Florida Senate - 2023                                     SB 988
       
       
        
       By Senator Burton
       
       
       
       
       
       12-00378B-23                                           2023988__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid coverage of continuous
    3         glucose monitors; creating s. 409.9063, F.S.; defining
    4         the term “continuous glucose monitor”; requiring the
    5         Agency for Health Care Administration, subject to the
    6         availability of funds and certain limitations and
    7         directions, to provide coverage for continuous glucose
    8         monitors for certain Medicaid recipients; providing
    9         construction; providing requirements for Medicaid
   10         recipients to continue receiving coverage for their
   11         continuous glucose monitors; requiring the agency to
   12         seek federal approval for implementation of the act,
   13         if needed; requiring the agency to include the rate
   14         impact of the act in certain rates that become
   15         effective on a specified date; providing an effective
   16         date.
   17          
   18  Be It Enacted by the Legislature of the State of Florida:
   19  
   20         Section 1. Section 409.9063, Florida Statutes, is created
   21  to read:
   22         409.9063 Coverage of continuous glucose monitors for
   23  Medicaid recipients.—
   24         (1) As used in this section, the term “continuous glucose
   25  monitor” means an instrument or a device designed for the
   26  purpose of aiding in the treatment of diabetes by measuring
   27  glucose levels on demand or at set intervals through a small,
   28  electronic sensor that slightly penetrates a person’s skin when
   29  applied and that is designed to remain in place and active for
   30  at least 10 days.
   31         (2) Subject to the availability of funds and subject to any
   32  limitations or directions provided in the General Appropriations
   33  Act, the agency must provide coverage for a continuous glucose
   34  monitor under the Medicaid pharmacy benefit for the treatment of
   35  a Medicaid recipient if:
   36         (a) The recipient has been diagnosed by his or her primary
   37  care physician, or another licensed health care practitioner
   38  authorized to make such diagnosis, with Type 1 diabetes, Type 2
   39  diabetes, gestational diabetes, or any other type of diabetes
   40  that may be treated with insulin; and
   41         (b) A health care practitioner with the applicable
   42  prescribing authority has prescribed insulin to treat the
   43  recipient’s diabetes and a continuous glucose monitor to assist
   44  the recipient and practitioner in managing the recipient’s
   45  diabetes.
   46         (3) Coverage under this section includes the cost of any
   47  necessary repairs or replacement parts for the continuous
   48  glucose monitor.
   49         (4) To qualify for continued coverage under this section,
   50  the Medicaid recipient must participate in follow-up care with
   51  his or her treating health care practitioner, in person or
   52  through telehealth, at least once every 6 months during the
   53  first 18 months after the first prescription of the continuous
   54  glucose monitor for the recipient has been issued under this
   55  section, to assess the efficacy of using the monitor for
   56  treatment of his or her diabetes. After the first 18 months,
   57  such follow-up care must occur at least once every 12 months.
   58         (5) The agency shall seek federal approval, if needed, for
   59  the implementation of this section.
   60         Section 2. The Agency for Health Care Administration shall
   61  include the rate impact of this act in the Medicaid managed
   62  medical assistance program and long-term care managed care
   63  program rates, as applicable, that take effect on October 1,
   64  2023.
   65         Section 3. This act shall take effect October 1, 2023.