Florida 2024 Regular Session

Florida House Bill H0265 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 behavioral 2
16	16	health interventions; creating s. 409.90205, F.S.; 3
17	17	providing definitions; requiring the Agency for Health 4
18	18	Care Administration, in conjunction with the 5
19	19	Department of Health, to create the Emergency Room 6
20	20	Utilization Mitigation Behavioral Health Intervention 7
21	21	Pilot Program to provide Medicaid coverage for 8
22	22	purchases and deliveries of prescribed healthful foods 9
23	23	and certain counseling, therapy, and education to 10
24	24	reduce emergency room visits; providing requirements 11
25	25	for the pilot program; requiring the agency, in 12
26	26	conjunction with the department, to seek federal 13
27	27	approval and waivers for the pilot program; requiring 14
28	28	federal waiver applications to seek matching funds; 15
29	29	providing a source of funding for the pilot program; 16
30	30	providing duties of the agency, in conjunction with 17
31	31	the department; requiring allocation of a portion of 18
32	32	the pilot program implementation budget to a specified 19
33	33	organization for the establishment of a specified 20
34	34	center; providing the center's name; providin g 21
35	35	operation requirements for the center; providing 22
36	36	reporting requirements; requiring referrals of program 23
37	37	patients to certain federal and federally funded 24
38	38	programs; requiring the agency to accept certain 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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49	49
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51	51	entities as essential statewide Medicaid providers 26
52	52	under the pilot program; providing payment 27
53	53	requirements; requiring evaluations of the pilot 28
54	54	program; requiring the agency, in conjunction with the 29
55	55	department, to adopt rules; providing requirements for 30
56	56	the rules; providing an effective date. 31
57	57	32
58	58	Be It Enacted by the Legislature of the State of Florida: 33
59	59	34
60	60	Section 1. Section 409.90205, Florida Statutes, is created 35
61	61	to read: 36
62	62	409.90205 Emergency Room Utilization Mitigation Behavioral 37
63	63	Health Intervention Pilot Program; Medicaid coverage for 38
64	64	behavioral health interventions; federal approval and waivers; 39
65	65	Florida Health and Nutrition Center of Excellence. — 40
66	66	(1) As used in this section, the term: 41
67	67	(a) "Center," unless the context clearly indicates 42
68	68	otherwise, means the Florida Health and Nutrition Center of 43
69	69	Excellence established in this section. 44
70	70	(b) "Health care provider" means a physician licensed 45
71	71	under chapter 458 or chapter 459, clinic or hospital staff 46
72	72	member, licensed clinical social worker, registered dietitian, 47
73	73	registered dietitian/nutritionist, or heal th plan. 48
74	74	(c) "Medically tailored groceries" means a medical 49
75	75	nutrition program in a protocol standard selected, reviewed, and 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	approved by a registered dietitian/nutritionist licensed under 51
89	89	s. 468.513 to provide fresh and healthful groceries to a 52
90	90	Medicaid recipient for positive health outcomes for a specific 53
91	91	diet-related disease or chronic condition. 54
92	92	1. The fresh and healthful groceries may be: 55
93	93	a. Picked up at a health plan facility, at a clinic, or at 56
94	94	an event organized by a community -based organization or by an 57
95	95	entity under contract with the program; or 58
96	96	b. Delivered to the residence of the Medicaid recipient. 59
97	97	2. The medical nutrition program may also include 60
98	98	healthful recipes and healthfully prepared ingredients, herbs, 61
99	99	spices, and sauces. 62
100	100	(d) "Medically tailored meals" means a medical meal plan 63
101	101	program that includes fully prepared meals that may be: 64
102	102	1. Picked up at a health plan facility, at a clinic, or at 65
103	103	an event organized by a community -based organization or by an 66
104	104	entity under contract with the program; or 67
105	105	2. Delivered to the residence of a Medicaid recipient. 68
106	106	(e) "Nutrition education" means a validated course and 69
107	107	series of nutrition classes in a 6 -month intervention program 70
108	108	such as the Expanded Food and Nutrition Education Program, a 71
109	109	research-based nutrition education program funded by the United 72
110	110	States Department of Agriculture which teaches participants to 73
111	111	grocery shop and plan and cook nutritious meals through lessons 74
112	112	given by in-language, in-culture paraprofessionals and other 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
