Full Text of SB3414 103rd General Assembly
SB3414sam001 103RD GENERAL ASSEMBLY | Sen. Julie A. Morrison Filed: 3/5/2024 | | 10300SB3414sam001 | | LRB103 38590 RPS 70406 a |
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| 1 | | AMENDMENT TO SENATE BILL 3414
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 3414 on page 1, | 3 | | line 10, by replacing " 2025 " with " 2026 "; and | 4 | | on page 1, line 17, by replacing " 2025 " with " 2026 "; and | 5 | | by replacing line 19 on page 1 through line 19 on page 2 with | 6 | | the following: | 7 | | " the use of continuous glucose monitors for any individual if | 8 | | the policy is in full alignment with Medicare and the | 9 | | following requirements are met: | 10 | | (1) the individual is diagnosed with diabetes | 11 | | mellitus; | 12 | | (2) the continuous glucose monitor has been prescribed | 13 | | by a physician licensed under the Medical Practice Act of | 14 | | 1987 or a certified nurse practitioner or physician | 15 | | assistant with a collaborative agreement with the | 16 | | physician; |
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| 1 | | (3) the continuous glucose monitor has been prescribed | 2 | | in accordance with the Food and Drug Administration's | 3 | | indications for use; | 4 | | (4) the prescriber has concluded that the individual | 5 | | or individual's caregiver has sufficient training in using | 6 | | the continuous glucose monitor, which may be evidenced by | 7 | | the prescriber having prescribed a continuous glucose | 8 | | monitor, and has attested that the patient will be | 9 | | provided with that training; | 10 | | (5) the individual either: | 11 | | (A) uses insulin for treatment via one or more | 12 | | injections or infusions of insulin per day, and only | 13 | | one injection or infusion of one type of insulin shall | 14 | | be sufficient utilization of insulin to qualify for a | 15 | | continuous glucose monitor under this Section; or | 16 | | (B) has reported a history of problematic | 17 | | hypoglycemia with documentation to the individual's | 18 | | medical provider showing at least one of the | 19 | | following: | 20 | | (i) recurrent hypoglycemic events | 21 | | characterized by an altered mental or physical | 22 | | state, despite multiple attempts to adjust | 23 | | medications or modify the diabetes treatment plan, | 24 | | as documented by a medical provider; or | 25 | | (ii) a history of at least one hypoglycemic | 26 | | event characterized by an altered mental or |
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| 1 | | physical state requiring third-party assistance | 2 | | for treatment of hypoglycemia, as documented by | 3 | | the individual's medical provider, which may be | 4 | | self-reported by the individual; third-party | 5 | | assistance shall not, in any event, be deemed to | 6 | | require that the individual had been admitted to a | 7 | | hospital or visited an emergency department; and | 8 | | (6) within 6 months prior to prescribing a continuous | 9 | | glucose monitor, the medical provider prescribing the | 10 | | continuous glucose monitor had an in-person or covered | 11 | | telehealth visit with the individual to evaluate the | 12 | | individual's diabetes control and has determined that the | 13 | | criteria of paragraphs (1) through (5) are met. | 14 | | Notwithstanding any other provision of this Section, to | 15 | | qualify for a continuous glucose monitor under this Section, | 16 | | an individual is not required to have a diagnosis of | 17 | | uncontrolled diabetes; have a history of emergency room visits | 18 | | or hospitalizations; or show improved glycemic control. | 19 | | All continuous glucose monitors covered under this Section | 20 | | shall be approved for use by individuals, and the choice of | 21 | | device shall be made based upon the individual's | 22 | | circumstances, preferences, and needs in consultation with the | 23 | | individual's medical provider. | 24 | | (b) Any individual who is diagnosed with diabetes mellitus | 25 | | and meets the requirements of this Section shall not be | 26 | | required to obtain prior authorization for coverage for a |
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| 1 | | continuous glucose monitor, and coverage shall be continuous | 2 | | once the continuous glucose monitor is prescribed. | 3 | | (c) A group or individual policy of accident and health | 4 | | insurance or a managed care plan that is amended, delivered, | 5 | | issued, or renewed on or after January 1, 2026 shall not impose | 6 | | a deductible, coinsurance, copayment, or any other | 7 | | cost-sharing requirement on the coverage provided under this | 8 | | Section. The provisions of this subsection do not apply to | 9 | | coverage under this Section to the extent such coverage would | 10 | | disqualify a high-deductible health plan from eligibility for | 11 | | a health savings account pursuant to the federal Internal | 12 | | Revenue Code, 26 U.S.C. 23. | 13 | | Section 10. The Illinois Public Aid Code is amended by | 14 | | adding Section 5-16.8a as follows: | 15 | | (305 ILCS 5/5-16.8a new) | 16 | | Sec. 5-16.8a. Rules concerning continuous glucose monitor | 17 | | coverage. The Department shall adopt rules to implement the | 18 | | changes made to Section 356z.59 of the Illinois Insurance | 19 | | Code, as applied to the medical assistance program. The rules | 20 | | shall, at a minimum, provide that: | 21 | | (1) the ordering provider must be a physician licensed | 22 | | under the Medical Practice Act of 1987 or a certified | 23 | | nurse practitioner or physician assistant with a | 24 | | collaborative agreement with the physician; |
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| 1 | | (2) continuous glucose monitors are not required to | 2 | | have an alarm when glucose levels are outside the | 3 | | pre-determined range; the capacity to generate predictive | 4 | | alerts in case of impending hypoglycemia; or the ability | 5 | | to transmit real-time glucose values and alerts to the | 6 | | patient and designated other persons; | 7 | | (3) the beneficiary is not required to need intensive | 8 | | insulin therapy; | 9 | | (4) the beneficiary is not required to have a recent | 10 | | history of emergency room visits or hospitalizations | 11 | | related to hypoglycemia, hyperglycemia, or ketoacidosis; | 12 | | (5) if the beneficiary has gestational diabetes, the | 13 | | beneficiary is not required to have suboptimal glycemic | 14 | | control that is likely to harm the beneficiary or the | 15 | | fetus; | 16 | | (6) if a beneficiary has diabetes mellitus and the | 17 | | beneficiary does not meet the coverage requirements or if | 18 | | the beneficiary is in a population in which continuous | 19 | | glucose monitor usage has not been well-studied, requests | 20 | | shall be reviewed, on a case-by-case basis, for medical | 21 | | necessity and approved if appropriate; and | 22 | | (7) the beneficiary is not required to obtain prior | 23 | | authorization for coverage for a continuous glucose | 24 | | monitor, and that coverage is continuous once the | 25 | | continuous glucose monitor is prescribed. ". |
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