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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 behavioral 2
health interventions; creating s. 409.90205, F.S.; 3
providing definitions; requiring the Agency for Health 4
Care Administration, in conjunction with the 5
Department of Health, to create the Emergency Room 6
Utilization Mitigation Behavioral Health Intervention 7
Pilot Program to provide Medicaid coverage for 8
purchases and deliveries of prescribed healthful foods 9
and certain counseling, therapy, and education to 10
reduce emergency room visits; providing requirements 11
for the pilot program; requiring the agency, in 12
conjunction with the department, to seek federal 13
approval and waivers for the pilot program; requiring 14
federal waiver applications to seek matching funds; 15
providing a source of funding for the pilot program; 16
providing duties of the agency, in conjunction with 17
the department; requiring allocation of a portion of 18
the pilot program implementation budget to a specified 19
organization for the establishment of a specified 20
center; providing the center's name; providin g 21
operation requirements for the center; providing 22
reporting requirements; requiring referrals of program 23
patients to certain federal and federally funded 24
programs; requiring the agency to accept certain 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
entities as essential statewide Medicaid providers 26
under the pilot program; providing payment 27
requirements; requiring evaluations of the pilot 28
program; requiring the agency, in conjunction with the 29
department, to adopt rules; providing requirements for 30
the rules; providing an effective date. 31
32
Be It Enacted by the Legislature of the State of Florida: 33
34
Section 1. Section 409.90205, Florida Statutes, is created 35
to read: 36
409.90205 Emergency Room Utilization Mitigation Behavioral 37
Health Intervention Pilot Program; Medicaid coverage for 38
behavioral health interventions; federal approval and waivers; 39
Florida Health and Nutrition Center of Excellence. — 40
(1) As used in this section, the term: 41
(a) "Center," unless the context clearly indicates 42
otherwise, means the Florida Health and Nutrition Center of 43
Excellence established in this section. 44
(b) "Health care provider" means a physician licensed 45
under chapter 458 or chapter 459, clinic or hospital staff 46
member, licensed clinical social worker, registered dietitian, 47
registered dietitian/nutritionist, or heal th plan. 48
(c) "Medically tailored groceries" means a medical 49
nutrition program in a protocol standard selected, reviewed, and 50
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approved by a registered dietitian/nutritionist licensed under 51
s. 468.513 to provide fresh and healthful groceries to a 52
Medicaid recipient for positive health outcomes for a specific 53
diet-related disease or chronic condition. 54
1. The fresh and healthful groceries may be: 55
a. Picked up at a health plan facility, at a clinic, or at 56
an event organized by a community -based organization or by an 57
entity under contract with the program; or 58
b. Delivered to the residence of the Medicaid recipient. 59
2. The medical nutrition program may also include 60
healthful recipes and healthfully prepared ingredients, herbs, 61
spices, and sauces. 62
(d) "Medically tailored meals" means a medical meal plan 63
program that includes fully prepared meals that may be: 64
1. Picked up at a health plan facility, at a clinic, or at 65
an event organized by a community -based organization or by an 66
entity under contract with the program; or 67
2. Delivered to the residence of a Medicaid recipient. 68
(e) "Nutrition education" means a validated course and 69
series of nutrition classes in a 6 -month intervention program 70
such as the Expanded Food and Nutrition Education Program, a 71
research-based nutrition education program funded by the United 72
States Department of Agriculture which teaches participants to 73
grocery shop and plan and cook nutritious meals through lessons 74
given by in-language, in-culture paraprofessionals and other 75
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educators from the Extension Family and Consumer Sciences 76
programs of the Univers ity of Florida Institute of Food and 77
Agricultural Sciences (UF/IFAS), with sites in multiple counties 78
across the state. The term includes surveys before and after 79
classes which measure habit changes and evaluate applications of 80
nutrition education among Fl orida residents, especially among 81
populations that endure a disproportionate share of food 82
insecurity. 83
(f) "Pilot program" means the Emergency Room Utilization 84
Mitigation Behavioral Health Intervention Pilot Program 85
established in this section. 86
(g) "Produce prescription" means a medical incentive 87
program for a Medicaid recipient to receive or purchase fresh 88
and frozen vegetables and fruit at no cost or low cost using a 89
technology-enabled platform, a coupon, a voucher, a debit card, 90
or other means of sto ring value at a farm store, a farm packing 91
house, a mobile farmers' market, a community -based organization, 92
a market as defined in s. 414.456(1), or other store. The 93
vegetables and fruit may be distributed through such store, 94
house, market, or organization or delivered to the residence of 95
the Medicaid recipient and must be in a protocol standard 96
selected, reviewed, and approved by a registered 97
dietitian/nutritionist licensed under s. 468.513. 98
