HB 428

This bill requires t he bureau of TennCare to provide coverage on behalf of an individual enrolled in TennCare (" enrollee "") for a continuous glucose monitor ("" CGM "") if either of the following criteria is met :  The patient (i) h as a diagnosis of Type 1 diabetes mellitus; (ii) has a diagnosis of gestational diabetes; (iii) has a history of problematic hypoglycemia; or (iv) requires the use of insulin .  The patient has a diagnosis of Type 2 diabetes mellitus and meets at least one of the following criteria: (i) d ocumented hemoglobin A1C greater than or equal to 7% measured within 6 months of a request for laboratory blood work; (ii) documented frequent hypoglycemia or nocturnal hypoglycemia episodes with blood glucose levels of less than 50 milligrams per deciliter; (iii) documented history of hypoglycemic unawareness; (iv) dawn phenomenon with fasting blood sugars frequently exceeding 200 milligrams per deciliter; or (v) history of emergency room visits or hospitalizations related to ketoacidosis or hypoglycemia. This bill provides that such mandatory c overage is only required if the CGM is prescribed by or in consultation with an endocrinologist or healthcare practitioner with experience in diabetes management who documents that the enrollee meets the criteria described above ."