Legislative Analysis
Phone: (517) 373-8080
PRESCRIBED PEDIATRIC EXTENDED CARE CENTERS
http://www.house.mi.gov/hfa
House Bills 5974 and 6152 as introduced Analysis available at
Sponsor: Rep. Julie M. Rogers http://www.legislature.mi.gov
House Bill 6153 as introduced
Sponsor: Rep. Curt S. VanderWall
Committee: Health Policy
Revised 12-12-24
SUMMARY:
House Bill 5974 would amend the Public Health Code to require the licensure of prescribed
pediatric extended care centers, which would be nonresidential facilities providing services to
three or more unrelated children with medical complexities. The bill would prescribe license
fees and provide parameters and requirements for these facilities as described below. The bill’s
provisions would apply beginning October 1, 2026.
House Bills 6152 and 6153 would amend the Insurance Code and the Social Welfare Act,
respectively, to require coverage for prescribed pediatric extended care by insurers and by the
Department of Health and Human Services (DHHS) under the medical assistance program.
House Bill 5974 would add Part 219A (Prescribed Pediatric Extended Care Centers) to Article
17 (Facilities and Agencies) of the Public Health Code. Beginning October 1, 2026, the new
part would require prescribed pediatric extended care centers to be licensed under Article 17
and would prohibit use of the term “prescribed pediatric extended care center” or “p.p.e.c.
center” to refer to any health facility or agency 1 that is not licensed as a prescribed pediatric
extended care center.
Prescribed pediatric extended care center would mean a facility, other than a hospital
or nursing home, that provides a basic service in a nonresidential setting to three or
more unrelated children with medical complexities.
Basic service would include at least both of the following:
• Developing, implementing, and monitoring a comprehensive protocol of care
for a child with a medical complexity as described below.
• The caregiver training needs to the extent it is for the parent or guardian of a
patient.
1
This term health facility or agency is defined in the code, and the bill would include prescribed pediatric extended
care centers as health facilities or agencies under the code beginning October 1, 2026. The term now includes
ambulance operations, aircraft transport operations, nontransport prehospital life support operations, or medical first
response services; county medical care facilities; freestanding surgical outpatient facilities; health maintenance
organizations; homes for the aged; hospitals; nursing homes; any of the preceding facilities or agencies that are located
in a university, college, or other educational institution; and hospices or hospice residences.
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 Child with a medical complexity would mean an individual who is under the age of 21
who has a chronic clinical condition that has been diagnosed or is unknown and that
causes a significant impact on the child’s family because of a functional limitation that
may require a technological dependency over the course of the child’s life and
substantially frequent and ongoing coordination of health care resources, such as
hospitalization, surgery, therapeutic intervention, and skilled nursing care.
Prescribed pediatric extended care centers would be subject to a $2,000 initial licensure
application fee for each initial license and an annual $500 fee for each facility license.
Duties and responsibilities
The owner, operator, and governing body of a prescribed pediatric extended care center would
be responsible for all phases of the operation of the center and the quality of care rendered
there. The owner, operator, and governing body would have to do all of the following:
• Cooperate with the Department of Licensing and Regulatory Affairs (LARA) in the
enforcement of Article 17 of the code.
• Require that a physician and other individuals working in the prescribed pediatric
extended care center are currently licensed or registered as required.
• Designate one individual to act as the center administrator.
The center administrator would be responsible for the overall management of the prescribed
pediatric extended care center. The center administrator would have to do all of the following:
• Provide necessary qualified employees and ancillary services to ensure the health,
safety, and proper care for each patient at the center.
• Develop and maintain a current job description for each care center employee.
• Maintain all of the following written records and make them available to LARA for
inspection upon request:
o A daily census record that includes the number of patients currently receiving
a basic service at the center.
o A personnel record for each employee that includes their employment
application, references, employment history for the five years preceding the
application, and a copy of each performance evaluation.
o A copy of each agreement with a provider of a contracted or supportive service
at the center.
o A copy of each agreement with a consultant employed by the center and
documentation of each visit by the consultant.
o A record of each accident or unusual incident involving a patient or employee
that caused (or could have caused) injury or harm to the center’s property or to
an individual at the center.
• Develop and implement an infection control policy that complies with any rules issued
by LARA.
• Designate in writing an individual who is responsible for the center when the center
administrator is absent for more than 24 hours.
Contracted or supportive service would include, at a minimum, speech therapy,
occupational therapy, physical therapy, social work services, developmental services,
child life services, and psychology services.
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 Personnel requirements
A prescribed pediatric extended care center would have to have both of the following on its
staff in order to be licensed:
• A medical director, who would have to be a licensed physician who is board-certified
in pediatrics.
• A nursing director, who would be responsible for the daily operation of the center. The
nursing director would have to be licensed as a registered professional nurse and
certified in basic life support. At the time they are hired, they would have to have at
least two years of nursing experience, at least six months of which was spent in a
pediatric intensive care unit, neonatal intensive care setting, prescribed pediatric
extended care center, or a similar care setting in which the nurse provided care to a
child with a medical complexity.
A registered professional nurse employed by a prescribed pediatric extended care center (apart
from the nursing director) would have to be licensed, be certified in basic life support, and meet
either of the following:
• Have, at the time they are hired, experience in the previous 24 months in caring for
acutely ill or chronically ill children.
• Have successfully completed a training program that meets all of the following:
o The training program demonstrates sufficient skills for the responsibilities of a
registered professional nurse in a prescribed pediatric extended care center.
o The training program is considered appropriate by the center administrator, the
medical director, and the nursing director.
o The training program is outlined in a written policy of the prescribed pediatric
extended care center.
