HB 253 2024
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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 Medicaid coverage for prescribed 2
foods for disease treatment and prevention; creating 3
s. 409.90203, F.S.; providing definitions; requiring 4
the Agency for Health Care Administration, in 5
conjunction with the Department of Health, to 6
establish the Food is Medicine Pilot Program to 7
provide Medicaid coverage for purchases and deliveries 8
of prescribed health -promoting foods under certain 9
circumstances; requiring the agency, in conjunction 10
with the department, to seek federal approval and 11
waivers for the pilot program; requiring the federal 12
waiver application to seek matching funds; requiring 13
referrals of pilot program patients to certain federal 14
and federally funded programs; requiring allocation of 15
a portion of pilot program implementation budget to a 16
specified organization for the establishment of a 17
specified center; providing operation requirements for 18
the center; providing reporting requirements; 19
requiring the agency, in conjunction with the 20
department, to adopt rules; providing requirements for 21
the rules; providing an effective date. 22
23
Be It Enacted by the Legislature of the State of Florida: 24
25
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Section 1. Section 409.90203, Florida Statutes , is created 26
to read: 27
409.90203 Food is Medicine Pilot Program; Medicaid 28
coverage for pilot program providing medically precise 29
nutrition, medically tailored meals, or produce prescriptions, 30
with nutrition education and supports; federal approval and 31
waivers; Florida Food is Medicine Center of Excellence. — 32
(1) As used in this section, the term: 33
(a) "Center," unless the context clearly indicates 34
otherwise, means the Florida Food is Medicine Center of 35
Excellence established in this section by the Florid a Health and 36
Nutrition Coalition. 37
(b) "Food is Medicine" means food -based interventions and 38
services that include medically precise nutrition, medically 39
tailored meals, or produce prescriptions, with nutrition 40
education and specific supports provided to a person with a 41
specific diet-related disease or chronic condition to 42
effectively support healthful food and physical activity 43
behavior change conducive to health and well -being while 44
improving health outcomes and health care cost savings through 45
the control and reversal of the disease or condition effects and 46
the prevention of further disease or condition complications. 47
(c) "Medically precise nutrition" means a medical 48
nutrition groceries program provided to a Medicaid recipient 49
through a prescription or referral from a physician licensed 50
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under chapter 458 or chapter 459, or through a referral from a 51
clinic or hospital staff member, a licensed clinical social 52
worker, a registered dietitian/nutritionist, or a health plan, 53
for fresh and health -promoting groceries purchased and 54
distributed with nutrition education and specific supports to 55
produce positive health outcomes for a specific diet -related 56
disease or chronic condition. 57
1. The medical nutrition groceries program must be in a 58
protocol standard select ed, reviewed, and approved by a 59
registered dietitian or registered dietitian/nutritionist 60
licensed under s. 468.513 as part of a 6 -month intervention 61
treatment program that follows the model of healthful food 62
prescription programs supported by research con ducted by the 63
Gerald J. and Dorothy R. Friedman School of Nutrition Science 64
and Policy at Tufts University and implemented by the nonprofit 65
organization Living Hungry and that is certified by the Florida 66
Food is Medicine Center of Excellence to meet the qu ality and 67
cultural standards and the health standards for the specific 68
disease or chronic condition. 69
2. The medical nutrition groceries program may include 70
supports through behavioral health counseling, Food is Medicine 71
functional medicine classes, anato my of disease classes, cooking 72
classes, gym or exercise classes, weekly menus and shopping 73
lists, grocery store tours, and motivational habit change 74
supports such as peer mentoring and health coaching in a 75
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protocol designed for a Medicaid recipient with a specific diet-76
related disease or chronic condition to effectively control or 77
reverse the disease or condition effects and prevent further 78
disease or condition complications. 79
3. The health-promoting groceries under the medical 80
nutrition groceries program may be: 81
a. Picked up at the health plan facility or clinic or at 82
an event organized by a community -based organization or by an 83
entity under contract with the program such as a grocery store; 84
or 85
b. Delivered to the residence of the Medicaid recipient by 86
the program or by an entity under contract with the program. 87
4. The medical nutrition groceries program: 88
a. May include healthful recipes and healthfully prepared 89
ingredients, herbs, spices, and sauces. 90
b. May include at-home laboratory tests, supplements, 91
monitoring supplies, and telehealth components. 92
c. Must include nutrition education. 93
d. Must include a program evaluation to report health 94
outcomes, including, but not limited to, biomarkers, nutri tion 95
security assessments, and healthful eating and behavior change 96
surveys before and after the use of the program to evaluate the 97
program's effectiveness. 98
(d) "Medically tailored meals" means a medical meal plan 99
program provided to a Medicaid recipient through a prescription 100
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or referral from a physician licensed under chapter 458 or 101
chapter 459, or through a referral from a clinic or hospital 102
staff member, a licensed clinical social worker, a registered 103
dietitian or registered dietitian/nutritionist, or a health 104
plan, for meals purchased and distributed with nutrition 105
