Stricken language would be deleted from and underlined language would be added to present law.
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State of Arkansas 1
94th General Assembly A Bill 2
Regular Session, 2023 SENATE BILL 236 3
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By: Senator Hester 5
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For An Act To Be Entitled 7
AN ACT TO ESTABLISH LICENSURE FOR PRESCR IBED 8
PEDIATRIC EXTENDED C ARE CENTERS BY THE D EPARTMENT OF 9
HEALTH; TO REQUIRE T HE ARKANSAS MEDICAID PROGRAM TO 10
REIMBURSE PRESCRIBED PEDIATRIC EXTENDED C ARE CENTERS; 11
AND FOR OTHER PURPOS ES. 12
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Subtitle 15
TO ESTABLISH LICENSURE FOR PRESCRIBED 16
PEDIATRIC EXTENDED CARE CENTERS BY THE 17
DEPARTMENT OF HEALTH; AND TO REQUIRE THE 18
ARKANSAS MEDICAID PROGRAM TO REIMBURSE 19
PRESCRIBED PEDIATRIC EXTENDED CARE 20
CENTERS. 21
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 24
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SECTION 1. Arkansas Code Title 20, Chapter 9, is amended to add an 26
additional subchapter to read as follows: 27
Subchapter 16 — Prescribed Pediatric Extended Care Centers 28
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20-9-1601. Definitions. 30
As used in this subchapter: 31
(1) "Basic nonresidential services" includes without limitation 32
the development, implementation, and monitoring of a comprehensive protocol 33
of care, developed in conjunction with a parent or guardian, which specifies 34
the medical, nursing, psychosocial, and developmental therapies required by 35
the medically dependent or technologically dependent child served as well as 36 SB236
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the caregiver training needs of the child's legal guardian; 1
(2) "Controlling person" means a person who has the ability, 2
acting alone or in concert with others, to directly or indirectly influence, 3
direct, or cause the direction of the management of, expenditure of money 4
for, or policies of a prescribed pediatric extended care center, including 5
without limitation: 6
(A) A management company, landlord, or other busi ness 7
entity that operates or contracts with another person for the operation of a 8
prescribed pediatric extended care center; 9
(B) Any person who controls a management company or other 10
business entity that operates a prescribed pediatric extended care ce nter or 11
that contracts with another person for the operation of a prescribed 12
pediatric extended care center; or 13
(C) Any other person who is formally named as an owner, 14
manager, director, officer, provider, consultant, or employee of the 15
prescribed pediatric extended care center regardless of a personal, familial, 16
or other relationship with the owner, manager, landlord, tenant, or provider 17
of a prescribed pediatric extended care center; 18
(3)(A) "Medically dependent or technologically dependent child" 19
means a child who because of a medical condition requires continuous 20
therapeutic interventions or skilled nursing supervision prescribed by a 21
licensed physician and administered by, or under the direct supervision of, a 22
licensed registered nurse with three (3) to five (5) years of experience. 23
(B) "Medically dependent or technologically dependent 24
child" includes without limitation a child who has or is: 25
(i) Born addicted to drugs; 26
(ii) Burns; 27
(iii) Congenital disorders; 28
(iv) End stage diseases; 29
(v) Failure to thrive; 30
(vi) Feeding disorders; 31
(vii) Gastrointestinal or enteral feedings; 32
(viii) Genetic disorders; 33
(ix) Metabolic and endocrine disorders including 34
diabetes with technology assistance; 35
(x) Oncological and hematological disorders; 36 SB236
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(xi) Orthopedic conditions including amputations and 1
surgery; 2
(xii) Post operation care; 3
(xiii) Post traumatic injury; or 4
(xiv) Prematurity and respiratory disorders; 5
(4) "Minor" means an individual who is twenty-one (21) years of 6
age or younger; 7
(5) "Prescribed pediatric extended care center" means any 8
building or other facility, whether operated for profit or not, which 9
undertakes through its ownership or management to provide basic 10
nonresidential services to three (3) or more medically dependent or 11
technologically dependent children who are not related to the owner or 12
operator by blood, marriage, or adoption and who require basic nonresidential 13
services; and 14
(6) "Supportive services or contrac ted services" means speech 15
