Bill Text: NH HB1571 | 2024 | Regular Session | Introduced
Bill Title: Relative to requiring insurance coverage for glucose monitoring devices for people with diabetes.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2024-09-25 - Executive Session: 10/17/2024 10:00 am Legislative Office Building 302-304 [HB1571 Detail]
Download: New_Hampshire-2024-HB1571-Introduced.html
HB 1571-FN - AS INTRODUCED
2024 SESSION
24-2125
05/10
HOUSE BILL 1571-FN
AN ACT relative to requiring insurance coverage for glucose monitoring devices for people with diabetes.
SPONSORS: Rep. Damon, Sull. 8; Rep. Germana, Ches. 1; Rep. O. Ford, Rock. 3; Rep. Balboni, Rock. 38; Rep. Newell, Ches. 4; Rep. Rochefort, Graf. 1; Rep. Nutter-Upham, Hills. 8; Rep. M. Perez, Hills. 43; Sen. Ward, Dist 8; Sen. Gannon, Dist 23
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill requires insurance coverage and Medicaid coverage for glucose monitoring devices for people with diabetes.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
24-2125
05/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to requiring insurance coverage for glucose monitoring devices for people with diabetes.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Accident and Health Insurance; Individual; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 415:6-e to read as follows:
415:6-e Coverage for Diabetes Services and Supplies.
I. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.
II. Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.
III. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides [for] pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a “continuous glucose monitor” means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.
(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.
(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.
(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.
(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured’s copayment or coinsurance.
(e) If application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
2 Accident and Health Insurance; Group; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 415:18-f to read as follows:
415:18-f Coverage for Diabetes Services and Supplies.
I. Each insurer that issues or renews any policy, plan, or contract of group accident or health insurance providing benefits for medical or hospital expenses, shall provide each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each insurer that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.
II. Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.
III. Each insurer that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides [for] pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a “continuous glucose monitor” means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.
(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.
(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.
(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.
(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured’s copayment or coinsurance.
(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
3 Health Service Corporation; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 420-A:17-a to read as follows:
420-A:17-a Coverage for Diabetes Services and Supplies.
I. Every health service corporation and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group accident or health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health service corporation that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.
II. Each health service corporation that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.
III. Each health service corporation that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides [for] pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a “continuous glucose monitor” means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.
(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.
(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.
(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.
(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured’s copayment or coinsurance.
(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
4 Health Maintenance Organizations; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 420-B:8-k to read as follows:
420-B:8-k Coverage for Diabetes Services and Supplies.
I. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.
II. Each health maintenance organization that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.
III. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides [for] pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a “continuous glucose monitor” means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.
(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.
(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.
(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.
(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured’s copayment or coinsurance.
(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.
5 New Section; Coverage for Diabetes Services and Supplies. Amend RSA 126-A by inserting after section 4-i the following new section:
126-A:4-j Medicaid Coverage for Diabetes Services and Supplies.
I. The commissioner of the department of health and human services shall submit a Title XIX Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services for the purpose of establishing a Medicaid benefit for diabetes services and supplies. The Medicaid benefit shall be in all respects equivalent to the terms of coverage established in RSA 420-B:8-k, including, but not limited to coverage relative to insulin and glucose monitoring devices.
II. The Medicaid benefit shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this section. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a “continuous glucose monitor” means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.
(a) Coverage shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.
(b) To qualify for continued coverage under Medicaid, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.
(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.
(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30- day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured’s copayment or coinsurance.
III. The commissioner shall adopt rules under RSA 541-A relative to the Medicaid benefit and shall provide an annual report to the oversight committee on health and human services regarding its implementation. Medicaid coverage for diabetes services and supplies shall apply to all 3 Medicaid populations: (i) fee for services; (ii) managed care; and (iii) Medicaid expansion, and coverage for each population.
