HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 1 of 21
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 coverage of dental services under 2
the Medicaid program; amending s. 409.906, F.S.; 3
removing provisions relating to optional services 4
rendered by providers in mobile units to Medicaid 5
recipients; adjustments in the Medicaid program due to 6
availability of moneys, limitations, and certain 7
directions; and the removal of certain Medicaid 8
service; revising adult dental services that are paid 9
by the Agency for Health Care Administration as 10
optional Medicaid services; requiring the agency to 11
reimburse Medicaid providers at a specified rate for 12
covered adult dental services; requiring the agency to 13
seek federal approval; amending s. 409.973, F.S.; 14
requiring the agency to implement a statewide Medicaid 15
prepaid dental health program for children and adults; 16
providing requirements for the benefits under the 17
program; removing obsolete language; providing an 18
effective date. 19
20
Be It Enacted by the Legislature of the State of Florida: 21
22
Section 1. Section 409.906, Florida Statutes, is amended 23
to read: 24
409.906 Optional Medicaid services. —Subject to specific 25
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 2 of 21
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
appropriations, the agency may make payments for services which 26
are optional to the state under Title XIX of the Social Security 27
Act and are furnished by Medicaid providers to recipients who 28
are determined to be eligible on the dates on which the services 29
were provided. Any optional service that is provided shall be 30
provided only when medically necessary and in accordance with 31
state and federal law. Optional services rendered by providers 32
in mobile units to Medicaid recipients may be restricted or 33
prohibited by the agency. Nothing in this section shall be 34
construed to prevent or limit the agency from adjus ting fees, 35
reimbursement rates, lengths of stay, number of visits, or 36
number of services, or making any other adjustments necessary to 37
comply with the availability of moneys and any limitations or 38
directions provided for in the General Appropriations Act o r 39
chapter 216. If necessary to safeguard the state's systems of 40
providing services to elderly and disabled persons and subject 41
to the notice and review provisions of s. 216.177, the Governor 42
may direct the Agency for Health Care Administration to amend 43
the Medicaid state plan to delete the optional Medicaid service 44
known as "Intermediate Care Facilities for the Developmentally 45
Disabled." Optional services may include: 46
(1) ADULT DENTAL SERVICES. — 47
(a) The agency may pay for services necessary to prevent 48
disease and promote oral health, restore oral structures to 49
health and function, and treat emergency conditions, including 50
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 3 of 21
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
routine diagnostic and preventive care, such as dental 51
cleanings, exams, and X rays; basic dental services, such as 52
fillings and extractions; major dental services, such as root 53
canals, crowns, and dentures and other dental prostheses; 54
emergency dental care; and other necessary services related to 55
dental and oral health medically necessary, emergency dental 56
procedures to alleviate pain o r infection. Emergency dental care 57
shall be limited to emergency oral examinations, necessary 58
radiographs, extractions, and incision and drainage of abscess , 59
for a recipient who is 21 years of age or older. 60
(b) Effective July 1, 2025, the agency shall re imburse 61
providers of Medicaid -covered adult dental services at a rate 62
equivalent to 80 percent of the 50th percentile of the 2024 63
Usual, Customary, and Reasonable fees, as determined by the 64
American Dental Association, or a comparable benchmark approved 65
by the agency. The agency shall seek federal approval through a 66
state plan amendment or Medicaid waiver as necessary to achieve 67
compliance with this paragraph The agency may pay for full or 68
partial dentures, the procedures required to seat full or 69
partial dentures, and the repair and reline of full or partial 70
dentures, provided by or under the direction of a licensed 71
dentist, for a recipient who is 21 years of age or older . 72
(c) However, Medicaid will not provide reimbursement for 73
dental services provided in a mobile dental unit, except for a 74
mobile dental unit: 75
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 4 of 21
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
1. Owned by, operated by, or having a contractual 76
agreement with the Department of Health and complying with 77
Medicaid's county health department clinic services program 78
specifications as a county he alth department clinic services 79
provider. 80
2. Owned by, operated by, or having a contractual 81
arrangement with a federally qualified health center and 82
complying with Medicaid's federally qualified health center 83
specifications as a federally qualified healt h center provider. 84
3. Rendering dental services to Medicaid recipients, 21 85
years of age and older, at nursing facilities. 86
4. Owned by, operated by, or having a contractual 87
agreement with a state -approved dental educational institution. 88
(2) ADULT HEALTH SCREENING SERVICES. —The agency may pay 89
for an annual routine physical examination, conducted by or 90
