| 16 | | - | requiring the Agency for Health Care Administration 3 |
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| 17 | | - | to, within a specified timeframe, seek federal 4 |
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| 18 | | - | approval as needed to provide coverage of continuous 5 |
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| 19 | | - | glucose monitors and related supplies as a durable 6 |
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| 20 | | - | medical equipment benefit under the Medicaid program; 7 |
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| 21 | | - | providing for the reimbursement of such equipment; 8 |
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| 22 | | - | providing construction; requiring the agency to 9 |
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| 23 | | - | implement these changes upon receiving any necessary 10 |
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| 24 | | - | federal approval; providing an effective date. 11 |
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| 25 | | - | 12 |
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| 26 | | - | Be It Enacted by the Legislature of the State of Florida: 13 |
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| 27 | | - | 14 |
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| 28 | | - | Section 1. (1) Within 30 days after this act becomes a 15 |
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| 29 | | - | law, the Agency for Health Care Administrat ion shall seek 16 |
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| 30 | | - | federal approval through a Medicaid waiver or state plan 17 |
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| 31 | | - | amendment as needed to provide coverage of continuous glucose 18 |
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| 32 | | - | monitors and related supplies as a durable medical equipment 19 |
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| 33 | | - | benefit for Medicaid recipients. A licensed durable medical 20 |
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| 34 | | - | equipment provider must be reimbursed for continuous glucose 21 |
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| 35 | | - | monitors and related supplies, provided the claim is submitted 22 |
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| 36 | | - | through an active Medicare Healthcare Common Procedure Coding 23 |
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| 37 | | - | System. The agency may not require such provider to use a 24 |
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| 38 | | - | National Drug Code number as part of such claim submission. 25 |
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| 16 | + | amending s. 409.9063, F.S.; revising the definition of 3 |
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| 17 | + | the term "continuous glucose monitor"; requiring the 4 |
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| 18 | + | Agency for Health Care Administration to provide 5 |
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| 19 | + | coverage for continuous glucose monitors; providing 6 |
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| 20 | + | requirements for such coverage and reimbursement; 7 |
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| 21 | + | providing an effective date. 8 |
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| 22 | + | 9 |
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| 23 | + | Be It Enacted by the Legislature of the State of Florida: 10 |
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| 24 | + | 11 |
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| 25 | + | Section 1. Section 409.9063, Florida Statutes, is amended 12 |
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| 26 | + | to read: 13 |
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| 27 | + | 409.9063 Coverage of continuous glucose monitors for 14 |
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| 28 | + | Medicare and Medicaid recipients. — 15 |
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| 29 | + | (1) As used in this section, the term "continuous glucose 16 |
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| 30 | + | monitor" means an instrument or a device that is considered 17 |
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| 31 | + | durable medical equipment as described in s. 409.815(2)(h) and 18 |
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| 32 | + | is designed for the purpose of aiding in the treatment of 19 |
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| 33 | + | diabetes by measuring glucose levels on demand or at set 20 |
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| 34 | + | intervals through a small, electronic sensor that slightly 21 |
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| 35 | + | penetrates a person's skin when applied and that is designed to 22 |
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| 36 | + | remain in place and active for at least 7 days. 23 |
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| 37 | + | (2)(a) Subject to the availability of funds and subject to 24 |
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| 38 | + | any limitations or directions provided in the General 25 |
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| 51 | | - | (2) This section does not preclude the agency from 26 |
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| 52 | | - | providing additional coverage of continuous glucose monitors as 27 |
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| 53 | | - | a Medicaid pharmacy benefit. 28 |
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| 54 | | - | (3) The agency shall begin implementation of these changes 29 |
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| 55 | | - | upon receiving any necessary federal approval. 30 |
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| 56 | | - | Section 2. This act shall take effect upon becoming a law. 31 |
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| 51 | + | Appropriations Act, the agency must provide coverage for a 26 |
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| 52 | + | continuous glucose monitor under the Medicare or Medicaid 27 |
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| 53 | + | pharmacy benefit for the treatment of a Medicare or Medicaid 28 |
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| 54 | + | recipient if: 29 |
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| 55 | + | 1.(a) The recipient has been diagnosed by his or her 30 |
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| 56 | + | primary care physician, or another licensed health care 31 |
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| 57 | + | practitioner authorized to make such diagnosis, with Type 1 32 |
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| 58 | + | diabetes, Type 2 diabetes, gestational diabetes, or any other 33 |
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| 59 | + | type of diabetes that may be treated with insulin; and 34 |
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| 60 | + | 2.(b) A health care practitioner with the applicable 35 |
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| 61 | + | prescribing authority has prescribed insulin to treat the 36 |
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| 62 | + | recipient's diabetes and a continuous glucose monitor to assist 37 |
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| 63 | + | the recipient and practitioner in managing the recipient's 38 |
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| 64 | + | diabetes. 39 |
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| 65 | + | (b) The agency shall also provide coverage for continuous 40 |
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| 66 | + | glucose monitors which shall be reimbursed under the Medicare 41 |
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| 67 | + | Part B Durable Medical Equipment benefits or under the Florida 42 |
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| 68 | + | Medicaid durable medical equipment program. The continuous 43 |
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| 69 | + | glucose monitors do not require the national drug code on the 44 |
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| 70 | + | claim for reimbursement. 45 |
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| 71 | + | (3) Coverage under this section includes the cost of any 46 |
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| 72 | + | necessary repairs or replacement parts for the continuous 47 |
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| 73 | + | glucose monitor. 48 |
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| 74 | + | (4) To qualify for continued coverage under this section, 49 |
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| 75 | + | the Medicare or Medicaid recipient must participate in followup 50 |
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| 76 | + | |
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| 77 | + | HB 1465 2025 |
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| 78 | + | |
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| 79 | + | |
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| 80 | + | |
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| 81 | + | CODING: Words stricken are deletions; words underlined are additions. |
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| 82 | + | hb1465-00 |
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| 83 | + | Page 3 of 3 |
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| 84 | + | F L O R I D A H O U S E O F R E P R E S E N T A T I V E S |
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| 85 | + | |
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| 86 | + | |
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| 87 | + | |
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| 88 | + | follow-up care with his or her treating health care 51 |
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| 89 | + | practitioner, in person or through telehealth, at least once 52 |
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| 90 | + | every 6 months during the first 18 months after the first 53 |
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| 91 | + | prescription of the continuous glucose monitor for the recipient 54 |
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| 92 | + | has been issued unde r this section, to assess the efficacy of 55 |
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| 93 | + | using the monitor for treatment of his or her diabetes. After 56 |
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| 94 | + | the first 18 months, such followup follow-up care must occur at 57 |
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| 95 | + | least once every 12 months. 58 |
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| 96 | + | (5) The agency shall seek federal approval, if needed, for 59 |
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| 97 | + | the implementation of this section. 60 |
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| 98 | + | Section 2. This act shall take effect July 1, 2025. 61 |
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