education and support to produce positive health outcomes for a 106
person with a specific diet -related disease or chronic 107
condition. The medical meal plan program must be designed, 108
reviewed, and approved by a registered dietitian or registered 109
dietitian/nutritionist licensed under s. 468.513 to reflect 110
appropriate medical nutrition therapy based on evidence -based 111
practice guidelines for the specific diet -related disease or 112
chronic condition tha t requires the prescription or referral. 113
1. The meals under the medical meal plan program must be 114
fully prepared by a Medicaid provider or by a person, entity, or 115
community-based organization under contract with a Medicaid 116
managed care organization or wi th a Medicaid provider and must 117
be certified by the Florida Food is Medicine Center of 118
Excellence to meet the quality and cultural standards and health 119
standards for the specific disease or chronic condition. The 120
meals may be: 121
a. Picked up at the health plan facility or clinic or at 122
an event organized by a community -based organization or by an 123
entity under contract with the program such as a restaurant or 124
grocery store; or 125
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b. Delivered to the residence of the Medicaid recipient by 126
the program or by an e ntity under contract with the program. 127
2. The medical meal plan program: 128
a. May include healthful recipes and healthfully prepared 129
ingredients, herbs, spices, and sauces. 130
b. May include at-home laboratory tests, supplements, 131
monitoring supplies, and telehealth components. 132
c. Must include nutrition education. 133
d. Must include a program evaluation to report health 134
outcomes, including, but not limited to, biomarkers, nutrition 135
security assessments, and healthful eating and behavior change 136
surveys before and after the use of the program to evaluate the 137
program's effectiveness. 138
(e) "Nutrition education" means a validated course and 139
series of nutrition education classes in a 6 -month intervention 140
program such as the Expanded Food and Nutrition Education 141
Program, a research-based nutrition education program funded by 142
the United States Department of Agriculture which teaches 143
participants to grocery shop and plan and cook nutritious meals 144
through lessons given by in -language, in-culture 145
paraprofessionals and other educators from the Extension Family 146
and Consumer Sciences programs of the University of Florida 147
Institute of Food and Agricultural Sciences (UF/IFAS), with 148
sites in multiple counties across the state. The term also 149
includes surveys before and after the classes to measure habit 150
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changes and evaluate applications of nutrition education among 151
Florida residents, especially among populations that endure a 152
disproportionate share of food insecurity. 153
(f) "Pilot program" means the Food is Medicine Pilot 154
Program established in this section. 155
(g) "Produce prescription" means a program that is 156
provided through a prescription or referral from a physician 157
licensed under chapter 458 or chapter 459, or through a referral 158
from a clinic or hospital staff member, a li censed clinical 159
social worker, a registered dietitian or registered 160
dietitian/nutritionist, or a health plan, to a Medicaid 161
recipient who has or is at risk of a specific diet -related 162
disease or chronic condition such as diabetes, coronary artery 163
disease, cancer, obesity, renal disease, celiac disease, asthma, 164
or dementia, to purchase produce at no cost or low cost using a 165
technology-enabled application such as About Fresh; a coupon; a 166
voucher; a debit card; a digital currency; or other means of 167
storing value to be redeemed for purchasing fresh or frozen 168
produce. 169
1.a. The technology -enabled application, coupon, voucher, 170
debit card, digital currency, or other means of storing value 171
may be redeemed at a farm store, farm packing house, mobile 172
farmers' market, market as defined in s. 414.456(1), or 173
community-based organization site; or 174
b. The produce may be delivered to the residence of the 175
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Medicaid recipient or distributed through a market or store or 176
through a Medicaid provider or health plan facility or cli nic. 177
2. The program must be in a protocol standard selected, 178
reviewed, and approved by a registered dietitian/nutritionist 179
licensed under s. 468.513 as part of an intervention program 180
that may include medical nutritional therapy by a registered 181
dietitian/nutritionist, behavioral health counseling, Food is 182
Medicine functional medicine classes, anatomy of disease 183
classes, cooking classes, gym or exercise classes, weekly menus 184
and shopping lists, grocery store tours, and habit change 185
supports such as peer me ntoring and health coaching designed for 186
a Medicaid recipient with a specific diet -related disease or 187
chronic condition to effectively control and reverse the disease 188
or condition effects and prevent the disease or condition 189
complications. The program: 190
a. May include healthful recipes and healthfully prepared 191
ingredients, herbs, spices, and sauces. 192
b. May include at-home laboratory tests, supplements, 193
monitoring supplies, and telehealth components. 194
c. Must include nutrition education. 195
d. Must include a program evaluation to report health 196
outcomes, including, but not limited to, biomarkers, nutrition 197
security assessments, and healthful eating and behavior change 198
surveys before and after the use of the program to evaluate the 199
program's effectiveness. 200
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(h) "Program evaluation" means an annual evaluation of a 201
state Medicaid-funded program that uses medically precise 202
nutrition, medically tailored meals, or produce prescriptions. 203
These evaluations assess fidelity of program implementation and 204
overall program effectiveness, as well as health biomarker 205