under the direction of a licensed physician, for a recipient age 91
21 or older, without regard to medical necessity, in order to 92
detect and prevent disease, disability, or other health 93
condition or its progression. 94
(3) AMBULATORY SURGICAL CENTER SERVICES. —The agency may 95
pay for services provided to a recipient in an ambulatory 96
surgical center licensed under part I of chapter 395, by or 97
under the direction o f a licensed physician or dentist. 98
(4) BIRTH CENTER SERVICES. —The agency may pay for 99
examinations and delivery, recovery, and newborn assessment, and 100
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 5 of 21
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
related services, provided in a licensed birth center staffed 101
with licensed physicians, certified nurse midwives, and midwives 102
licensed in accordance with chapter 467, to a recipient expected 103
to experience a low-risk pregnancy and delivery. 104
(5) CASE MANAGEMENT SERVICES. —The agency may pay for 105
primary care case management services rendered to a recipient 106
pursuant to a federally approved waiver, and targeted case 107
management services for specific groups of targeted recipients, 108
for which funding has been provided and which are rendered 109
pursuant to federal guidelines. The agency is authorized to 110
limit reimbursement for targeted case management services in 111
order to comply with any limitations or directions provided for 112
in the General Appropriations Act. 113
(6) CHILDREN'S DENTAL SERVICES. —The agency may pay for 114
diagnostic, preventive, or corrective procedures, inclu ding 115
orthodontia in severe cases, provided to a recipient under age 116
21, by or under the supervision of a licensed dentist. The 117
agency may also reimburse a health access setting as defined in 118
s. 466.003 for the remediable tasks that a licensed dental 119
hygienist is authorized to perform under s. 466.024(2). Services 120
provided under this program include treatment of the teeth and 121
associated structures of the oral cavity, as well as treatment 122
of disease, injury, or impairment that may affect the oral or 123
general health of the individual. However, Medicaid will not 124
provide reimbursement for dental services provided in a mobile 125
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 6 of 21
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
dental unit, except for a mobile dental unit: 126
(a) Owned by, operated by, or having a contractual 127
agreement with the Department of Health an d complying with 128
Medicaid's county health department clinic services program 129
specifications as a county health department clinic services 130
provider. 131
(b) Owned by, operated by, or having a contractual 132
arrangement with a federally qualified health center an d 133
complying with Medicaid's federally qualified health center 134
specifications as a federally qualified health center provider. 135
(c) Rendering dental services to Medicaid recipients, 21 136
years of age and older, at nursing facilities. 137
(d) Owned by, operated by, or having a contractual 138
agreement with a state -approved dental educational institution. 139
(7) CHIROPRACTIC SERVICES. —The agency may pay for manual 140
manipulation of the spine and initial services, screening, and X 141
rays provided to a recipient by a licen sed chiropractic 142
physician. 143
(8) COMMUNITY MENTAL HEALTH SERVICES. — 144
(a) The agency may pay for rehabilitative services 145
provided to a recipient by a mental health or substance abuse 146
provider under contract with the agency or the Department of 147
Children and Families to provide such services. Those services 148
which are psychiatric in nature shall be rendered or recommended 149
by a psychiatrist, and those services which are medical in 150
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 7 of 21
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
nature shall be rendered or recommended by a physician or 151
psychiatrist. The agen cy must develop a provider enrollment 152
process for community mental health providers which bases 153
provider enrollment on an assessment of service need. The 154
provider enrollment process shall be designed to control costs, 155
prevent fraud and abuse, consider prov ider expertise and 156
capacity, and assess provider success in managing utilization of 157
care and measuring treatment outcomes. Providers will be 158
selected through a competitive procurement or selective 159
contracting process. In addition to other community mental 160
health providers, the agency shall consider for enrollment 161
mental health programs licensed under chapter 395 and group 162
practices licensed under chapter 458, chapter 459, chapter 490, 163
or chapter 491. The agency is also authorized to continue 164
operation of its behavioral health utilization management 165
program and may develop new services if these actions are 166
necessary to ensure savings from the implementation of the 167
utilization management system. The agency shall coordinate the 168
implementation of this enrollment process with the Department of 169
Children and Families and the Department of Juvenile Justice. 170
The agency is authorized to utilize diagnostic criteria in 171
setting reimbursement rates, to preauthorize certain high -cost 172
or highly utilized services, to limit or eliminate coverage for 173
certain services, or to make any other adjustments necessary to 174
comply with any limitations or directions provided for in the 175
