How to Open a PPEC in Florida

What Florida licenses as a PPEC

Florida does not license "pediatric medical daycare" as a general idea. It licenses a specific thing with a statutory definition, and the definition sets the floor for everything else. Under Section 400.902(1), Florida Statutes, a PPEC center is any building or place that provides basic nonresidential services to three or more medically dependent or technologically dependent children who are not related to the owner or operator. Children admitted must have complex medical conditions requiring continual care, and the statute names two prerequisites for admission: a prescription from the child's attending physician and the consent of a parent or guardian.

Two consequences follow immediately. The three-child threshold is what pulls you into licensure at all. And because admission requires a physician's prescription, your census depends on referring clinicians from the day you open, not on marketing to families. If you are still deciding whether this is the right model, start with what a PPEC is and who it serves.

AHCA's PPEC licensing page describes the same thing in plainer words: a non-residential provider serving three or more children under 21 who need short, long term, or intermittent medical care because of medically complex conditions.

Before you apply: entity, location, and zoning

The zoning requirement is the one that most often costs an applicant months, because it is not something AHCA can waive and not something you can fix after signing a lease. Section 400.906, Florida Statutes requires the initial application to contain the location of the facility and documentation, signed by the appropriate local government official, stating that the applicant has met local zoning requirements. Get that signature commitment before you commit to a building.

Two more location rules shape what you can lease. Rule 59A-13.004(3), F.A.C., requires separate licenses for buildings on separate premises, and Section 400.905(1) confirms that separate licenses are needed for centers on separate premises even under common management, though not for separate buildings on the same grounds. Rule 59A-13.004(6) also restricts sharing your address: no other licensed or certified health care or business entity may be located within a PPEC center, except one that provides care or services only to clients of the PPEC. That exception is new in the 2026 amendment.

Staffing screening also begins here rather than at hiring time. Section 400.9065, Florida Statutes requires level 2 background screening for personnel under Chapter 435 and Section 408.809. Level 2 screening takes calendar time you should assume, not discover.

The AHCA license application

This is the section where older guides are now wrong, so it is worth being precise about what the current rule says. Before the 2026 amendment, Rule 59A-13.004 incorporated a specific paper form, AHCA Form 3110-8002, by reference. It no longer does. The rule effective April 28, 2026 instead requires the application to be submitted by the owner or administrator as required by Rules 59A-35.040 and 59A-35.060, F.A.C., which are AHCA's general health care licensing procedures. If a checklist tells you to mail in form 3110-8002, that checklist predates the current rule.

What the rule still specifies is what must accompany the application:

• The fee A biennial licensure fee of $1,512.35 payable to the Agency for Health Care Administration, under Rule 59A-13.004(2)(a). A license for an initial or change of ownership application is not issued until the fee is received and the checks have cleared. The statutory band behind that number is in Section 400.905(2): the fee is set by rule and may be no less than $1,000 and no more than $3,000 per biennium. County-operated and municipally operated centers are exempt from license fees.
• Fire safety documentation Documentation of compliance with Rule 59A-13.022(1), F.A.C., regarding fire safety, conducted within the previous three months. This is a deadline on the inspection, not on the application: an inspection that is four months old will not do.

Two operating limits are set at licensure and are worth planning around now. A license expires two years from issuance unless revoked, and you must not operate with a census greater than the number of children on the face of the license. To raise that number later, Rule 59A-13.004(7) requires an application 60 days before the requested effective date, and the license is modified only after a successful health and life safety survey.

Staffing you must have on day one

Staffing is where a PPEC business plan usually succeeds or fails, because the ratios are fixed by rule and scale with census. Rule 59A-13.010, F.A.C. requires a registered nurse serving full-time as Director of Nursing, holding a current Florida RN license and CPR certification, with at least two years of general pediatric nursing experience, of which at least six months must have been spent caring for medically fragile infants or children in a pediatric intensive care, neonatal intensive care, PPEC, or similar setting during the previous five years. Separately, Rule 59A-13.009 requires a board certified pediatrician as medical director.

The minimum total staffing by census is set out in Rule 59A-13.010(6). This is the complete table as adopted, all fifteen rows:

The table stops at 45 children; the rule does not. Above that census, Rule 59A-13.010(6) provides that "the staffing must increase by one staff for every three (3) children alternating between a direct care staff and licensed nurse." If you plan to grow past 45, that sentence, not the table, governs your model.

