Provider Notice issued 11/27/2024
To: | Enrolled Physicians; Physician Assistants; Advanced Practice Registered Nurses; Local Health Departments; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; and Pharmacies |
Date | November 27, 2024 |
Re: |
Confirmation of Coverage for Continuous Glucose Monitors in Compliance with Public Act 103-0639 |
This notice informs providers of changes related to approval of continuous glucose monitors (CGMs), in compliance with Public Act 103-0639. These changes became effective July 1, 2024, and affect both the Medicaid fee-for-service (FFS) program and managed care organizations (MCOs).
In accordance with the Act, the Department of HealthCare and Family Services (HFS) will approve a valid prior authorization request for a CGM for no less than a 12-month period, for any type of diabetes. Please refer to the posted criteria for additional detail.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate MCO.
Kelly Cunningham, Administrator
Division of Medical Programs