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 8 of 21
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
General Appropriations Act. 176
(b) The agency is authorized to implement reimbursement 177
and use management r eforms in order to comply with any 178
limitations or directions in the General Appropriations Act, 179
which may include, but are not limited to: prior authorization 180
of treatment and service plans; prior authorization of services; 181
enhanced use review programs for highly used services; and 182
limits on services for those determined to be abusing their 183
benefit coverages. 184
(9) DIALYSIS FACILITY SERVICES. —Subject to specific 185
appropriations being provided for this purpose, the agency may 186
pay a dialysis facility that is a pproved as a dialysis facility 187
in accordance with Title XVIII of the Social Security Act, for 188
dialysis services that are provided to a Medicaid recipient 189
under the direction of a physician licensed to practice medicine 190
or osteopathic medicine in this state , including dialysis 191
services provided in the recipient's home by a hospital -based or 192
freestanding dialysis facility. 193
(10) DURABLE MEDICAL EQUIPMENT. —The agency may authorize 194
and pay for certain durable medical equipment and supplies 195
provided to a Medica id recipient as medically necessary. 196
(11) HEALTHY START SERVICES. —The agency may pay for a 197
continuum of risk-appropriate medical and psychosocial services 198
for the Healthy Start program in accordance with a federal 199
waiver. The agency may not implement the federal waiver unless 200
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 9 of 21
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
the waiver permits the state to limit enrollment or the amount, 201
duration, and scope of services to ensure that expenditures will 202
not exceed funds appropriated by the Legislature or available 203
from local sources. If the Health Care Fin ancing Administration 204
does not approve a federal waiver for Healthy Start services, 205
the agency, in consultation with the Department of Health and 206
the Florida Association of Healthy Start Coalitions, is 207
authorized to establish a Medicaid certified -match program for 208
Healthy Start services. Participation in the Healthy Start 209
certified-match program shall be voluntary, and reimbursement 210
shall be limited to the federal Medicaid share to Medicaid -211
enrolled Healthy Start coalitions for services provided to 212
Medicaid recipients. The agency shall take no action to 213
implement a certified -match program without ensuring that the 214
amendment and review requirements of ss. 216.177 and 216.181 215
have been met. 216
(12) HEARING SERVICES. —The agency may pay for hearing and 217
related services, including hearing evaluations, hearing aid 218
devices, dispensing of the hearing aid, and related repairs, if 219
provided to a recipient by a licensed hearing aid specialist, 220
otolaryngologist, otologist, audiologist, or physician. 221
(13) HOME AND COMMUNI TY-BASED SERVICES.— 222
(a) The agency may pay for home -based or community-based 223
services that are rendered to a recipient in accordance with a 224
federally approved waiver program. The agency may limit or 225
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 10 of 21
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
eliminate coverage for certain services, preauthorize h igh-cost 226
or highly utilized services, or make any other adjustments 227
necessary to comply with any limitations or directions provided 228
for in the General Appropriations Act. 229
(b) The agency may implement a utilization management 230
program designed to prior -authorize home and community -based 231
service plans and includes, but is not limited to, assessing 232
proposed quantity and duration of services and monitoring 233
ongoing service use by participants in the program. The agency 234
is authorized to competitively procure a q ualified organization 235
to provide utilization management of home and community -based 236
services. The agency is authorized to seek any federal waivers 237
to implement this initiative. 238
(c) The agency shall request federal approval to develop a 239
system to require payment of premiums or other cost sharing by 240
the parents of a child who is being served by a waiver under 241
this subsection if the adjusted household income is greater than 242
100 percent of the federal poverty level. The amount of the 243
premium or cost sharing s hall be calculated using a sliding 244
scale based on the size of the family, the amount of the 245
parent's adjusted gross income, and the federal poverty 246
guidelines. The premium and cost -sharing system developed by the 247
agency shall not adversely affect federal f unding to the state. 248
After the agency receives federal approval, the Department of 249
Children and Families may collect income information from 250
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 11 of 21
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
parents of children who will be affected by this paragraph. 251
(d) The agency shall seek federal approval to pay for 252
flexible services for persons with severe mental illness or 253
substance use disorders, including, but not limited to, 254
temporary housing assistance. Payments may be made as enhanced 255
capitation rates or incentive payments to managed care plans 256
that meet the requirements of s. 409.968(4). 257
(14) HOSPICE CARE SERVICES. —The agency may pay for all 258
