IL HB5382

Requires group and individual health insurance policies and managed care plans amended, delivered, issued, or renewed on or after January 1, 2025 to cover continuous glucose monitors, related supplies, and training for individuals diagnosed with diabetes mellitus who meet specified eligibility criteria.

Establishes that patients are not required to have uncontrolled diabetes, emergency room visits, hospitalizations, or improved glycemic control to qualify for coverage; individuals using insulin or with problematic hypoglycemia history qualify if prescribed by appropriate healthcare providers within 6 months of an in-person or telehealth evaluation.

Eliminates prior authorization requirements for continuous glucose monitors and mandates continuous coverage once prescribed; prohibits deductibles, coinsurance, copayments, and other cost-sharing except where needed to maintain high-deductible health plan eligibility for health savings accounts.

Defines "diabetes mellitus" broadly to include type 1, type 2, gestational, cystic fibrosis-related, and medication-induced diabetes, among others, as well as related genetic syndromes.

Directs the Department of Healthcare and Family Services to adopt rules implementing continuous glucose monitor coverage under the medical assistance program with specified minimum provisions regarding ordering providers, device requirements, eligibility, and prohibition on prior authorization.