Florida Senate - 2024 SB 488
By Senator Polsky
30-01023-24 2024488__
1 A bill to be entitled
2 An act relating to Medicaid coverage for prescribed
3 foods for disease treatment and prevention; creating
4 s. 409.90203, F.S.; defining terms; requiring the
5 Agency for Health Care Administration, in conjunction
6 with the Department of Health, to establish the Food
7 is Medicine Pilot Program to provide Medicaid coverage
8 for purchases and deliveries of prescribed health
9 promoting foods under certain circumstances; requiring
10 the agency, in conjunction with the department, to
11 seek federal approval and waivers for the pilot
12 program; requiring the federal waiver application to
13 seek matching funds; requiring referrals of pilot
14 program patients to certain federal and federally
15 funded programs; requiring allocation of a portion of
16 the pilot program implementation budget to a specified
17 organization for the establishment of a specified
18 center; providing operation requirements for the
19 center; providing reporting requirements; requiring
20 the agency, in conjunction with the department, to
21 adopt rules; providing requirements for the rules;
22 providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Section 409.90203, Florida Statutes, is created
27 to read:
28 409.90203 Food is Medicine Pilot Program; Medicaid coverage
29 for pilot program; federal approval and waivers; Florida Food is
30 Medicine Center of Excellence.—
31 (1) As used in this section, the term:
32 (a) “Center,” unless the context clearly indicates
33 otherwise, means the Florida Food is Medicine Center of
34 Excellence established under this section and operated by the
35 Florida Health and Nutrition Coalition.
36 (b) “Food is Medicine” means food-based interventions and
37 services that include medically precise nutrition, medically
38 tailored meals, or produce prescriptions, with nutrition
39 education and specific supports provided to a person with a
40 specific diet-related disease or chronic condition to
41 effectively support behavioral change related to the consumption
42 of healthful food and physical activity conducive to health and
43 well-being while improving health outcomes and achieving health
44 care cost savings through the control and reversal of the
45 disease or condition and the prevention of further disease or
46 condition complications.
47 (c) “Medically precise nutrition” means a medical nutrition
48 groceries program provided to a Medicaid recipient through a
49 prescription or referral from a physician licensed under chapter
50 458 or chapter 459, or through a referral from a clinic or
51 hospital staff member, a licensed clinical social worker, a
52 registered dietitian/nutritionist, or a health plan, for fresh
53 and health-promoting groceries purchased and distributed with
54 nutrition education and specific supports to produce positive
55 health outcomes for a specific diet-related disease or chronic
56 condition.
57 1. The medical nutrition groceries program must be in a
58 protocol standard selected, reviewed, and approved by a
59 registered dietitian or registered dietitian/nutritionist
60 licensed under s. 468.513 as part of a 6-month intervention
61 treatment program that follows the model of healthful food
62 prescription programs supported by research conducted by the
63 Gerald J. and Dorothy R. Friedman School of Nutrition Science
64 and Policy at Tufts University and implemented by the nonprofit
65 organization Living Hungry and that is certified by the Florida
66 Food is Medicine Center of Excellence to meet the quality and
67 cultural standards and the health standards for the specific
68 disease or chronic condition.
69 2. The medical nutrition groceries program may include
70 supports through behavioral health counseling, Food is Medicine
71 functional medicine classes, anatomy of disease classes, cooking
72 classes, gym or exercise classes, weekly menus and shopping
73 lists, grocery store tours, and motivational habit change
74 supports such as peer mentoring and health coaching in a
75 protocol designed for a Medicaid recipient with a specific diet
76 related disease or chronic condition to effectively control or
77 reverse the disease or condition effects and prevent further
78 disease or condition complications.
79 3. The health-promoting groceries under the medical
80 nutrition groceries program may be:
81 a. Picked up at the health plan facility or clinic or at an
82 event organized by a community-based organization or by an
83 entity under contract with the program, such as a grocery store;
84 or
85 b. Delivered to the residence of the Medicaid recipient by
86 the program or by an entity under contract with the program.
87 4. The medical nutrition groceries program:
88 a. May include healthful recipes and healthfully prepared
89 ingredients, herbs, spices, and sauces.
90 b. May include at-home laboratory tests, supplements,
91 monitoring supplies, and telehealth components.
92 c. Must include nutrition education.
93 d. Must include a program evaluation to report health
94 outcomes, including, but not limited to, biomarkers, nutrition
95 security assessments, and healthful eating and behavior change
96 surveys before and after the use of the program to evaluate the
97 program’s effectiveness.
98 (d) “Medically tailored meals” means a medical meal plan
99 program, provided to a Medicaid recipient through a prescription
100 or referral from a physician licensed under chapter 458 or
101 chapter 459, or through a referral from a clinic or hospital
102 staff member, a licensed clinical social worker, a registered
103 dietitian or registered dietitian/nutritionist, or a health
104 plan, for meals purchased and distributed with nutrition
105 education and support to produce positive health outcomes for a
106 person with a specific diet-related disease or chronic
107 condition. The medical meal plan program must be designed,
108 reviewed, and approved by a registered dietitian or registered
109 dietitian/nutritionist licensed under s. 468.513 to reflect
110 appropriate medical nutrition therapy based on evidence-based
111 practice guidelines for the specific diet-related disease or
112 chronic condition that requires the prescription or referral.