therapy, occupational therapy, physical therapy, social work, developmental, 16
child life, psychological services, and other services to support the child. 17
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20-9-1602. License required — Exemption. 19
(a) A person or entity shall not own or operate a prescribed pediatric 20
extended care center in this state unless the person or entity holds a 21
license under this subchapter. 22
(b)(1) A separate license is required for a prescribed pediatric 23
extended care center maintained on separate p remises, regardless of whether 24
the prescribed pediatric extended care center is operated under the same 25
management. 26
(2) A separate license is not required for separate buildings on 27
the same grounds. 28
(c) A facility that is operated by the United States Government or any 29
agency of the United States Government is exempt from licensure under this 30
subchapter. 31
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20-9-1603. Application — Issuance of license. 33
(a) An applicant for a prescribed pediatric extended care center 34
license shall submit to the Depart ment of Health: 35
(1) An application on the form prescribed by the department; 36 SB236
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(2) A letter of credit as prescribed by the department to 1
demonstrate the applicant’s financial viability; and 2
(3) Application fees as determined by the department. 3
(b) The application under subsection (a) of this section shall 4
contain: 5
(1) The location of the premises of the prescribed pediatric 6
extended care center for which the license is sought; 7
(2) Documentation, signed by the appropriate local government 8
official, stating that the location and use of the premises meet local zoning 9
requirements; 10
(3) The name, address, and Social Security number of and 11
criminal background check information for: 12
(A) The applicant; 13
(B) The administrator responsible for daily operations of 14
the prescribed pediatric extended care center; 15
(C) The financial officer responsible for financial 16
operations of the prescribed pediatric extended care center; and 17
(D) Each controlling person; 18
(4) The name, address, and feder al employer identification 19
number or taxpayer identification number of the applicant and of each 20
controlling person, if the applicant or controlling person is not an 21
individual; 22
(5) The business name of the prescribed pediatric extended care 23
center; 24
(6) The maximum patient capacity requested for the prescribed 25
pediatric extended care center; 26
(7) A sworn affidavit that the applicant has complied with this 27
subchapter and rules adopted under this subchapter; and 28
(8) Documentation that the applican t has at least one (1) person 29
on staff with a degree in accounting or finance from an accredited 30
institution of higher education and has at least five (5) years' experience. 31
(c)(1) The department shall issue a license to a prescribed pediatric 32
extended care center under this subchapter if the department determines that 33
the applicant and the prescribed pediatric extended care center meet the 34
requirements of this subchapter and comply with the rules and standards 35
adopted under this subchapter. 36 SB236
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(2) The license shall include: 1
(A) The license holder’s name; 2
(B) The location of the premises of the prescribed 3
pediatric extended care center; and 4
(C) A statement indicating that the prescribed pediatric 5
extended care center provides services to minor s for twelve (12) hours or 6
less in a twenty-four-hour period and does not provide twenty -four-hour care. 7
(d) A county-operated or municipally operated prescribed pediatric 8
extended care center applying for licensure under this subchapter is exempt 9
from the payment of license fees. 10
(e) A license under this subchapter is issued to the license holder 11
named on the license at the location of the premises listed on the license 12
and is not transferable or assignable. 13
14
20-9-1604. License term — Renewal. 15
(a) A license issued under this subchapter expires on the second 16
anniversary of the date of issuance. 17
(b) A person applying to renew a prescribed pediatric extended care 18
center license shall: 19
(1) Submit a renewal application to the Department of Health on 20
the form prescribed by the department at least sixty (60) days but not more 21
than one hundred twenty (120) days before expiration of the license; 22
(2) Submit the renewal fee in the amount required by the 23
department; and 24
