Florida 2025 Regular Session

Florida House Bill H0975 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	HB 975 2025
4	4
5	5
6	6
7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb975-00
9	9	Page 1 of 21
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
11	11
12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to coverage of dental services under 2
16	16	the Medicaid program; amending s. 409.906, F.S.; 3
17	17	removing provisions relating to optional services 4
18	18	rendered by providers in mobile units to Medicaid 5
19	19	recipients; adjustments in the Medicaid program due to 6
20	20	availability of moneys, limitations, and certain 7
21	21	directions; and the removal of certain Medicaid 8
22	22	service; revising adult dental services that are paid 9
23	23	by the Agency for Health Care Administration as 10
24	24	optional Medicaid services; requiring the agency to 11
25	25	reimburse Medicaid providers at a specified rate for 12
26	26	covered adult dental services; requiring the agency to 13
27	27	seek federal approval; amending s. 409.973, F.S.; 14
28	28	requiring the agency to implement a statewide Medicaid 15
29	29	prepaid dental health program for children and adults; 16
30	30	providing requirements for the benefits under the 17
31	31	program; removing obsolete language; providing an 18
32	32	effective date. 19
33	33	20
34	34	Be It Enacted by the Legislature of the State of Florida: 21
35	35	22
36	36	Section 1. Section 409.906, Florida Statutes, is amended 23
37	37	to read: 24
38	38	409.906 Optional Medicaid services. —Subject to specific 25
39	39
40	40	HB 975 2025
41	41
42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb975-00
46	46	Page 2 of 21
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
48	48
49	49
50	50
51	51	appropriations, the agency may make payments for services which 26
52	52	are optional to the state under Title XIX of the Social Security 27
53	53	Act and are furnished by Medicaid providers to recipients who 28
54	54	are determined to be eligible on the dates on which the services 29
55	55	were provided. Any optional service that is provided shall be 30
56	56	provided only when medically necessary and in accordance with 31
57	57	state and federal law. Optional services rendered by providers 32
58	58	in mobile units to Medicaid recipients may be restricted or 33
59	59	prohibited by the agency. Nothing in this section shall be 34
60	60	construed to prevent or limit the agency from adjus ting fees, 35
61	61	reimbursement rates, lengths of stay, number of visits, or 36
62	62	number of services, or making any other adjustments necessary to 37
63	63	comply with the availability of moneys and any limitations or 38
64	64	directions provided for in the General Appropriations Act o r 39
65	65	chapter 216. If necessary to safeguard the state's systems of 40
66	66	providing services to elderly and disabled persons and subject 41
67	67	to the notice and review provisions of s. 216.177, the Governor 42
68	68	may direct the Agency for Health Care Administration to amend 43
69	69	the Medicaid state plan to delete the optional Medicaid service 44
70	70	known as "Intermediate Care Facilities for the Developmentally 45
71	71	Disabled." Optional services may include: 46
72	72	(1) ADULT DENTAL SERVICES. — 47
73	73	(a) The agency may pay for services necessary to prevent 48
74	74	disease and promote oral health, restore oral structures to 49
75	75	health and function, and treat emergency conditions, including 50
76	76
77	77	HB 975 2025
78	78
79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb975-00
83	83	Page 3 of 21
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
85	85
86	86
87	87
88	88	routine diagnostic and preventive care, such as dental 51
89	89	cleanings, exams, and X rays; basic dental services, such as 52
90	90	fillings and extractions; major dental services, such as root 53
91	91	canals, crowns, and dentures and other dental prostheses; 54
92	92	emergency dental care; and other necessary services related to 55
93	93	dental and oral health medically necessary, emergency dental 56
94	94	procedures to alleviate pain o r infection. Emergency dental care 57
95	95	shall be limited to emergency oral examinations, necessary 58
96	96	radiographs, extractions, and incision and drainage of abscess , 59
97	97	for a recipient who is 21 years of age or older. 60
98	98	(b) Effective July 1, 2025, the agency shall re imburse 61
99	99	providers of Medicaid -covered adult dental services at a rate 62
100	100	equivalent to 80 percent of the 50th percentile of the 2024 63
101	101	Usual, Customary, and Reasonable fees, as determined by the 64
102	102	American Dental Association, or a comparable benchmark approved 65
103	103	by the agency. The agency shall seek federal approval through a 66
104	104	state plan amendment or Medicaid waiver as necessary to achieve 67
105	105	compliance with this paragraph The agency may pay for full or 68
106	106	partial dentures, the procedures required to seat full or 69
107	107	partial dentures, and the repair and reline of full or partial 70
108	108	dentures, provided by or under the direction of a licensed 71
109	109	dentist, for a recipient who is 21 years of age or older . 72
110	110	(c) However, Medicaid will not provide reimbursement for 73
111	111	dental services provided in a mobile dental unit, except for a 74
112	112	mobile dental unit: 75
113	113
114	114	HB 975 2025
115	115
116	116
117	117
118	118	CODING: Words stricken are deletions; words underlined are additions.