(h) "Provider service network" has the same meaning as in 99
s. 409.962. 100
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(2) By July 1, 2025, the Agency for Health Care 101
Administration, in conjunction with the Department of Health, 102
shall: 103
(a) Create the Emergency Room Utilization Mitigation 104
Behavioral Health Intervention Pilot Program to provide Medicaid 105
coverage for behavioral health interventions through a 106
prescription by a physician licensed under chapter 458 or 107
chapter 459 or through a referral by a health care provider to 108
Medicaid recipients who are high -need patients or patients with 109
high-cost care or with the highest health care utilization and 110
who have a diet-related disease or chronic condition such as 111
diabetes, coronary artery disease, cancer, obesity, renal 112
disease, celiac disease, asthma, dementia, or autoimmune 113
disease. 114
1. The purpose of the pilot prog ram is to: 115
a. Help Medicaid recipients who are enrolled in the pilot 116
program to effectively control and reverse the disease or 117
condition and prevent complications from the disease or 118
condition. 119
b. Reduce the frequency of visits to the emergency room by 120
the Medicaid recipients enrolled in the pilot program. 121
2. The behavioral health interventions under the pilot 122
program must be for 6 months. 123
a. Such interventions must include: 124
(I) Health counseling by a licensed clinical social worker 125
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or certified health coach, medical nutritional therapy by a 126
registered dietitian/nutritionist, and nutrition education in a 127
series of classes. 128
(II) A medically precise nutrition protocol, backed by 129
scientific research, of medically tailored groceries, produce 130
prescriptions, or medically tailored meals fully prepared by a 131
community-based organization or entity under contract with a 132
provider service network. 133
(III) An evaluation to report health outcomes of 134
enrollees, including, but not limited to, biomarkers, nutrition 135
security assessments, and healthy eating and behavior change 136
surveys before and after the behavioral health interventions 137
under the pilot program to evaluate the effectiveness of the 138
interventions. 139
b. Such interventions may include: 140
(I) Functional medicine classes, anatomy of disease 141
classes, cooking classes with weekly menus, gym or exercise 142
classes, shopping lists and grocery store tours, one -on-one and 143
group health coaching for lifestyle change, peer supports for 144
lifestyle and habit change, and comm unity events for connected 145
lives. 146
(II) Technology innovations such as digital curriculum; 147
virtual live or recorded presentations; personalized laboratory 148
tests; personalized supplement regimen with vitamins, nutrients, 149
and at-home laboratory tests; monit oring supplies; and 150
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telehealth components. 151
(b) Seek: 152
1. The pilot program's approval by the United States 153
Secretary of Health and Human Services under s. 1115 of the 154
Social Security Act, which gives the secretary the authority to 155
approve, for a 5-year period, experimental, pilot, or 156
demonstration projects that are likely to assist in promoting 157
the objectives of the Medicaid program. 158
2. Any federal waivers necessary for the implementation of 159
the pilot program, including any waivers necessary to obtain 160
federal finances to secure Title XIX matching funds for the 161
pilot program. The federal waiver application shall seek 162
Medicaid matching funds for all general revenues, family 163
contributions, and local contributions. 164
(c) Use the money granted under s. 1115 of the Social 165
Security Act to fund the pilot program. 166
(d) Add Medicaid recipients who are high -need patients or 167
patients with high-cost care or with the highest health care 168
utilization and who have a diet -related disease or chronic 169
condition to the list of enrollees in the pilot program. 170
(e)1. Add behavioral health interventions under the pilot 171
program as an additional requirement in its selection of managed 172
care plans through a single statewide procurement of provider 173
service networks via an invitation to negotiate. 174
2. During the invitation to negotiate contracting phase: 175
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a. Require as part of the contract that provider service 176
networks share at least 50 percent of the savings generated by 177
fewer visits to emergency rooms, as a result of the behavior al 178
health interventions under the pilot program, with the health 179
care providers who prescribe or refer patients to behavioral 180
health interventions under the pilot program. 181
b. Add to the list of quality indicators required of 182
provider service networks an emergency room visit mitigation 183
indicator measuring emergency room usage year over year by 184
Medicaid recipients who are high -need patients or patients with 185
high-cost care or with the highest health care utilization and 186
who have a diet-related disease or chr onic condition. The agency 187
may refer or enroll Medicaid recipients under the pilot program 188
to provider service networks excelling in emergency room visit 189
mitigation indicator. 190
191
Provider service networks, Medicaid providers, or managed care 192
plans failing to meet the emergency room visit mitigation 193
indicator may lose enrollees with a diet -related disease or 194