reasonable and necessary services for the palliation or 259
management of a recipient's terminal illness, if the services 260
are provided by a hospice that is licensed under pa rt IV of 261
chapter 400 and meets Medicare certification requirements. 262
(15) INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY 263
DISABLED SERVICES.—The agency may pay for health -related care 264
and services provided on a 24 -hour-a-day basis by a facility 265
licensed and certified as a Medicaid Intermediate Care Facility 266
for the Developmentally Disabled, for a recipient who needs such 267
care because of a developmental disability. Payment shall not 268
include bed-hold days except in facilities with occupancy rates 269
of 95 percent or greater. The agency is authorized to seek any 270
federal waiver approvals to implement this policy. The agency 271
shall seek federal approval to implement a payment rate for 272
Medicaid intermediate care facilities serving individuals with 273
developmental disabilities, severe maladaptive behaviors, severe 274
maladaptive behaviors and co -occurring complex medical 275
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 12 of 21
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
conditions, or a dual diagnosis of developmental disability and 276
mental illness. 277
(16) INTERMEDIATE CARE SERVICES. —The agency may pay for 278
24-hour-a-day intermediate care nursing and rehabilitation 279
services rendered to a recipient in a nursing facility licensed 280
under part II of chapter 400, if the services are ordered by and 281
provided under the direction of a physician. 282
(17) OPTOMETRIC SERVICES. —The agency may pay for services 283
provided to a recipient, including examination, diagnosis, 284
treatment, and management, related to ocular pathology, if the 285
services are provided by a licensed optometrist or physician. 286
(18) PHYSICIAN ASSISTANT SERVICES. —The agency may pay for 287
all services provided to a recipient by a physician assistant 288
licensed under s. 458.347 or s. 459.022. Reimbursement for such 289
services must be not less than 80 percent of the reimbursement 290
that would be paid to a physician who provided the same 291
services. 292
(19) PODIATRIC SERVICES. —The agency may pay for services, 293
including diagnosis and medical, surgical, palliative, and 294
mechanical treatment, related to ailments of the human foot and 295
lower leg, if provided to a recipient by a podiatric physician 296
licensed under state law. 297
(20) PRESCRIBED DRUG SERVICES. —The agency may pay for 298
medications that are prescribed for a recipient by a physician 299
or other licensed practitioner of the healing arts authorized to 300
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 13 of 21
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
prescribe medications and that are dispensed t o the recipient by 301
a licensed pharmacist or physician in accordance with applicable 302
state and federal law. 303
(21) REGISTERED NURSE FIRST ASSISTANT SERVICES. —The agency 304
may pay for all services provided to a recipient by a registered 305
nurse first assistant a s described in s. 464.027. Reimbursement 306
for such services may not be less than 80 percent of the 307
reimbursement that would be paid to a physician providing the 308
same services. 309
(22) STATE HOSPITAL SERVICES. —The agency may pay for all -310
inclusive psychiatric inpatient hospital care provided to a 311
recipient age 65 or older in a state mental hospital. 312
(23) VISUAL SERVICES. —The agency may pay for visual 313
examinations, eyeglasses, and eyeglass repairs for a recipient 314
if they are prescribed by a licensed physician specializing in 315
diseases of the eye or by a licensed optometrist. Eyeglass 316
frames for adult recipients shall be limited to one pair per 317
recipient every 2 years, except a second pair may be provided 318
during that period after prior authorization. Eyeglass len ses 319
for adult recipients shall be limited to one pair per year 320
except a second pair may be provided during that period after 321
prior authorization. 322
(24) CHILD-WELFARE-TARGETED CASE MANAGEMENT. —The Agency 323
for Health Care Administration, in consultation with the 324
Department of Children and Families, may establish a targeted 325
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 14 of 21
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
case-management project in those counties identified by the 326
Department of Children and Families and for all counties with a 327
community-based child welfare project, as authorized under s. 328
409.987 which have been specifically approved by the department. 329
The covered group of individuals who are eligible to receive 330
targeted case management include children who are eligible for 331
Medicaid; who are between the ages of birth through 21; and who 332
are under protective supervision or postplacement supervision, 333
under foster-care supervision, or in shelter care or foster 334
care. The number of individuals who are eligible to receive 335
targeted case management is limited to the number for whom the 336
Department of Children and Families has matching funds to cover 337
the costs. The general revenue funds required to match the funds 338
for services provided by the community -based child welfare 339
projects are limited to funds available for services described 340
under s. 409.990. The Department of Children and Families may 341
transfer the general revenue matching funds as billed by the 342
