Full Text of HB5382 103rd General Assembly
HB5382ham002 103RD GENERAL ASSEMBLY | Rep. Jenn Ladisch Douglass Filed: 4/2/2024 | | 10300HB5382ham002 | | LRB103 39371 RPS 71744 a |
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| 1 | | AMENDMENT TO HOUSE BILL 5382
| 2 | | AMENDMENT NO. ______. Amend House Bill 5382, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following: | 5 | | "Section 5. The Illinois Insurance Code is amended by | 6 | | changing Section 356z.59 as follows: | 7 | | (215 ILCS 5/356z.59) | 8 | | Sec. 356z.59. Coverage for continuous glucose monitors. | 9 | | (a) In this Section, "diabetes mellitus" includes all | 10 | | forms of diabetes, a chronic condition where the pancreas does | 11 | | not produce insulin or does not produce enough insulin or the | 12 | | body cannot effectively use the insulin it produces. | 13 | | (b) A group or individual policy of accident and health | 14 | | insurance or a managed care plan that is amended, delivered, | 15 | | issued, or renewed on or after January 1, 2024 and before | 16 | | January 1, 2026 shall provide coverage for medically necessary |
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| 1 | | continuous glucose monitors for individuals who are diagnosed | 2 | | with type 1 or type 2 diabetes and require insulin for the | 3 | | management of their diabetes. A group or individual policy of | 4 | | accident and health insurance or a managed care plan that is | 5 | | amended, delivered, issued, or renewed on or after January 1, | 6 | | 2026 shall provide coverage for continuous glucose monitors, | 7 | | related supplies, and training in the use of continuous | 8 | | glucose monitors for any individual who is diagnosed with | 9 | | diabetes mellitus, and the coverage shall fully align with the | 10 | | coverage for continuous glucose monitors under Medicare and | 11 | | the eligibility requirements shall be no more restrictive than | 12 | | the eligibility requirements for continuous glucose monitors | 13 | | under Medicare. | 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 usage 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 so long as the continuous | 24 | | glucose monitor has been approved by the United States Food | 25 | | and Drug Administration. | 26 | | (c) Any individual who is diagnosed with diabetes mellitus |
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| 1 | | and meets the requirements of this Section shall not be | 2 | | required to obtain prior authorization for coverage for a | 3 | | continuous glucose monitor, and coverage shall be continuous | 4 | | once the continuous glucose monitor is prescribed. | 5 | | (d) A group or individual policy of accident and health | 6 | | insurance or a managed care plan that is amended, delivered, | 7 | | issued, or renewed on or after January 1, 2026 shall not impose | 8 | | a deductible, coinsurance, copayment, or any other | 9 | | cost-sharing requirement on the coverage provided under this | 10 | | Section for a one-month supply of continuous glucose monitors, | 11 | | including a transmitter if necessary. The provisions of this | 12 | | subsection do not apply to coverage under this Section to the | 13 | | extent such coverage would disqualify a high-deductible health | 14 | | plan from eligibility for a health savings account pursuant to | 15 | | the federal Internal Revenue Code, 26 U.S.C. 23. | 16 | | (Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.) | 17 | | Section 10. The Illinois Public Aid Code is amended by | 18 | | adding Section 5-16.8a as follows: | 19 | | (305 ILCS 5/5-16.8a new) | 20 | | Sec. 5-16.8a. Continuous glucose monitor coverage. | 21 | | (a) The Department shall adopt rules to implement the | 22 | | changes made to Section 356z.59 of the Illinois Insurance | 23 | | Code, as applied to the medical assistance program, including | 24 | | the fee-for-service medical assistance program. The rules |
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| 1 | | shall, at a minimum, provide that: | 2 | | (1) the ordering provider must be any physician | 3 | | licensed under the Medical Practice Act of 1987 or | 4 | | certified nurse practitioner or physician assistant with a | 5 | | collaborative agreement with the physician; | 6 | | (2) the beneficiary is not required to have a | 7 | | diagnosis of uncontrolled diabetes; | 8 | | (3) the beneficiary is not required to need intensive | 9 | | insulin therapy, to take multiple injections of insulin | 10 | | per day, or to use more than one type of insulin; | 11 | | (4) the beneficiary is not required to have a recent | 12 | | history of emergency room visits or hospitalizations | 13 | | related to hypoglycemia, hyperglycemia, or ketoacidosis; | 14 | | (5) if the beneficiary has gestational diabetes, the | 15 | | beneficiary is not required to have suboptimal glycemic | 16 | | control that is likely to harm the beneficiary or the | 17 | | fetus; | 18 | | (6) if a beneficiary has diabetes mellitus and the | 19 | | beneficiary does not meet the coverage requirements or if | 20 | | the beneficiary is in a population in which continuous | 21 | | glucose monitor usage has not been well-studied, requests | 22 | | shall be reviewed, on a case-by-case basis, for medical | 23 | | necessity and approved if appropriate; | 24 | | (7) the beneficiary is not required to obtain prior | 25 | | authorization for coverage for a continuous glucose | 26 | | monitor, and that coverage is continuous once the |
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| 1 | | continuous glucose monitor is prescribed; and | 2 | | (8) continuous glucose monitors covered under this | 3 | | Section shall not be required to have alarms or predictive | 4 | | alerts and shall only be required to have United States | 5 | | Food and Drug Administration approval to be covered. | 6 | | (b) The fee-for-service medical assistance program shall | 7 | | comply with the requirements of Section 356z.59 of the | 8 | | Illinois Insurance Code. | 9 | | Section 99. Effective date. This Act takes effect January | 10 | | 1, 2026.". |
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