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 adherence to prescribed usage guidelines for coverage. Additionally, recipients must participate in follow-up care with their healthcare provider at least once every six months for the first 18 months after receiving the monitor, with coverage continuing only if regular follow-up care is maintained.

The bill also establishes that the prescribing physician must determine that the recipient or their caregiver has adequate training to use the CGM. It allows the Commissioner of Human Services to apply for necessary State plan amendments or waivers to implement these changes and secure federal financial participation. The commissioner is authorized to adopt rules and regulations to facilitate the bill's objectives, with the ability to file these regulations immediately for a temporary period of up to six months. Overall, the legislation aims to improve diabetes management for Medicaid recipients by ensuring access to essential monitoring technology, thereby enhancing health outcomes for individuals living with diabetes.

Statutes affected:
Introduced: 30:4D-6