HOUSE BILL 428
By Stinnett
SENATE BILL 610
By Massey
SB0610
001606
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AN ACT to amend Tennessee Code Annotated, Title 56
and Title 71, relative to continuous glucose
monitoring.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Bureau" means the bureau of TennCare;
(2) "Continuous glucose monitor" or "CGM" means a device that
automatically and continuously monitors a user's blood glucose levels through
the use of a sensor on the user's body, and enables the user to read the blood
glucose level; and
(3) "Enrollee" means an individual enrolled in TennCare.
(b) The bureau shall provide coverage on behalf of an enrollee for a CGM if:
(1) The patient:
(A) Has a diagnosis of Type 1 diabetes mellitus;
(B) Has a diagnosis of gestational diabetes;
(C) Has a history of problematic hypoglycemia; or
(D) Requires the use of insulin; or
(2) The patient has a diagnosis of Type 2 diabetes mellitus and the
patient meets at least one (1) of the following criteria:
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(A) Documented hemoglobin A1C greater than or equal to seven
percent (7%) measured within six (6) months of a request for laboratory
blood work;
(B) Documented frequent hypoglycemia or nocturnal
hypoglycemia episodes with blood glucose levels of less than fifty
milligrams per deciliter (50 mg/dl);
(C) Documented history of hypoglycemic unawareness;
(D) Dawn phenomenon with fasting blood sugars frequently
exceeding two hundred milligrams per deciliter (200 mg/dl); or
(E) History of emergency room visits or hospitalizations related to
ketoacidosis or hypoglycemia.
(c) The mandatory coverage under subsection (b) is required only 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
under subdivision (b)(1) or subdivision (b)(2).
SECTION 2. This act takes effect January 1, 2026, the public welfare requiring it.