| 7 | 7 | | |
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| 8 | 8 | | |
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| 9 | 9 | | HB0428 |
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| 10 | 10 | | 001606 |
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| 11 | 11 | | - 1 - |
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| 12 | 12 | | |
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| 13 | 13 | | AN ACT to amend Tennessee Code Annotated, Title 56 |
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| 14 | 14 | | and Title 71, relative to continuous glucose |
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| 15 | 15 | | monitoring. |
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| 16 | 16 | | |
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| 17 | 17 | | BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE: |
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| 18 | 18 | | SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by |
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| 19 | 19 | | adding the following as a new section: |
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| 20 | 20 | | (a) As used in this section: |
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| 21 | 21 | | (1) "Bureau" means the bureau of TennCare; |
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| 22 | 22 | | (2) "Continuous glucose monitor" or "CGM" means a device that |
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| 23 | 23 | | automatically and continuously monitors a user's blood glucose levels through |
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| 24 | 24 | | the use of a sensor on the user's body, and enables the user to read the blood |
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| 25 | 25 | | glucose level; and |
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| 26 | 26 | | (3) "Enrollee" means an individual enrolled in TennCare. |
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| 27 | 27 | | (b) The bureau shall provide coverage on behalf of an enrollee for a CGM if: |
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| 28 | 28 | | (1) The patient: |
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| 29 | 29 | | (A) Has a diagnosis of Type 1 diabetes mellitus; |
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| 30 | 30 | | (B) Has a diagnosis of gestational diabetes; |
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| 31 | 31 | | (C) Has a history of problematic hypoglycemia; or |
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| 32 | 32 | | (D) Requires the use of insulin; or |
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| 33 | 33 | | (2) The patient has a diagnosis of Type 2 diabetes mellitus and the |
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| 34 | 34 | | patient meets at least one (1) of the following criteria: |
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| 35 | 35 | | |
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| 36 | 36 | | |
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| 37 | 37 | | - 2 - 001606 |
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| 38 | 38 | | |
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| 39 | 39 | | (A) Documented hemoglobin A1C greater than or equal to seven |
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| 40 | 40 | | percent (7%) measured within six (6) months of a request for laboratory |
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| 41 | 41 | | blood work; |
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| 42 | 42 | | (B) Documented frequent hypoglycemia or nocturnal |
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| 43 | 43 | | hypoglycemia episodes with blood glucose levels of less than fifty |
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| 44 | 44 | | milligrams per deciliter (50 mg/dl); |
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| 45 | 45 | | (C) Documented history of hypoglycemic unawareness; |
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| 46 | 46 | | (D) Dawn phenomenon with fasting blood sugars frequently |
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| 47 | 47 | | exceeding two hundred milligrams per deciliter (200 mg/dl); or |
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| 48 | 48 | | (E) History of emergency room visits or hospitalizations related to |
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| 49 | 49 | | ketoacidosis or hypoglycemia. |
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| 50 | 50 | | (c) The mandatory coverage under subsection (b) is required only if the CGM is |
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| 51 | 51 | | prescribed by or in consultation with an endocrinologist or healthcare practitioner with |
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| 52 | 52 | | experience in diabetes management who documents that the enrollee meets the criteria |
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| 53 | 53 | | under subdivision (b)(1) or subdivision (b)(2). |
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| 54 | 54 | | SECTION 2. This act takes effect January 1, 2026, the public welfare requiring it. |
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