BILL NUMBER: S8592
SPONSOR: SUTTON
 
TITLE OF BILL:
An act to amend the insurance law, in relation to requiring health
insurance plans to provide coverage for continuous blood glucose moni-
tors for all children
 
PURPOSE OR GENERAL IDEA OF BILL:
This bill seeks to ensure that children diagnosed with certain rare and
serious sugar disorders, including Glycogen Storage Disease (GSD),
Hyperinsulinism (HI), Ketotic Hypoglycemia (KH), Mitochondrial Diseases,
and other genetic disorders associated with hypoglycemia, have access to
continuous glucose monitoring (CGM) devices, specifically the Dexcom
device, through insurance coverage.
 
SUMMARY OF PROVISIONS:
Section 1 amends section 3216 of the insurance law.
Section 2 amends section 3221 of the insurance law.
Section 3 amends section 4303 of the insurance law.
Section 4 sets the effective date.
 
JUSTIFICATION:
Currently, children diagnosed with Glycogen Storage Disease (GSD), Mito-
chondrial Disease, Ketotic Hypoglycemia, and other rare diseases face
frequent hospitalizations due to unstable blood sugar levels. These
conditions require constant monitoring to prevent life-threatening
events, but existing methods such as finger-stick tests are not suffi-
cient for ensuring timely intervention, especially for nocturnal hypo-
glycemia.
The first two years of life for a child are crucial for brain develop-
ment, and children under 2 with hypoglycemic disorders need access to
advanced glucose monitoring technologies to ensure their safety and
support proper growth. Delays in diagnosis are common with rare
diseases, but even in the absence of a definitive diagnosis, monitoring
and addressing low blood sugar levels during this period, is essential
for preventing brain damage and promoting healthy neurological develop-
ment.
Continuous glucose monitors like the Dexcom device provide real-time
alerts when a child's blood sugar levels become dangerously low or high,
particularly in the middle of the night. For children with GSD or mito-
chondrial disorders, nighttime hypoglycemia is especially dangerous, as
it may occur without any noticeable symptoms. With Dexcom's real-time
alerts, caregivers can be immediately notified and intervene before a
critical situation arises, thus preventing seizures, unconsciousness,
and potential death. The Dexcom device can help prevent emergency hospi-
tal visits, as it allows parents and caregivers to manage glucose levels
from home. Many children with GSD, HI, or KH spend days in the hospital
for glucose stabilization-efforts that could be managed at home with
proper monitoring. The cost of a Dexcom device for a year is often less
than the cost of a single hospitalization for hypoglycemia. Specif-
ically, the annual cost for a Dexcom system (around $2,600) is far less
than the cost of a hospital stay for severe hypoglycemia, which often
exceeds $4,000.
Parents of children with severe hypoglycemia disorders experience,
immense anxiety, especially during the night when the risk of a hypogly-
cemic episode is high. The Dexcom device not only alerts parents when a
child's glucose is dangerously low but also helps ease the burden of
constant vigilance. This technology provides peace of mind, ensuring
that if an emergency arises during the night, parents will be promptly
alerted and be able to take action before a situation becomes life-
threatening.
Clinical experience and research confirm the effectiveness of continuous
glucose monitoring devices for children with Glycogen Storage Disease,
Mitochondrial Disorders, and other related conditions. Studies have
demonstrated that CGMs help detect both hypoglycemic and hyperglycemic
events, allowing for improved management of these disorders and ulti-
mately reducing long-term complications and hospitalizations. Notably,
the use of CGMs in managing these conditions can lead to better clinical
outcomes and improved quality of life for affected children.
 
PRIOR LEGISLATIVE HISTORY:
This is a new bill.
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall have
become a law, and shall apply to policies and contracts issued, renewed,
amended, modified or altered on or after such date.

Statutes affected:
S8592: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(k) insurance law, 4303 insurance law, 4303(u) insurance law