119	119	hb975-00
120	120	Page 4 of 21
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
124	124
125	125	1. Owned by, operated by, or having a contractual 76
126	126	agreement with the Department of Health and complying with 77
127	127	Medicaid's county health department clinic services program 78
128	128	specifications as a county he alth department clinic services 79
129	129	provider. 80
130	130	2. Owned by, operated by, or having a contractual 81
131	131	arrangement with a federally qualified health center and 82
132	132	complying with Medicaid's federally qualified health center 83
133	133	specifications as a federally qualified healt h center provider. 84
134	134	3. Rendering dental services to Medicaid recipients, 21 85
135	135	years of age and older, at nursing facilities. 86
136	136	4. Owned by, operated by, or having a contractual 87
137	137	agreement with a state -approved dental educational institution. 88
138	138	(2) ADULT HEALTH SCREENING SERVICES. —The agency may pay 89
139	139	for an annual routine physical examination, conducted by or 90
140	140	under the direction of a licensed physician, for a recipient age 91
141	141	21 or older, without regard to medical necessity, in order to 92
142	142	detect and prevent disease, disability, or other health 93
143	143	condition or its progression. 94
144	144	(3) AMBULATORY SURGICAL CENTER SERVICES. —The agency may 95
145	145	pay for services provided to a recipient in an ambulatory 96
146	146	surgical center licensed under part I of chapter 395, by or 97
147	147	under the direction o f a licensed physician or dentist. 98
148	148	(4) BIRTH CENTER SERVICES. —The agency may pay for 99
149	149	examinations and delivery, recovery, and newborn assessment, and 100
150	150
151	151	HB 975 2025
152	152
153	153
154	154
155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb975-00
157	157	Page 5 of 21
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
159	159
160	160
161	161
162	162	related services, provided in a licensed birth center staffed 101
163	163	with licensed physicians, certified nurse midwives, and midwives 102
164	164	licensed in accordance with chapter 467, to a recipient expected 103
165	165	to experience a low-risk pregnancy and delivery. 104
166	166	(5) CASE MANAGEMENT SERVICES. —The agency may pay for 105
167	167	primary care case management services rendered to a recipient 106
168	168	pursuant to a federally approved waiver, and targeted case 107
169	169	management services for specific groups of targeted recipients, 108
170	170	for which funding has been provided and which are rendered 109
171	171	pursuant to federal guidelines. The agency is authorized to 110
172	172	limit reimbursement for targeted case management services in 111
173	173	order to comply with any limitations or directions provided for 112
174	174	in the General Appropriations Act. 113
175	175	(6) CHILDREN'S DENTAL SERVICES. —The agency may pay for 114
176	176	diagnostic, preventive, or corrective procedures, inclu ding 115
177	177	orthodontia in severe cases, provided to a recipient under age 116
178	178	21, by or under the supervision of a licensed dentist. The 117
179	179	agency may also reimburse a health access setting as defined in 118
180	180	s. 466.003 for the remediable tasks that a licensed dental 119
181	181	hygienist is authorized to perform under s. 466.024(2). Services 120
182	182	provided under this program include treatment of the teeth and 121
183	183	associated structures of the oral cavity, as well as treatment 122
184	184	of disease, injury, or impairment that may affect the oral or 123
185	185	general health of the individual. However, Medicaid will not 124
186	186	provide reimbursement for dental services provided in a mobile 125
187	187
188	188	HB 975 2025
189	189
190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb975-00
194	194	Page 6 of 21
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
196	196
197	197
198	198
199	199	dental unit, except for a mobile dental unit: 126
200	200	(a) Owned by, operated by, or having a contractual 127
201	201	agreement with the Department of Health an d complying with 128
202	202	Medicaid's county health department clinic services program 129
203	203	specifications as a county health department clinic services 130
204	204	provider. 131
205	205	(b) Owned by, operated by, or having a contractual 132
206	206	arrangement with a federally qualified health center an d 133
207	207	complying with Medicaid's federally qualified health center 134
208	208	specifications as a federally qualified health center provider. 135
209	209	(c) Rendering dental services to Medicaid recipients, 21 136
210	210	years of age and older, at nursing facilities. 137
211	211	(d) Owned by, operated by, or having a contractual 138
212	212	agreement with a state -approved dental educational institution. 139
