Florida 2024 Regular Session

Florida House Bill H0253 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 Medicaid coverage for prescribed 2
16	16	foods for disease treatment and prevention; creating 3
17	17	s. 409.90203, F.S.; providing definitions; requiring 4
18	18	the Agency for Health Care Administration, in 5
19	19	conjunction with the Department of Health, to 6
20	20	establish the Food is Medicine Pilot Program to 7
21	21	provide Medicaid coverage for purchases and deliveries 8
22	22	of prescribed health -promoting foods under certain 9
23	23	circumstances; requiring the agency, in conjunction 10
24	24	with the department, to seek federal approval and 11
25	25	waivers for the pilot program; requiring the federal 12
26	26	waiver application to seek matching funds; requiring 13
27	27	referrals of pilot program patients to certain federal 14
28	28	and federally funded programs; requiring allocation of 15
29	29	a portion of pilot program implementation budget to a 16
30	30	specified organization for the establishment of a 17
31	31	specified center; providing operation requirements for 18
32	32	the center; providing reporting requirements; 19
33	33	requiring the agency, in conjunction with the 20
34	34	department, to adopt rules; providing requirements for 21
35	35	the rules; providing an effective date. 22
36	36	23
37	37	Be It Enacted by the Legislature of the State of Florida: 24
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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	Section 1. Section 409.90203, Florida Statutes , is created 26
52	52	to read: 27
53	53	409.90203 Food is Medicine Pilot Program; Medicaid 28
54	54	coverage for pilot program providing medically precise 29
55	55	nutrition, medically tailored meals, or produce prescriptions, 30
56	56	with nutrition education and supports; federal approval and 31
57	57	waivers; Florida Food is Medicine Center of Excellence. — 32
58	58	(1) As used in this section, the term: 33
59	59	(a) "Center," unless the context clearly indicates 34
60	60	otherwise, means the Florida Food is Medicine Center of 35
61	61	Excellence established in this section by the Florid a Health and 36
62	62	Nutrition Coalition. 37
63	63	(b) "Food is Medicine" means food -based interventions and 38
64	64	services that include medically precise nutrition, medically 39
65	65	tailored meals, or produce prescriptions, with nutrition 40
66	66	education and specific supports provided to a person with a 41
67	67	specific diet-related disease or chronic condition to 42
68	68	effectively support healthful food and physical activity 43
69	69	behavior change conducive to health and well -being while 44
70	70	improving health outcomes and health care cost savings through 45
71	71	the control and reversal of the disease or condition effects and 46
72	72	the prevention of further disease or condition complications. 47
73	73	(c) "Medically precise nutrition" means a medical 48
74	74	nutrition groceries program provided to a Medicaid recipient 49
75	75	through a prescription or referral from a physician licensed 50
76	76
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84	84	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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88	88	under chapter 458 or chapter 459, or through a referral from a 51
89	89	clinic or hospital staff member, a licensed clinical social 52
90	90	worker, a registered dietitian/nutritionist, or a health plan, 53
91	91	for fresh and health -promoting groceries purchased and 54
92	92	distributed with nutrition education and specific supports to 55
93	93	produce positive health outcomes for a specific diet -related 56
94	94	disease or chronic condition. 57
95	95	1. The medical nutrition groceries program must be in a 58
96	96	protocol standard select ed, reviewed, and approved by a 59
97	97	registered dietitian or registered dietitian/nutritionist 60
98	98	licensed under s. 468.513 as part of a 6 -month intervention 61
99	99	treatment program that follows the model of healthful food 62
100	100	prescription programs supported by research con ducted by the 63
101	101	Gerald J. and Dorothy R. Friedman School of Nutrition Science 64
102	102	and Policy at Tufts University and implemented by the nonprofit 65
103	103	organization Living Hungry and that is certified by the Florida 66
104	104	Food is Medicine Center of Excellence to meet the qu ality and 67
105	105	cultural standards and the health standards for the specific 68
106	106	disease or chronic condition. 69
107	107	2. The medical nutrition groceries program may include 70
108	108	supports through behavioral health counseling, Food is Medicine 71
109	109	functional medicine classes, anato my of disease classes, cooking 72
110	110	classes, gym or exercise classes, weekly menus and shopping 73
111	111	lists, grocery store tours, and motivational habit change 74
112	112	supports such as peer mentoring and health coaching in a 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	protocol designed for a Medicaid recipient with a specific diet-76
126	126	related disease or chronic condition to effectively control or 77
127	127	reverse the disease or condition effects and prevent further 78
128	128	disease or condition complications. 79
129	129	3. The health-promoting groceries under the medical 80
130	130	nutrition groceries program may be: 81
131	131	a. Picked up at the health plan facility or clinic or at 82
