F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
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.; providing definitions; requiring
5 the Agency for Health Care Administration, in
6 conjunction with the Department of Health, to
7 establish the Food is Medicine Pilot Program to
8 provide Medicaid coverage for purchases and deliveries
9 of prescribed health-promoting foods under certain
10 circumstances; requiring the agency, in conjunction
11 with the department, to seek federal approval and
12 waivers for the pilot program; requiring the federal
13 waiver application to seek matching funds; requiring
14 referrals of pilot program patients to certain federal
15 and federally funded programs; requiring allocation of
16 a portion of pilot program implementation budget to a
17 specified organization for the establishment of a
18 specified center; providing operation requirements for
19 the center; providing reporting requirements;
20 requiring the agency, in conjunction with the
21 department, to adopt rules; providing requirements for
22 the rules; providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
Page 1 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
26 Section 1. Section 409.90203, Florida Statutes, is created
27 to read:
28 409.90203 Food is Medicine Pilot Program; Medicaid
29 coverage for pilot program providing medically precise
30 nutrition, medically tailored meals, or produce prescriptions,
31 with nutrition education and supports; federal approval and
32 waivers; Florida Food is Medicine Center of Excellence. —
33 (1) As used in this section, the term:
34 (a) "Center," unless the context clearly indicates
35 otherwise, means the Florida Food is Medicine Center of
36 Excellence established in this section by the Florida Health and
37 Nutrition Coalition.
38 (b) "Food is Medicine" means food-based interventions and
39 services that include medically precise nutrition, medically
40 tailored meals, or produce prescriptions, with nutrition
41 education and specific supports provided to a person with a
42 specific diet-related disease or chronic condition to
43 effectively support healthful food and physical activity
44 behavior change conducive to health and well-being while
45 improving health outcomes and health care cost savings through
46 the control and reversal of the disease or condition effects and
47 the prevention of further disease or condition complications.
48 (c) "Medically precise nutrition" means a medical
49 nutrition groceries program provided to a Medicaid recipient
50 through a prescription or referral from a physician licensed
Page 2 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
51 under chapter 458 or chapter 459, or through a referral from a
52 clinic or hospital staff member, a licensed clinical social
53 worker, a registered dietitian/nutritionist, or a health plan,
54 for fresh and health-promoting groceries purchased and
55 distributed with nutrition education and specific supports to
56 produce positive health outcomes for a specific diet-related
57 disease or chronic condition.
58 1. The medical nutrition groceries program must be in a
59 protocol standard selected, reviewed, and approved by a
60 registered dietitian or registered dietitian/nutritionist
61 licensed under s. 468.513 as part of a 6-month intervention
62 treatment program that follows the model of healthful food
63 prescription programs supported by research conducted by the
64 Gerald J. and Dorothy R. Friedman School of Nutrition Science
65 and Policy at Tufts University and implemented by the nonprofit
66 organization Living Hungry and that is certified by the Florida
67 Food is Medicine Center of Excellence to meet the quality and
68 cultural standards and the health standards for the specific
69 disease or chronic condition.
70 2. The medical nutrition groceries program may include
71 supports through behavioral health counseling, Food is Medicine
72 functional medicine classes, anatomy of disease classes, cooking
73 classes, gym or exercise classes, weekly menus and shopping
74 lists, grocery store tours, and motivational habit change
75 supports such as peer mentoring and health coaching in a
Page 3 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
76 protocol designed for a Medicaid recipient with a specific diet-
77 related disease or chronic condition to effectively control or
78 reverse the disease or condition effects and prevent further
79 disease or condition complications.
80 3. The health-promoting groceries under the medical
81 nutrition groceries program may be:
82 a. Picked up at the health plan facility or clinic or at
83 an event organized by a community-based organization or by an
84 entity under contract with the program such as a grocery store;
85 or
86 b. Delivered to the residence of the Medicaid recipient by
87 the program or by an entity under contract with the program.
88 4. The medical nutrition groceries program:
89 a. May include healthful recipes and healthfully prepared
90 ingredients, herbs, spices, and sauces.
91 b. May include at-home laboratory tests, supplements,
92 monitoring supplies, and telehealth components.
93 c. Must include nutrition education.
94 d. Must include a program evaluation to report health
95 outcomes, including, but not limited to, biomarkers, nutri tion
96 security assessments, and healthful eating and behavior change
97 surveys before and after the use of the program to evaluate the
98 program's effectiveness.
99 (d) "Medically tailored meals" means a medical meal plan
100 program provided to a Medicaid recipient through a prescription
Page 4 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
101 or referral from a physician licensed under chapter 458 or
102 chapter 459, or through a referral from a clinic or hospital
103 staff member, a licensed clinical social worker, a registered
104 dietitian or registered dietitian/nutritionist, or a health
105 plan, for meals purchased and distributed with nutrition
106 education and support to produce positive health outcomes for a
107 person with a specific diet-related disease or chronic
108 condition. The medical meal plan program must be designed,
109 reviewed, and approved by a registered dietitian or registered
110 dietitian/nutritionist licensed under s. 468.513 to reflect
111 appropriate medical nutrition therapy based on evidence -based
112 practice guidelines for the specific diet-related disease or
113 chronic condition that requires the prescription or referral.
