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Elizabeth M. Whitehorn, Director

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