HB 1461 2023
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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
A bill to be entitled 1
An act relating to dental services under the Medicaid 2
program; amending s. 409.906, F.S.; revising adult 3
dental services as optional Medicaid services for 4
which the Agency for Health Care Administration may 5
pay; amending s. 409.973, F.S.; deleting provisions 6
relating to a specified report; deleting obsolete 7
language; extending the date by which the agency may 8
seek state plan amendments and federal waivers to 9
commence enrollment in the Medicaid prepaid dental 10
health program; extending the term of existing program 11
contracts with dental managed care providers; 12
providing requirements for minimum benefits provided 13
by the program; providing an effective date. 14
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Be It Enacted by the Legislature of the State of Florida: 16
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Section 1. Paragraph (c) of subsection (1) of section 18
409.906, Florida Statutes, is redesignated as paragraph (b), and 19
paragraph (a) and present paragraph (b) of that subsection are 20
amended, to read: 21
409.906 Optional Medicaid services. —Subject to specific 22
appropriations, the agency may make payments for services which 23
are optional to the state under Title XIX of the Social Security 24
Act and are furnished by Medicaid providers to recipients who 25
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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
are determined to be eligible on the dates on which the services 26
were provided. Any optional service that is provided shall be 27
provided only when medically necessary and in accordance with 28
state and federal law. Optional services rendered by providers 29
in mobile units to Medicaid recipients may be restricted or 30
prohibited by the agency. Nothing in this section shall be 31
construed to prevent or limit the agency from adjusting fees, 32
reimbursement rates, lengths of stay, number of visits, or 33
number of services, or mak ing any other adjustments necessary to 34
comply with the availability of moneys and any limitations or 35
directions provided for in the General Appropriations Act or 36
chapter 216. If necessary to safeguard the state's systems of 37
providing services to elderly an d disabled persons and subject 38
to the notice and review provisions of s. 216.177, the Governor 39
may direct the Agency for Health Care Administration to amend 40
the Medicaid state plan to delete the optional Medicaid service 41
known as "Intermediate Care Facilit ies for the Developmentally 42
Disabled." Optional services may include: 43
(1) ADULT DENTAL SERVICES. — 44
(a) The agency may pay for services medically necessary to 45
prevent disease and promote oral health, restore oral structures 46
to health and function, and tr eat emergency conditions , 47
emergency dental procedures to alleviate pain or infection. 48
Emergency dental care shall be limited to emergency oral 49
examinations, necessary radiographs, extractions, and incision 50
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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
and drainage of abscess, for a recipient who is 21 years of age 51
or older. Such services include, but are not limited to, routine 52
diagnostic and preventive care such as dental cleanings, 53
examinations, and X-rays; basic dental services such as fillings 54
and extractions; major dental services such as root can als, 55
crowns, and dentures and other dental protheses; emergency 56
dental care; and other necessary services related to dental and 57
oral health. 58
(b) The agency may pay for full or partial dentures, the 59
procedures required to seat full or partial dentures, an d the 60
repair and reline of full or partial dentures, provided by or 61
under the direction of a licensed dentist, for a recipient who 62
is 21 years of age or older. 63
Section 2. Subsection (5) of section 409.973, Florida 64
Statutes, is amended to read: 65
409.973 Benefits.— 66
(5) PROVISION OF DENTAL SERVICES.— 67
(a) The Legislature may use the findings of the Office of 68
Program Policy Analysis and Government Accountability's report 69
no. 16-07, December 2016, in setting the scope of minimum 70
benefits set forth in thi s section for future procurements of 71
eligible plans as described in s. 409.966. Specifically, the 72
decision to include dental services as a minimum benefit under 73
this section, or to provide Medicaid recipients with dental 74
benefits separate from the Medicaid managed medical assistance 75
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program described in this part, may take into consideration the 76
data and findings of the report. 77
(a)(b) In the event the Legislature takes no action before 78
July 1, 2017, with respect to the report findings required under 79
paragraph (a), The agency shall implement a statewide Medicaid 80
prepaid dental health program for children and adults with a 81
choice of at least two licensed dental managed care providers 82
who must have substantial experience in providing dental care to 83
Medicaid enrollees and children eligible for medical assistance 84
under Title XXI of the Social Security Act and who meet all 85
agency standards and requirements. To qualify as a provider 86
under the prepaid dental health program, the entity must be 87
licensed as a prepaid limited health service organization under 88
part I of chapter 636 or as a health maintenance organization 89
under part I of chapter 641. The contracts for program providers 90
shall be awarded through a competitive procurement process. 91
Beginning with the contract procurement process initiated during 92
the 2023 calendar year, the contracts must be for 6 years and 93
may not be renewed; however, the agency may extend the term of a 94
plan contract to cover delays during a transition to a new plan 95
provider. The agency shall include in the contracts a medical 96
loss ratio provision consistent with s. 409.967(4). The agency 97
is authorized to seek any necessary state plan amendment or 98
federal waiver to commence enrollment in the Medicaid prepaid 99
dental health program no later than March 1, 2024 2019. The 100
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agency shall extend until December 31, 2025 2024, the term of 101
existing plan contracts awarded pursuant to the invitation to 102
negotiate published in October 2017. 103
(b) The minimum benefits provided by the Medicaid prepaid 104
dental health program for children under age 21 must include all 105
dental benefits required under the early and periodic screening, 106
diagnostic, and treatment services in accordance with Title 42, 107
U.S.C. s. 1396d(r)(3) and (r)(5). 108
(c) The minimum benefits provided by the Medicaid prepaid 109
dental health program for enrollees aged 21 years or older must 110
cover services necessary to prevent disease and promote oral 111
health, restore oral structures to health and function, and 112
treat emergency conditions. Such services include, but are not 113
limited to, routine diagnostic and preventive care such as 114
dental cleanings, examinations, and X -rays; basic dental 115
services such as fillings and extractions; major dental services 116
such as root canals, crowns, and dentures and other dental 117
protheses; emergency dental care; and other necessary services 118
related to dental and oral health. 119
Section 3. This act shall take effect July 1, 2023. 120