114 1. The meals under the medical meal plan program must be
115 fully prepared by a Medicaid provider or by a person, entity, or
116 community-based organization under contract with a Medicaid
117 managed care organization or with a Medicaid provider and must
118 be certified by the Florida Food is Medicine Center of
119 Excellence to meet the quality and cultural standards and health
120 standards for the specific disease or chronic condition. The
121 meals may be:
122 a. Picked up at the health plan facility or clinic or at
123 an event organized by a community-based organization or by an
124 entity under contract with the program such as a restaurant or
125 grocery store; or
Page 5 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
126 b. Delivered to the residence of the Medicaid recipient by
127 the program or by an entity under contract with the program.
128 2. The medical meal plan program:
129 a. May include healthful recipes and healthfully prepared
130 ingredients, herbs, spices, and sauces.
131 b. May include at-home laboratory tests, supplements,
132 monitoring supplies, and telehealth components.
133 c. Must include nutrition education.
134 d. Must include a program evaluation to report health
135 outcomes, including, but not limited to, biomarkers, nutrition
136 security assessments, and healthful eating and behavior change
137 surveys before and after the use of the program to evaluate the
138 program's effectiveness.
139 (e) "Nutrition education" means a validated course and
140 series of nutrition education classes in a 6-month intervention
141 program such as the Expanded Food and Nutrition Education
142 Program, a research-based nutrition education program funded by
143 the United States Department of Agriculture which teaches
144 participants to grocery shop and plan and cook nutritious meals
145 through lessons given by in-language, in-culture
146 paraprofessionals and other educators from the Extension Family
147 and Consumer Sciences programs of the University of Florida
148 Institute of Food and Agricultural Sciences (UF/IFAS), with
149 sites in multiple counties across the state. The term also
150 includes surveys before and after the classes to measure habit
Page 6 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
151 changes and evaluate applications of nutrition education among
152 Florida residents, especially among populations that endure a
153 disproportionate share of food insecurity.
154 (f) "Pilot program" means the Food is Medicine Pilot
155 Program established in this section.
156 (g) "Produce prescription" means a program that is
157 provided through a prescription or referral from a physician
158 licensed under chapter 458 or chapter 459, or through a referral
159 from a clinic or hospital staff member, a licensed clinical
160 social worker, a registered dietitian or registered
161 dietitian/nutritionist, or a health plan, to a Medicaid
162 recipient who has or is at risk of a specific diet-related
163 disease or chronic condition such as diabetes, coronary artery
164 disease, cancer, obesity, renal disease, celiac disease, asthma,
165 or dementia, to purchase produce at no cost or low cost using a
166 technology-enabled application such as About Fresh; a coupon; a
167 voucher; a debit card; a digital currency; or other means of
168 storing value to be redeemed for purchasing fresh or frozen
169 produce.
170 1.a. The technology-enabled application, coupon, voucher,
171 debit card, digital currency, or other means of storing value
172 may be redeemed at a farm store, farm packing house, mobile
173 farmers' market, market as defined in s. 414.456(1), or
174 community-based organization site; or
175 b. The produce may be delivered to the residence of the
Page 7 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
176 Medicaid recipient or distributed through a market or store or
177 through a Medicaid provider or health plan facility or cli nic.
178 2. The program must be in a protocol standard selected,
179 reviewed, and approved by a registered dietitian/nutritionist
180 licensed under s. 468.513 as part of an intervention program
181 that may include medical nutritional therapy by a registered
182 dietitian/nutritionist, behavioral health counseling, Food is
183 Medicine functional medicine classes, anatomy of disease
184 classes, cooking classes, gym or exercise classes, weekly menus
185 and shopping lists, grocery store tours, and habit change
186 supports such as peer mentoring and health coaching designed for
187 a Medicaid recipient with a specific diet-related disease or
188 chronic condition to effectively control and reverse the disease
189 or condition effects and prevent the disease or condition
190 complications. The program:
191 a. May include healthful recipes and healthfully prepared
192 ingredients, herbs, spices, and sauces.
193 b. May include at-home laboratory tests, supplements,
194 monitoring supplies, and telehealth components.
195 c. Must include nutrition education.
196 d. Must include a program evaluation to report health
197 outcomes, including, but not limited to, biomarkers, nutrition
198 security assessments, and healthful eating and behavior change
199 surveys before and after the use of the program to evaluate the
200 program's effectiveness.
Page 8 of 13
CODING: Words stricken are deletions; words underlined are additions.
hb0253-00
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 253 2024
201 (h) "Program evaluation" means an annual evaluation of a
202 state Medicaid-funded program that uses medically precise
203 nutrition, medically tailored meals, or produce prescriptions.
204 These evaluations assess fidelity of program implementation and
205 overall program effectiveness, as well as health biomarker
206 outcomes, nutrition intake, health equity, healthful habit
207 adoption, and food insecurity. The annual evaluation:
208 1. May either be funded by the agency and conducted by
209 UF/IFAS Food is Medicine evaluators or be a component of the
210 program's implementation budget.
211 2. Is reported to the agency and the Legislature.
212 (2) By July 1, 2025, the agency, in conjunction with the
213 Dep