Bill Text: IL HB5382 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for continuous glucose monitors, related supplies, and training in the use of continuous glucose monitors for any individual who is diagnosed with diabetes mellitus and meets other requirements, including that the prescriber had an in-person or covered telehealth visit with the individual to evaluate the individual's diabetes control and has determined that the eligibility criteria is met. Provides that to qualify for a continuous glucose monitor, a patient is not required to have a diagnosis of uncontrolled diabetes; have a history of emergency room visits or hospitalizations; or show improved glycemic control. Provides that an individual who is diagnosed with diabetes mellitus and meets the requirements shall not be required to obtain prior authorization for coverage for a continuous glucose monitor, and coverage shall be continuous once the continuous glucose monitor is prescribed. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall adopt rules to implement the changes made by the amendatory Act. Specifies that the rules shall, at a minimum contain certain provisions concerning the ordering provider, continuous glucose monitors not being required to have certain functionalities, eligibility requirements for a beneficiary, and not requiring prior authorization. Effective July 1, 2024.

Spectrum: Partisan Bill (Democrat 25-0)

Status: (Introduced) 2024-04-05 - House Committee Amendment No. 2 Rule 19(c) / Re-referred to Rules Committee [HB5382 Detail]

Download: Illinois-2023-HB5382-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5382 Introduced , by Rep. Jenn Ladisch Douglass SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.59
305 ILCS 5/5-16.8a new
Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for continuous glucose monitors, related supplies, and training in the use of continuous glucose monitors for any individual who is diagnosed with diabetes mellitus and meets other requirements, including that the prescriber had an in-person or covered telehealth visit with the individual to evaluate the individual's diabetes control and has determined that the eligibility criteria is met. Provides that to qualify for a continuous glucose monitor, a patient is not required to have a diagnosis of uncontrolled diabetes; have a history of emergency room visits or hospitalizations; or show improved glycemic control. Provides that an individual who is diagnosed with diabetes mellitus and meets the requirements shall not be required to obtain prior authorization for coverage for a continuous glucose monitor, and coverage shall be continuous once the continuous glucose monitor is prescribed. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall adopt rules to implement the changes made by the amendatory Act. Specifies that the rules shall, at a minimum contain certain provisions concerning the ordering provider, continuous glucose monitors not being required to have certain functionalities, eligibility requirements for a beneficiary, and not requiring prior authorization. Effective July 1, 2024.
LRB103 39371 RPS 69536 b
A BILL FOR
HB5382 LRB103 39371 RPS 69536 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.59 as follows:
(215 ILCS 5/356z.59)
Sec. 356z.59. Coverage for continuous glucose monitors.
(a) In this Section, "diabetes mellitus" includes, but is
not limited to: type 1 diabetes; type 1.5 diabetes; type 2
diabetes; type 3c diabetes; maturity-onset diabetes of the
young; neonatal diabetes; latent autoimmune diabetes of
adults; Wolfram Syndrome; Alstrom Syndrome; cystic fibrosis
diabetes; gestational diabetes; diabetes caused by the loss
of, or permanent damage to, the pancreas; or
medication-induced diabetes.
(b) A group or individual policy of accident and health
insurance or a managed care plan that is amended, delivered,
issued, or renewed on or after January 1, 2024 and before
January 1, 2025 shall provide coverage for medically necessary
continuous glucose monitors for individuals who are diagnosed
with type 1 or type 2 diabetes and require insulin for the
management of their diabetes. A group or individual policy of
accident and health insurance or a managed care plan that is

HB5382 - 2 - LRB103 39371 RPS 69536 b
amended, delivered, issued, or renewed on or after January 1,
2025 shall provide coverage for continuous glucose monitors,
related supplies, and training in the use of continuous
glucose monitors for any individual if the following
requirements are met:
(1) the individual is diagnosed with diabetes
mellitus;
(2) the continuous glucose monitor has been prescribed
by a physician licensed under the Medical Practice Act of
1987 or a certified nurse practitioner or physician
assistant with a collaborative agreement with the
physician;
(3) the continuous glucose monitor has been prescribed
in accordance with the Food and Drug Administration's
indications for use;
(4) the prescriber has concluded that the individual
or individual's caregiver has sufficient training in using
the continuous glucose monitor, which may be evidenced by
the prescriber having prescribed a continuous glucose
monitor, and has attested that the patient will be
provided with that training;
(5) the individual either:
(A) uses insulin for treatment via one or more
injections or infusions of insulin per day, and only
one injection or infusion of one type of insulin shall
be sufficient utilization of insulin to qualify for a

