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ARIZONA STATE SENATE
Fifty-Seventh Legislature, First Regular Session
AHCCCS; continuous glucose monitors
Purpose
Requires contractors with the Arizona Health Care Cost Containment System (AHCCCS) to provide AHCCCS members with continuous glucose monitors and outlines requirements related to coverage criteria for continuous glucose monitors.
Background
AHCCCS contracts
with health professionals to provide medically necessary health and medical
services to eligible members. Currently, AHCCCS contractors are required to
provide:
1) inpatient and outpatient hospital services, excluding speech therapy; 2)
laboratory and X-ray services; 3) prescription medications; 4) medical
supplies, durable medical equipment, insulin pumps and prosthetic devices; 5)
treatment of medical conditions of the eye; 6) early and periodic health
screening and diagnostic services; 7) family planning services; 8) podiatry
services;
9) nonexperimental transplants; 10) emergency dental care; 11) ambulance and
nonambulance transportation; 12) hospice care; 13) orthotics; and 14) diabetes
outpatient self-management training services (A.R.S.
ยง 36-2907).
Continuous glucose monitoring means using a device to automatically estimate a person's blood glucose level throughout the day and night. A person can see what the individual's blood glucose level is at any time and review how the person's blood glucose level changes over a period of time from a few hours to days. A continuous glucose monitor (CGM) is the device used to monitor a person's glucose level every few minutes and to keep track of the glucose levels over time. A CGM has three parts which include a: 1) sensor that can either be inserted under the person's skin and held in place with a sticky patch or that can be implanted under the skin; 2) transmitter that sends the glucose levels collected by the sensor; and 3) software that receives the person's glucose levels from the transmitter and is stored on a smartphone, insulin pump or a separate device known as a receiver (National Institute of Diabetes and Digestive and Kidney Diseases).
If there is a cost associated with requiring AHCCCS contractors to provide coverage of continuous glucose monitors for members, there may be a fiscal impact to the state General Fund.
Provisions
1. Requires contractors with AHCCCS to:
a) provide AHCCCS members with CGMs through a pharmacy benefit and a durable medical equipment benefit; and
b) allow a member's prescribing provider to determine the appropriate CGM for the member.
2. Requires AHCCCS to update the coverage criteria for CGMs to align with the current standards of care and to post the criteria for CGM coverage on AHCCCS's public website as a standalone document.
3. Specifies that the criteria for CGM coverage must be consistent, regardless of whether the monitor is received as a pharmacy benefit or a durable medical equipment benefit.
4. Becomes effective on the general effective date.
Prepared by Senate Research
January 27, 2025
MM/KS/slp