HB 1571-FN is a legislative bill that seeks to enhance insurance and Medicaid coverage for diabetes management, specifically focusing on glucose monitoring devices. The bill mandates that health insurance policies, including those provided by health maintenance organizations (HMOs), cover medically necessary insulin, oral agents, and diabetes equipment, such as continuous and traditional blood glucose monitors and their necessary supplies. It introduces a cap of $30 for a 30-day supply of covered insulin prescriptions and diabetes devices, which is not subject to a deductible. However, if applying this cap before a covered person meets their plan's deductible would make them ineligible for health savings accounts, the cap would only apply after the deductible is met. The bill also requires follow-up care with a healthcare practitioner for continued coverage and stipulates that coverage for new FDA-approved diabetes equipment and supplies must be provided when prescribed by a licensed healthcare practitioner.

The bill proposes a new section, 126-A:4-j, to amend RSA 126-A, directing the commissioner of the department of health and human services to submit a Medicaid state plan amendment to establish a Medicaid benefit for diabetes services and supplies equivalent to the coverage terms in RSA 420-B:8-k. This includes coverage for insulin and glucose monitoring devices without the need for an endocrinology referral or prescription, and without prior authorization. The fiscal impact of the bill is indeterminable, and it does not provide funding to cover estimated expenditures or authorize new positions for implementation. The bill is set to take effect 60 days after its passage. It is expected to increase the number of claims for CGMS devices and supplies, potentially leading to higher insurance premiums and premium tax revenues, and may result in an indeterminable expense to the general fund due to federal regulations. The Department of Health and Human Services anticipates challenges in enforcing the follow-up care requirement for Medicaid recipients.

Statutes affected:
Introduced: 415:6-e, 415:18-f, 420-A:17-a, 420-B:8-k