213	213	(7) CHIROPRACTIC SERVICES. —The agency may pay for manual 140
214	214	manipulation of the spine and initial services, screening, and X 141
215	215	rays provided to a recipient by a licen sed chiropractic 142
216	216	physician. 143
217	217	(8) COMMUNITY MENTAL HEALTH SERVICES. — 144
218	218	(a) The agency may pay for rehabilitative services 145
219	219	provided to a recipient by a mental health or substance abuse 146
220	220	provider under contract with the agency or the Department of 147
221	221	Children and Families to provide such services. Those services 148
222	222	which are psychiatric in nature shall be rendered or recommended 149
223	223	by a psychiatrist, and those services which are medical in 150
224	224
225	225	HB 975 2025
226	226
227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb975-00
231	231	Page 7 of 21
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
233	233
234	234
235	235
236	236	nature shall be rendered or recommended by a physician or 151
237	237	psychiatrist. The agen cy must develop a provider enrollment 152
238	238	process for community mental health providers which bases 153
239	239	provider enrollment on an assessment of service need. The 154
240	240	provider enrollment process shall be designed to control costs, 155
241	241	prevent fraud and abuse, consider prov ider expertise and 156
242	242	capacity, and assess provider success in managing utilization of 157
243	243	care and measuring treatment outcomes. Providers will be 158
244	244	selected through a competitive procurement or selective 159
245	245	contracting process. In addition to other community mental 160
246	246	health providers, the agency shall consider for enrollment 161
247	247	mental health programs licensed under chapter 395 and group 162
248	248	practices licensed under chapter 458, chapter 459, chapter 490, 163
249	249	or chapter 491. The agency is also authorized to continue 164
250	250	operation of its behavioral health utilization management 165
251	251	program and may develop new services if these actions are 166
252	252	necessary to ensure savings from the implementation of the 167
253	253	utilization management system. The agency shall coordinate the 168
254	254	implementation of this enrollment process with the Department of 169
255	255	Children and Families and the Department of Juvenile Justice. 170
256	256	The agency is authorized to utilize diagnostic criteria in 171
257	257	setting reimbursement rates, to preauthorize certain high -cost 172
258	258	or highly utilized services, to limit or eliminate coverage for 173
259	259	certain services, or to make any other adjustments necessary to 174
260	260	comply with any limitations or directions provided for in the 175
261	261
262	262	HB 975 2025
263	263
264	264
265	265
266	266	CODING: Words stricken are deletions; words underlined are additions.
267	267	hb975-00
268	268	Page 8 of 21
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
270	270
271	271
272	272
273	273	General Appropriations Act. 176
274	274	(b) The agency is authorized to implement reimbursement 177
275	275	and use management r eforms in order to comply with any 178
276	276	limitations or directions in the General Appropriations Act, 179
277	277	which may include, but are not limited to: prior authorization 180
278	278	of treatment and service plans; prior authorization of services; 181
279	279	enhanced use review programs for highly used services; and 182
280	280	limits on services for those determined to be abusing their 183
281	281	benefit coverages. 184
282	282	(9) DIALYSIS FACILITY SERVICES. —Subject to specific 185
283	283	appropriations being provided for this purpose, the agency may 186
284	284	pay a dialysis facility that is a pproved as a dialysis facility 187
285	285	in accordance with Title XVIII of the Social Security Act, for 188
286	286	dialysis services that are provided to a Medicaid recipient 189
287	287	under the direction of a physician licensed to practice medicine 190
288	288	or osteopathic medicine in this state , including dialysis 191
289	289	services provided in the recipient's home by a hospital -based or 192
290	290	freestanding dialysis facility. 193
291	291	(10) DURABLE MEDICAL EQUIPMENT. —The agency may authorize 194
292	292	and pay for certain durable medical equipment and supplies 195
293	293	provided to a Medica id recipient as medically necessary. 196
294	294	(11) HEALTHY START SERVICES. —The agency may pay for a 197
295	295	continuum of risk-appropriate medical and psychosocial services 198
296	296	for the Healthy Start program in accordance with a federal 199
297	297	waiver. The agency may not implement the federal waiver unless 200
298	298
299	299	HB 975 2025
300	300
301	301
302	302
303	303	CODING: Words stricken are deletions; words underlined are additions.