122	122
123	123
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125	125	educators from the Extension Family and Consumer Sciences 76
126	126	programs of the Univers ity of Florida Institute of Food and 77
127	127	Agricultural Sciences (UF/IFAS), with sites in multiple counties 78
128	128	across the state. The term includes surveys before and after 79
129	129	classes which measure habit changes and evaluate applications of 80
130	130	nutrition education among Fl orida residents, especially among 81
131	131	populations that endure a disproportionate share of food 82
132	132	insecurity. 83
133	133	(f) "Pilot program" means the Emergency Room Utilization 84
134	134	Mitigation Behavioral Health Intervention Pilot Program 85
135	135	established in this section. 86
136	136	(g) "Produce prescription" means a medical incentive 87
137	137	program for a Medicaid recipient to receive or purchase fresh 88
138	138	and frozen vegetables and fruit at no cost or low cost using a 89
139	139	technology-enabled platform, a coupon, a voucher, a debit card, 90
140	140	or other means of sto ring value at a farm store, a farm packing 91
141	141	house, a mobile farmers' market, a community -based organization, 92
142	142	a market as defined in s. 414.456(1), or other store. The 93
143	143	vegetables and fruit may be distributed through such store, 94
144	144	house, market, or organization or delivered to the residence of 95
145	145	the Medicaid recipient and must be in a protocol standard 96
146	146	selected, reviewed, and approved by a registered 97
147	147	dietitian/nutritionist licensed under s. 468.513. 98
148	148	(h) "Provider service network" has the same meaning as in 99
149	149	s. 409.962. 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	(2) By July 1, 2025, the Agency for Health Care 101
163	163	Administration, in conjunction with the Department of Health, 102
164	164	shall: 103
165	165	(a) Create the Emergency Room Utilization Mitigation 104
166	166	Behavioral Health Intervention Pilot Program to provide Medicaid 105
167	167	coverage for behavioral health interventions through a 106
168	168	prescription by a physician licensed under chapter 458 or 107
169	169	chapter 459 or through a referral by a health care provider to 108
170	170	Medicaid recipients who are high -need patients or patients with 109
171	171	high-cost care or with the highest health care utilization and 110
172	172	who have a diet-related disease or chronic condition such as 111
173	173	diabetes, coronary artery disease, cancer, obesity, renal 112
174	174	disease, celiac disease, asthma, dementia, or autoimmune 113
175	175	disease. 114
176	176	1. The purpose of the pilot prog ram is to: 115
177	177	a. Help Medicaid recipients who are enrolled in the pilot 116
178	178	program to effectively control and reverse the disease or 117
179	179	condition and prevent complications from the disease or 118
180	180	condition. 119
181	181	b. Reduce the frequency of visits to the emergency room by 120
182	182	the Medicaid recipients enrolled in the pilot program. 121
183	183	2. The behavioral health interventions under the pilot 122
184	184	program must be for 6 months. 123
185	185	a. Such interventions must include: 124
186	186	(I) Health counseling by a licensed clinical social worker 125
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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	or certified health coach, medical nutritional therapy by a 126
200	200	registered dietitian/nutritionist, and nutrition education in a 127
201	201	series of classes. 128
202	202	(II) A medically precise nutrition protocol, backed by 129
203	203	scientific research, of medically tailored groceries, produce 130
204	204	prescriptions, or medically tailored meals fully prepared by a 131
205	205	community-based organization or entity under contract with a 132
206	206	provider service network. 133
207	207	(III) An evaluation to report health outcomes of 134
208	208	enrollees, including, but not limited to, biomarkers, nutrition 135
209	209	security assessments, and healthy eating and behavior change 136
210	210	surveys before and after the behavioral health interventions 137
211	211	under the pilot program to evaluate the effectiveness of the 138
212	212	interventions. 139
213	213	b. Such interventions may include: 140
214	214	(I) Functional medicine classes, anatomy of disease 141
215	215	classes, cooking classes with weekly menus, gym or exercise 142
216	216	classes, shopping lists and grocery store tours, one -on-one and 143
217	217	group health coaching for lifestyle change, peer supports for 144
218	218	lifestyle and habit change, and comm unity events for connected 145
219	219	lives. 146
220	220	(II) Technology innovations such as digital curriculum; 147
