SB 35 – Continuous Glucose Monitors as Medicaid Benefit

• Requires the Georgia Department of Community Health to include coverage for continuous glucose monitors (CGMs) as a Medicaid benefit, delivered through the most cost-effective benefit delivery channel, effective July 1, 2023
• Eligible recipients must have a diabetes mellitus diagnosis and either receive at least one daily insulin administration or have a documented history of problematic hypoglycemia (recurrent level 2 events below 54 mg/dL persisting despite two or more treatment adjustments, or a level 3 event requiring third-party assistance)
• The treating practitioner must confirm the recipient or caregiver has received sufficient training on using a CGM, as evidenced by the provision of a prescription
• Within six months prior to prescribing a CGM, the treating practitioner must conduct an in-person or telehealth visit to evaluate the recipient's diabetes control and confirm eligibility criteria are met
• Every six months after the initial prescription, the treating practitioner must conduct an in-person or telehealth follow-up visit to assess adherence to the CGM regimen and diabetes treatment plan