Florida Senate - 2025                                     SB 648
       
       
        
       By Senator Rodriguez
       
       
       
       
       
       40-01424-25                                            2025648__
    1                        A bill to be entitled                      
    2         An act relating to the Diabetes Prevention and Obesity
    3         Treatment Act; creating s. 385.2035, F.S.; providing a
    4         short title; defining terms; beginning on a specified
    5         date, requiring the Agency for Health Care
    6         Administration to provide Medicaid coverage for
    7         diabetes prevention programs if the Medicaid recipient
    8         meets specified criteria; requiring the agency to
    9         provide Medicaid coverage for certain treatments for
   10         obesity; providing that covered services may be
   11         offered in various settings; providing construction;
   12         requiring the agency to adopt rules and provide
   13         written notification of certain information to
   14         Medicaid recipients; authorizing the agency to seek
   15         federal approval through a state plan amendment or
   16         Medicaid waiver if necessary to implement specified
   17         provisions; providing an effective date.
   18          
   19  Be It Enacted by the Legislature of the State of Florida:
   20  
   21         Section 1. Section 385.2035, Florida Statutes, is created
   22  to read:
   23         385.2035 Diabetes prevention and obesity treatment.—
   24         (1) SHORT TITLE.—This section may be cited as the “Diabetes
   25  Prevention and Obesity Treatment Act.”
   26         (2) DEFINITIONS.—As used in this section, the term:
   27         (a) “Agency” means the Agency for Health Care
   28  Administration.
   29         (b) “Diabetes prevention program” means structured
   30  behavioral health change sessions that are furnished to an
   31  eligible individual by a diabetes prevention program provider
   32  for the purpose of preventing or delaying the onset of type 2
   33  diabetes and that follow a curriculum approved by the United
   34  States Centers for Disease Control and Prevention.
   35         (c) “Diabetes prevention program provider” means an entity
   36  that is recognized under the United States Centers for Disease
   37  Control and Prevention Diabetes Prevention Recognition Program
   38  to offer a diabetes prevention program through an approved
   39  delivery method, including in person, online, and distance
   40  learning, or a combination thereof, and other synchronous and
   41  asynchronous modalities.
   42         (d) “FDA-approved obesity medication” means any medication
   43  approved by the United States Food and Drug Administration with
   44  an indication for chronic weight management in patients with an
   45  obesity diagnosis.
   46         (e) “Intensive health behavioral and lifestyle treatment”
   47  means an evidence-based, intensive, multicomponent behavioral or
   48  lifestyle modification intervention that supports healthy weight
   49  management and is delivered in person or through telehealth as
   50  defined in s. 456.47.
   51         (f) “Metabolic and bariatric surgery” means any surgical
   52  intervention included in the most current American Society for
   53  Metabolic and Bariatric Surgery (ASMBS)/International Federation
   54  for the Surgery of Obesity and Metabolic Disorders Guidelines on
   55  Indications for Metabolic and Bariatric Surgery.
   56         (3) MEDICAID COVERAGE FOR DIABETES PREVENTION PROGRAMS.
   57  Beginning January 1, 2026, the agency shall reimburse a diabetes
   58  prevention program provider for a Medicaid recipient’s
   59  participation in the program if the recipient:
   60         (a) Meets the diabetes prevention program’s eligibility
   61  requirements; and
   62         (b) Has not previously participated in the program while
   63  enrolled in the Medicaid program.
   64         (4) MEDICAID COVERAGE FOR MANAGEMENT AND TREATMENT OF
   65  OBESITY REQUIRED.—
   66         (a) The agency shall pay for the treatment of Medicaid
   67  recipients for the chronic disease of obesity, including, but
   68  not limited to, all of the following:
   69         1. Intensive health behavioral and lifestyle treatment.
   70         2. Metabolic and bariatric surgery.
   71         3. FDA-approved obesity medication.
   72         (b) The coverage criteria for an FDA-approved obesity
   73  medication may not be more restrictive than the FDA-approved
   74  indications for such medication.
   75         (c) Intensive health behavioral and lifestyle treatment may
   76  include interventions certified by or recognized by the United
   77  States Centers for Disease Control and Prevention or recommended
   78  by current clinical standards of care. The services may be
   79  provided in office settings, virtually, or in community-based
   80  settings to support patient access and needs.
   81         (d) This subsection does not prohibit the agency from
   82  applying its standard methodologies to determine the medical
   83  necessity or appropriateness of a course of treatment authorized
   84  under this section, provided that such determinations are made
   85  in the same manner as those made for the treatment of any other
   86  illness, condition, or disorder covered by the state Medicaid
   87  program.
   88         (5) RULES.—The agency shall adopt rules to implement this
   89  section and shall notify Medicaid recipients in writing about
   90  the availability of treatment for the chronic disease of obesity
   91  and diabetes prevention programs under this section.
   92         (6) FEDERAL APPROVAL.—The agency may seek federal approval
   93  through a state plan amendment or a Medicaid waiver as needed to
   94  implement this section.
   95         Section 2. This act shall take effect July 1, 2025.