HB5382 - 3 - LRB103 39371 RPS 69536 b
continuous glucose monitor under this Section; or
(B) has reported a history of problematic
hypoglycemia with documentation to the individual's
medical provider showing at least one of the
following:
(i) recurrent hypoglycemic events
characterized by an altered mental or physical
state, despite multiple attempts to adjust
medications or modify the diabetes treatment plan,
as documented by a medical provider; or
(ii) a history of at least one hypoglycemic
event characterized by an altered mental or
physical state requiring third-party assistance
for treatment of hypoglycemia, as documented by
the individual's medical provider, which may be
self-reported by the individual; third-party
assistance shall not, in any event, be deemed to
require that the individual had been admitted to a
hospital or visited an emergency department; and
(6) within 6 months prior to prescribing a continuous
glucose monitor, the medical provider prescribing the
continuous glucose monitor had an in-person or covered
telehealth visit with the individual to evaluate the
individual's diabetes control and has determined that the
criteria of paragraphs (1) through (5) are met.
Notwithstanding any other provision of this Section, to

HB5382 - 4 - LRB103 39371 RPS 69536 b
qualify for a continuous glucose monitor under this Section,
an individual is not required to have a diagnosis of
uncontrolled diabetes; have a history of emergency room visits
or hospitalizations; or show improved glycemic control.
All continuous glucose monitors covered under this Section
shall be approved for usage by individuals, and the choice of
device shall be made based upon the individual's
circumstances, preferences, and needs in consultation with the
individual's medical provider.
(c) Any individual who is diagnosed with diabetes mellitus
and meets the requirements of this Section shall not be
required to obtain prior authorization for coverage for a
continuous glucose monitor, and coverage shall be continuous
once the continuous glucose monitor is prescribed.
(d) A group or individual policy of accident and health
insurance or a managed care plan that is amended, delivered,
issued, or renewed on or after January 1, 2025 shall not impose
a deductible, coinsurance, copayment, or any other
cost-sharing requirement on the coverage provided under this
Section. The provisions of this subsection do not apply to
coverage under this Section to the extent such coverage would
disqualify a high-deductible health plan from eligibility for
a health savings account pursuant to the federal Internal
Revenue Code, 26 U.S.C. 23.
(Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.)

HB5382 - 5 - LRB103 39371 RPS 69536 b
Section 10. The Illinois Public Aid Code is amended by
adding Section 5-16.8a as follows:
(305 ILCS 5/5-16.8a new)
Sec. 5-16.8a. Rules concerning continuous glucose monitor
coverage. The Department shall adopt rules to implement the
changes made to Section 356z.59 of the Illinois Insurance
Code, as applied to the medical assistance program. The rules
shall, at a minimum, provide that:
(1) the ordering provider must be a physician licensed
under the Medical Practice Act of 1987 or a certified
nurse practitioner or physician assistant with a
collaborative agreement with the physician;
(2) continuous glucose monitors are not required to
have an alarm when glucose levels are outside the
pre-determined range; the capacity to generate predictive
alerts in case of impending hypoglycemia; or the ability
to transmit real-time glucose values and alerts to the
patient and designated other persons;
(3) the beneficiary is not required to need intensive
insulin therapy;
(4) the beneficiary is not required to have a recent
history of emergency room visits or hospitalizations
related to hypoglycemia, hyperglycemia, or ketoacidosis;
(5) if the beneficiary has gestational diabetes, the
beneficiary is not required to have suboptimal glycemic

HB5382 - 6 - LRB103 39371 RPS 69536 b
control that is likely to harm the beneficiary or the
fetus;
(6) if a beneficiary has diabetes mellitus and the
beneficiary does not meet the coverage requirements or if
the beneficiary is in a population in which continuous
glucose monitor usage has not been well-studied, requests
shall be reviewed, on a case-by-case basis, for medical
necessity and approved if appropriate; and
(7) the beneficiary is not required to obtain prior
authorization for coverage for a continuous glucose
monitor, and that coverage is continuous once the
continuous glucose monitor is prescribed.