24 SB 35/AP
Senate Bill 35
By: Senators Merritt of the 9th, Jones II of the 22nd, Butler of the 55th, Harbison of the 15th,
Parent of the 42nd and others
AS PASSED
A BILL TO BE ENTITLED
AN ACT
To amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated,
1
relating to medical assistance generally, so as to require the Department of Community2
Health to include continuous glucose monitors as a benefit for Medicaid recipients via the3
most cost-effective benefit delivery channel; to provide for coverage criteria; to provide for4
certain consultations by treating practitioners; to provide for related matters; to provide for5
an effective date; to repeal conflicting laws; and for other purposes.6
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
SECTION 1.8
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to9
medical assistance generally, is amended by adding a new Code section to read as follows:10
"49-4-159.2.
11
(a) On and after July 1, 2023, the department shall include coverage for continuous12
glucose monitors as a benefit under Medicaid via the most cost-effective benefit delivery13
channel. The criteria for such coverage shall be updated to align with current standards of14
care and shall include, but shall not be limited to, requirements that:15
(1) The recipient has been diagnosed with diabetes mellitus by a treating practitioner;16
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(2) The recipient's treating practitioner has concluded that the recipient or the recipient's17
caregiver has had sufficient training in using a continuous glucose monitor as evidenced18
by the provision of a prescription therefor; and19
(3) The recipient:20
(A) Is treated with at least one daily administration of insulin; or21
(B) Has a history of problematic hypoglycemia with documentation of at least one of22
the following:23
(i) Recurrent level 2 hypoglycemic events (glucose less than 54 mg/dL (3.0 mmol/L))24
that persist despite two or more attempts to adjust medication, modify the diabetes25
treatment plan, or both; or26
(ii) A history of a level 3 hypoglycemic event (glucose less than 54 mg/dL27
(3.0 mmol/L)) characterized by altered mental or physical state requiring third-party28
assistance for treatment for hypoglycemia.29
(b) Within six months prior to prescribing a continuous glucose monitor for a recipient,30
the treating practitioner shall have had an in-person or telehealth visit with the recipient to31
evaluate the recipient's diabetes control and shall have concluded that the recipient meets32
the criteria set forth in subsection (a) of this Code section.33
(c) Every six months following the initial prescription of a continuous glucose monitor,34
the treating practitioner shall have an in-person or telehealth visit with the recipient to35
assess adherence to his or her continuous glucose monitor regimen and diabetes treatment36
plan."37
SECTION 2.38
This Act shall become effective on July 1, 2023.39
SECTION 3.40
All laws and parts of laws in conflict with this Act are repealed.41
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