Statute 409.973

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409.973 Benefits.—
(1) MINIMUM BENEFITS.—Managed care plans shall cover, at a minimum, the following services:
(a) Advanced practice registered nurse services.
(b) Ambulatory surgical treatment center services.
(c) Birthing center services.
(d) Chiropractic services.
(e) Donor human milk bank services.
(f) Early periodic screening diagnosis and treatment services for recipients under age 21.
(g) Emergency services.
(h) Family planning services and supplies. Pursuant to 42 C.F.R. s. 438.102, plans may elect to not provide these services due to an objection on moral or religious grounds, and must notify the agency of that election when submitting a reply to an invitation to negotiate.
(i) Healthy start services, except as provided in s. 409.975(4).
(j) Hearing services.
(k) Home health agency services.
(l) Hospice services.
(m) Hospital inpatient services.
(n) Hospital outpatient services.
(o) Laboratory and imaging services.
(p) Medical supplies, equipment, prostheses, and orthoses.
(q) Mental health services.
(r) Nursing care.
(s) Optical services and supplies.
(t) Optometrist services.
(u) Physical, occupational, respiratory, and speech therapy services.
(v) Physician services, including physician assistant services.
(w) Podiatric services.
(x) Prescription drugs.
(y) Renal dialysis services.
(z) Respiratory equipment and supplies.
(aa) Rural health clinic services.
(bb) Substance abuse treatment services.
(cc) Transportation to access covered services.
(2) CUSTOMIZED BENEFITS.—Managed care plans may customize benefit packages for nonpregnant adults, vary cost-sharing provisions, and provide coverage for additional services. The agency shall evaluate the proposed benefit packages to ensure services are sufficient to meet the needs of the plan’s enrollees and to verify actuarial equivalence.
409.966. Specifically, the decision to include dental services as a minimum benefit under this section, or to provide Medicaid recipients with dental benefits separate from the Medicaid managed medical assistance program described in this part, may take into consideration the data and findings of the report.
(b) In the event the Legislature takes no action before July 1, 2017, with respect to the report findings required under paragraph (a), the agency shall implement a statewide Medicaid prepaid dental health program for children and adults with a choice of at least two licensed dental managed care providers who must have substantial experience in providing dental care to Medicaid enrollees and children eligible for medical assistance under Title XXI of the Social Security Act and who meet all agency standards and requirements. To qualify as a provider under the prepaid dental health program, the entity must be licensed as a prepaid limited health service organization under part I of chapter 636 or as a health maintenance organization under part I of chapter 641. The contracts for program providers shall be awarded through a competitive procurement process. Beginning with the contract procurement process initiated during the 2023 calendar year, the contracts must be for 6 years and may not be renewed; however, the agency may extend the term of a plan contract to cover delays during a transition to a new plan provider. The agency shall include in the contracts a medical loss ratio provision consistent with s. 409.967(4). The agency is authorized to seek any necessary state plan amendment or federal waiver to commence enrollment in the Medicaid prepaid dental health program no later than March 1, 2019. The agency shall extend until December 31, 2024, the term of existing plan contracts awarded pursuant to the invitation to negotiate published in October 2017.
(6) INTEGRATED BEHAVIORAL HEALTH INITIATIVE.—Each plan operating in the managed medical assistance program shall work with the managing entity in its service area to establish specific organizational supports and protocols that enhance the integration and coordination of primary care and behavioral health services for Medicaid recipients. Progress in this initiative shall be measured using the integration framework and core measures developed by the Agency for Healthcare Research and Quality.
History.—s. 14, ch. 2011-134; s. 52, ch. 2012-5; s. 8, ch. 2012-44; ss. 1, 2, ch. 2016-109; s. 45, ch. 2016-241; ss. 40, 41, ch. 2018-106; s. 45, ch. 2020-156; s. 32, ch. 2021-51; s. 3, ch. 2022-40; s. 7, ch. 2022-42.
1Note.—Section 16, ch. 2022-42, provides that “[t]he Agency for Health Care Administration shall amend existing Statewide Medicaid Managed Care contracts to implement the changes made by this act to sections 409.973, 409.975, and 409.977, Florida Statutes. The agency shall implement the changes made by this act to sections 409.966, 409.974, and 409.981, Florida Statutes, for the 2025 plan year.”