Agency for Health Care Administration. 343
(25) ASSISTIVE-CARE SERVICES.—The agency may pay for 344
assistive-care services provided to recipients with function al 345
or cognitive impairments residing in assisted living facilities, 346
adult family-care homes, or residential treatment facilities. 347
These services may include health support, assistance with the 348
activities of daily living and the instrumental acts of daily 349
living, assistance with medication administration, and 350
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 15 of 21
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
arrangements for health care. 351
(26) HOME AND COMMUNITY -BASED SERVICES FOR AUTISM SPECTRUM 352
DISORDER AND OTHER DEVELOPMENTAL DISABILITIES. —The agency is 353
authorized to seek federal approval through a Medi caid waiver or 354
a state plan amendment for the provision of occupational 355
therapy, speech therapy, physical therapy, behavior analysis, 356
and behavior assistant services to individuals who are 5 years 357
of age and under and have a diagnosed developmental disabil ity 358
as defined in s. 393.063, autism spectrum disorder as defined in 359
s. 627.6686, or Down syndrome, a genetic disorder caused by the 360
presence of extra chromosomal material on chromosome 21. Causes 361
of the syndrome may include Trisomy 21, Mosaicism, Robertso nian 362
Translocation, and other duplications of a portion of chromosome 363
21. Coverage for such services shall be limited to $36,000 364
annually and may not exceed $108,000 in total lifetime benefits. 365
The agency shall submit an annual report on January 1 to the 366
President of the Senate, the Speaker of the House of 367
Representatives, and the relevant committees of the Senate and 368
the House of Representatives regarding progress on obtaining 369
federal approval and recommendations for the implementation of 370
these home and community-based services. The agency may not 371
implement this subsection without prior legislative approval. 372
(27) ANESTHESIOLOGIST ASSISTANT SERVICES. —The agency may 373
pay for all services provided to a recipient by an 374
anesthesiologist assistant licensed under s. 458.3475 or s. 375
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 16 of 21
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
459.023. Reimbursement for such services must be not less than 376
80 percent of the reimbursement that would be paid to a 377
physician who provided the same services. 378
(28) DONOR HUMAN MILK BANK SERVICES. —The agency may pay 379
for the provision of donor human milk and human milk products 380
derived therefrom for inpatient use, for which a licensed 381
physician, nurse practitioner, physician assistant, or dietitian 382
has issued an order for an infant who is medically or physically 383
unable to receive matern al breast milk or to breastfeed or whose 384
mother is medically or physically unable to produce maternal 385
breast milk or breastfeed. Such infant must have a documented 386
birth weight of 1,800 grams or less; have a congenital or 387
acquired condition and be at high risk for developing a feeding 388
intolerance, necrotizing enterocolitis, or an infection; or 389
otherwise have a medical indication for a human milk diet. The 390
agency shall adopt rules that include, but are not limited to, 391
eligible providers of donor human milk a nd donor human milk 392
derivates. The agency may seek federal approval necessary to 393
implement this subsection. 394
(29) BIOMARKER TESTING SERVICES. — 395
(a) The agency may pay for biomarker testing for the 396
purposes of diagnosis, treatment, appropriate management, or 397
ongoing monitoring of a recipient's disease or condition to 398
guide treatment decisions if medical and scientific evidence 399
indicates that the biomarker testing provides clinical utility 400
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 17 of 21
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
to the recipient. Such medical and scientific evidence includes, 401
but is not limited to: 402
1. A labeled indication for a test approved or cleared by 403
the United States Food and Drug Administration; 404
2. An indicated test for a drug approved by the United 405
States Food and Drug Administration; 406
3. A national coverage determina tion made by the Centers 407
for Medicare and Medicaid Services or a local coverage 408
determination made by the Medicare Administrative Contractor; or 409
4. A nationally recognized clinical practice guideline. As 410
used in this subparagraph, the term "nationally re cognized 411
clinical practice guideline" means an evidence -based clinical 412
practice guideline developed by independent organizations or 413
medical professional societies using a transparent methodology 414
and reporting structure and with a conflict -of-interest policy. 415
Guidelines developed by such organizations or societies 416
establish standards of care informed by a systematic review of 417
evidence and an assessment of the benefits and costs of 418
alternative care options and include recommendations intended to 419
optimize patient care. 420
(b) As used in this subsection, the term: 421
1. "Biomarker" means a defined characteristic that is 422
measured as an indicator of normal biological processes, 423
pathogenic processes, or responses to an exposure or 424
intervention, including therapeutic interventions. The term 425
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 18 of 21
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
