Full Text of SB3414 103rd General Assembly
SB3414sam002 103RD GENERAL ASSEMBLY | Sen. Julie A. Morrison Filed: 3/8/2024 | | 10300SB3414sam002 | | LRB103 38590 RPS 70809 a |
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| 1 | | AMENDMENT TO SENATE BILL 3414
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 3414 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) A group or individual policy of accident and health | 9 | | insurance or a managed care plan that is amended, delivered, | 10 | | issued, or renewed before January 1, 2026 on or after January | 11 | | 1, 2024 shall provide coverage for medically necessary | 12 | | continuous glucose monitors for individuals who are diagnosed | 13 | | with any form of diabetes mellitus type 1 or type 2 diabetes | 14 | | and require insulin for the management of their diabetes. A | 15 | | group or individual policy of accident and health insurance or | 16 | | a managed care plan that is amended, delivered, issued, or |
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| 1 | | renewed on or after January 1, 2026 shall provide coverage for | 2 | | continuous glucose monitors, related supplies, and training in | 3 | | the use of continuous glucose monitors for any individual if | 4 | | the policy is in full alignment with Medicare and the | 5 | | following requirements are met: | 6 | | (1) the individual is diagnosed with diabetes | 7 | | mellitus; | 8 | | (2) the continuous glucose monitor has been prescribed | 9 | | by a physician licensed under the Medical Practice Act of | 10 | | 1987 or a certified nurse practitioner or physician | 11 | | assistant with a collaborative agreement with the | 12 | | physician; | 13 | | (3) the continuous glucose monitor has been prescribed | 14 | | in accordance with the Food and Drug Administration's | 15 | | indications for use; | 16 | | (4) the prescriber has concluded that the individual | 17 | | or individual's caregiver has sufficient training in using | 18 | | the continuous glucose monitor, which may be evidenced by | 19 | | the prescriber having prescribed a continuous glucose | 20 | | monitor, and has attested that the patient will be | 21 | | provided with that training; | 22 | | (5) the individual either: | 23 | | (A) uses insulin for treatment via one or more | 24 | | injections or infusions of insulin per day, and only | 25 | | one injection or infusion of one type of insulin shall | 26 | | be sufficient utilization of insulin to qualify for a |
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| 1 | | continuous glucose monitor under this Section; or | 2 | | (B) has reported a history of problematic | 3 | | hypoglycemia with documentation to the individual's | 4 | | medical provider showing at least one of the | 5 | | following: | 6 | | (i) recurrent hypoglycemic events | 7 | | characterized by an altered mental or physical | 8 | | state, despite multiple attempts to adjust | 9 | | medications or modify the diabetes treatment plan, | 10 | | as documented by a medical provider; or | 11 | | (ii) a history of at least one hypoglycemic | 12 | | event characterized by an altered mental or | 13 | | physical state requiring third-party assistance | 14 | | for treatment of hypoglycemia, as documented by | 15 | | the individual's medical provider, which may be | 16 | | self-reported by the individual; third-party | 17 | | assistance shall not, in any event, be deemed to | 18 | | require that the individual had been admitted to a | 19 | | hospital or visited an emergency department; and | 20 | | (6) within 6 months prior to prescribing a continuous | 21 | | glucose monitor, the medical provider prescribing the | 22 | | continuous glucose monitor had an in-person or covered | 23 | | telehealth visit with the individual to evaluate the | 24 | | individual's diabetes control and has determined that the | 25 | | criteria of paragraphs (1) through (5) are met. | 26 | | Notwithstanding any other provision of this Section, to |
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| 1 | | qualify for a continuous glucose monitor under this Section, | 2 | | an individual is not required to have a diagnosis of | 3 | | uncontrolled diabetes; have a history of emergency room visits | 4 | | or hospitalizations; or show improved glycemic control. | 5 | | All continuous glucose monitors covered under this Section | 6 | | shall be approved for use by individuals, and the choice of | 7 | | device shall be made based upon the individual's circumstances | 8 | | and medical needs in consultation with the individual's | 9 | | medical provider, subject to the terms of the policy. | 10 | | (b) Any individual who is diagnosed with diabetes mellitus | 11 | | and meets the requirements of this Section shall not be | 12 | | required to obtain prior authorization for coverage for a | 13 | | continuous glucose monitor, and coverage shall be continuous | 14 | | once the continuous glucose monitor is prescribed. | 15 | | (c) A group or individual policy of accident and health | 16 | | insurance or a managed care plan that is amended, delivered, | 17 | | issued, or renewed on or after January 1, 2026 shall not impose | 18 | | a deductible, coinsurance, copayment, or any other | 19 | | cost-sharing requirement on the coverage of one continuous | 20 | | glucose monitor, as provided under this Section. The | 21 | | provisions of this subsection do not apply to coverage under | 22 | | this Section to the extent such coverage would disqualify a | 23 | | high-deductible health plan from eligibility for a health | 24 | | savings account pursuant to the federal Internal Revenue Code, | 25 | | 26 U.S.C. 23. | 26 | | (Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.) |
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| 1 | | Section 10. The Illinois Public Aid Code is amended by | 2 | | adding Section 5-16.8a as follows: | 3 | | (305 ILCS 5/5-16.8a new) | 4 | | Sec. 5-16.8a. Rules concerning continuous glucose monitor | 5 | | coverage. The Department shall adopt rules to implement the | 6 | | changes made to Section 356z.59 of the Illinois Insurance | 7 | | Code, as applied to the medical assistance program. The rules | 8 | | shall, at a minimum, provide that: | 9 | | (1) the ordering provider must be a physician licensed | 10 | | under the Medical Practice Act of 1987 or a certified | 11 | | nurse practitioner or physician assistant with a | 12 | | collaborative agreement with the physician; | 13 | | (2) continuous glucose monitors are not required to | 14 | | have an alarm when glucose levels are outside the | 15 | | pre-determined range; the capacity to generate predictive | 16 | | alerts in case of impending hypoglycemia; or the ability | 17 | | to transmit real-time glu | | | cose values and alerts to the | 18 | | patient and designated other persons; | 19 | | (3) the beneficiary is not required to need intensive | 20 | | insulin therapy; | 21 | | (4) the beneficiary is not required to have a recent | 22 | | history of emergency room visits or hospitalizations | 23 | | related to hypoglycemia, hyperglycemia, or ketoacidosis; | 24 | | (5) if the beneficiary has gestational diabetes, the |
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| 1 | | beneficiary is not required to have suboptimal glycemic | 2 | | control that is likely to harm the beneficiary or the | 3 | | fetus; | 4 | | (6) if a beneficiary has diabetes mellitus and the | 5 | | beneficiary does not meet the coverage requirements or if | 6 | | the beneficiary is in a population in which continuous | 7 | | glucose monitor usage has not been well-studied, requests | 8 | | shall be reviewed, on a case-by-case basis, for medical | 9 | | necessity and approved if appropriate; and | 10 | | (7) the beneficiary is not required to obtain prior | 11 | | authorization for coverage for a continuous glucose | 12 | | monitor, and that coverage is continuous once the | 13 | | continuous glucose monitor is prescribed. | 14 | | Section 99. Effective date. This Act takes effect July 1, | 15 | | 2024.". |
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