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.