Florida 2023 Regular Session

Florida House Bill H1461 Compare Versions

Only one version of the bill is available at this time.

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10	10	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
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14	14	A bill to be entitled 1
15	15	An act relating to dental services under the Medicaid 2
16	16	program; amending s. 409.906, F.S.; revising adult 3
17	17	dental services as optional Medicaid services for 4
18	18	which the Agency for Health Care Administration may 5
19	19	pay; amending s. 409.973, F.S.; deleting provisions 6
20	20	relating to a specified report; deleting obsolete 7
21	21	language; extending the date by which the agency may 8
22	22	seek state plan amendments and federal waivers to 9
23	23	commence enrollment in the Medicaid prepaid dental 10
24	24	health program; extending the term of existing program 11
25	25	contracts with dental managed care providers; 12
26	26	providing requirements for minimum benefits provided 13
27	27	by the program; providing an effective date. 14
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29	29	Be It Enacted by the Legislature of the State of Florida: 16
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31	31	Section 1. Paragraph (c) of subsection (1) of section 18
32	32	409.906, Florida Statutes, is redesignated as paragraph (b), and 19
33	33	paragraph (a) and present paragraph (b) of that subsection are 20
34	34	amended, to read: 21
35	35	409.906 Optional Medicaid services. —Subject to specific 22
36	36	appropriations, the agency may make payments for services which 23
37	37	are optional to the state under Title XIX of the Social Security 24
38	38	Act and are furnished by Medicaid providers to recipients who 25
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47	47	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
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51	51	are determined to be eligible on the dates on which the services 26
52	52	were provided. Any optional service that is provided shall be 27
53	53	provided only when medically necessary and in accordance with 28
54	54	state and federal law. Optional services rendered by providers 29
55	55	in mobile units to Medicaid recipients may be restricted or 30
56	56	prohibited by the agency. Nothing in this section shall be 31
57	57	construed to prevent or limit the agency from adjusting fees, 32
58	58	reimbursement rates, lengths of stay, number of visits, or 33
59	59	number of services, or mak ing any other adjustments necessary to 34
60	60	comply with the availability of moneys and any limitations or 35
61	61	directions provided for in the General Appropriations Act or 36
62	62	chapter 216. If necessary to safeguard the state's systems of 37
63	63	providing services to elderly an d disabled persons and subject 38
64	64	to the notice and review provisions of s. 216.177, the Governor 39
65	65	may direct the Agency for Health Care Administration to amend 40
66	66	the Medicaid state plan to delete the optional Medicaid service 41
67	67	known as "Intermediate Care Facilit ies for the Developmentally 42
68	68	Disabled." Optional services may include: 43
69	69	(1) ADULT DENTAL SERVICES. — 44
70	70	(a) The agency may pay for services medically necessary to 45
71	71	prevent disease and promote oral health, restore oral structures 46
72	72	to health and function, and tr eat emergency conditions , 47
73	73	emergency dental procedures to alleviate pain or infection. 48
74	74	Emergency dental care shall be limited to emergency oral 49
75	75	examinations, necessary radiographs, extractions, and incision 50
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88	88	and drainage of abscess, for a recipient who is 21 years of age 51
89	89	or older. Such services include, but are not limited to, routine 52
90	90	diagnostic and preventive care such as dental cleanings, 53
91	91	examinations, and X-rays; basic dental services such as fillings 54
92	92	and extractions; major dental services such as root can als, 55
93	93	crowns, and dentures and other dental protheses; emergency 56
94	94	dental care; and other necessary services related to dental and 57
95	95	oral health. 58
96	96	(b) The agency may pay for full or partial dentures, the 59
97	97	procedures required to seat full or partial dentures, an d the 60
98	98	repair and reline of full or partial dentures, provided by or 61
99	99	under the direction of a licensed dentist, for a recipient who 62
100	100	is 21 years of age or older. 63
101	101	Section 2. Subsection (5) of section 409.973, Florida 64
102	102	Statutes, is amended to read: 65
103	103	409.973 Benefits.— 66
104	104	(5) PROVISION OF DENTAL SERVICES.— 67
105	105	(a) The Legislature may use the findings of the Office of 68
106	106	Program Policy Analysis and Government Accountability's report 69
107	107	no. 16-07, December 2016, in setting the scope of minimum 70
108	108	benefits set forth in thi s section for future procurements of 71
109	109	eligible plans as described in s. 409.966. Specifically, the 72
110	110	decision to include dental services as a minimum benefit under 73
111	111	this section, or to provide Medicaid recipients with dental 74
112	112	benefits separate from the Medicaid managed medical assistance 75
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121	121	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
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125	125	program described in this part, may take into consideration the 76
126	126	data and findings of the report. 77
127	127	(a)(b) In the event the Legislature takes no action before 78
128	128	July 1, 2017, with respect to the report findings required under 79
129	129	paragraph (a), The agency shall implement a statewide Medicaid 80
130	130	prepaid dental health program for children and adults with a 81
131	131	choice of at least two licensed dental managed care providers 82
132	132	who must have substantial experience in providing dental care to 83
133	133	Medicaid enrollees and children eligible for medical assistance 84
134	134	under Title XXI of the Social Security Act and who meet all 85
135	135	agency standards and requirements. To qualify as a provider 86
136	136	under the prepaid dental health program, the entity must be 87
137	137	licensed as a prepaid limited health service organization under 88
138	138	part I of chapter 636 or as a health maintenance organization 89
139	139	under part I of chapter 641. The contracts for program providers 90
140	140	shall be awarded through a competitive procurement process. 91
141	141	Beginning with the contract procurement process initiated during 92
142	142	the 2023 calendar year, the contracts must be for 6 years and 93
143	143	may not be renewed; however, the agency may extend the term of a 94
144	144	plan contract to cover delays during a transition to a new plan 95
145	145	provider. The agency shall include in the contracts a medical 96
146	146	loss ratio provision consistent with s. 409.967(4). The agency 97
147	147	is authorized to seek any necessary state plan amendment or 98
148	148	federal waiver to commence enrollment in the Medicaid prepaid 99
149	149	dental health program no later than March 1, 2024 2019. The 100
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158	158	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
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162	162	agency shall extend until December 31, 2025 2024, the term of 101
163	163	existing plan contracts awarded pursuant to the invitation to 102
164	164	negotiate published in October 2017. 103
165	165	(b) The minimum benefits provided by the Medicaid prepaid 104
166	166	dental health program for children under age 21 must include all 105
167	167	dental benefits required under the early and periodic screening, 106
168	168	diagnostic, and treatment services in accordance with Title 42, 107
169	169	U.S.C. s. 1396d(r)(3) and (r)(5). 108
170	170	(c) The minimum benefits provided by the Medicaid prepaid 109
171	171	dental health program for enrollees aged 21 years or older must 110
172	172	cover services necessary to prevent disease and promote oral 111
173	173	health, restore oral structures to health and function, and 112
174	174	treat emergency conditions. Such services include, but are not 113
175	175	limited to, routine diagnostic and preventive care such as 114
176	176	dental cleanings, examinations, and X -rays; basic dental 115
177	177	services such as fillings and extractions; major dental services 116
178	178	such as root canals, crowns, and dentures and other dental 117
179	179	protheses; emergency dental care; and other necessary services 118
180	180	related to dental and oral health. 119
181	181	Section 3. This act shall take effect July 1, 2023. 120