113 1. The meals under the medical meal plan program must be
114 fully prepared by a Medicaid provider or by a person, entity, or
115 community-based organization under contract with a Medicaid
116 managed care organization or with a Medicaid provider and must
117 be certified by the Florida Food is Medicine Center of
118 Excellence to meet the quality and cultural standards and health
119 standards for the specific disease or chronic condition. The
120 meals may be:
121 a. Picked up at the health plan facility or clinic or at an
122 event organized by a community-based organization or by an
123 entity under contract with the program, such as a restaurant or
124 grocery store; or
125 b. Delivered to the residence of the Medicaid recipient by
126 the program or by an entity under contract with the program.
127 2. The medical meal plan program:
128 a. May include healthful recipes and healthfully prepared
129 ingredients, herbs, spices, and sauces.
130 b. May include at-home laboratory tests, supplements,
131 monitoring supplies, and telehealth components.
132 c. Must include nutrition education.
133 d. Must include a program evaluation to report health
134 outcomes, including, but not limited to, biomarkers, nutrition
135 security assessments, and healthful eating and behavior change
136 surveys before and after the use of the program to evaluate the
137 program’s effectiveness.
138 (e) “Nutrition education” means a validated course and
139 series of nutrition education classes in a 6-month intervention
140 program such as the Expanded Food and Nutrition Education
141 Program, a research-based nutrition education program funded by
142 the United States Department of Agriculture which teaches
143 participants to grocery shop and plan and cook nutritious meals
144 through lessons given by in-language, in-culture
145 paraprofessionals and other educators from the Extension Family
146 and Consumer Sciences programs of the University of Florida
147 Institute of Food and Agricultural Sciences (IFAS), with sites
148 in multiple counties across the state. The term also includes
149 surveys before and after the classes to measure habit changes
150 and evaluate applications of nutrition education among Florida
151 residents, especially among populations that endure a
152 disproportionate share of food insecurity.
153 (f) “Pilot program” means the Food is Medicine Pilot
154 Program established in this section.
155 (g) “Produce prescription” means a program that is
156 provided, through a prescription or referral from a physician
157 licensed under chapter 458 or chapter 459, or through a referral
158 from a clinic or hospital staff member, a licensed clinical
159 social worker, a registered dietitian or registered
160 dietitian/nutritionist, or a health plan, to a Medicaid
161 recipient who has or is at risk of a specific diet-related
162 disease or chronic condition such as diabetes, coronary artery
163 disease, cancer, obesity, renal disease, celiac disease, asthma,
164 or dementia, to purchase produce at no cost or low cost using a
165 technology-enabled application such as About Fresh; a coupon; a
166 voucher; a debit card; a digital currency; or other means of
167 storing value to be redeemed for purchasing fresh or frozen
168 produce.
169 1.a. The technology-enabled application, coupon, voucher,
170 debit card, digital currency, or other means of storing value
171 may be redeemed at a farm store, farm packing house, mobile
172 farmers’ market, market as defined in s. 414.456(1), or
173 community-based organization site; or
174 b. The produce may be delivered to the residence of the
175 Medicaid recipient or distributed through a market or store or
176 through a Medicaid provider or health plan facility or clinic.
177 2. The program must be in a protocol standard selected,
178 reviewed, and approved by a registered dietitian/nutritionist
179 licensed under s. 468.513 as part of an intervention program
180 that may include medical nutritional therapy by a registered
181 dietitian/nutritionist, behavioral health counseling, Food is
182 Medicine functional medicine classes, anatomy of disease
183 classes, cooking classes, gym or exercise classes, weekly menus
184 and shopping lists, grocery store tours, and habit change
185 supports such as peer mentoring and health coaching designed for
186 a Medicaid recipient with a specific diet-related disease or
187 chronic condition to effectively control and reverse the disease
188 or condition effects and prevent disease or condition
189 complications. The program:
190 a. May include healthful recipes and healthfully prepared
191 ingredients, herbs, spices, and sauces.
192 b. May include at-home laboratory tests, supplements,
193 monitoring supplies, and telehealth components.
194 c. Must include nutrition education.
195 d. Must include a program evaluation to report health
196 outcomes, including, but not limited to, biomarkers, nutrition
197 security assessments, and healthful eating and behavior change
198 surveys before and after the use of the program to evaluate the
199 program’s effectiveness.
200 (h) “Program evaluation” means an annual evaluation of a
201 state Medicaid-funded program that uses medically precise
202 nutrition, medically tailored meals, or produce prescriptions to
203 assess fidelity of program implementation and overall program
204 effectiveness, as well as health biomarker outcomes, nutrition
205 intake, health equity, healthful habit adoption, and food
206 insecurity. The annual evaluation:
207 1. May either be funded by the agency and conducted by IFAS
208 Food is Medicine evaluators or be a component of the program’s
209 implementation budget.
