Florida Senate - 2026                                    SB 1640
       
       
        
       By Senator Smith
       
       
       
       
       
       17-01369A-26                                          20261640__
    1                        A bill to be entitled                      
    2         An act relating to the Medicaid dental pilot program
    3         for persons with disabilities; creating s. 409.9079,
    4         F.S.; defining the term “persons with disabilities”;
    5         requiring the Agency for Health Care Administration to
    6         establish and operate a Medicaid dental pilot program
    7         in a specified region to provide enhanced dental
    8         services to persons with disabilities; specifying
    9         eligibility for participation in the pilot program;
   10         specifying dental services covered by the pilot
   11         program; providing construction; requiring the agency
   12         to reimburse dental providers under the pilot program
   13         at a specified rate; providing for the delivery of
   14         services under the pilot program through at least two
   15         licensed dental managed care organizations meeting
   16         certain criteria; requiring the agency to submit any
   17         necessary state plan amendments or federal waiver
   18         applications for federal approval; requiring the
   19         agency to collect certain data on the pilot program;
   20         requiring the agency to submit a report on the pilot
   21         program to the Governor and the Legislature by a
   22         specified date; providing for expiration of the pilot
   23         program; providing an effective date.
   24          
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Section 409.9079, Florida Statutes, is created
   28  to read:
   29         409.9079 Medicaid dental pilot program for persons with
   30  disabilities in Region E.—
   31         (1) DEFINITION.—As used in this section, the term “persons
   32  with disabilities” means Medicaid-eligible individuals who:
   33         (a) Receive Supplemental Security Income (SSI) on the basis
   34  of disability;
   35         (b) Are enrolled in a home and community-based services
   36  (HCBS) waiver program under s. 1915(c) of the Social Security
   37  Act; or
   38         (c) Meet federal disability criteria under 42 U.S.C. s.
   39  1382c(a)(3), as determined by the Social Security Administration
   40  or the state Medicaid program.
   41         (2) PILOT PROGRAM ESTABLISHED.—The agency shall establish
   42  and operate a 3-year Medicaid dental pilot program in Region E
   43  of the Statewide Medicaid Managed Care program to provide
   44  enhanced dental services to persons with disabilities.
   45         (3) ELIGIBILITY.—Participation in the pilot program is
   46  limited to persons with disabilities who reside in Region E and
   47  are enrolled in the Medicaid program.
   48         (4) COVERED SERVICES.—
   49         (a) Dental services provided under the pilot program must
   50  include all of the following:
   51         1. Routine diagnostic and preventive care, including
   52  examinations, cleanings, and radiographs.
   53         2. Basic dental services, including fillings and
   54  extractions.
   55         3. Major dental services, including root canals, crowns,
   56  dentures, and other dental prostheses.
   57         4. Emergency dental services.
   58         5. Any additional dental services the agency determines are
   59  necessary to promote oral health and prevent disease.
   60         (b) Services provided under this subsection supplement, and
   61  do not replace, dental benefits available under ss. 409.906 and
   62  409.973.
   63         (5) REIMBURSEMENT.—The agency shall reimburse providers of
   64  dental services under the pilot program at a rate equivalent to
   65  80 percent of the 50th percentile of the 2024 Usual, Customary,
   66  and Reasonable fees, as determined by the American Dental
   67  Association or a comparable benchmark approved by the agency.
   68         (6) MANAGED CARE PARTICIPATION.—The pilot program must be
   69  delivered through at least two licensed dental managed care
   70  organizations that meet agency standards and have demonstrated
   71  experience in providing dental services to persons with
   72  disabilities.
   73         (7) FEDERAL APPROVAL.—The agency shall submit for federal
   74  approval any Medicaid state plan amendments or federal waiver
   75  applications necessary to implement the pilot program.
   76         (8) EVALUATION; REPORT.—
   77         (a) The agency shall collect pilot program data on all of
   78  the following:
   79         1. Access to dental care.
   80         2. Utilization of services.
   81         3. Reimbursement expenditures.
   82         4. Oral health outcomes for participants.
   83         (b) By January 1, 2029, the agency shall submit a report to
   84  the Governor, the President of the Senate, and the Speaker of
   85  the House of Representatives evaluating the effectiveness of the
   86  pilot program and recommending whether it should be expanded
   87  statewide.
   88         (9) EXPIRATION.—This section expires June 30, 2029.
   89         Section 2. This act shall take effect July 1, 2026.