132	132	an event organized by a community -based organization or by an 83
133	133	entity under contract with the program such as a grocery store; 84
134	134	or 85
135	135	b. Delivered to the residence of the Medicaid recipient by 86
136	136	the program or by an entity under contract with the program. 87
137	137	4. The medical nutrition groceries program: 88
138	138	a. May include healthful recipes and healthfully prepared 89
139	139	ingredients, herbs, spices, and sauces. 90
140	140	b. May include at-home laboratory tests, supplements, 91
141	141	monitoring supplies, and telehealth components. 92
142	142	c. Must include nutrition education. 93
143	143	d. Must include a program evaluation to report health 94
144	144	outcomes, including, but not limited to, biomarkers, nutri tion 95
145	145	security assessments, and healthful eating and behavior change 96
146	146	surveys before and after the use of the program to evaluate the 97
147	147	program's effectiveness. 98
148	148	(d) "Medically tailored meals" means a medical meal plan 99
149	149	program provided to a Medicaid recipient through a prescription 100
150	150
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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	or referral from a physician licensed under chapter 458 or 101
163	163	chapter 459, or through a referral from a clinic or hospital 102
164	164	staff member, a licensed clinical social worker, a registered 103
165	165	dietitian or registered dietitian/nutritionist, or a health 104
166	166	plan, for meals purchased and distributed with nutrition 105
167	167	education and support to produce positive health outcomes for a 106
168	168	person with a specific diet -related disease or chronic 107
169	169	condition. The medical meal plan program must be designed, 108
170	170	reviewed, and approved by a registered dietitian or registered 109
171	171	dietitian/nutritionist licensed under s. 468.513 to reflect 110
172	172	appropriate medical nutrition therapy based on evidence -based 111
173	173	practice guidelines for the specific diet -related disease or 112
174	174	chronic condition tha t requires the prescription or referral. 113
175	175	1. The meals under the medical meal plan program must be 114
176	176	fully prepared by a Medicaid provider or by a person, entity, or 115
177	177	community-based organization under contract with a Medicaid 116
178	178	managed care organization or wi th a Medicaid provider and must 117
179	179	be certified by the Florida Food is Medicine Center of 118
180	180	Excellence to meet the quality and cultural standards and health 119
181	181	standards for the specific disease or chronic condition. The 120
182	182	meals may be: 121
183	183	a. Picked up at the health plan facility or clinic or at 122
184	184	an event organized by a community -based organization or by an 123
185	185	entity under contract with the program such as a restaurant or 124
186	186	grocery store; or 125
187	187
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195	195	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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199	199	b. Delivered to the residence of the Medicaid recipient by 126
200	200	the program or by an e ntity under contract with the program. 127
201	201	2. The medical meal plan program: 128
202	202	a. May include healthful recipes and healthfully prepared 129
203	203	ingredients, herbs, spices, and sauces. 130
204	204	b. May include at-home laboratory tests, supplements, 131
205	205	monitoring supplies, and telehealth components. 132
206	206	c. Must include nutrition education. 133
207	207	d. Must include a program evaluation to report health 134
208	208	outcomes, including, but not limited to, biomarkers, nutrition 135
209	209	security assessments, and healthful eating and behavior change 136
210	210	surveys before and after the use of the program to evaluate the 137
211	211	program's effectiveness. 138
212	212	(e) "Nutrition education" means a validated course and 139
213	213	series of nutrition education classes in a 6 -month intervention 140
214	214	program such as the Expanded Food and Nutrition Education 141
215	215	Program, a research-based nutrition education program funded by 142
216	216	the United States Department of Agriculture which teaches 143
217	217	participants to grocery shop and plan and cook nutritious meals 144
218	218	through lessons given by in -language, in-culture 145
219	219	paraprofessionals and other educators from the Extension Family 146
220	220	and Consumer Sciences programs of the University of Florida 147
221	221	Institute of Food and Agricultural Sciences (UF/IFAS), with 148
222	222	sites in multiple counties across the state. The term also 149
223	223	includes surveys before and after the classes to measure habit 150
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232	232	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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236	236	changes and evaluate applications of nutrition education among 151
237	237	Florida residents, especially among populations that endure a 152
238	238	disproportionate share of food insecurity. 153
239	239	(f) "Pilot program" means the Food is Medicine Pilot 154
240	240	Program established in this section. 155
241	241	(g) "Produce prescription" means a program that is 156
242	242	provided through a prescription or referral from a physician 157
