THE BILL ITSELF
HB 1315
Behavioral Health Intervention Services
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A bill to be entitled
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An act relating to behavioral health intervention
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services; creating s. 409.9206, F.S.; providing
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legislative findings and purpose; providing
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definitions; authorizing, contingent upon an
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appropriation, the state Medicaid plan to fund a
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demonstration pilot program for specified purposes in
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specified counties; providing pilot program
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requirements; requiring the state Medicaid plan to
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provide a specified report to the Legislature in a
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certain timeframe; providing for expiration of the
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pilot program; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 409.9206, Florida Statutes, is created
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to read:
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409.9206 De-risking disease behavioral health intervention
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services pilot program.—
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(1) LEGISLATIVE FINDING; PURPOSE.—
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(a) The Legislature finds that under federal Medicaid
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managed care regulations 42 CFR 438.3(e)(2) and 42 CFR 438.16,
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the Agency for Health Care Administration may approve de-risking
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disease behavioral health intervention services.
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(b) The purpose of this section is to authorize the state
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Medicaid plan to fund a demonstration pilot program that shall
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provide a de-risking disease behavioral health intervention
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services management plan to recipients of the state Medicaid
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plan in Region G, which consists of Indian River, Martin,
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Okeechobee, Palm Beach, and St. Lucie Counties.
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(2) DEFINITIONS.—As used in this section, the term:
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(a) "De-risking disease behavioral health intervention
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services" means a set of five concurrent, chronic disease, self-
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management services and medical nutrition supports demonstrated
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in scientific research to improve behavioral health and chronic
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disease outcomes. The term includes:
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1. Behavioral health counseling by a licensed clinical
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social worker for lifestyle modifications for patients diagnosed
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with depression and uncontrolled diabetes mellitus.
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2. Medical nutrition therapy by a registered dietitian
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nutritionist for diet and lifestyle modifications for patients
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with depression and uncontrolled diabetes mellitus.
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3. Biomarker health tracking, nudging, and reporting by
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Diabetes Supply Services Coverage Policy approved devices
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including HbA1C, blood sugar glucose, oxygen, heart rate,
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lipids, weight, body mass index, blood pressures, and other
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biomarkers.
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4. Medical disease nutrition education designed for
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depression or diabetes mellitus, and is evidence-based, and
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demonstrated to improve measurable health outcomes.
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5. Medical nutrition supports are evidence-based lifestyle
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modification services demonstrated to improve health outcomes
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for patients diagnosed with depression and diabetes mellitus,
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and include clinical nutrition groceries, or home-delivered
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medically tailored meals, or produce prescriptions, or other
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evidence-based medically necessary nutrition interventions
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demonstrated to be cost effective by scientific research
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studies.
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(b) "Participant" means a Medicaid enrollee recipient and
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recipient family participating in the pilot program.
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(c) "Pilot program" means the demonstration pilot program
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established by the state Medicaid plan.
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(3) PILOT PROGRAM.—Contingent upon an appropriation, the
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state Medicaid plan may fund a demonstration pilot program to
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provide behavioral health intervention services for Region G,
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which consists of Indian River, Martin, Okeechobee, Palm Beach,
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and St. Lucie Counties.
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(a) Under the pilot program, Medicaid managed assistance
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providers may offer de-risking disease behavioral health
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intervention services:
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1. In lieu of services specified in the state Medicaid
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plan to an enrollee who is diagnosed with both of the following:
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a. Depression or anxiety.
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b. Diabetes mellitus, obesity, or coronary heart disease.
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2. To 1,000 participants as a disease management plan.
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(b) The design, evaluation, and outcomes shall be from a
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research evaluation conducted by nutrition scientists at Tufts
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University Friedman School of Nutrition Science and Policy, a
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qualified and accredited academic institution specialized in
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nutrition, and the Florida Health and Nutrition Coalition
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program implementation experts. The pilot program shall:
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1. Design the de-risking disease behavioral health
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intervention services, diabetic supply services, chronic disease
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self-management and education services, and medical nutrition
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supports coverage in lieu of services.
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2. Review and assess health outcomes, biomarkers and data
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on the impact to the pilot program participant, their family,
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and their children to evaluate the pilot program disease
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management plan impact.
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3. Collect data including, but not limited to, the rate by
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which pilot program participants, family, and children comply
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with de-risking disease behavioral health intervention services;
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health outcomes and biomarkers associated with the participant,
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their family, and their children; impact on diagnosis, chronic
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health condition and disease symptoms.
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(4) ANNUAL REPORT.—The state Medicaid plan shall:
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(a) As soon as practicable after the expiration of the
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pilot program, prepare and submit to the Legislature a report on
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the number of times during the preceding year the de-risking
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disease behavioral health intervention services were used in
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Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
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Counties, a summary of the data the state Medicaid plan
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collected, and recommendations for any Legislative action.
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(b) Consider the actual cost, measurable goals and health
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outcomes met, and enrollee adherence of the de-risking disease
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behavioral health intervention services when paying the
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capitation rates for that organization under the contract.
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(5) EXPIRATION.—
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(a) The pilot program shall expire August 31, 2030.
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(b) This section expires September 1, 2031.
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Section 2. This act shall take effect July 1, 2026.