chronic condition or may be removed from the contract with the 195
agency. 196
(3) By July 1, 2025, the agency, in conjunction with the 197
Department of Health, sh all provide to the Florida Health and 198
Nutrition Coalition, a nonprofit corporation and coalition of 199
Food is Medicine stakeholders in the state, a portion of the 200
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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
pilot program implementation budget, not to exceed 15 percent of 201
the overall funds expended for the pilot program, to establish 202
an innovation center, formed after the national best practices 203
of the United States Department of Agriculture Gus Schumacher 204
Nutrition Incentive Program and the National Institutes of 205
Health, to collect data and analyze, it erate, and scale best 206
practices in implementation and operations for the pilot 207
program. The center established by the coalition shall be called 208
the Florida Health and Nutrition Center of Excellence. 209
(a) The Florida Health and Nutrition Coalition shall 210
operate the center as an online, Florida -based research and 211
expertise repository by accumulating data in the following 212
areas: 213
1. Research. 214
2. Provision of services and activities such as referrals, 215
food sourcing, and logistics. 216
3. Community outreach and engagement. 217
4. Education and training. 218
5. Coverage for services such as billing and fulfillment 219
of patients' needs. 220
6. Health disparities. 221
(b) The center, in collaboration with UF/IFAS research 222
evaluators, shall: 223
1. Inform behavioral health i nterventions operators during 224
the pilot program implementation. 225
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2. Disseminate findings throughout the state and 226
nationally through the center's stakeholder network. 227
3. Include in-language and in-culture behavioral health 228
activities for Florida residen ts. 229
(c) The center shall report its research literature, 230
validated pilot program models, operational planning frameworks, 231
nutrition standards, and strategies and tactics for effective 232
emergency room visit mitigation through behavior health 233
interventions to the agency and the Legislature. 234
(4) By July 1, 2025, the agency shall: 235
(a) Require UF/IFAS nutrition education providers to 236
refer the pilot program enrollees to the federal Supplemental 237
Nutrition Assistance Program, the Temporary Assistance for Nee dy 238
Families Program, and the Special Supplemental Nutrition Program 239
for Women, Infants, and Children to meet the Centers for 240
Medicare and Medicaid Services financial directive for Medicaid 241
waiver for the pilot program. 242
(b) During the invitation to negoti ate contracting phase: 243
1. Accept the Florida Health and Nutrition Coalition and 244
UF/IFAS as essential statewide Medicaid providers under the 245
pilot program if the coalition and UF/IFAS meet the requirements 246
of this section and any other requirements deemed necessary by 247
the agency. Payments to the coalition and UF/IFAS must be equal 248
to a percentage rate of the pilot program budget. 249
2. Add to the statewide resources and essential providers 250
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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
list: 251
a. The Florida Health and Nutrition Coalition as the 252
Florida Health and Nutrition Center of Excellence. Payments for 253
services rendered by the coalition shall be made at the 254
applicable rate negotiated as of the first day of the contract. 255
b. UF/IFAS as a research evaluator and nutrition education 256
provider for the pilot program. Payments for services rendered 257
by UF/IFAS shall be made at the applicable rate negotiated as of 258
the first day of the contract. 259
(5) Evaluations of the pilot program shall be conducted 260
and reported to the agency and the Legislature by July 1, 2027, 261
and July 1, 2030. The evaluations may be conducted by UF/IFAS 262
research evaluators as a component of the pilot program's 263
implementation budget. The evaluations must assess fidelity of 264
the pilot program implementation and overall program 265
effectiveness, as well as health biomarker outcomes, nutrition 266
intake, healthy equity, healthy habit adoption, and nutrition 267
insecurity. 268
(6) By July 1, 2025, the agency, in conjunction with the 269
Department of Health, shall adopt rules to implement and 270
administer this section, including, but not limited to, rules 271
relating to: 272
(a) The quality standard and quantity of the behavioral 273
health interventions delivered under the pilot program to a 274
Medicaid recipient having a diet -related disease or chronic 275
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condition. 276
(b) The funds allowed per Medicaid recipient for 277
behavioral health interventions under the pilot program. 278
(c) Notification to Medicaid providers and Medicaid 279
recipients of the availability of and requirements for 280
behavioral health interventions under the pilot program. 281
(d) The funds and model for evaluations by UF/IFAS 282
research evaluators. 283
(e) The funds and model for the best practice repository 284
and stakeholder network at the center or effective behavioral 285
health interventions for emergency room visit mitig ation. 286
(f) Methodology for reimbursing Medicaid providers for 287
products, events, services, classes, or activities provided 288
under the pilot program. 289
Section 2. This act shall take effect July 1, 2024. 290