(a) As used in this section, “continuous glucose monitor” means an instrument or device, including repair and replacement parts, that:(1) Is designed and offered for the purpose of aiding an individual with diabetes;(2) Measures glucose levels at set intervals by means of a small electrode placed under the skin and held in place by an adhesive; and(3) Is generally not useful to an individual who has not been diagnosed with diabetes.
(1) Is designed and offered for the purpose of aiding an individual with diabetes;
(2) Measures glucose levels at set intervals by means of a small electrode placed under the skin and held in place by an adhesive; and
(3) Is generally not useful to an individual who has not been diagnosed with diabetes.
(b) The Arkansas Medicaid Program shall provide coverage for a continuous glucose monitor for the treatment of an individual if the individual has:(1) Either:(A) A presence of type 1 diabetes or any other type of diabetes with:(i) The use of insulin in accordance with Medicare policy; or(ii) Evidence of Level 2 or Level 3 hypoglycemia; or(B) Diagnosis of glycogen storage disease type 1a; and(2) Regular follow-up visits with a healthcare provider at a minimum of every six (6) months to assess for ongoing benefit of the continuous glucose monitor.
(1) Either:(A) A presence of type 1 diabetes or any other type of diabetes with:(i) The use of insulin in accordance with Medicare policy; or(ii) Evidence of Level 2 or Level 3 hypoglycemia; or(B) Diagnosis of glycogen storage disease type 1a; and
(A) A presence of type 1 diabetes or any other type of diabetes with:(i) The use of insulin in accordance with Medicare policy; or(ii) Evidence of Level 2 or Level 3 hypoglycemia; or
(i) The use of insulin in accordance with Medicare policy; or
(ii) Evidence of Level 2 or Level 3 hypoglycemia; or
(B) Diagnosis of glycogen storage disease type 1a; and
(2) Regular follow-up visits with a healthcare provider at a minimum of every six (6) months to assess for ongoing benefit of the continuous glucose monitor.
(c) Coverage for a continuous glucose monitor under the Arkansas Medicaid Program shall allow the beneficiary to obtain a continuous glucose monitor through:(1) A prescription at a pharmacy and be eligible for rebates as a pharmacy benefit; or(2) (A) A written order from an ordering practitioner for durable medical equipment provided by a durable medical equipment provider and be eligible as a durable medical equipment benefit.(B) A durable medical equipment provider shall not be required to submit a National Drug Code as part of any claim submission under this section.
(1) A prescription at a pharmacy and be eligible for rebates as a pharmacy benefit; or
(2) (A) A written order from an ordering practitioner for durable medical equipment provided by a durable medical equipment provider and be eligible as a durable medical equipment benefit.(B) A durable medical equipment provider shall not be required to submit a National Drug Code as part of any claim submission under this section.
(A) A written order from an ordering practitioner for durable medical equipment provided by a durable medical equipment provider and be eligible as a durable medical equipment benefit.
(B) A durable medical equipment provider shall not be required to submit a National Drug Code as part of any claim submission under this section.
(d) Regardless of whether the coverage for a continuous glucose monitor is provided through a pharmacy or a durable medical equipment provider, the Department of Human Services shall:(1) Implement consistent approval requirements; and(2) Reimburse for a continuous glucose monitor provided by a durable medical equipment provider at no less than the Medicare reimbursement under the Healthcare Common Procedure Coding System.
(1) Implement consistent approval requirements; and
(2) Reimburse for a continuous glucose monitor provided by a durable medical equipment provider at no less than the Medicare reimbursement under the Healthcare Common Procedure Coding System.