304	304	hb975-00
305	305	Page 9 of 21
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
307	307
308	308
309	309
310	310	the waiver permits the state to limit enrollment or the amount, 201
311	311	duration, and scope of services to ensure that expenditures will 202
312	312	not exceed funds appropriated by the Legislature or available 203
313	313	from local sources. If the Health Care Fin ancing Administration 204
314	314	does not approve a federal waiver for Healthy Start services, 205
315	315	the agency, in consultation with the Department of Health and 206
316	316	the Florida Association of Healthy Start Coalitions, is 207
317	317	authorized to establish a Medicaid certified -match program for 208
318	318	Healthy Start services. Participation in the Healthy Start 209
319	319	certified-match program shall be voluntary, and reimbursement 210
320	320	shall be limited to the federal Medicaid share to Medicaid -211
321	321	enrolled Healthy Start coalitions for services provided to 212
322	322	Medicaid recipients. The agency shall take no action to 213
323	323	implement a certified -match program without ensuring that the 214
324	324	amendment and review requirements of ss. 216.177 and 216.181 215
325	325	have been met. 216
326	326	(12) HEARING SERVICES. —The agency may pay for hearing and 217
327	327	related services, including hearing evaluations, hearing aid 218
328	328	devices, dispensing of the hearing aid, and related repairs, if 219
329	329	provided to a recipient by a licensed hearing aid specialist, 220
330	330	otolaryngologist, otologist, audiologist, or physician. 221
331	331	(13) HOME AND COMMUNI TY-BASED SERVICES.— 222
332	332	(a) The agency may pay for home -based or community-based 223
333	333	services that are rendered to a recipient in accordance with a 224
334	334	federally approved waiver program. The agency may limit or 225
335	335
336	336	HB 975 2025
337	337
338	338
339	339
340	340	CODING: Words stricken are deletions; words underlined are additions.
341	341	hb975-00
342	342	Page 10 of 21
343	343	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
344	344
345	345
346	346
347	347	eliminate coverage for certain services, preauthorize h igh-cost 226
348	348	or highly utilized services, or make any other adjustments 227
349	349	necessary to comply with any limitations or directions provided 228
350	350	for in the General Appropriations Act. 229
351	351	(b) The agency may implement a utilization management 230
352	352	program designed to prior -authorize home and community -based 231
353	353	service plans and includes, but is not limited to, assessing 232
354	354	proposed quantity and duration of services and monitoring 233
355	355	ongoing service use by participants in the program. The agency 234
356	356	is authorized to competitively procure a q ualified organization 235
357	357	to provide utilization management of home and community -based 236
358	358	services. The agency is authorized to seek any federal waivers 237
359	359	to implement this initiative. 238
360	360	(c) The agency shall request federal approval to develop a 239
361	361	system to require payment of premiums or other cost sharing by 240
362	362	the parents of a child who is being served by a waiver under 241
363	363	this subsection if the adjusted household income is greater than 242
364	364	100 percent of the federal poverty level. The amount of the 243
365	365	premium or cost sharing s hall be calculated using a sliding 244
366	366	scale based on the size of the family, the amount of the 245
367	367	parent's adjusted gross income, and the federal poverty 246
368	368	guidelines. The premium and cost -sharing system developed by the 247
369	369	agency shall not adversely affect federal f unding to the state. 248
370	370	After the agency receives federal approval, the Department of 249
371	371	Children and Families may collect income information from 250
372	372
373	373	HB 975 2025
374	374
375	375
376	376
377	377	CODING: Words stricken are deletions; words underlined are additions.
