Florida Senate - 2025                                    SB 1048
       
       
        
       By Senator Jones
       
       
       
       
       
       34-01205-25                                           20251048__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid coverage for dental
    3         services; amending s. 409.906, F.S.; revising optional
    4         adult dental services covered by the state Medicaid
    5         program; beginning on a specified date, requiring the
    6         Agency for Health Care Administration to reimburse
    7         providers of Medicaid-covered adult dental services at
    8         a specified rate; requiring the agency to implement
    9         any state plan amendments and seek any federal waivers
   10         necessary to implement these changes; amending s.
   11         409.973, F.S.; revising dental services benefits
   12         covered under Medicaid managed care plans; requiring
   13         the agency to implement a statewide Medicaid prepaid
   14         dental health program for children and adults;
   15         specifying minimum benefits required under the
   16         program; providing an effective date.
   17          
   18  Be It Enacted by the Legislature of the State of Florida:
   19  
   20         Section 1. Subsection (1) of section 409.906, Florida
   21  Statutes, is amended to read:
   22         409.906 Optional Medicaid services.—Subject to specific
   23  appropriations, the agency may make payments for services which
   24  are optional to the state under Title XIX of the Social Security
   25  Act and are furnished by Medicaid providers to recipients who
   26  are determined to be eligible on the dates on which the services
   27  were provided. Any optional service that is provided shall be
   28  provided only when medically necessary and in accordance with
   29  state and federal law. Optional services rendered by providers
   30  in mobile units to Medicaid recipients may be restricted or
   31  prohibited by the agency. Nothing in this section shall be
   32  construed to prevent or limit the agency from adjusting fees,
   33  reimbursement rates, lengths of stay, number of visits, or
   34  number of services, or making any other adjustments necessary to
   35  comply with the availability of moneys and any limitations or
   36  directions provided for in the General Appropriations Act or
   37  chapter 216. If necessary to safeguard the state’s systems of
   38  providing services to elderly and disabled persons and subject
   39  to the notice and review provisions of s. 216.177, the Governor
   40  may direct the Agency for Health Care Administration to amend
   41  the Medicaid state plan to delete the optional Medicaid service
   42  known as “Intermediate Care Facilities for the Developmentally
   43  Disabled.” Optional services may include:
   44         (1) ADULT DENTAL SERVICES.—
   45         (a) The agency may pay for services medically necessary to
   46  prevent disease and promote oral health, restore oral structures
   47  to health and function, and treat emergency conditions,
   48  including routine diagnostic and preventive care, such as dental
   49  cleanings, exams, and x-rays; basic dental services, such as
   50  fillings and extractions; major dental services, such as root
   51  canals, crowns, and dentures and other dental prostheses;
   52  emergency dental care; and other necessary services related to
   53  dental and oral health for recipients, emergency dental
   54  procedures to alleviate pain or infection. Emergency dental care
   55  shall be limited to emergency oral examinations, necessary
   56  radiographs, extractions, and incision and drainage of abscess,
   57  for a recipient who is 21 years of age or older.
   58         (b) Effective July 1, 2025, the agency shall reimburse
   59  providers of Medicaid-covered adult dental services at a rate
   60  equivalent to 80 percent of the 50th percentile of the 2024
   61  Usual, Customary, and Reasonable fees, as determined by the
   62  American Dental Association or a comparable benchmark approved
   63  by the agency. The agency shall implement any necessary
   64  amendments to the state Medicaid plan and seek any necessary
   65  federal Medicaid waivers to implement this paragraph may pay for
   66  full or partial dentures, the procedures required to seat full
   67  or partial dentures, and the repair and reline of full or
   68  partial dentures, provided by or under the direction of a
   69  licensed dentist, for a recipient who is 21 years of age or
   70  older.
   71         (c) However, Medicaid may will not provide reimbursement
   72  for dental services provided in a mobile dental unit, except for
   73  a mobile dental unit:
   74         1. Owned by, operated by, or having a contractual agreement
   75  with the Department of Health and complying with Medicaid’s
   76  county health department clinic services program specifications
   77  as a county health department clinic services provider.
   78         2. Owned by, operated by, or having a contractual
   79  arrangement with a federally qualified health center and
   80  complying with Medicaid’s federally qualified health center
   81  specifications as a federally qualified health center provider.
   82         3. Rendering dental services to Medicaid recipients, 21
   83  years of age and older, at nursing facilities.
   84         4. Owned by, operated by, or having a contractual agreement
   85  with a state-approved dental educational institution.
   86         Section 2. Subsection (5) of section 409.973, Florida
   87  Statutes, is amended to read:
   88         409.973 Benefits.—
   89         (5) PROVISION OF DENTAL SERVICES.—
   90         (a) The agency shall implement a statewide Medicaid prepaid
   91  dental health program for children and adults with a choice of
   92  at least two licensed dental managed care providers who meet
   93  agency standards The Legislature may use the findings of the
   94  Office of Program Policy Analysis and Government
   95  Accountability’s report no. 16-07, December 2016, in setting the
   96  scope of minimum benefits set forth in this section for future
   97  procurements of eligible plans as described in s. 409.966.
   98  Specifically, the decision to include dental services as a
   99  minimum benefit under this section, or to provide Medicaid
  100  recipients with dental benefits separate from the Medicaid
  101  managed medical assistance program described in this part, may
  102  take into consideration the data and findings of the report.
  103         (b) The minimum benefits provided under the Medicaid
  104  prepaid dental health program to recipients younger than 21
  105  years of age must include all dental benefits included within
  106  the meaning of the term “early and periodic screening,
  107  diagnosis, and treatment services” as defined in 42 U.S.C. s.
  108  1396d(r) In the event the Legislature takes no action before
  109  July 1, 2017, with respect to the report findings required under
  110  paragraph (a), the agency shall implement a statewide Medicaid
  111  prepaid dental health program for children and adults with a
  112  choice of at least two licensed dental managed care providers
  113  who must have substantial experience in providing dental care to
  114  Medicaid enrollees and children eligible for medical assistance
  115  under Title XXI of the Social Security Act and who meet all
  116  agency standards and requirements. To qualify as a provider
  117  under the prepaid dental health program, the entity must be
  118  licensed as a prepaid limited health service organization under
  119  part I of chapter 636 or as a health maintenance organization
  120  under part I of chapter 641. The contracts for program providers
  121  shall be awarded through a competitive procurement process.
  122  Beginning with the contract procurement process initiated during
  123  the 2023 calendar year, the contracts must be for 6 years and
  124  may not be renewed; however, the agency may extend the term of a
  125  plan contract to cover delays during a transition to a new plan
  126  provider. The agency shall include in the contracts a medical
  127  loss ratio provision consistent with s. 409.967(4). The agency
  128  is authorized to seek any necessary state plan amendment or
  129  federal waiver to commence enrollment in the Medicaid prepaid
  130  dental health program no later than March 1, 2019. The agency
  131  shall extend until December 31, 2024, the term of existing plan
  132  contracts awarded pursuant to the invitation to negotiate
  133  published in October 2017.
  134         (c)The minimum benefits provided by the Medicaid prepaid
  135  dental health program to recipients 21 years of age or older
  136  must include services necessary to prevent disease and promote
  137  oral health, restore oral structures to health and function, and
  138  treat emergency conditions, including routine diagnostic and
  139  preventive care, such as dental cleanings, exams, and X-rays;
  140  basic dental services, such as fillings and extractions; major
  141  dental services, such as root canals, crowns, and dentures and
  142  other dental prostheses; emergency dental care; and other
  143  necessary services related to dental and oral health.
  144         Section 3. This act shall take effect July 1, 2025.