Public Act 103-0639
 
SB3414 EnrolledLRB103 38590 RPS 68726 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by 
changing Section 356z.59 as follows:
 
    (215 ILCS 5/356z.59)
    Sec. 356z.59. Coverage for continuous glucose monitors. 
    (a) A group or individual policy of accident and health 
insurance or a managed care plan that is amended, delivered, 
issued, or renewed before January 1, 2026 on or after January 
1, 2024 shall provide coverage for medically necessary 
continuous glucose monitors for individuals who are diagnosed 
with any form of diabetes mellitus type 1 or type 2 diabetes 
and require insulin for the management of their diabetes. A 
group or individual policy of accident and health insurance or 
a managed care plan that is amended, delivered, issued, or 
renewed on or after January 1, 2026 shall provide coverage for 
continuous glucose monitors, related supplies, and training in 
the use of continuous glucose monitors for any individual if 
the following requirements are met: 
        (1) the individual is diagnosed with diabetes 
    mellitus;
        (2) the continuous glucose monitor has been prescribed 
    by a physician licensed under the Medical Practice Act of 
    1987 or a certified nurse practitioner or physician 
    assistant with a collaborative agreement with the 
    physician;
        (3) the continuous glucose monitor has been prescribed 
    in accordance with the Food and Drug Administration's 
    indications for use;
        (4) the prescriber has concluded that the individual 
    or individual's caregiver has sufficient training in using 
    the continuous glucose monitor, which may be evidenced by 
    the prescriber having prescribed a continuous glucose 
    monitor, and has attested that the patient will be 
    provided with that training;
        (5) the individual either:
            (A) uses insulin for treatment via one or more 
        injections or infusions of insulin per day, and only 
        one injection or infusion of one type of insulin shall 
        be sufficient utilization of insulin to qualify for a 
        continuous glucose monitor under this Section; or
            (B) has reported a history of problematic 
        hypoglycemia with documentation to the individual's 
        medical provider showing at least one of the 
        following:
                (i) recurrent hypoglycemic events 
            characterized by an altered mental or physical 
            state, despite multiple attempts to adjust 
            medications or modify the diabetes treatment plan, 
            as documented by a medical provider; or
                (ii) a history of at least one hypoglycemic 
            event characterized by an altered mental or 
            physical state requiring third-party assistance 
            for treatment of hypoglycemia, as documented by 
            the individual's medical provider, which may be 
            self-reported by the individual; third-party 
            assistance shall not, in any event, be deemed to 
            require that the individual had been admitted to a 
            hospital or visited an emergency department; and
        (6) within 6 months prior to prescribing a continuous 
    glucose monitor, the medical provider prescribing the 
    continuous glucose monitor had an in-person or covered 
    telehealth visit with the individual to evaluate the 
    individual's diabetes control and has determined that the 
    criteria of paragraphs (1) through (5) are met.
    Notwithstanding any other provision of this Section, to 
qualify for a continuous glucose monitor under this Section, 
an individual is not required to have a diagnosis of 
uncontrolled diabetes; have a history of emergency room visits 
or hospitalizations; or show improved glycemic control.
    All continuous glucose monitors covered under this Section 
shall be approved for use by individuals, and the choice of 
device shall be made based upon the individual's circumstances 
and medical needs in consultation with the individual's 
medical provider, subject to the terms of the policy.
    (b) Any individual who is diagnosed with diabetes mellitus 
and meets the requirements of this Section shall not be 
required to obtain prior authorization for coverage for a 
continuous glucose monitor, and coverage shall be continuous 
once the continuous glucose monitor is prescribed.
    (c) A group or individual policy of accident and health 
insurance or a managed care plan that is amended, delivered, 
issued, or renewed on or after January 1, 2026 shall not impose 
a deductible, coinsurance, copayment, or any other 
cost-sharing requirement on the coverage of a one-month supply 
of continuous glucose monitors, including one transmitter if 
necessary, as provided under this Section. The provisions of 
this subsection do not apply to coverage under this Section to 
the extent such coverage would disqualify a high-deductible 
health plan from eligibility for a health savings account 
pursuant to the federal Internal Revenue Code, 26 U.S.C. 23.
(Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
    Section 10. The Illinois Public Aid Code is amended by 
adding Section 5-16.8a as follows:
 
    (305 ILCS 5/5-16.8a new)
    Sec. 5-16.8a. Rules concerning continuous glucose monitor 
coverage. The Department shall adopt rules to implement the 
changes made to Section 356z.59 of the Illinois Insurance 
Code, as applied to the medical assistance program. The rules 
shall, at a minimum, provide that:
        (1) the ordering provider must be a physician licensed 
    under the Medical Practice Act of 1987 or a certified 
    nurse practitioner or physician assistant with a 
    collaborative agreement with the physician; the ordering 
    provider is not required to obtain continuing medical 
    education in order to prescribe a continuous glucose 
    monitor;
        (2) continuous glucose monitors are not required to 
    have an alarm when glucose levels are outside the 
    pre-determined range; the capacity to generate predictive 
    alerts in case of impending hypoglycemia; or the ability 
    to transmit real-time glucose values and alerts to the 
    patient and designated other persons;
        (3) the beneficiary is not required to need intensive 
    insulin therapy;
        (4) the beneficiary is not required to have a recent 
    history of emergency room visits or hospitalizations 
    related to hypoglycemia, hyperglycemia, or ketoacidosis;
        (5) if the beneficiary has gestational diabetes, the 
    beneficiary is not required to have suboptimal glycemic 
    control that is likely to harm the beneficiary or the 
    fetus;
        (6) if a beneficiary has diabetes mellitus and the 
    beneficiary does not meet the coverage requirements or if 
    the beneficiary is in a population in which continuous 
    glucose monitor usage has not been well-studied, requests 
    shall be reviewed, on a case-by-case basis, for medical 
    necessity and approved if appropriate; and
        (7) prior authorization is required for a prescription 
    of a continuous glucose monitor; once a continuous glucose 
    monitor is prescribed, the prior authorization shall be 
    approved for a 12-month period.
 
    Section 99. Effective date. This Act takes effect July 1, 
2024.

Effective Date:  7/1/2024