities of treatment less restrictive than residential treatment have been considered, and a less restrictive alternative that would offer comparable benefits to the child is unavailable.

2.

A copy of the written findings of the evaluation and suitability assessment must be provided to the department, to the guardian ad litem, and, if the child is a member of a Medicaid managed care plan, to the plan that is financially responsible for the child's care in residential treatment, all of whom must be provided with the opportunity to discuss the findings with the evaluator.

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 3.

If the written findings of the evaluation and suitability assessment state that the child meets the criteria of a high-acuity child and there is not a suitable residential treatment program or medical placement for the high-acuity child identified within 5 business days after the written findings are provided to the department and guardian ad litem, the high- acuity child's guardian ad litem must notify the court within 24 hours after the expiration of the 5-day time period that there is a failure to identify a suitable placement.

Within 5 business days after receiving such notification, the court must set an emergency evidentiary hearing to determine the most suitable placement for the high-acuity child in accordance with s.

39.4078.

The court may prioritize the placement of a high-acuity child who is being placed or currently residing in foster care to a specialized and appropriate placement, including, but not limited to, a medical bed or group home in a facility licensed or maintained by the department, the Agency for Persons with Disabilities, the Department of Health, or the Agency for Health Care Administration.

Section 8.

Section 39.4078, Florida Statutes, is created to read:

39.4078 Medical Placement for High-acuity Children Act.— (1) SHORT TITLE.—This section may be cited as the "Medical Placement for High-acuity Children Act." (2) LEGISLATIVE FINDINGS AND INTENT.— Page 27 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 (a) The Legislature finds that high-acuity children, particularly those with disabilities, who are entering or currently involved in the child protection system in this state require prompt and specialized medical health assessments, as well as appropriate medical placements.

(b) It is the intent of the Legislature to establish a time-limited, court-supervised process for the medical placement of high-acuity children which:

1.

Ensures the high-acuity child receives medically necessary treatment and stabilization in the least restrictive setting that can safely meet the child's needs.

2.

Coordinates judicial oversight with clinical assessment, case planning, and transition planning.

3.

Promotes a prompt transfer to a less restrictive setting as acute symptoms resolve, while preserving the high- acuity child's rights to education, visitation, and normalcy.

(3) DEFINITIONS.—As used in this section, the term:

(a) "Community-based care lead agency" has the same meaning as in s.

409.986(3).

(b) "Multidisciplinary team" has the same meaning as in s.

39.4022(2).

(4) APPLICABILITY.—This section applies to the assessment, eligibility, placement, case plan tasks, transfers to more restrictive and less restrictive settings, and discharge of high-acuity children in medical placements.

This section Page 28 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 operates in accordance with ss.

39.4022, 39.407, 39.523, and 39.6013;

however, if this section conflicts with another section of law, this section prevails to the extent necessary to address the needs of a high-acuity child.

(5) MEDICAL PLACEMENT.—A medical placement may include all of the following, as clinically appropriate and subject to applicable licensure under chapter 394, chapter 395, chapter 400, or chapter 409:

(a) Acute care beds for short-term intensive medical or psychiatric treatment.

(b) Subacute beds for continued clinical support after acute care.

(c) Therapeutic medical foster care providing in-home medical services directed by a licensed health care professional.

(d) Specialized residential treatment programs for children with significant co-occurring medical and behavioral health conditions.

(e) Placements that meet the requirements of the pilot program of treatment foster care under s.

409.996(27).

(f) Other licensed settings capable of delivering equivalent medically necessary services to a high-acuity child in the least restrictive environment.

(6) REQUIREMENTS OF A MEDICAL PLACEMENT.—A medical placement must do all of the following:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 (a) Stabilize the high-acuity child's acute symptoms and address any immediate safety risks.

(b) Initiate or continue evidence-based treatment and medication management consistent with s.

39.407.

(c) Maintain the high-acuity child's educational services and reasonable family and sibling contact.

(d) Develop clear, time-limited clinical and functional goals that determine when the high-acuity child is ready for a less restrictive setting.

