SB 3414

Abstract

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed before January 1, 2025 shall provide coverage for medically necessary continuous glucose monitors for individuals who are diagnosed with any form of diabetes mellitus (instead of type 1 or type 2 diabetes) and require insulin for the management of their diabetes. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for continuous glucose monitors, related supplies, and training in the use of continuous glucose monitors for any individual who is diagnosed with diabetes, who requires at least one daily injection or infusion of insulin, and who has been prescribed a continuous glucose monitor by a physician, a certified nurse practitioner, or a physician assistant. Provides that an individual who is diagnosed with diabetes and meets the specified requirements shall not be required to obtain prior authorization for coverage for a continuous glucose monitor, and coverage shall be continuous once the continuous glucose monitor is prescribed. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage required under the provisions. Effective July 1, 2024. Senate Committee Amendment No. 2 Adds reference to: 305 ILCS 5/5-16.8a new Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with changes that include the following. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed before January 1, 2026 (rather than January 1, 2025) shall provide coverage for medically necessary continuous glucose monitors for individuals who are diagnosed with any form of diabetes mellitus and require insulin for the management of their diabetes. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for continuous glucose monitors, related supplies, and training in the use of continuous glucose monitors for any individual if specified requirements are met and the policy is in full alignment with Medicare. Sets forth eligibility requirements and requirements for covered glucose monitors. Provides that the coverage of one glucose monitor shall be provided with a deductible, coinsurance, copayment, or any other cost-sharing requirement. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall adopt rules to implement the changes made by the amendatory Act. Specifies that the rules shall, at a minimum contain certain provisions concerning the ordering provider, continuous glucose monitors not being required to have certain functionalities, eligibility requirements for a beneficiary, and not requiring prior authorization. Effective July 1, 2024. Senate Floor Amendment No. 3 Replaces everything after the enacting clause. Reinserts the provisions of the bill, as amended by Senate Amendment No. 2, with the following changes. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage of a one-month supply of continuous glucose monitors, including one transmitter if necessary, as provided under the provisions (instead of on the coverage of continuous glucose monitors). Effective July 1, 2024. House Floor Amendment No. 2 Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for continuous glucose monitors, related supplies, and training in the use of continuous glucose monitors for any individual if certain requirements are met (rather than if the policy is in full alignment with Medicare and certain requirements are met). In provisions of the Illinois Public Aid Code concerning rules for continuous glucose monitor coverage, provides that an ordering provider is not required to obtain continuing medical education in order to prescribe a continuous glucose monitor. Removes language providing that a beneficiary is not required to obtain prior authorization for coverage for a continuous glucose monitor and that coverage is continuous once the continuous glucose monitor is prescribed. Provides that prior authorization is required for a prescription of a continuous glucose monitor. Provides that once a continuous glucose monitor is prescribed, the prior authorization shall be approved for a 12-month period.