221	221	virtual live or recorded presentations; personalized laboratory 148
222	222	tests; personalized supplement regimen with vitamins, nutrients, 149
223	223	and at-home laboratory tests; monit oring supplies; and 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	telehealth components. 151
237	237	(b) Seek: 152
238	238	1. The pilot program's approval by the United States 153
239	239	Secretary of Health and Human Services under s. 1115 of the 154
240	240	Social Security Act, which gives the secretary the authority to 155
241	241	approve, for a 5-year period, experimental, pilot, or 156
242	242	demonstration projects that are likely to assist in promoting 157
243	243	the objectives of the Medicaid program. 158
244	244	2. Any federal waivers necessary for the implementation of 159
245	245	the pilot program, including any waivers necessary to obtain 160
246	246	federal finances to secure Title XIX matching funds for the 161
247	247	pilot program. The federal waiver application shall seek 162
248	248	Medicaid matching funds for all general revenues, family 163
249	249	contributions, and local contributions. 164
250	250	(c) Use the money granted under s. 1115 of the Social 165
251	251	Security Act to fund the pilot program. 166
252	252	(d) Add Medicaid recipients who are high -need patients or 167
253	253	patients with high-cost care or with the highest health care 168
254	254	utilization and who have a diet -related disease or chronic 169
255	255	condition to the list of enrollees in the pilot program. 170
256	256	(e)1. Add behavioral health interventions under the pilot 171
257	257	program as an additional requirement in its selection of managed 172
258	258	care plans through a single statewide procurement of provider 173
259	259	service networks via an invitation to negotiate. 174
260	260	2. During the invitation to negotiate contracting phase: 175
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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	a. Require as part of the contract that provider service 176
274	274	networks share at least 50 percent of the savings generated by 177
275	275	fewer visits to emergency rooms, as a result of the behavior al 178
276	276	health interventions under the pilot program, with the health 179
277	277	care providers who prescribe or refer patients to behavioral 180
278	278	health interventions under the pilot program. 181
279	279	b. Add to the list of quality indicators required of 182
280	280	provider service networks an emergency room visit mitigation 183
281	281	indicator measuring emergency room usage year over year by 184
282	282	Medicaid recipients who are high -need patients or patients with 185
283	283	high-cost care or with the highest health care utilization and 186
284	284	who have a diet-related disease or chr onic condition. The agency 187
285	285	may refer or enroll Medicaid recipients under the pilot program 188
286	286	to provider service networks excelling in emergency room visit 189
287	287	mitigation indicator. 190
288	288	191
289	289	Provider service networks, Medicaid providers, or managed care 192
290	290	plans failing to meet the emergency room visit mitigation 193
291	291	indicator may lose enrollees with a diet -related disease or 194
292	292	chronic condition or may be removed from the contract with the 195
293	293	agency. 196
294	294	(3) By July 1, 2025, the agency, in conjunction with the 197
295	295	Department of Health, sh all provide to the Florida Health and 198
296	296	Nutrition Coalition, a nonprofit corporation and coalition of 199
297	297	Food is Medicine stakeholders in the state, a portion of the 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	pilot program implementation budget, not to exceed 15 percent of 201
311	311	the overall funds expended for the pilot program, to establish 202
312	312	an innovation center, formed after the national best practices 203
313	313	of the United States Department of Agriculture Gus Schumacher 204
314	314	Nutrition Incentive Program and the National Institutes of 205
315	315	Health, to collect data and analyze, it erate, and scale best 206
316	316	practices in implementation and operations for the pilot 207
317	317	program. The center established by the coalition shall be called 208
318	318	the Florida Health and Nutrition Center of Excellence. 209
319	319	(a) The Florida Health and Nutrition Coalition shall 210
320	320	operate the center as an online, Florida -based research and 211
321	321	expertise repository by accumulating data in the following 212
322	322	areas: 213
323	323	1. Research. 214
324	324	2. Provision of services and activities such as referrals, 215
325	325	food sourcing, and logistics. 216
326	326	3. Community outreach and engagement. 217