378	378	hb975-00
379	379	Page 11 of 21
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
381	381
382	382
383	383
384	384	parents of children who will be affected by this paragraph. 251
385	385	(d) The agency shall seek federal approval to pay for 252
386	386	flexible services for persons with severe mental illness or 253
387	387	substance use disorders, including, but not limited to, 254
388	388	temporary housing assistance. Payments may be made as enhanced 255
389	389	capitation rates or incentive payments to managed care plans 256
390	390	that meet the requirements of s. 409.968(4). 257
391	391	(14) HOSPICE CARE SERVICES. —The agency may pay for all 258
392	392	reasonable and necessary services for the palliation or 259
393	393	management of a recipient's terminal illness, if the services 260
394	394	are provided by a hospice that is licensed under pa rt IV of 261
395	395	chapter 400 and meets Medicare certification requirements. 262
396	396	(15) INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY 263
397	397	DISABLED SERVICES.—The agency may pay for health -related care 264
398	398	and services provided on a 24 -hour-a-day basis by a facility 265
399	399	licensed and certified as a Medicaid Intermediate Care Facility 266
400	400	for the Developmentally Disabled, for a recipient who needs such 267
401	401	care because of a developmental disability. Payment shall not 268
402	402	include bed-hold days except in facilities with occupancy rates 269
403	403	of 95 percent or greater. The agency is authorized to seek any 270
404	404	federal waiver approvals to implement this policy. The agency 271
405	405	shall seek federal approval to implement a payment rate for 272
406	406	Medicaid intermediate care facilities serving individuals with 273
407	407	developmental disabilities, severe maladaptive behaviors, severe 274
408	408	maladaptive behaviors and co -occurring complex medical 275
409	409
410	410	HB 975 2025
411	411
412	412
413	413
414	414	CODING: Words stricken are deletions; words underlined are additions.
415	415	hb975-00
416	416	Page 12 of 21
417	417	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
418	418
419	419
420	420
421	421	conditions, or a dual diagnosis of developmental disability and 276
422	422	mental illness. 277
423	423	(16) INTERMEDIATE CARE SERVICES. —The agency may pay for 278
424	424	24-hour-a-day intermediate care nursing and rehabilitation 279
425	425	services rendered to a recipient in a nursing facility licensed 280
426	426	under part II of chapter 400, if the services are ordered by and 281
427	427	provided under the direction of a physician. 282
428	428	(17) OPTOMETRIC SERVICES. —The agency may pay for services 283
429	429	provided to a recipient, including examination, diagnosis, 284
430	430	treatment, and management, related to ocular pathology, if the 285
431	431	services are provided by a licensed optometrist or physician. 286
432	432	(18) PHYSICIAN ASSISTANT SERVICES. —The agency may pay for 287
433	433	all services provided to a recipient by a physician assistant 288
434	434	licensed under s. 458.347 or s. 459.022. Reimbursement for such 289
435	435	services must be not less than 80 percent of the reimbursement 290
436	436	that would be paid to a physician who provided the same 291
437	437	services. 292
438	438	(19) PODIATRIC SERVICES. —The agency may pay for services, 293
439	439	including diagnosis and medical, surgical, palliative, and 294
440	440	mechanical treatment, related to ailments of the human foot and 295
441	441	lower leg, if provided to a recipient by a podiatric physician 296
442	442	licensed under state law. 297
443	443	(20) PRESCRIBED DRUG SERVICES. —The agency may pay for 298
444	444	medications that are prescribed for a recipient by a physician 299
445	445	or other licensed practitioner of the healing arts authorized to 300
446	446
447	447	HB 975 2025
448	448
449	449
450	450
451	451	CODING: Words stricken are deletions; words underlined are additions.
452	452	hb975-00
453	453	Page 13 of 21
454	454	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
455	455
456	456
457	457
458	458	prescribe medications and that are dispensed t o the recipient by 301
459	459	a licensed pharmacist or physician in accordance with applicable 302
460	460	state and federal law. 303
461	461	(21) REGISTERED NURSE FIRST ASSISTANT SERVICES. —The agency 304
462	462	may pay for all services provided to a recipient by a registered 305
463	463	nurse first assistant a s described in s. 464.027. Reimbursement 306
464	464	for such services may not be less than 80 percent of the 307
465	465	reimbursement that would be paid to a physician providing the 308
466	466	same services. 309
467	467	(22) STATE HOSPITAL SERVICES. —The agency may pay for all -310
468	468	inclusive psychiatric inpatient hospital care provided to a 311
469	469	recipient age 65 or older in a state mental hospital. 312
470	470	(23) VISUAL SERVICES. —The agency may pay for visual 313
471	471	examinations, eyeglasses, and eyeglass repairs for a recipient 314
472	472	if they are prescribed by a licensed physician specializing in 315
473	473	diseases of the eye or by a licensed optometrist. Eyeglass 316
474	474	frames for adult recipients shall be limited to one pair per 317
475	475	recipient every 2 years, except a second pair may be provided 318
476	476	during that period after prior authorization. Eyeglass len ses 319
477	477	for adult recipients shall be limited to one pair per year 320
478	478	except a second pair may be provided during that period after 321
479	479	prior authorization. 322
480	480	(24) CHILD-WELFARE-TARGETED CASE MANAGEMENT. —The Agency 323
481	481	for Health Care Administration, in consultation with the 324
482	482	Department of Children and Families, may establish a targeted 325
483	483
484	484	HB 975 2025
485	485
486	486
487	487
488	488	CODING: Words stricken are deletions; words underlined are additions.