210 2. Must be reported to the agency and the Legislature.
211 (2) By July 1, 2025, the agency, in conjunction with the
212 Department of Health, shall:
213 (a) Establish the Food is Medicine Pilot Program to provide
214 Medicaid coverage for purchases and deliveries of prescribed
215 healthful foods in disease-specific protocols through programs
216 that use medically precise nutrition, medically tailored meals,
217 or produce prescriptions to meet the specific needs of Medicaid
218 recipients who have or are at risk of a specific diet-related
219 disease or chronic condition and who are high-need patients or
220 patients requiring high-cost patient care or having the highest
221 health care expenditures. The pilot program shall serve to
222 establish the impact of healthful foods on health outcomes of
223 Medicaid recipients and the cost-effectiveness of food and
224 services provided under the program.
225 (b) Seek:
226 1. The pilot program’s approval by the United States
227 Secretary of Health and Human Services under s. 1115 of the
228 Social Security Act, which gives the secretary the authority to
229 approve, for an initial 5-year period, experimental, pilot, or
230 demonstration projects that are likely to assist in promoting
231 the objectives of the Medicaid program.
232 2. Any federal waivers necessary for the implementation of
233 the pilot program, including any waivers necessary to obtain
234 federal finances to secure Title XIX matching funds for the
235 pilot program. The federal waiver application shall seek
236 Medicaid matching funds for all general revenue, family
237 contributions, and local contributions.
238 (c) Require IFAS nutrition education providers or other
239 nutrition educators to refer pilot program patients to the
240 federal Supplemental Nutrition Assistance Program, the Temporary
241 Assistance for Needy Families program, and the Special
242 Supplemental Nutrition Program for Women, Infants, and Children
243 in order to meet the Centers for Medicare and Medicaid Services
244 financial directive for Medicaid waiver for the pilot program.
245 (d) Provide a portion of the pilot program implementation
246 budget, not to exceed 15 percent of the overall funds expended
247 for the pilot program, to the Florida Health and Nutrition
248 Coalition, a nonprofit corporation and coalition of Food is
249 Medicine stakeholders in this state, to establish a network
250 model central hub formed using the national best practices of
251 the United States Department of Agriculture Gus Schumacher
252 Nutrition Incentive Program and the National Institutes of
253 Health. The central hub established by the coalition shall be
254 called the Florida Food is Medicine Center of Excellence.
255 (3)(a) The Florida Health and Nutrition Coalition shall
256 operate the Florida Food is Medicine Center of Excellence as an
257 online, Florida-based research and expertise repository by
258 accumulating data in the following areas:
259 1. Research.
260 2. Provision of services and activities such as referrals,
261 food sourcing, and logistics.
262 3. Community outreach and engagement.
263 4. Education and training.
264 5. Coverage for services such as billing and fulfillment of
265 patients’ needs.
266 6. Health disparities.
267 (b) The center, in collaboration with IFAS Food is Medicine
268 evaluators, shall:
269 1. Inform program operators during the pilot program
270 implementation.
271 2. Disseminate findings throughout this state and
272 nationally through the center’s stakeholder network.
273 3. Include in-language and in-culture Food is Medicine
274 activities for Florida residents.
275 (c) The center shall report its research literature,
276 validated program models, operational planning frameworks,
277 nutrition standards, and strategies and tactics for effective
278 program activities to the agency and the United States
279 Department of Agriculture, the National Institutes of Health,
280 and the Centers for Disease Control and Prevention.
281 (4) The agency, in collaboration with the center and IFAS,
282 shall file an annual compilation report with the Legislature on
283 the pilot program, any reduction in food insecurity, health
284 outcome improvements and savings from the enrolled high-need
285 patients and patients with high-cost patient care, and any
286 advances in health equity.
287 (5) The agency, in conjunction with the Department of
288 Health, shall adopt rules to implement and administer this
289 section, including, but not limited to, rules relating to:
290 (a) The quality standard and quantity and the number of
291 medically tailored meals delivered per week to a Medicaid
292 recipient.
293 (b) The funds allowed per Medicaid recipient for medically
294 precise nutrition, medically tailored meals, and produce
295 prescriptions.
296 (c) Notification to Medicaid providers and Medicaid
297 recipients of the availability of and requirements for medically
298 precise nutrition, medically tailored meals, and produce
299 prescriptions.
300 (d) The funds and model for evaluations for IFAS Food is
301 Medicine evaluators.
302 (e) The funds and model for the best-practices information
303 repository hub and stakeholder network at the Florida Food is
304 Medicine Center of Excellence.
305 (f) Methodology for reimbursing Medicaid providers and
306 other managed care organizations and health plans for products,
307 events, services, classes, or activities provided under the
308 pilot program by the providers, organizations, and plans that
309 use medically precise nutrition, medically tailored meals, or
310 produce prescriptions.
311 Section 2. This act shall take effect July 1, 2024.