327	327	4. Education and training. 218
328	328	5. Coverage for services such as billing and fulfillment 219
329	329	of patients' needs. 220
330	330	6. Health disparities. 221
331	331	(b) The center, in collaboration with UF/IFAS research 222
332	332	evaluators, shall: 223
333	333	1. Inform behavioral health i nterventions operators during 224
334	334	the pilot program implementation. 225
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347	347	2. Disseminate findings throughout the state and 226
348	348	nationally through the center's stakeholder network. 227
349	349	3. Include in-language and in-culture behavioral health 228
350	350	activities for Florida residen ts. 229
351	351	(c) The center shall report its research literature, 230
352	352	validated pilot program models, operational planning frameworks, 231
353	353	nutrition standards, and strategies and tactics for effective 232
354	354	emergency room visit mitigation through behavior health 233
355	355	interventions to the agency and the Legislature. 234
356	356	(4) By July 1, 2025, the agency shall: 235
357	357	(a) Require UF/IFAS nutrition education providers to 236
358	358	refer the pilot program enrollees to the federal Supplemental 237
359	359	Nutrition Assistance Program, the Temporary Assistance for Nee dy 238
360	360	Families Program, and the Special Supplemental Nutrition Program 239
361	361	for Women, Infants, and Children to meet the Centers for 240
362	362	Medicare and Medicaid Services financial directive for Medicaid 241
363	363	waiver for the pilot program. 242
364	364	(b) During the invitation to negoti ate contracting phase: 243
365	365	1. Accept the Florida Health and Nutrition Coalition and 244
366	366	UF/IFAS as essential statewide Medicaid providers under the 245
367	367	pilot program if the coalition and UF/IFAS meet the requirements 246
368	368	of this section and any other requirements deemed necessary by 247
369	369	the agency. Payments to the coalition and UF/IFAS must be equal 248
370	370	to a percentage rate of the pilot program budget. 249
371	371	2. Add to the statewide resources and essential providers 250
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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	list: 251
385	385	a. The Florida Health and Nutrition Coalition as the 252
386	386	Florida Health and Nutrition Center of Excellence. Payments for 253
387	387	services rendered by the coalition shall be made at the 254
388	388	applicable rate negotiated as of the first day of the contract. 255
389	389	b. UF/IFAS as a research evaluator and nutrition education 256
390	390	provider for the pilot program. Payments for services rendered 257
391	391	by UF/IFAS shall be made at the applicable rate negotiated as of 258
392	392	the first day of the contract. 259
393	393	(5) Evaluations of the pilot program shall be conducted 260
394	394	and reported to the agency and the Legislature by July 1, 2027, 261
395	395	and July 1, 2030. The evaluations may be conducted by UF/IFAS 262
396	396	research evaluators as a component of the pilot program's 263
397	397	implementation budget. The evaluations must assess fidelity of 264
398	398	the pilot program implementation and overall program 265
399	399	effectiveness, as well as health biomarker outcomes, nutrition 266
400	400	intake, healthy equity, healthy habit adoption, and nutrition 267
401	401	insecurity. 268
402	402	(6) By July 1, 2025, the agency, in conjunction with the 269
403	403	Department of Health, shall adopt rules to implement and 270
404	404	administer this section, including, but not limited to, rules 271
405	405	relating to: 272
406	406	(a) The quality standard and quantity of the behavioral 273
407	407	health interventions delivered under the pilot program to a 274
408	408	Medicaid recipient having a diet -related disease or chronic 275
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421	421	condition. 276
422	422	(b) The funds allowed per Medicaid recipient for 277
423	423	behavioral health interventions under the pilot program. 278
424	424	(c) Notification to Medicaid providers and Medicaid 279
425	425	recipients of the availability of and requirements for 280
426	426	behavioral health interventions under the pilot program. 281
427	427	(d) The funds and model for evaluations by UF/IFAS 282
428	428	research evaluators. 283
429	429	(e) The funds and model for the best practice repository 284
430	430	and stakeholder network at the center or effective behavioral 285
431	431	health interventions for emergency room visit mitig ation. 286
432	432	(f) Methodology for reimbursing Medicaid providers for 287
433	433	products, events, services, classes, or activities provided 288
434	434	under the pilot program. 289
435	435	Section 2. This act shall take effect July 1, 2024. 290