489	489	hb975-00
490	490	Page 14 of 21
491	491	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
492	492
493	493
494	494
495	495	case-management project in those counties identified by the 326
496	496	Department of Children and Families and for all counties with a 327
497	497	community-based child welfare project, as authorized under s. 328
498	498	409.987 which have been specifically approved by the department. 329
499	499	The covered group of individuals who are eligible to receive 330
500	500	targeted case management include children who are eligible for 331
501	501	Medicaid; who are between the ages of birth through 21; and who 332
502	502	are under protective supervision or postplacement supervision, 333
503	503	under foster-care supervision, or in shelter care or foster 334
504	504	care. The number of individuals who are eligible to receive 335
505	505	targeted case management is limited to the number for whom the 336
506	506	Department of Children and Families has matching funds to cover 337
507	507	the costs. The general revenue funds required to match the funds 338
508	508	for services provided by the community -based child welfare 339
509	509	projects are limited to funds available for services described 340
510	510	under s. 409.990. The Department of Children and Families may 341
511	511	transfer the general revenue matching funds as billed by the 342
512	512	Agency for Health Care Administration. 343
513	513	(25) ASSISTIVE-CARE SERVICES.—The agency may pay for 344
514	514	assistive-care services provided to recipients with function al 345
515	515	or cognitive impairments residing in assisted living facilities, 346
516	516	adult family-care homes, or residential treatment facilities. 347
517	517	These services may include health support, assistance with the 348
518	518	activities of daily living and the instrumental acts of daily 349
519	519	living, assistance with medication administration, and 350
520	520
521	521	HB 975 2025
522	522
523	523
524	524
525	525	CODING: Words stricken are deletions; words underlined are additions.
526	526	hb975-00
527	527	Page 15 of 21
528	528	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
529	529
530	530
531	531
532	532	arrangements for health care. 351
533	533	(26) HOME AND COMMUNITY -BASED SERVICES FOR AUTISM SPECTRUM 352
534	534	DISORDER AND OTHER DEVELOPMENTAL DISABILITIES. —The agency is 353
535	535	authorized to seek federal approval through a Medi caid waiver or 354
536	536	a state plan amendment for the provision of occupational 355
537	537	therapy, speech therapy, physical therapy, behavior analysis, 356
538	538	and behavior assistant services to individuals who are 5 years 357
539	539	of age and under and have a diagnosed developmental disabil ity 358
540	540	as defined in s. 393.063, autism spectrum disorder as defined in 359
541	541	s. 627.6686, or Down syndrome, a genetic disorder caused by the 360
542	542	presence of extra chromosomal material on chromosome 21. Causes 361
543	543	of the syndrome may include Trisomy 21, Mosaicism, Robertso nian 362
544	544	Translocation, and other duplications of a portion of chromosome 363
545	545	21. Coverage for such services shall be limited to $36,000 364
546	546	annually and may not exceed $108,000 in total lifetime benefits. 365
547	547	The agency shall submit an annual report on January 1 to the 366
548	548	President of the Senate, the Speaker of the House of 367
549	549	Representatives, and the relevant committees of the Senate and 368
550	550	the House of Representatives regarding progress on obtaining 369
551	551	federal approval and recommendations for the implementation of 370
552	552	these home and community-based services. The agency may not 371
553	553	implement this subsection without prior legislative approval. 372
554	554	(27) ANESTHESIOLOGIST ASSISTANT SERVICES. —The agency may 373
555	555	pay for all services provided to a recipient by an 374
556	556	anesthesiologist assistant licensed under s. 458.3475 or s. 375
557	557
558	558	HB 975 2025
559	559
560	560
561	561
562	562	CODING: Words stricken are deletions; words underlined are additions.