Two details in the column headings carry real cost. The RN column is a floor of registered nurses specifically; the "RN or LPN" column may be filled by either. Direct care personnel are defined in Rule 59A-13.010(5) more broadly than many operators expect, and include nursing assistants, patient care technicians, medical assistants, EMTs or paramedics licensed under Chapter 401, and individuals with training and experience in education, social services, or child care fields. They must have one year of experience caring for infants and toddlers, employment references documenting that skill, current CPR certification, and they must work under RN supervision.

Physical plant, fire safety, and emergency power

Construction and renovation requirements come from Section 400.915, Florida Statutes, which points to Chapter 553 building construction standards, Section 633.206 and its rules on physical standards for nonresidential child care facilities, and the standards adopted under Part VI and Part II of Chapter 408. Section 400.914(1)(c) adds that the appropriate provisions of the most recent edition of the Life Safety Code (NFPA-101) apply.

Rule 59A-13.022, F.A.C., sets the operational side of that, and these are concrete items a surveyor can confirm in minutes:

• Fire safety The center must conform to State Fire Marshal standards in Chapter 69A-36, F.A.C., Uniform Fire Safety Standards for Child Care Facilities, and be inspected annually. A copy of the current annual fire inspection report must be on file at the center.
• Emergency generator An emergency generator must exist with sufficient generating power to continue function of medical equipment during a power failure. It must be tested every 30 days, with satisfactory mechanical operation documented on a log signed by the person conducting the test. The log is the evidence; the generator alone is not.
• Telephone and emergency numbers A working telephone that is neither locked nor a pay station, with emergency telephone numbers posted on or in the immediate vicinity of all telephones.
• Transport and first aid Emergency transportation must be performed by a licensed E.M.S. provider, with a center staff member accompanying each child, and the center must keep an emergency kit for basic first aid and CPR.

Policies and records the surveyor will ask for

Chapter 59A-13 is unusually explicit about paperwork, and the survey is largely a documents exercise. Rule 59A-13.005, F.A.C., requires a written table of organization describing lines of authority down to the child care level, one designated administrator accountable for overall management, and a person designated in writing to be responsible whenever the administrator is absent for more than 24 hours. The administrator must keep records available in the center for AHCA inspection during normal business hours, including a daily census record, a record of all accidents or unusual incidents, current agreements with third party providers and consultants, and a personnel record for each employee with licenses, the original application, references, five years of employment history where applicable, and job performance evaluations.

The clinical record is governed by Rule 59A-13.014, F.A.C. A medical record must be developed at the time of admission and contain a medical plan of treatment and nursing protocol of care, referral and admission details, physician orders, a flow chart of medications and treatments administered, initialed case notes reflecting progress toward care goals, nutritional management, therapy documentation, medical history with allergies and special precautions, and an immunization record. The individualized nursing care protocol has its own clock: it must be developed within ten working days of admission, reviewed monthly, and revised quarterly. Discharge requires a physician's order and a discharge summary in the record.

Chapter 59A-13 also carries separate rules for admission, transfer and discharge policies (59A-13.007), child care policies (59A-13.008), in-service training for staff and for parents and guardians (59A-13.013), a quality assurance committee (59A-13.015), and infection control (59A-13.020). Write these before the survey, not after a deficiency.

Medicaid enrollment and how you get paid

A license lets you operate. It does not let you bill. Per AHCA's PPEC Medicaid page, to enroll as a Medicaid provider a PPEC must be licensed under Chapter 400, Part VI, Florida Statutes and be in compliance with Chapter 59A-13, F.A.C. Licensure is the prerequisite, so the sequence is fixed: license first, enrollment second, first claim third.

AHCA states that Medicaid eligible children from birth through age 20 with medically complex conditions may attend a PPEC up to a maximum of 12 hours per day while receiving nursing services, personal care, developmental therapies, and caregiver training. That 12-hour ceiling is not a plan policy that varies; it traces to Section 400.914(2)(a), Florida Statutes, which directs the agency to adopt rules ensuring no child attends for more than 12 hours within a 24-hour period. Model your revenue against authorized hours, not licensed capacity.