(e) Create a plan for placement and services that address the range of needs of the high-acuity child from his or her admission to a medical bed until he or she transitions to a less restrictive setting and eventually reaches permanency.

(f) Ensure that high-acuity children in the custody of the department under this chapter are given priority for placements in the most appropriate facilities licensed or maintained by the Agency for Persons with Disabilities, the Agency for Health Care Administration, the Department of Health, or the department, as applicable.

(7) ASSESSMENT AND ADMISSION.— (a) Before admission to a medical placement, or within 24 hours after an emergency admission, a Child Protection Team must collaborate with the department or community-based care lead agency to obtain a comprehensive clinical assessment conducted by a qualified licensed professional which identifies a high- Page 30 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 acuity child's needs, recommended level of care, and anticipated length of stay.

(b) In accordance with s.

39.4022, a multidisciplinary team staffing must occur within 72 hours after a child is classified as a high-acuity child and the staffing must include all necessary participants who can appropriately address the basis for classifying the child as a high-acuity child.

(c) The multidisciplinary team staffing must recommend the least restrictive medical bed placement that is capable of meeting the needs of the high-acuity child and identify measurable goals and criteria for less restrictive placement.

The recommendations of the multidisciplinary team staffing must be filed with a court pursuant to subsection (8).

(d) If the multidisciplinary team staffing cannot reach a consensus on the placement of a high-acuity child, a designated person present at the staffing must notify the court and, within 10 days after such notification, the court must hold an emergency evidentiary hearing in accordance with s.

39.4022(6)(d)2.b.

(8) COURT APPROVAL AND WRITTEN FINDINGS.— (a) Within 72 hours after a multidisciplinary team staffing at which a consensus is made to place a high-acuity child in a medical placement, the department shall petition the court for approval of such placement.

The petition must include a copy of the comprehensive clinical assessment and Page 31 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 recommendations of the multidisciplinary team staffing.

(b) The court shall conduct an evidentiary hearing and provide written findings on all of the following:

1.

The medical, behavioral, or complex conditions of the child which is the basis for classifying the child as a high- acuity child.

2.

The medical bed suggested by the multidisciplinary team staffing is the least restrictive setting available for the high-acuity child.

3.

Clearly defined goals and criteria for the high-acuity child to enter a less restrictive placement.

4.

The appropriate timeframe in which the case plan must be updated to address the written findings of the court.

(c) Consent and authorization for medical, psychiatric, and behavioral health services must be obtained and documented in accordance with s.

39.407.

(d) The court must ensure that a high-acuity child's educational services, including any individualized education program services if applicable, continue without interruption and that reasonable family and sibling contact occurs unless such contact is against clinical judgment and court order.

(9) PERIODIC REVIEWS.—Within 30 days after the court provides its written findings under subsection (8), and every 30 days thereafter for as long as the high-acuity child remains in a medical placement, the court must review the high-acuity Page 32 of 55 CODING:

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hb475-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB 475 2026 child's progress through acute presentation of complex behaviors.

Each review must include updated clinical reports, the progress of the high-acuity child toward defined goals that address the stabilization and treatment of any identified acuity behaviors, educational progress, family and sibling contact, and a recommendation regarding whether the high-acuity child is ready for a less restrictive setting.

Within 5 days before each review hearing, the department must file with the court an updated report that includes a recommendation for maintaining the medical placement or, if appropriate, transferring the high- acuity child to a less restrictive setting.

The multidisciplinary team staffing must reconvene before each review unless such requirement is waived by the court.

(10) PLACEMENT PROCEDURES.— (a) Upon motion of any party or on the court's own motion, and based on competent substantial evidence of the high-acuity child's clinical status, the court may immediately order the high-acuity child to be moved to a less or more restrictive licensed placement as indicated by the presence or resolution of acute symptoms without having to wait for a regularly scheduled review.

(b) The department may implement emergency procedures to a more restrictive setting for the safety of the high-acuity child or based on medical necessity.