563	563	hb975-00
564	564	Page 16 of 21
565	565	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
566	566
567	567
568	568
569	569	459.023. Reimbursement for such services must be not less than 376
570	570	80 percent of the reimbursement that would be paid to a 377
571	571	physician who provided the same services. 378
572	572	(28) DONOR HUMAN MILK BANK SERVICES. —The agency may pay 379
573	573	for the provision of donor human milk and human milk products 380
574	574	derived therefrom for inpatient use, for which a licensed 381
575	575	physician, nurse practitioner, physician assistant, or dietitian 382
576	576	has issued an order for an infant who is medically or physically 383
577	577	unable to receive matern al breast milk or to breastfeed or whose 384
578	578	mother is medically or physically unable to produce maternal 385
579	579	breast milk or breastfeed. Such infant must have a documented 386
580	580	birth weight of 1,800 grams or less; have a congenital or 387
581	581	acquired condition and be at high risk for developing a feeding 388
582	582	intolerance, necrotizing enterocolitis, or an infection; or 389
583	583	otherwise have a medical indication for a human milk diet. The 390
584	584	agency shall adopt rules that include, but are not limited to, 391
585	585	eligible providers of donor human milk a nd donor human milk 392
586	586	derivates. The agency may seek federal approval necessary to 393
587	587	implement this subsection. 394
588	588	(29) BIOMARKER TESTING SERVICES. — 395
589	589	(a) The agency may pay for biomarker testing for the 396
590	590	purposes of diagnosis, treatment, appropriate management, or 397
591	591	ongoing monitoring of a recipient's disease or condition to 398
592	592	guide treatment decisions if medical and scientific evidence 399
593	593	indicates that the biomarker testing provides clinical utility 400
594	594
595	595	HB 975 2025
596	596
597	597
598	598
599	599	CODING: Words stricken are deletions; words underlined are additions.
600	600	hb975-00
601	601	Page 17 of 21
602	602	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
603	603
604	604
605	605
606	606	to the recipient. Such medical and scientific evidence includes, 401
607	607	but is not limited to: 402
608	608	1. A labeled indication for a test approved or cleared by 403
609	609	the United States Food and Drug Administration; 404
610	610	2. An indicated test for a drug approved by the United 405
611	611	States Food and Drug Administration; 406
612	612	3. A national coverage determina tion made by the Centers 407
613	613	for Medicare and Medicaid Services or a local coverage 408
614	614	determination made by the Medicare Administrative Contractor; or 409
615	615	4. A nationally recognized clinical practice guideline. As 410
616	616	used in this subparagraph, the term "nationally re cognized 411
617	617	clinical practice guideline" means an evidence -based clinical 412
618	618	practice guideline developed by independent organizations or 413
619	619	medical professional societies using a transparent methodology 414
620	620	and reporting structure and with a conflict -of-interest policy. 415
621	621	Guidelines developed by such organizations or societies 416
622	622	establish standards of care informed by a systematic review of 417
623	623	evidence and an assessment of the benefits and costs of 418
624	624	alternative care options and include recommendations intended to 419
625	625	optimize patient care. 420
626	626	(b) As used in this subsection, the term: 421
627	627	1. "Biomarker" means a defined characteristic that is 422
628	628	measured as an indicator of normal biological processes, 423
629	629	pathogenic processes, or responses to an exposure or 424
630	630	intervention, including therapeutic interventions. The term 425
631	631
632	632	HB 975 2025
633	633
634	634
635	635
636	636	CODING: Words stricken are deletions; words underlined are additions.
637	637	hb975-00
638	638	Page 18 of 21
639	639	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
640	640
641	641
642	642
643	643	includes, but is not limited to, molecular, histologic, 426
644	644	radiographic, or physiologic characteristics but does not 427
645	645	include an assessment of how a patient feels, functions, or 428
646	646	survives. 429
647	647	2. "Biomarker testing" means an analysis of a patient's 430
648	648	tissue, blood, or other biospecimen for the presence of a 431
649	649	biomarker. The term includes, but is not limited to, single 432
650	650	analyte tests, multiplex panel tests, protein expression, and 433
651	651	whole exome, whole genome, and whole transcriptome sequencing 434
652	652	performed at a participating in -network laboratory facility that 435
653	653	is certified pursuant to the federal Clinical Laboratory 436
654	654	Improvement Amendment (CLIA) or that has obtained a CLIA 437
655	655	Certificate of Waiver by the United States Food and Drug 438
656	656	Administration for the t ests. 439
657	657	3. "Clinical utility" means the test result provides 440
658	658	information that is used in the formulation of a treatment or 441
659	659	monitoring strategy that informs a patient's outcome and impacts 442
660	660	the clinical decision. 443
661	661	(c) A recipient and participating provider shall have 444
662	662	access to a clear and convenient process to request 445
663	663	authorization for biomarker testing as provided under this 446
664	664	subsection. Such process shall be made readily accessible to all 447
665	665	recipients and participating providers online. 448
666	666	(d) This subsection does not require coverage of biomarker 449
667	667	testing for screening purposes. 450
668	668
669	669	HB 975 2025
670	670
671	671
672	672
673	673	CODING: Words stricken are deletions; words underlined are additions.