includes, but is not limited to, molecular, histologic, 426
radiographic, or physiologic characteristics but does not 427
include an assessment of how a patient feels, functions, or 428
survives. 429
2. "Biomarker testing" means an analysis of a patient's 430
tissue, blood, or other biospecimen for the presence of a 431
biomarker. The term includes, but is not limited to, single 432
analyte tests, multiplex panel tests, protein expression, and 433
whole exome, whole genome, and whole transcriptome sequencing 434
performed at a participating in -network laboratory facility that 435
is certified pursuant to the federal Clinical Laboratory 436
Improvement Amendment (CLIA) or that has obtained a CLIA 437
Certificate of Waiver by the United States Food and Drug 438
Administration for the t ests. 439
3. "Clinical utility" means the test result provides 440
information that is used in the formulation of a treatment or 441
monitoring strategy that informs a patient's outcome and impacts 442
the clinical decision. 443
(c) A recipient and participating provider shall have 444
access to a clear and convenient process to request 445
authorization for biomarker testing as provided under this 446
subsection. Such process shall be made readily accessible to all 447
recipients and participating providers online. 448
(d) This subsection does not require coverage of biomarker 449
testing for screening purposes. 450
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 19 of 21
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
(e) The agency may seek federal approval necessary to 451
implement this subsection. 452
Section 2. Subsection (5) of section 409.973, Florida 453
Statutes, is amended to read: 454
409.973 Benefits.— 455
(5) PROVISION OF DENTAL SERVICES.— 456
(a) The agency shall implement a statewide Medicaid 457
prepaid dental health program for children and adults with a 458
choice of at least two licensed dental Medicaid providers who 459
meet agency standards. 460
(b) The minimum benefits provided by the Medicaid prepaid 461
dental health programs to recipients under age 21 must include 462
all dental benefits required under the early and periodic 463
screening, diagnostic, and treatment services in accordance with 464
42 U.S.C. s. 1396d(r)( 3) and (5). 465
(c) The minimum benefits provided by the Medicaid prepaid 466
dental health program to recipients aged 21 years or older must 467
cover services necessary to prevent disease and promote oral 468
health, restore oral structures to health and function, and 469
treat emergency conditions, including routine diagnostic and 470
preventive care, such as dental cleanings, exams, and X rays; 471
basic dental services, such as fillings and extractions; major 472
dental services, such as root canals, crowns, and dentures and 473
other dental prostheses; emergency dental care; and other 474
necessary services related to dental and oral health. 475
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 20 of 21
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) The Legislature may use the findings of the Office of 476
Program Policy Analysis and Government Accountability's report 477
no. 16-07, December 2016, i n setting the scope of minimum 478
benefits set forth in this section for future procurements of 479
eligible plans as described in s. 409.966. Specifically, the 480
decision to include dental services as a minimum benefit under 481
this section, or to provide Medicaid re cipients with dental 482
benefits separate from the Medicaid managed medical assistance 483
program described in this part, may take into consideration the 484
data and findings of the report. 485
(b) In the event the Legislature takes no action before 486
July 1, 2017, with respect to the report findings required under 487
paragraph (a), the agency shall implement a statewide Medicaid 488
prepaid dental health program for children and adults with a 489
choice of at least two licensed dental managed care providers 490
who must have substant ial experience in providing dental care to 491
Medicaid enrollees and children eligible for medical assistance 492
under Title XXI of the Social Security Act and who meet all 493
agency standards and requirements. To qualify as a provider 494
under the prepaid dental heal th program, the entity must be 495
licensed as a prepaid limited health service organization under 496
part I of chapter 636 or as a health maintenance organization 497
under part I of chapter 641. The contracts for program providers 498
shall be awarded through a competi tive procurement process. 499
Beginning with the contract procurement process initiated during 500
HB 975 2025
CODING: Words stricken are deletions; words underlined are additions.
hb975-00
Page 21 of 21
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
the 2023 calendar year, the contracts must be for 6 years and 501
may not be renewed; however, the agency may extend the term of a 502
plan contract to cover delays during a transition to a new plan 503
provider. The agency shall include in the contracts a medical 504
loss ratio provision consistent with s. 409.967(4). The agency 505
is authorized to seek any necessary state plan amendment or 506
federal waiver to commence enrollment in the Medicaid prepaid 507
dental health program no later than March 1, 2019. The agency 508
shall extend until December 31, 2024, the term of existing plan 509
contracts awarded pursuant to the invitation to negotiate 510
published in October 2017. 511
Section 3. This act shall take effect July 1, 2025. 512