THE BILL ITSELF
HB 1507
Medicaid Dental Pilot Program
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A bill to be entitled
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An act relating to a Medicaid dental pilot program;
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creating s. 409.9079, F.S.; defining the term "persons
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with disabilities"; requiring the Agency for Health
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Care Administration to establish and operate a 3-year
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Medicaid dental pilot program in Region B of the
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Statewide Medicaid Managed Care program for persons
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with disabilities; providing eligibility criteria;
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specifying covered benefits; providing reimbursement
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requirements; requiring managed care participation;
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directing the agency to seek federal approval;
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requiring the agency to collect specified data and
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submit a report to the Governor and Legislature by a
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specified date; providing for expiration; providing an
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effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 409.9079, Florida Statutes, is created
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to read:
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409.9079 Medicaid dental pilot program for persons with
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disabilities in Region B.—
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(1) As used in this section, the term "persons with
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disabilities" means Medicaid-eligible individuals who:
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(a) Receive Supplemental Security Income on the basis of
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disability;
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(b) Are enrolled in a home and community-based services
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waiver program under s. 1915(c) of the Social Security Act; or
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(c) Meet federal disability criteria under 42 U.S.C. s.
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1382c(a)(3) as determined by the Social Security Administration
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or the state Medicaid program.
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(2) The agency shall establish and operate a 3-year
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Medicaid dental pilot program in Region B of the Statewide
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Medicaid Managed Care program to provide enhanced dental
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services to persons with disabilities.
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(3) Participation in the pilot program is limited to
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persons with disabilities who reside in Region B and are
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enrolled in the state Medicaid program.
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(4) Dental services provided under the pilot program must
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include:
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(a) Routine diagnostic and preventive care, including
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examinations, cleanings, and radiographs.
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(b) Basic dental services, including fillings and
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extractions.
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(c) Major dental services, including root canals, crowns,
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and dentures and other dental prostheses.
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(d) Emergency dental services.
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(e) Any additional dental services that the agency
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determines are necessary to promote oral health and prevent
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disease.
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Services provided under this subsection supplement and do not
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replace the dental benefits available under ss. 409.906 and
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409.973.
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(5) The agency shall reimburse providers of dental
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services under the pilot program at a rate equivalent to 80
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percent of the 50th percentile of the usual, customary, and
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reasonable fees as determined by the American Dental Association
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or a comparable benchmark approved by the agency.
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(6) The pilot program must be delivered through at least
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two licensed dental managed care organizations that meet agency
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standards and have demonstrated experience in providing dental
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services to persons with disabilities.
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(7) The agency shall submit any Medicaid state plan
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amendments or federal waiver applications necessary to implement
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the pilot program.
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(8)(a) The agency shall collect data on:
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1. Access to dental care.
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2. Utilization of services.
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3. Reimbursement expenditures.
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4. Oral health outcomes for participants.
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(b) By January 1, 2028, the agency shall submit a report
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to the Governor, the President of the Senate, and the Speaker of
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the House of Representatives evaluating the effectiveness of the
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pilot program and recommending whether the pilot program should
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be expanded statewide.
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(9) This section expires June 30, 2028, unless reviewed
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and saved from repeal through reenactment by the Legislature.
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Section 2. This act shall take effect July 1, 2026.