243	243	licensed under chapter 458 or chapter 459, or through a referral 158
244	244	from a clinic or hospital staff member, a li censed clinical 159
245	245	social worker, a registered dietitian or registered 160
246	246	dietitian/nutritionist, or a health plan, to a Medicaid 161
247	247	recipient who has or is at risk of a specific diet -related 162
248	248	disease or chronic condition such as diabetes, coronary artery 163
249	249	disease, cancer, obesity, renal disease, celiac disease, asthma, 164
250	250	or dementia, to purchase produce at no cost or low cost using a 165
251	251	technology-enabled application such as About Fresh; a coupon; a 166
252	252	voucher; a debit card; a digital currency; or other means of 167
253	253	storing value to be redeemed for purchasing fresh or frozen 168
254	254	produce. 169
255	255	1.a. The technology -enabled application, coupon, voucher, 170
256	256	debit card, digital currency, or other means of storing value 171
257	257	may be redeemed at a farm store, farm packing house, mobile 172
258	258	farmers' market, market as defined in s. 414.456(1), or 173
259	259	community-based organization site; or 174
260	260	b. The produce may be delivered to the residence of the 175
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262	262	HB 253 2024
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269	269	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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273	273	Medicaid recipient or distributed through a market or store or 176
274	274	through a Medicaid provider or health plan facility or cli nic. 177
275	275	2. The program must be in a protocol standard selected, 178
276	276	reviewed, and approved by a registered dietitian/nutritionist 179
277	277	licensed under s. 468.513 as part of an intervention program 180
278	278	that may include medical nutritional therapy by a registered 181
279	279	dietitian/nutritionist, behavioral health counseling, Food is 182
280	280	Medicine functional medicine classes, anatomy of disease 183
281	281	classes, cooking classes, gym or exercise classes, weekly menus 184
282	282	and shopping lists, grocery store tours, and habit change 185
283	283	supports such as peer me ntoring and health coaching designed for 186
284	284	a Medicaid recipient with a specific diet -related disease or 187
285	285	chronic condition to effectively control and reverse the disease 188
286	286	or condition effects and prevent the disease or condition 189
287	287	complications. The program: 190
288	288	a. May include healthful recipes and healthfully prepared 191
289	289	ingredients, herbs, spices, and sauces. 192
290	290	b. May include at-home laboratory tests, supplements, 193
291	291	monitoring supplies, and telehealth components. 194
292	292	c. Must include nutrition education. 195
293	293	d. Must include a program evaluation to report health 196
294	294	outcomes, including, but not limited to, biomarkers, nutrition 197
295	295	security assessments, and healthful eating and behavior change 198
296	296	surveys before and after the use of the program to evaluate the 199
297	297	program's effectiveness. 200
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306	306	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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310	310	(h) "Program evaluation" means an annual evaluation of a 201
311	311	state Medicaid-funded program that uses medically precise 202
312	312	nutrition, medically tailored meals, or produce prescriptions. 203
313	313	These evaluations assess fidelity of program implementation and 204
314	314	overall program effectiveness, as well as health biomarker 205
315	315	outcomes, nutrition intake, health equity, healthful habit 206
316	316	adoption, and food insecurity. The annual evaluation: 207
317	317	1. May either be funded by the agency and conducted by 208
318	318	UF/IFAS Food is Medicine evaluators or b e a component of the 209
319	319	program's implementation budget. 210
320	320	2. Is reported to the agency and the Legislature. 211
321	321	(2) By July 1, 2025, the agency, in conjunction with the 212
322	322	Department of Health, shall: 213
323	323	(a) Establish the Food is Medicine Pilot Program to 214
324	324	provide Medicaid coverage for purchases and deliveries of 215
325	325	prescribed healthful foods in disease -specific protocols through 216
326	326	programs that use medically precise nutrition, medically 217
327	327	tailored meals, or produce prescriptions to meet the specific 218
328	328	needs of Medicaid reci pients who have or are at risk of a 219
329	329	specific diet-related disease or chronic condition and who are 220
330	330	high-need patients or patients with high -cost patient care or 221
331	331	with the highest health care expenditures. The pilot program 222
332	332	shall serve to establish the impac t of healthful foods on health 223
333	333	outcomes of Medicaid recipients and the cost -effectiveness of 224
334	334	such practices. 225
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347	347	(b) Seek: 226
348	348	1. The pilot program's approval by the United States 227
349	349	Secretary of Health and Human Services under s. 1115 of the 228
350	350	Social Security Act, which gives the secretary the authority to 229
351	351	approve, for an initial 5 -year period, experimental, pilot, or 230