(3) Comply with any other requi rements specified by rule. 25
(c)(1) The department shall assess a fifty dollar ($50) per day late 26
fee to a license holder who submits a renewal application after the date 27
required by subdivision (b)(1) of this section. 28
(2) However, the total amount of a late fee shall not exceed the 29
lesser of fifty percent (50%) of the license renewal fee or five hundred 30
dollars ($500). 31
(d) At least one hundred twenty (120) days before expiration of a 32
prescribed pediatric extended care center license, the department sh all 33
notify the owner or operator of the prescribed pediatric extended care center 34
of the license expiration. 35
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20-9-1605. Denial, suspension, or revocation of licensure — 1
Disciplinary action grounds. 2
(a) The Department of Health may deny, revoke, and su spend a license 3
and impose an administrative fine for a violation of this subchapter or 4
applicable rules. 5
(b) Any of the following actions by a prescribed pediatric extended 6
care center or a controlling person or employee of a prescribed pediatric 7
extended care center is grounds for disciplinary and administrative action by 8
the department: 9
(1) An intentional or negligent act materially affecting the 10
health or safety of children in the prescribed pediatric extended care 11
center; 12
(2) A violation of thi s subchapter or applicable rules; or 13
(3) Multiple and repeated violations of this subchapter or of 14
minimum standards or rules adopted under this subchapter. 15
16
20-9-1606. Administrative fines — Corrective action plan. 17
(a) If the Department of Health determines that a prescribed pediatric 18
extended care center is not in compliance with this subchapter or applicable 19
rules, the department may request that the prescribed pediatric extended care 20
center submit a corrective action plan that demonstrates a goo d-faith effort 21
to remedy each violation by a specific date, subject to the approval of the 22
department. 23
(b)(1) The department may fine a prescribed pediatric extended care 24
center or employee found in violation of this subchapter or applicable rules, 25
in an amount not to exceed five hundred dollars ($500) for each violation. 26
(2) The fine described in subdivision (b)(1) of this section 27
shall not exceed five thousand dollars ($5,000) in the aggregate. 28
(c) The failure to correct a violation by the date set by the 29
department, or the failure to comply with an approved corrective action plan, 30
is a separate violation for each day such failure continues, unless the 31
department approves an extension to a specific date. 32
(d) In determining if a fine is to be impos ed and in fixing the amount 33
of any fine, the department shall consider the following factors: 34
(1) The gravity of the violation, including the probability that 35
death or serious physical or emotional harm to a child will result or has 36 SB236
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resulted, the severi ty of the actual or potential harm, and the extent to 1
which this subchapter or rules were violated; 2
(2) Actions taken by the owner, operator, or controlling person 3
to correct violations; 4
(3) Any previous violations; and 5
(4) The financial benefit t o the prescribed pediatric extended 6
care center of committing or continuing the violation. 7
8
20-9-1607. Closing of a prescribed pediatric extended care center. 9
Whenever a prescribed pediatric extended care center voluntarily 10
discontinues operation, the p rescribed pediatric extended care center shall, 11
at least thirty (30) days before the discontinuance of operation, inform each 12
child's legal guardian of the fact and the proposed time of such 13
discontinuance. 14
15
20-9-1608. Construction and renovation. 16
The requirements for the construction or renovation of a prescribed 17
pediatric extended care center shall comply with: 18
(1) The provisions of law, which pertain to building 19
construction standards, including plumbing, electrical code, glass, 20
manufactured buildings, and accessibility for individuals with physical 21
disabilities; 22
(2) The minimum standards for physical facilities in the child 23
care facilities; and 24
(3) The standards or rules adopted pursuant to this subchapter. 25
26
20-9-1609. License display — Maintenance of records. 27
A prescribed pediatric extended care center licensed under this 28
subchapter shall: 29
(1) Display the license issued under this subchapter in a 30
conspicuous location readily visible to a person entering the prescribed 31