outcomes, nutrition intake, health equity, healthful habit 206
adoption, and food insecurity. The annual evaluation: 207
1. May either be funded by the agency and conducted by 208
UF/IFAS Food is Medicine evaluators or b e a component of the 209
program's implementation budget. 210
2. Is reported to the agency and the Legislature. 211
(2) By July 1, 2025, the agency, in conjunction with the 212
Department of Health, shall: 213
(a) Establish the Food is Medicine Pilot Program to 214
provide Medicaid coverage for purchases and deliveries of 215
prescribed healthful foods in disease -specific protocols through 216
programs that use medically precise nutrition, medically 217
tailored meals, or produce prescriptions to meet the specific 218
needs of Medicaid reci pients who have or are at risk of a 219
specific diet-related disease or chronic condition and who are 220
high-need patients or patients with high -cost patient care or 221
with the highest health care expenditures. The pilot program 222
shall serve to establish the impac t of healthful foods on health 223
outcomes of Medicaid recipients and the cost -effectiveness of 224
such practices. 225
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(b) Seek: 226
1. The pilot program's approval by the United States 227
Secretary of Health and Human Services under s. 1115 of the 228
Social Security Act, which gives the secretary the authority to 229
approve, for an initial 5 -year period, experimental, pilot, or 230
demonstration projects that are likely to assist in promoting 231
the objectives of the Medicaid program. 232
2. Any federal waivers necessary for the implementation of 233
the pilot program, including any waivers necessary to obtain 234
federal finances to secure Title XIX matching funds for the 235
pilot program. The federal waiver application shall seek 236
Medicaid matching funds for all general revenue, family 237
contributions, and local contributions. 238
(c) Require UF/IFAS nutrition education providers or other 239
nutrition educators to refer the pilot program patients to the 240
federal Supplemental Nutrition Assistance Program, the Temporary 241
Assistance for Needy Families, and the Special Supplemental 242
Nutrition Program for Women, Infants, and Children to meet the 243
Centers for Medicare and Medicaid Services financial directive 244
for Medicaid waiver for the pilot program. 245
(d) Provide a portion of the pilot program implementation 246
budget, not to exceed 15 percent of the overall funds expended 247
for the pilot program, to the Florida Health and Nutrition 248
Coalition, a nonprofit corporation and coalition of Food is 249
Medicine stakeholders in this state, to establish a network 250
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model center hub formed after the national best practices of the 251
United States Department of Agriculture Gus Schumacher Nutrition 252
Incentive Program and the National Institutes of Health. The 253
center hub established by the coali tion shall be called the 254
Florida Food is Medicine Center of Excellence. 255
(3)(a) The Florida Health and Nutrition Coalition shall 256
operate the Florida Food is Medicine Center of Excellence as an 257
online, Florida-based research and expertise repository by 258
accumulating data in the following areas: 259
1. Research. 260
2. Provision of services and activities such as referrals, 261
food sourcing, and logistics. 262
3. Community outreach and engagement. 263
4. Education and training. 264
5. Coverage for services such as billing and fulfillment 265
of patients' needs. 266
6. Health disparities. 267
(b) The center, in collaboration with UF/IFAS Food is 268
Medicine evaluators, shall: 269
1. Inform program operators during the pilot program 270
implementation. 271
2. Disseminate findings throughout th is state and 272
nationally through the center's stakeholder network. 273
3. Include in-language and in-culture Food is Medicine 274
activities for Florida residents. 275
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(c) The center shall report its research literature, 276
validated program models, operational planni ng frameworks, 277
nutrition standards, and strategies and tactics for effective 278
program activities to the agency and the United States 279
Department of Agriculture, the National Institutes of Health, 280
and the Centers for Disease Control and Prevention. 281
(4) The agency, in collaboration with the center and 282
UF/IFAS, shall file an annual compilation report with the 283
Legislature on the pilot program, the reduction of food 284
insecurity, health outcome improvements and savings from the 285
enrolled high-need patients and pati ents with high-cost patient 286
care, and advances in health equity. 287
(5) The agency, in conjunction with the Department of 288
Health, shall adopt rules to implement and administer this 289
section, including, but not limited to, rules relating to: 290
(a) The quality standard and quantity and the number of 291
medically tailored meals delivered per week to a Medicaid 292
recipient. 293
(b) The funds allowed per Medicaid recipient for medically 294
precise nutrition, medically tailored meals, and produce 295
prescriptions. 296
(c) Notification to Medicaid providers and Medicaid 297
recipients of the availability of and requirements for medically 298
precise nutrition, medically tailored meals, and produce 299
prescriptions. 300
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(d) The funds and model for evaluations for UF/IFAS Food 301
is Medicine evaluators. 302
(e) The funds and model for the best -practices information 303
repository hub and stakeholder network at the Florida Food is 304
Medicine Center of Excellence. 305
(f) Methodology for reimbursing Medicaid providers and 306
other managed care organizations and hea lth plans for products, 307
events, services, classes, or activities provided under the 308
pilot program by the providers, organizations, and plans that 309
use medically precise nutrition, medically tailored meals, or 310
produce prescriptions. 311
Section 2. This act s hall take effect July 1, 2024. 312