Downloads
CS/HB 967 — Medicaid Coverage of Continuous Glucose Monitors
by Healthcare Regulation Subcommittee and Rep. Bell and others (CS/SB 988 by Health Policy Committee and Senators Burton and Davis)
This summary is provided for information only and does not represent the opinion of any Senator, Senate Officer, or Senate Office.
Prepared by: Health Policy Committee (HP)
The bill requires the Agency for Health Care Administration (AHCA) to provide coverage for continuous glucose monitors (CGM) under the Medicaid pharmacy benefit to treat Medicaid recipients diagnosed with diabetes, subject to the availability of funds and any parameters provided in the General Appropriations Act.
A CGM is defined under the bill as a device to aid in the treatment of diabetes by measuring glucose levels on demand or at set intervals through a small, electronic sensor that slightly penetrates a person’s skin and is designed to remain in place and active for at least seven days. In order to qualify for this benefit, a Medicaid recipient must be diagnosed with a type of diabetes that may be treated with insulin, prescribed insulin and a CGM by a health care practitioner authorized for such prescribing, and participate in applicable follow-up care.
The bill requires the AHCA to seek federal approval, if needed, for implementation. The bill also requires the AHCA to include the fiscal impact of the bill in the rate-setting process for Medicaid managed care plans for the contract year beginning on October 1, 2023.
If approved by the Governor, or allowed to become law without the Governor’s signature, these provisions take effect October 1, 2023.
Vote: Senate 39-0; House 116-0