pediatric extended care center; and 32
(2) Maintain at the center the medical and other records 33
required by this subchapter and by rules adopted under this subchapter. 34
35
20-9-1610. Admission criteria for minors. 36 SB236
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(a) A prescribed pediatric extended care center shall no t admit a 1
minor unless: 2
(1) The client is a medically dependent or technologically 3
dependent minor; 4
(2) The minor’s prescribing physician issues a prescription 5
ordering care at a prescribed pediatric extended care center; 6
(3) The minor’s parent or legal guardian consents to the minor’s 7
admission to the prescribed pediatric extended care center; and 8
(4) The admission is voluntary based on the parent’s or legal 9
guardian’s preference in both managed care and nonmanaged care service 10
delivery systems. 11
(b) An admission authorized under this section does not supplant the 12
right to a Medicaid private duty nursing benefit when medically necessary. 13
14
20-9-1611. Complaints. 15
(a) A person may file a complaint with the Department of Health 16
against a prescribed pediatric extended care center licensed or required to 17
be licensed under this subchapter. 18
(b) The department shall investigate the complaint in accordance with 19
the Arkansas Administrative Procedure Act, § 25 -15-201 et seq. 20
21
20-9-1612. Penalty. 22
(a) Any person who violates this subchapter is upon conviction guilty 23
of an unclassified misdemeanor subject to a fine of ten thousand dollars 24
($10,000). 25
(b) Each day of continuing violation is a separate offense. 26
27
20-9-1613. Rules and standards. 28
(a) The Department of Health shall adopt and publish rules to 29
implement this subchapter, which shall include reasonable and fair standards. 30
(b) Any conflict between the standards set by the department and 31
standards that may be set forth in local, count y, or city ordinances shall be 32
resolved in favor of those having statewide effect. 33
(c) The department shall include standards that relate to: 34
(1) The assurance that services provided by a prescribed 35
pediatric extended care center are family centered a nd provide individualized 36 SB236
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medical, developmental, and family training services; 1
(2) The maintenance of prescribed pediatric extended care 2
centers, based upon the size of the structure and number of children, 3
relating to plumbing, heating, lighting, vent ilation, and other building 4
conditions, including adequate space, which will ensure the health, safety, 5
comfort, and protection from fire of the children served; 6
(3) The appropriate provisions of the most recent edition of the 7
National Fire Protection A ssociation 101 Life Safety Code shall be applied; 8
(4) The number and qualifications of all personnel who have 9
responsibility for the care of the children served; 10
(5) All sanitary conditions within the prescribed pediatric 11
extended care center and its surroundings, including water supply, sewage 12
disposal, food handling and general hygiene, and maintenance; 13
(6) Programs and basic services promoting and maintaining the 14
health and development of the children served and meeting the training needs 15
of the children's parents or legal guardians; 16
(7) Supportive, contracted, other operational and transportation 17
services; and 18
(8) Maintenance of appropriate medical records, data, and 19
information relative to the children and programs. 20
(d) The department s hall adopt rules to ensure that a: 21
(1) Child does not attend a prescribed pediatric extended care 22
center for more than twelve (12) hours within a twenty -four-hour period; and 23
(2) Prescribed pediatric extended care center does not provide 24
services other than those provided to medically or technologically dependent 25
children. 26
27
SECTION 2. Arkansas Code Title 20, Chapter 77, Subchapter 1, is 28
amended to add an additional section to read as follows: 29
20-77-148. Prescribed pediatric extended care center. 30
(a) The Arkansas Medicaid Program shall: 31
(1) Provide reimbursement for services provided through a 32
prescribed pediatric extended care center licensed in this state; and 33
(2) Develop a new Medicaid provider type for a prescribed 34
pediatric extended car e center. 35
(b) The Department of Human Services shall apply for any federal 36 SB236
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waiver, Medicaid state plan amendment, or other authorization necessary to 1
implement this section. 2
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