674	674	hb975-00
675	675	Page 19 of 21
676	676	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
677	677
678	678
679	679
680	680	(e) The agency may seek federal approval necessary to 451
681	681	implement this subsection. 452
682	682	Section 2. Subsection (5) of section 409.973, Florida 453
683	683	Statutes, is amended to read: 454
684	684	409.973 Benefits.— 455
685	685	(5) PROVISION OF DENTAL SERVICES.— 456
686	686	(a) The agency shall implement a statewide Medicaid 457
687	687	prepaid dental health program for children and adults with a 458
688	688	choice of at least two licensed dental Medicaid providers who 459
689	689	meet agency standards. 460
690	690	(b) The minimum benefits provided by the Medicaid prepaid 461
691	691	dental health programs to recipients under age 21 must include 462
692	692	all dental benefits required under the early and periodic 463
693	693	screening, diagnostic, and treatment services in accordance with 464
694	694	42 U.S.C. s. 1396d(r)( 3) and (5). 465
695	695	(c) The minimum benefits provided by the Medicaid prepaid 466
696	696	dental health program to recipients aged 21 years or older must 467
697	697	cover services necessary to prevent disease and promote oral 468
698	698	health, restore oral structures to health and function, and 469
699	699	treat emergency conditions, including routine diagnostic and 470
700	700	preventive care, such as dental cleanings, exams, and X rays; 471
701	701	basic dental services, such as fillings and extractions; major 472
702	702	dental services, such as root canals, crowns, and dentures and 473
703	703	other dental prostheses; emergency dental care; and other 474
704	704	necessary services related to dental and oral health. 475
705	705
706	706	HB 975 2025
707	707
708	708
709	709
710	710	CODING: Words stricken are deletions; words underlined are additions.
711	711	hb975-00
712	712	Page 20 of 21
713	713	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
714	714
715	715
716	716
717	717	(a) The Legislature may use the findings of the Office of 476
718	718	Program Policy Analysis and Government Accountability's report 477
719	719	no. 16-07, December 2016, i n setting the scope of minimum 478
720	720	benefits set forth in this section for future procurements of 479
721	721	eligible plans as described in s. 409.966. Specifically, the 480
722	722	decision to include dental services as a minimum benefit under 481
723	723	this section, or to provide Medicaid re cipients with dental 482
724	724	benefits separate from the Medicaid managed medical assistance 483
725	725	program described in this part, may take into consideration the 484
726	726	data and findings of the report. 485
727	727	(b) In the event the Legislature takes no action before 486
728	728	July 1, 2017, with respect to the report findings required under 487
729	729	paragraph (a), the agency shall implement a statewide Medicaid 488
730	730	prepaid dental health program for children and adults with a 489
731	731	choice of at least two licensed dental managed care providers 490
732	732	who must have substant ial experience in providing dental care to 491
733	733	Medicaid enrollees and children eligible for medical assistance 492
734	734	under Title XXI of the Social Security Act and who meet all 493
735	735	agency standards and requirements. To qualify as a provider 494
736	736	under the prepaid dental heal th program, the entity must be 495
737	737	licensed as a prepaid limited health service organization under 496
738	738	part I of chapter 636 or as a health maintenance organization 497
739	739	under part I of chapter 641. The contracts for program providers 498
740	740	shall be awarded through a competi tive procurement process. 499
741	741	Beginning with the contract procurement process initiated during 500
742	742
743	743	HB 975 2025
744	744
745	745
746	746
747	747	CODING: Words stricken are deletions; words underlined are additions.
748	748	hb975-00
749	749	Page 21 of 21
750	750	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
751	751
752	752
753	753
754	754	the 2023 calendar year, the contracts must be for 6 years and 501
755	755	may not be renewed; however, the agency may extend the term of a 502
756	756	plan contract to cover delays during a transition to a new plan 503
757	757	provider. The agency shall include in the contracts a medical 504
758	758	loss ratio provision consistent with s. 409.967(4). The agency 505
759	759	is authorized to seek any necessary state plan amendment or 506
760	760	federal waiver to commence enrollment in the Medicaid prepaid 507
761	761	dental health program no later than March 1, 2019. The agency 508
762	762	shall extend until December 31, 2024, the term of existing plan 509
763	763	contracts awarded pursuant to the invitation to negotiate 510
764	764	published in October 2017. 511
765	765	Section 3. This act shall take effect July 1, 2025. 512