THE BILL ITSELF
HB 935
Community Health Worker Services
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A bill to be entitled
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An act relating to community health worker services;
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amending s. 409.906, F.S.; authorizing the Agency for
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Health Care Administration to pay for community health
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worker services as an optional Medicaid service;
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specifying coverage requirements; defining the term
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"community health worker"; requiring the agency to
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adopt rules; authorizing the agency to seek federal
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approval; amending s. 409.908, F.S.; adding community
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health worker services to the list of Medicaid
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services authorized for reimbursement on a fee-for-
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service basis; amending s. 409.973, F.S.; adding
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community health worker services to the list of
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minimum benefits required to be covered by Medicaid
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managed care plans; 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. Subsection (30) is added section 409.906,
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Florida Statutes, to read:
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409.906 Optional Medicaid services.—Subject to specific
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appropriations, the agency may make payments for services which
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are optional to the state under Title XIX of the Social Security
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Act and are furnished by Medicaid providers to recipients who
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are determined to be eligible on the dates on which the services
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were provided. Any optional service that is provided shall be
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provided only when medically necessary and in accordance with
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state and federal law. Optional services rendered by providers
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in mobile units to Medicaid recipients may be restricted or
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prohibited by the agency. Nothing in this section shall be
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construed to prevent or limit the agency from adjusting fees,
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reimbursement rates, lengths of stay, number of visits, or
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number of services, or making any other adjustments necessary to
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comply with the availability of moneys and any limitations or
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directions provided for in the General Appropriations Act or
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chapter 216. If necessary to safeguard the state's systems of
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providing services to elderly and disabled persons and subject
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to the notice and review provisions of s. 216.177, the Governor
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may direct the Agency for Health Care Administration to amend
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the Medicaid state plan to delete the optional Medicaid service
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known as "Intermediate Care Facilities for the Developmentally
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Disabled." Optional services may include:
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(30) COMMUNITY HEALTH WORKERS.—The agency may pay for the
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provision of community health worker services including, but not
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limited to, health promotion, wellness coaching, and self-
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management education; cultural mediation; interpretation or
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translation services; health system navigation; patient and
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family advocacy; outreach before appointments, including
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appointment reminders; outreach to ensure adherence to
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treatments and medications; home visits; individual, community,
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and environmental assessments; arranging transportation; making
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connections to community resources or social services; and
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providing care coordination and case management.
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(a) As used in this subsection, the term "community health
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worker" means a frontline public health worker who provides a
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range of services addressing the health and social needs of the
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community and is a trusted member of or has a close
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understanding of the community he or she serves. The term
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includes community health representatives, promotores de salud,
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and public or private community-based organizations.
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(b) The agency shall adopt rules that include, but are not
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limited to, eligible services provided by community health
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workers.
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(c) The agency may seek federal approval necessary to
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implement this subsection.
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Section 2. Paragraphs (c) through (u) of subsection (3) of
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section 409.908, Florida Statutes, are redesignated as
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paragraphs (d) through (v), respectively, and a new paragraph
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(c) is added to subsection (3) of that section, to read:
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409.908 Reimbursement of Medicaid providers.—Subject to
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specific appropriations, the agency shall reimburse Medicaid
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providers, in accordance with state and federal law, according
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to methodologies set forth in the rules of the agency and in
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policy manuals and handbooks incorporated by reference therein.
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These methodologies may include fee schedules, reimbursement
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methods based on cost reporting, negotiated fees, competitive
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bidding pursuant to s. 287.057, and other mechanisms the agency
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considers efficient and effective for purchasing services or
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goods on behalf of recipients. If a provider is reimbursed based
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on cost reporting and submits a cost report late and that cost
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report would have been used to set a lower reimbursement rate
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for a rate semester, then the provider's rate for that semester
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shall be retroactively calculated using the new cost report, and
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full payment at the recalculated rate shall be effected
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retroactively. Medicare-granted extensions for filing cost
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reports, if applicable, shall also apply to Medicaid cost
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reports. Payment for Medicaid compensable services made on
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behalf of Medicaid-eligible persons is subject to the
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availability of moneys and any limitations or directions
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provided for in the General Appropriations Act or chapter 216.
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Further, nothing in this section shall be construed to prevent
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or limit the agency from adjusting fees, reimbursement rates,
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lengths of stay, number of visits, or number of services, or
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making any other adjustments necessary to comply with the
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availability of moneys and any limitations or directions
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provided for in the General Appropriations Act, provided the
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adjustment is consistent with legislative intent.
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(3) Subject to any limitations or directions provided for
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in the General Appropriations Act, the following Medicaid
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services and goods may be reimbursed on a fee-for-service basis.
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For each allowable service or goods furnished in accordance with
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Medicaid rules, policy manuals, handbooks, and state and federal
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law, the payment shall be the amount billed by the provider, the
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provider's usual and customary charge, or the maximum allowable
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fee established by the agency, whichever amount is less, with
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the exception of those services or goods for which the agency
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makes payment using a methodology based on capitation rates,
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average costs, or negotiated fees.
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(c) Community health workers services.
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Section 3. Paragraphs (e) through (cc) of subsection (1)
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of section 409.973, Florida Statutes, are redesignated as
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paragraphs (f) through (dd), respectively, and a new paragraph
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(e) is added to subsection (1) of that section, to read:
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409.973 Benefits.—
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(1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
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minimum, the following services:
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(e) Community health worker services.
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Section 4. This act shall take effect July 1, 2026.