Florida Senate - 2021                                    SB 1552
       
       
        
       By Senator Pizzo
       
       
       
       
       
       38-01734-21                                           20211552__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid coverage for adult dental
    3         services; amending s. 409.905, F.S.; requiring the
    4         reimbursement of certain adult dental services by the
    5         Agency for Health Care Administration under the
    6         Medicaid program; prohibiting reimbursement for such
    7         services if provided in a mobile dental unit;
    8         providing exceptions; amending s. 409.906, F.S.;
    9         conforming provisions to changes made by the act;
   10         amending s. 409.973, F.S.; requiring that the minimum
   11         benefits provided under the Medicaid prepaid dental
   12         health program cover certain adult dental services;
   13         amending ss. 393.0661, 409.815, 409.908, and 409.968,
   14         F.S.; conforming cross-references; providing an
   15         effective date.
   16          
   17  Be It Enacted by the Legislature of the State of Florida:
   18  
   19         Section 1. Subsection (13) is added to section 409.905,
   20  Florida Statutes, to read:
   21         409.905 Mandatory Medicaid services.—The agency may make
   22  payments for the following services, which are required of the
   23  state by Title XIX of the Social Security Act, furnished by
   24  Medicaid providers to recipients who are determined to be
   25  eligible on the dates on which the services were provided. Any
   26  service under this section shall be provided only when medically
   27  necessary and in accordance with state and federal law.
   28  Mandatory services rendered by providers in mobile units to
   29  Medicaid recipients may be restricted by the agency. Nothing in
   30  this section shall be construed to prevent or limit the agency
   31  from adjusting fees, reimbursement rates, lengths of stay,
   32  number of visits, number of services, or any other adjustments
   33  necessary to comply with the availability of moneys and any
   34  limitations or directions provided for in the General
   35  Appropriations Act or chapter 216.
   36         (13)ADULT DENTAL SERVICES.—
   37         (a)The agency shall pay for dental services provided to a
   38  recipient who is 21 years of age or older which are necessary to
   39  prevent disease and promote oral health, restore the health and
   40  function of structures of the oral cavity, and treat emergency
   41  conditions, including routine diagnostic and preventive care,
   42  such as dental cleanings, exams, and X rays; basic dental
   43  services, such as fillings and extractions; major dental
   44  services, such as root canals, crowns, and dentures or other
   45  dental prostheses; emergency dental care; and any other
   46  necessary services related to dental and oral health.
   47         (b)However, Medicaid will not provide reimbursement for
   48  adult dental services provided in a mobile dental unit, except
   49  for a mobile dental unit:
   50         1.Owned by, operated by, or having a contractual agreement
   51  with the Department of Health and complying with Medicaid’s
   52  county health department clinic services program specifications
   53  as a county health department clinic services provider.
   54         2.Owned by, operated by, or having a contractual
   55  arrangement with a federally qualified health center and
   56  complying with Medicaid’s federally qualified health center
   57  specifications as a federally qualified health center provider.
   58         3.Rendering dental services to Medicaid recipients, 21
   59  years of age or older, at nursing facilities.
   60         4.Owned by, operated by, or having a contractual agreement
   61  with a state-approved dental educational institution.
   62         Section 2. Subsection (1) of section 409.906, Florida
   63  Statutes, is amended to read:
   64         409.906 Optional Medicaid services.—Subject to specific
   65  appropriations, the agency may make payments for services which
   66  are optional to the state under Title XIX of the Social Security
   67  Act and are furnished by Medicaid providers to recipients who
   68  are determined to be eligible on the dates on which the services
   69  were provided. Any optional service that is provided shall be
   70  provided only when medically necessary and in accordance with
   71  state and federal law. Optional services rendered by providers
   72  in mobile units to Medicaid recipients may be restricted or
   73  prohibited by the agency. Nothing in this section shall be
   74  construed to prevent or limit the agency from adjusting fees,
   75  reimbursement rates, lengths of stay, number of visits, or
   76  number of services, or making any other adjustments necessary to
   77  comply with the availability of moneys and any limitations or
   78  directions provided for in the General Appropriations Act or
   79  chapter 216. If necessary to safeguard the state’s systems of
   80  providing services to elderly and disabled persons and subject
   81  to the notice and review provisions of s. 216.177, the Governor
   82  may direct the Agency for Health Care Administration to amend
   83  the Medicaid state plan to delete the optional Medicaid service
   84  known as “Intermediate Care Facilities for the Developmentally
   85  Disabled.” Optional services may include:
   86         (1)ADULT DENTAL SERVICES.—
   87         (a)The agency may pay for medically necessary, emergency
   88  dental procedures to alleviate pain or infection. Emergency
   89  dental care shall be limited to emergency oral examinations,
   90  necessary radiographs, extractions, and incision and drainage of
   91  abscess, for a recipient who is 21 years of age or older.
   92         (b)The agency may pay for full or partial dentures, the
   93  procedures required to seat full or partial dentures, and the
   94  repair and reline of full or partial dentures, provided by or
   95  under the direction of a licensed dentist, for a recipient who
   96  is 21 years of age or older.
   97         (c)However, Medicaid will not provide reimbursement for
   98  dental services provided in a mobile dental unit, except for a
   99  mobile dental unit:
  100         1.Owned by, operated by, or having a contractual agreement
  101  with the Department of Health and complying with Medicaid’s
  102  county health department clinic services program specifications