6 Effective Date. This act shall take effect 60 days after its passage.
24-2125
12/8/23
HB 1571-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to requiring insurance coverage for glucose monitoring devices for people with diabetes.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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Estimated State Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
Revenue | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Revenue Fund(s) | General Fund Insurance Premium Tax | |||||
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Funding Source(s) | General Fund Various Government Funds | |||||
Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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• Does this bill provide sufficient funding to cover estimated expenditures? [X] No • Does this bill authorize new positions to implement this bill? [X] No | ||||||
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Estimated Political Subdivision Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
County Revenue | $0 | $0 | $0 | $0 | ||
County Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Local Revenue | $0 | $0 | $0 | $0 | ||
Local Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
The Office of Legislative Budget Assistant is unable to complete a fiscal note for this bill as it is awaiting information from the Department of Health and Human Services. The Department of Health and Human Services was contacted on November 15, 2023 for a fiscal note worksheet, which they have not provided as of December 8, 2023. When completed, the fiscal note will be forwarded to the House Clerk's Office.
METHODOLOGY:
This bill requires insurance coverage and Medicaid coverage for glucose monitoring devices for people with diabetes.
The Insurance Department indicates this bill seeks to expand coverage for diabetes monitoring supplies and equipment for individuals living with diabetes that do not currently use insulin therapy. The bill would amend RSAs 415:6-e, 415:18-f, 420-A:17-a, and 420-B:8-k, to require insurers issuing health plans to individuals, groups, health service organizations (HSOs), and health maintenance organizations (HMOs) respectively, to cover continuous glucose monitoring devices and sensors (CGMS), as well as associated follow-up care for the first 6, 12, and 18 months of use. Additionally, the bill seeks to prohibit the application of a deductible and limit the insured’s cost-sharing responsibility to no more than $30, for a 30-day supply, which shall be applied to the member’s plan deductible.
The Department indicates the American Association of Clinical Endocrinology currently recommends CGMS technology for individuals diagnosed with Type 1 diabetes (insulin dependent diabetes mellitus) and those diagnosed with Type 2 diabetes (non-insulin dependent diabetes mellitus) who also use insulin therapy, and as such, are considered the ‘eligible population’. Additionally, pregnant women diagnosed with gestational diabetes, and not on insulin, may be indicated for CGMS use. This bill would increase the eligible population for this service significantly. A query of the NH All Payers Claim Database (NH CHIS), revealed that, in 2022, 575 unique claims for CGMS devices and supplies were submitted to commercial (fully insured) insurers, all of which were prescribed to individuals living with Type 1, insulin-dependent diabetes. The Department assumes this bill would increase the frequency, unit cost, and total cost of claims. The Department expects the extent of this increase be non-trivial, but indeterminable at this time. This may result in upward pressure on premiums and increased premium tax revenues. To the extent insurance premiums increase county and local expenditures for health insurance would also increase.
The Department states this is new coverage requirement could be subject to cost defrayal of state-mandated requirements pursuant to 45 CFR §155.170. Under this federal regulation, passage of this bill could be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits (EHB) offered in the Exchange Marketplace. This could be the case even though the specific coverage required is already subsumed under existing categories of EHB coverage. Under this regulation, the State may be required to defray the cost of the additional required benefits to Qualified Health Plan enrollees or to QHP issuers. This would represent a general fund expense which is indeterminable at this time. However, under RSA 400-A:39-b, the legislative committee, having jurisdiction over this bill, may refer the proposed mandated coverage to the Insurance Department which is authorized to retain an external actuarial review of the costs and benefits of the proposed mandate. In this manner, a qualified opinion of the cost could be obtained. In addition, CMS encourages states to reach out to CMS concerning any state defrayal questions in advance of passing and implementing benefit mandates and to provide QHP issuers in the state ample time to quantify the cost attributable to each additional required benefit and report these calculations to the state.
AGENCIES CONTACTED:
Insurance Department and Department of Health and Human Services