352	352	demonstration projects that are likely to assist in promoting 231
353	353	the objectives of the Medicaid program. 232
354	354	2. Any federal waivers necessary for the implementation of 233
355	355	the pilot program, including any waivers necessary to obtain 234
356	356	federal finances to secure Title XIX matching funds for the 235
357	357	pilot program. The federal waiver application shall seek 236
358	358	Medicaid matching funds for all general revenue, family 237
359	359	contributions, and local contributions. 238
360	360	(c) Require UF/IFAS nutrition education providers or other 239
361	361	nutrition educators to refer the pilot program patients to the 240
362	362	federal Supplemental Nutrition Assistance Program, the Temporary 241
363	363	Assistance for Needy Families, and the Special Supplemental 242
364	364	Nutrition Program for Women, Infants, and Children to meet the 243
365	365	Centers for Medicare and Medicaid Services financial directive 244
366	366	for Medicaid waiver for the pilot program. 245
367	367	(d) Provide a portion of the pilot program implementation 246
368	368	budget, not to exceed 15 percent of the overall funds expended 247
369	369	for the pilot program, to the Florida Health and Nutrition 248
370	370	Coalition, a nonprofit corporation and coalition of Food is 249
371	371	Medicine stakeholders in this state, to establish a network 250
372	372
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380	380	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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384	384	model center hub formed after the national best practices of the 251
385	385	United States Department of Agriculture Gus Schumacher Nutrition 252
386	386	Incentive Program and the National Institutes of Health. The 253
387	387	center hub established by the coali tion shall be called the 254
388	388	Florida Food is Medicine Center of Excellence. 255
389	389	(3)(a) The Florida Health and Nutrition Coalition shall 256
390	390	operate the Florida Food is Medicine Center of Excellence as an 257
391	391	online, Florida-based research and expertise repository by 258
392	392	accumulating data in the following areas: 259
393	393	1. Research. 260
394	394	2. Provision of services and activities such as referrals, 261
395	395	food sourcing, and logistics. 262
396	396	3. Community outreach and engagement. 263
397	397	4. Education and training. 264
398	398	5. Coverage for services such as billing and fulfillment 265
399	399	of patients' needs. 266
400	400	6. Health disparities. 267
401	401	(b) The center, in collaboration with UF/IFAS Food is 268
402	402	Medicine evaluators, shall: 269
403	403	1. Inform program operators during the pilot program 270
404	404	implementation. 271
405	405	2. Disseminate findings throughout th is state and 272
406	406	nationally through the center's stakeholder network. 273
407	407	3. Include in-language and in-culture Food is Medicine 274
408	408	activities for Florida residents. 275
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421	421	(c) The center shall report its research literature, 276
422	422	validated program models, operational planni ng frameworks, 277
423	423	nutrition standards, and strategies and tactics for effective 278
424	424	program activities to the agency and the United States 279
425	425	Department of Agriculture, the National Institutes of Health, 280
426	426	and the Centers for Disease Control and Prevention. 281
427	427	(4) The agency, in collaboration with the center and 282
428	428	UF/IFAS, shall file an annual compilation report with the 283
429	429	Legislature on the pilot program, the reduction of food 284
430	430	insecurity, health outcome improvements and savings from the 285
431	431	enrolled high-need patients and pati ents with high-cost patient 286
432	432	care, and advances in health equity. 287
433	433	(5) The agency, in conjunction with the Department of 288
434	434	Health, shall adopt rules to implement and administer this 289
435	435	section, including, but not limited to, rules relating to: 290
436	436	(a) The quality standard and quantity and the number of 291
437	437	medically tailored meals delivered per week to a Medicaid 292
438	438	recipient. 293
439	439	(b) The funds allowed per Medicaid recipient for medically 294
440	440	precise nutrition, medically tailored meals, and produce 295
441	441	prescriptions. 296
442	442	(c) Notification to Medicaid providers and Medicaid 297
443	443	recipients of the availability of and requirements for medically 298
444	444	precise nutrition, medically tailored meals, and produce 299
445	445	prescriptions. 300
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458	458	(d) The funds and model for evaluations for UF/IFAS Food 301
459	459	is Medicine evaluators. 302
460	460	(e) The funds and model for the best -practices information 303
461	461	repository hub and stakeholder network at the Florida Food is 304
462	462	Medicine Center of Excellence. 305
463	463	(f) Methodology for reimbursing Medicaid providers and 306
464	464	other managed care organizations and hea lth plans for products, 307
465	465	events, services, classes, or activities provided under the 308
466	466	pilot program by the providers, organizations, and plans that 309
467	467	use medically precise nutrition, medically tailored meals, or 310
468	468	produce prescriptions. 311
469	469	Section 2. This act s hall take effect July 1, 2024. 312