  103  as a county health department clinic services provider.
  104         2.Owned by, operated by, or having a contractual
  105  arrangement with a federally qualified health center and
  106  complying with Medicaid’s federally qualified health center
  107  specifications as a federally qualified health center provider.
  108         3.Rendering dental services to Medicaid recipients, 21
  109  years of age and older, at nursing facilities.
  110         4.Owned by, operated by, or having a contractual agreement
  111  with a state-approved dental educational institution.
  112         Section 3. Paragraph (c) is added to subsection (5) of
  113  section 409.973, Florida Statutes, to read:
  114         409.973 Benefits.—
  115         (5) PROVISION OF DENTAL SERVICES.—
  116         (c)The minimum benefits provided under the Medicaid
  117  prepaid dental health program for a recipient who is 21 years of
  118  age or older must cover services necessary to prevent disease
  119  and promote oral health, restore the health and function of
  120  structures of the oral cavity, and treat emergency conditions,
  121  including routine diagnostic and preventive care, such as dental
  122  cleanings, exams, and X rays; basic dental services, such as
  123  fillings and extractions; major dental services, such as root
  124  canals, crowns, and dentures or other dental prostheses;
  125  emergency dental care; and any other necessary services related
  126  to dental and oral health.
  127         Section 4. Subsection (7) of section 393.0661, Florida
  128  Statutes, is amended to read:
  129         393.0661 Home and community-based services delivery system;
  130  comprehensive redesign.—The Legislature finds that the home and
  131  community-based services delivery system for persons with
  132  developmental disabilities and the availability of appropriated
  133  funds are two of the critical elements in making services
  134  available. Therefore, it is the intent of the Legislature that
  135  the Agency for Persons with Disabilities shall develop and
  136  implement a comprehensive redesign of the system.
  137         (7) The agency shall collect premiums or cost sharing
  138  pursuant to s. 409.906(12)(c) s. 409.906(13)(c).
  139         Section 5. Paragraph (q) of subsection (2) of section
  140  409.815, Florida Statutes, is amended to read:
  141         409.815 Health benefits coverage; limitations.—
  142         (2) BENCHMARK BENEFITS.—In order for health benefits
  143  coverage to qualify for premium assistance payments for an
  144  eligible child under ss. 409.810-409.821, the health benefits
  145  coverage, except for coverage under Medicaid and Medikids, must
  146  include the following minimum benefits, as medically necessary.
  147         (q) Dental services.—Dental services shall be covered as
  148  required under federal law and may also include those dental
  149  benefits provided to children by the Florida Medicaid program
  150  under s. 409.906(5) s. 409.906(6).
  151         Section 6. Subsection (20) of section 409.908, Florida
  152  Statutes, is amended to read:
  153         409.908 Reimbursement of Medicaid providers.—Subject to
  154  specific appropriations, the agency shall reimburse Medicaid
  155  providers, in accordance with state and federal law, according
  156  to methodologies set forth in the rules of the agency and in
  157  policy manuals and handbooks incorporated by reference therein.
  158  These methodologies may include fee schedules, reimbursement
  159  methods based on cost reporting, negotiated fees, competitive
  160  bidding pursuant to s. 287.057, and other mechanisms the agency
  161  considers efficient and effective for purchasing services or
  162  goods on behalf of recipients. If a provider is reimbursed based
  163  on cost reporting and submits a cost report late and that cost
  164  report would have been used to set a lower reimbursement rate
  165  for a rate semester, then the provider’s rate for that semester
  166  shall be retroactively calculated using the new cost report, and
  167  full payment at the recalculated rate shall be effected
  168  retroactively. Medicare-granted extensions for filing cost
  169  reports, if applicable, shall also apply to Medicaid cost
  170  reports. Payment for Medicaid compensable services made on
  171  behalf of Medicaid eligible persons is subject to the
  172  availability of moneys and any limitations or directions
  173  provided for in the General Appropriations Act or chapter 216.
  174  Further, nothing in this section shall be construed to prevent
  175  or limit the agency from adjusting fees, reimbursement rates,
  176  lengths of stay, number of visits, or number of services, or
  177  making any other adjustments necessary to comply with the
  178  availability of moneys and any limitations or directions
  179  provided for in the General Appropriations Act, provided the
  180  adjustment is consistent with legislative intent.
  181         (20) A renal dialysis facility that provides dialysis
  182  services under 409.906(8) s. 409.906(9) must be reimbursed the
  183  lesser of the amount billed by the provider, the provider’s
  184  usual and customary charge, or the maximum allowable fee
  185  established by the agency, whichever amount is less.
  186         Section 7. Paragraph (a) of subsection (4) of section
  187  409.968, Florida Statutes, is amended to read:
  188         409.968 Managed care plan payments.—
  189         (4)(a) Subject to a specific appropriation and federal
  190  approval under s. 409.906(12)(d) s. 409.906(13)(d), the agency
  191  shall establish a payment methodology to fund managed care plans
  192  for flexible services for persons with severe mental illness and
  193  substance use disorders, including, but not limited to,
  194  temporary housing assistance. A managed care plan eligible for
  195  these payments must do all of the following:
  196         1. Participate as a specialty plan for severe mental
  197  illness or substance use disorders or participate in counties
  198  designated by the General Appropriations Act;
  199         2. Include providers of behavioral health services pursuant
  200  to chapters 394 and 397 in the managed care plan’s provider
  201  network; and
  202         3. Document a capability to provide housing assistance
  203  through agreements with housing providers, relationships with
  204  local housing coalitions, and other appropriate arrangements.
  205         Section 8. This act shall take effect July 1, 2021.