Bill Text: IL SB3414 | 2023-2024 | 103rd General Assembly | Engrossed

---

Bill Title: 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.

Spectrum: Bipartisan Bill

Status: (Engrossed) 2024-04-30 - House Committee Amendment No. 1 Tabled [SB3414 Detail]

Download: Illinois-2023-SB3414-Engrossed.html

---

SB3414 Engrossed LRB103 38590 RPS 68726 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356z.59 as follows:
(215 ILCS 5/356z.59)
Sec. 356z.59. Coverage for continuous glucose monitors.
(a) 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 on or after January
1, 2024 shall provide coverage for medically necessary
continuous glucose monitors for individuals who are diagnosed
with any form of diabetes mellitus type 1 or type 2 diabetes
and require insulin for the management of their diabetes. 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
the policy is in full alignment with Medicare and the
following requirements are met:
(1) the individual is diagnosed with diabetes
mellitus;

SB3414 Engrossed - 2 - LRB103 38590 RPS 68726 b
(2) the continuous glucose monitor has been prescribed
by a physician licensed under the Medical Practice Act of
1987 or a certified nurse practitioner or physician
assistant with a collaborative agreement with the
physician;
(3) the continuous glucose monitor has been prescribed
in accordance with the Food and Drug Administration's
indications for use;
(4) the prescriber has concluded that the individual
or individual's caregiver has sufficient training in using
the continuous glucose monitor, which may be evidenced by
the prescriber having prescribed a continuous glucose
monitor, and has attested that the patient will be
provided with that training;
(5) the individual either:
(A) uses insulin for treatment via one or more
injections or infusions of insulin per day, and only
one injection or infusion of one type of insulin shall
be sufficient utilization of insulin to qualify for a
continuous glucose monitor under this Section; or
(B) has reported a history of problematic
hypoglycemia with documentation to the individual's
medical provider showing at least one of the
following:
(i) recurrent hypoglycemic events
characterized by an altered mental or physical

SB3414 Engrossed - 3 - LRB103 38590 RPS 68726 b
state, despite multiple attempts to adjust
medications or modify the diabetes treatment plan,
as documented by a medical provider; or
(ii) a history of at least one hypoglycemic
event characterized by an altered mental or
physical state requiring third-party assistance
for treatment of hypoglycemia, as documented by
the individual's medical provider, which may be
self-reported by the individual; third-party
assistance shall not, in any event, be deemed to
require that the individual had been admitted to a
hospital or visited an emergency department; and
(6) within 6 months prior to prescribing a continuous
glucose monitor, the medical provider prescribing the
continuous glucose monitor had an in-person or covered
telehealth visit with the individual to evaluate the
individual's diabetes control and has determined that the
criteria of paragraphs (1) through (5) are met.
Notwithstanding any other provision of this Section, to
qualify for a continuous glucose monitor under this Section,
an individual is not required to have a diagnosis of
uncontrolled diabetes; have a history of emergency room visits
or hospitalizations; or show improved glycemic control.
All continuous glucose monitors covered under this Section
shall be approved for use by individuals, and the choice of
device shall be made based upon the individual's circumstances

SB3414 Engrossed - 4 - LRB103 38590 RPS 68726 b
and medical needs in consultation with the individual's
medical provider, subject to the terms of the policy.
(b) Any individual who is diagnosed with diabetes mellitus
and meets the requirements of this Section 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.
(c) 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 this Section. The provisions of
this subsection do not apply to coverage under this Section to
the extent such coverage would disqualify a high-deductible
health plan from eligibility for a health savings account
pursuant to the federal Internal Revenue Code, 26 U.S.C. 23.
(Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.)
Section 10. The Illinois Public Aid Code is amended by
adding Section 5-16.8a as follows:
(305 ILCS 5/5-16.8a new)
Sec. 5-16.8a. Rules concerning continuous glucose monitor
coverage. The Department shall adopt rules to implement the

SB3414 Engrossed - 5 - LRB103 38590 RPS 68726 b
changes made to Section 356z.59 of the Illinois Insurance
Code, as applied to the medical assistance program. The rules
shall, at a minimum, provide that:
(1) the ordering provider must be a physician licensed
under the Medical Practice Act of 1987 or a certified
nurse practitioner or physician assistant with a
collaborative agreement with the physician;
(2) continuous glucose monitors are not required to
have an alarm when glucose levels are outside the
pre-determined range; the capacity to generate predictive
alerts in case of impending hypoglycemia; or the ability
to transmit real-time glucose values and alerts to the
patient and designated other persons;
(3) the beneficiary is not required to need intensive
insulin therapy;
(4) the beneficiary is not required to have a recent
history of emergency room visits or hospitalizations
related to hypoglycemia, hyperglycemia, or ketoacidosis;
(5) if the beneficiary has gestational diabetes, the
beneficiary is not required to have suboptimal glycemic
control that is likely to harm the beneficiary or the
fetus;
(6) if a beneficiary has diabetes mellitus and the
beneficiary does not meet the coverage requirements or if
the beneficiary is in a population in which continuous
glucose monitor usage has not been well-studied, requests

SB3414 Engrossed - 6 - LRB103 38590 RPS 68726 b
shall be reviewed, on a case-by-case basis, for medical
necessity and approved if appropriate; and
(7) the 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.