Full Text of HB5382 103rd General Assembly
HB5382ham001 103RD GENERAL ASSEMBLY | Rep. Jenn Ladisch Douglass Filed: 3/20/2024 | | 10300HB5382ham001 | | LRB103 39371 RPS 71255 a |
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| 1 | | AMENDMENT TO HOUSE BILL 5382
| 2 | | AMENDMENT NO. ______. Amend House Bill 5382 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356z.59 as follows: | 6 | | (215 ILCS 5/356z.59) | 7 | | Sec. 356z.59. Coverage for continuous glucose monitors. | 8 | | (a) In this Section, "diabetes mellitus" includes all | 9 | | forms of diabetes, a chronic condition where the pancreas does | 10 | | not produce insulin or does not produce enough insulin or the | 11 | | body cannot effectively use the insulin it produces. | 12 | | (b) A group or individual policy of accident and health | 13 | | insurance or a managed care plan that is amended, delivered, | 14 | | issued, or renewed on or after January 1, 2024 and before | 15 | | January 1, 2026 shall provide coverage for medically necessary | 16 | | continuous glucose monitors for individuals who are diagnosed |
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| 1 | | with type 1 or type 2 diabetes and require insulin for the | 2 | | management of their diabetes. A group or individual policy of | 3 | | accident and health insurance or a managed care plan that is | 4 | | amended, delivered, issued, or renewed on or after January 1, | 5 | | 2026 shall provide coverage for continuous glucose monitors, | 6 | | related supplies, and training in the use of continuous | 7 | | glucose monitors for any individual who is diagnosed with | 8 | | diabetes mellitus, and the coverage shall fully align with the | 9 | | coverage for continuous glucose monitors under Medicare and | 10 | | the eligibility requirements shall be no more restrictive than | 11 | | the eligibility requirements for continuous glucose monitors | 12 | | under Medicare. | 13 | | Notwithstanding any other provision of this Section, to | 14 | | qualify for a continuous glucose monitor under this Section, | 15 | | an individual is not required to have a diagnosis of | 16 | | uncontrolled diabetes; have a history of emergency room visits | 17 | | or hospitalizations; or show improved glycemic control. | 18 | | All continuous glucose monitors covered under this Section | 19 | | shall be approved for usage by individuals, and the choice of | 20 | | device shall be made based upon the individual's | 21 | | circumstances, preferences, and needs in consultation with the | 22 | | individual's medical provider so long as the continuous | 23 | | glucose monitor has been approved by the United States Food | 24 | | and Drug Administration. | 25 | | (c) Any individual who is diagnosed with diabetes mellitus | 26 | | and meets the requirements of this Section shall not be |
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| 1 | | required to obtain prior authorization for coverage for a | 2 | | continuous glucose monitor, and coverage shall be continuous | 3 | | once the continuous glucose monitor is prescribed. | 4 | | (d) A group or individual policy of accident and health | 5 | | insurance or a managed care plan that is amended, delivered, | 6 | | issued, or renewed on or after January 1, 2026 shall not impose | 7 | | a deductible, coinsurance, copayment, or any other | 8 | | cost-sharing requirement on the coverage provided under this | 9 | | Section. The provisions of this subsection do not apply to | 10 | | coverage under this Section to the extent such coverage would | 11 | | disqualify a high-deductible health plan from eligibility for | 12 | | a health savings account pursuant to the federal Internal | 13 | | Revenue Code, 26 U.S.C. 23. | 14 | | (Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.) | 15 | | Section 10. The Illinois Public Aid Code is amended by | 16 | | adding Section 5-16.8a as follows: | 17 | | (305 ILCS 5/5-16.8a new) | 18 | | Sec. 5-16.8a. Continuous glucose monitor coverage. | 19 | | (a) The Department shall adopt rules to implement the | 20 | | changes made to Section 356z.59 of the Illinois Insurance | 21 | | Code, as applied to the medical assistance program, including | 22 | | the fee-for-service medical assistance program. The rules | 23 | | shall, at a minimum, provide that: | 24 | | (1) the ordering provider must be any physician |
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| 1 | | licensed under the Medical Practice Act of 1987 or | 2 | | certified nurse practitioner or physician assistant with a | 3 | | collaborative agreement with the physician; | 4 | | (2) the beneficiary is not required to have a | 5 | | diagnosis of uncontrolled diabetes; | 6 | | (3) the beneficiary is not required to need intensive | 7 | | insulin therapy; | 8 | | (4) the beneficiary is not required to have a recent | 9 | | history of emergency room visits or hospitalizations | 10 | | related to hypoglycemia, hyperglycemia, or ketoacidosis; | 11 | | (5) if the beneficiary has gestational diabetes, the | 12 | | beneficiary is not required to have suboptimal glycemic | 13 | | control that is likely to harm the beneficiary or the | 14 | | fetus; | 15 | | (6) if a beneficiary has diabetes mellitus and the | 16 | | beneficiary does not meet the coverage requirements or if | 17 | | the beneficiary is in a population in which continuous | 18 | | glucose monitor usage has not been well-studied, requests | 19 | | shall be reviewed, on a case-by-case basis, for medical | 20 | | necessity and approved if appropriate; and | 21 | | (7) the beneficiary is not required to obtain prior | 22 | | authorization for coverage for a continuous glucose | 23 | | monitor, and that coverage is continuous once the | 24 | | continuous glucose monitor is prescribed. | 25 | | (b) The fee-for-service medical assistance program shall | 26 | | comply with the requirements of Section 356z.59 of the |
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| 1 | | Illinois Insurance Code. | 2 | | Section 99. Effective date. This Act takes effect January | 3 | | 1, 2025.". |
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