This bill mandates Medicaid coverage for continuous glucose monitors (CGMs) and related supplies for individuals diagnosed with diabetes who meet specific eligibility criteria. It amends Section 6 of P.L.1968, c.413 (C.30:4D-6) to include provisions that require a diagnosis of diabetes by a licensed healthcare practitioner, treatment with insulin or a history of problematic hypoglycemia, and participation in follow-up care with a healthcare provider. The bill also specifies that expenses for necessary repairs or replacement parts for the CGM will be covered, enhancing diabetes management for Medicaid recipients.

Additionally, the bill outlines criteria for CGM prescriptions, including adherence to FDA-approved indications and adequate training for recipients or their caregivers. Recipients must engage in regular follow-up care with their healthcare providers, initially at least once every six months for the first 18 months, and at least once every 12 months thereafter. The bill also includes provisions for the Commissioner of Human Services to apply for necessary State plan amendments or waivers and to adopt rules and regulations to implement these changes. Notably, it deletes the term "form" related to reimbursement claims and clarifies that providers cannot seek reimbursement from recipients for services deemed medically unnecessary.

Statutes affected:
Introduced: 30:4D-6