Bill > S4651

Introduced Session

This bill requires the State Medicaid program to cover the costs of continuous glucose monitors (CGM), including the cost of any necessary repairs or replacement parts, for Medicaid recipients who are diagnosed with diabetes and are treated with insulin or have a history of problematic hypoglycemia with documentation of at least one of the following: two or more level two hypoglycemic events, defined as a glucose level below 54 mg/dL (3.0 mmol/L), that persist despite attempts to adjust medications, modify the diabetes treatment plan, or both or a history of one level three hypoglycemic event, defined as a glucose level below 54 mg/dL (3.0 mmol/L) that is characterized by altered mental or physical state requiring third-party assistance for treatment of hypoglycemia. To be eligible for coverage, this bill requires the CGM to be prescribed in accordance with the indications for use for the device, as approved by the federal Food and Drug Administration; for the recipient's treating physician to determine that the recipient, or the recipient's caregiver, has sufficient training using the CGM prescribed; and for the recipient to satisfy any additional criteria established by the commissioner based on current evidence-based standards. Under this bill, to be eligible for continuous coverage, Medicaid recipients must participate in follow-up care with their treating health care practitioners at least once every six months during the first 18 months following receipt of the CGM and at least once every 12 months thereafter. This bill directs the Commissioner of Human Services (the commissioner) to apply for State plan amendments or waivers necessary to implement the provisions of this bill and to secure federal financial participation. This bill authorizes the commissioner to adopt rules and regulations necessary to effectuate the purposes of this bill, and allows for the immediate filing of those rules and regulations with the Office of Administrative Law, effective for a period not to exceed six months.

AI Summary

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Joe Vitale (D)*, 

Introduced in the Senate, Referred to Senate Health, Human Services and Senior Citizens Committee (on 06/23/2025)

Official Document