PPEC services are subject to utilization management. AHCA's page states that the Agency contracts for utilization management, including prior authorization of PPEC services, and that it issues updates through the Medicaid fiscal agent's web portal, provider bulletins, notification letters, and Medicaid Health Care Alerts. Coverage policy and limits are in the Florida Medicaid PPEC coverage policy and the general provider handbooks. Confirm the current prior-authorization vendor and its submission process with AHCA directly before you build intake around it, because vendors and branding in this space have changed.

An out-of-state note that occasionally matters: AHCA states that a PPEC located in Alabama or Georgia that regularly serves Florida Medicaid recipients may enroll as an in-state Florida Medicaid provider, subject to the same enrollment requirements except that licensure follows the state where it operates.

Timeline and budget expectations

Only some of this has a legal clock. What follows separates the two, because a deadline in rule is a fact and a duration in practice is an estimate.

Fixed by rule or statute: the fire safety inspection supporting the application must have been conducted within the previous three months; a capacity increase requires application 60 days before the requested effective date and a successful health and life safety survey; the license runs two years; the nursing care protocol is due within ten working days of each admission; and the generator test log runs on a 30-day cycle.

Not fixed anywhere, and therefore your risk: how long zoning sign-off takes in your municipality, how long build-out and Life Safety Code compliance take in your building, level 2 background screening turnaround, AHCA's review and survey scheduling, and Medicaid enrollment processing. These vary by county, by building, and by workload, and no published rule commits the agency to a number.

On budget, the only figure fixed in rule is the $1,512.35 biennial license fee. Everything that actually determines whether the center opens is unpriced by regulation: the building and its Life Safety Code work, the emergency generator, the full-time Director of Nursing and the board certified medical director, and the staff you must have hired and screened before the survey rather than after your first admission. Treat published fee figures as the smallest line item in the plan.

Timelines that are commonly quoted operator-to-operator for AHCA review, survey scheduling, or Medicaid enrollment are experience, not regulation. We do not publish them as durations here because we cannot point to a source that binds the agency to them, and a number in a guide tends to get treated as a commitment.

Frequently asked questions

How much does a PPEC license cost in Florida?

Rule 59A-13.004(2)(a), F.A.C., sets a biennial licensure fee of $1,512.35 payable to the Agency for Health Care Administration. That is the license fee alone. It does not include the fire safety inspection, background screening, construction or renovation, or any of the staffing you must have in place before the survey.

How long is a Florida PPEC license valid?

Two years. Under Rule 59A-13.004(5), F.A.C., a PPEC license expires two years from the date of issuance unless it is revoked, which is why the fee in the rule is described as biennial.

What is the staffing ratio for a PPEC in Florida?

Rule 59A-13.010(6), F.A.C., sets minimum total staffing by census, from one staff member for one child up to fifteen staff for 43 to 45 children, and specifies how many of those must be RNs and how many may be an RN or an LPN. Above 45 children the rule stops using a table: staffing must increase by one staff for every three children, alternating between a direct care staff member and a licensed nurse.

Does a PPEC need a medical director?

Yes. Rule 59A-13.009, F.A.C., requires that a board certified pediatrician serve as the medical director. The rule also assigns that role specific duties, including periodic review of services, review of accident and unusual incident reports, and a written policy for delivering emergency services when the child's attending physician is unavailable.

How many hours a day can a child attend a PPEC in Florida?

No more than 12 hours in any 24-hour period. This is statutory, not a plan rule: Section 400.914(2)(a), Florida Statutes, directs the agency to adopt rules ensuring that no child attends a PPEC center for more than 12 hours within a 24-hour period.

Does a PPEC have to have an emergency generator?

Yes. Rule 59A-13.022(4), F.A.C., requires an emergency generator with sufficient generating power to continue function of medical equipment during a power failure. It must be tested every 30 days, and satisfactory mechanical operation must be documented on a log signed by the person who conducted the test.

Can I increase my licensed capacity after opening?

Yes, but not on your own schedule. Rule 59A-13.004(7), F.A.C., requires the licensee to apply to the Agency 60 days before the requested effective date, and the license is modified only after a successful health and life safety survey. Until then, Rule 59A-13.004(4) prohibits operating above the census printed on the face of the license.