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         409.90203Food 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.