A licensed practical nurse who is employed by a prescribed pediatric extended care center
would have to be licensed, be certified in basic life support, and meet either of the following:
• Have, at the time they are hired, experience in the previous 24 months in pediatrics.
• Have successfully completed a training program that meets all of the following:
o The training program demonstrates sufficient skills for the responsibilities of a
licensed practical nurse in a prescribed pediatric extended care center.
o The training program is considered appropriate by the center administrator, the
medical director, and the nursing director.
o The training program is outlined in a written policy of the prescribed pediatric
extended care center.
An individual providing direct care who is employed by a prescribed pediatric extended care
center would have to work under the supervision of a registered professional nurse. They would
have to be certified in basic life support and meet either of the following:
• Have extensive, documented education and training in providing direct care to infants
and toddlers and provide employment references documenting skill in the direct care
of infants and toddlers.
• Have successfully completed a training program that meets all of the following:
o The training program demonstrates sufficient skills for individuals providing
direct care in a prescribed pediatric extended care center.
o The training program is considered appropriate by the center administrator, the
medical director, and the nursing director.
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 o The training program is outlined in a written policy of the prescribed pediatric
extended care center.
Direct care would mean education, social services, or child care.
Staffing plans
A prescribed pediatric extended care center would have to provide appropriate staffing for
nursing services and direct care at the center.
To determine appropriate staffing, the center would have to implement a staffing plan that
outlines the minimum number of employees required to achieve quality patient outcomes in a
healthy work environment. The staffing plan would have to be developed by a standing
committee led by a group of registered professional nurses and licensed practical nurses in the
center, exactly half of whom would have to be nonmanagement employees providing care
directly to patients. The standing committee would have to consider all of the following in
developing a staffing plan:
• The number of patients treated in the center.
• The level of skilled nursing care a patient needs, depending on the severity of their
chronic clinical condition.
• The number of productive hours worked by a registered professional nurse or licensed
practical nurse who is providing care directly to a patient. The number of productive
hours worked would be calculated by dividing the total number of nursing hours
worked by the number of patients in the center.
• The various levels of education, experience, job performance, and other skills of a
registered professional nurse or licensed practical nurse that are required to provide
effective care to a patient in the center.
The staffing plan would have to be in writing, be updated and disclosed quarterly, and be
available to the employees of the center and the public upon request.
Development, orientation, and training
A prescribed pediatric extended care center would have to do all of the following:
• Conduct monthly staff development programs to maintain quality patient care. A staff
development program would have to be appropriate to the category of employee
attending it and would have to be documented by the center. The program would have
to do all of the following:
o Facilitate the ability of an employee to function as a member of an
interdisciplinary team with other health professionals and a parent or guardian
of a child with a medical complexity.
o Improve the communication skills of an employee to facilitate a collaborative
relationship with a parent or guardian of a child with a medical complexity.
o Increase employee understanding of how to cope with the effects of childhood
illness.
o Cover issues related to death and dying.
o Cover information on appropriate services available from hospitals, schools,
and community, state, and professional organizations.
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 o Foster advocacy skills and develop case management skills to assist a parent or
guardian of a child with a medical complexity with setting priorities and
planning and implementing the patient’s care at home.
• Ensure that an employee maintains certification in basic life support.
• Ensure that a new employee participates in an orientation to acquaint them with the
philosophy, organization, program, practices, and goals of the center.
• Ensure that a parent or guardian of a child with a medical complexity attends a
comprehensive orientation to acquaint them with the philosophy and services provided
in the center.
• Provide training to an employee when implementing new technology.
Functional assessments
A prescribed pediatric extended care center would have to perform a functional assessment of
a child with a medical complexity and create an individualized program plan to accommodate
their developmental needs. The functional assessment, considering the child’s age, would have
to assess their self-care, motor skills, communication and social skills, cognitive function, play,
and growth and development. The individualized program plan required would have to be in
writing and include all of the following:
• Specific programs and actions to facilitate the developmental progress of the child.
• Measurable goals for each need area.
• The child’s strengths and present performance level with respect to each of those
measurable goals.
• Anticipatory planning for specific areas identified as at risk for future problems.
The center would have to include a child’s parent or guardian in a care-related conference and,
if applicable, facilitate training on how to meet the child’s developmental and psychosocial
needs while the child is at home.
Admissions
A prescribed pediatric extended care center would have to have a written policy governing the
admission, transfer, and discharge of a child with a medical complexity.
A physician could refer a child to a prescribed pediatric extended care center after consulting
with the child’s parent or guardian. A child with a medical complexity could not be admitted
to a prescribed pediatric extended care center unless at least all of the following are met:
• Before admission, it is determined that the child does not present a significant risk of
infection to other children or employees in the center. The medical director and nursing
director would have to review a child who is suspected of having an infectious disease
to determine whether admission of the child is appropriate.
• The child is medically stable, requires skilled nursing care or other intervention, and
has a clinical condition that is appropriate for outpatient care.
• The child’s admission is in accordance with a written order of a physician. A copy of
the order would have to be provided to the child’s parent or guardian and placed in the
child’s medical record.
If a child meets the above requirements, the medical director or nursing director would have to
implement a preadmission plan. The preadmission plan would have to describe the services to
be provided to the child in the center and the sources for the services.
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 If the child is hospitalized at the time of their referral, the development of the preadmission
plan would have to include the child’s parent or guardian, a representative of the center, and
hospital medical, nursing, social services, and developmental staff, to ensure that the hospital’s
discharge plans are implemented upon the child’s admission to the center.
If the child is no