1 Accident and Health Insurance; Individual; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 415:6-e to read as follows:

415:6-e Coverage for Diabetes Services and Supplies.

Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy .

Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides for durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy .

2 Accident and Health Insurance; Group; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 415:18-f to read as follows:

415:18-f Coverage for Diabetes Services and Supplies.

Each insurer that issues or renews any policy, plan, or contract of group accident or health insurance providing benefits for medical or hospital expenses, shall provide each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each insurer that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy .

Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

Each insurer that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides for pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

3 Health Service Corporation; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 420-A:17-a to read as follows:

420-A:17-a Coverage for Diabetes Services and Supplies.

I. Every health service corporation and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group accident or health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health service corporation that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.

II. Each health service corporation that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

III. Each health service corporation that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides for pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

4 Health Maintenance Organizations; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 420-B:8-k to read as follows:

420-B:8-k Coverage for Diabetes Services and Supplies.

I. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.

II. Each health maintenance organization that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

III. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides for pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

5 New Section; Coverage for Diabetes Services and Supplies. Amend RSA 126-A by inserting after section 4-i the following new section:

126-A:4-j Medicaid Coverage for Diabetes Services and Supplies.

I. The commissioner of the department of health and human services shall submit a Title XIX Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services for the purpose of establishing a Medicaid benefit for diabetes services and supplies. The Medicaid benefit shall be in all respects equivalent to the terms of coverage established in RSA 420-B:8-k, including, but not limited to coverage relative to insulin and glucose monitoring devices.

II. The Medicaid benefit shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this section. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under Medicaid, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30- day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

III. The commissioner shall adopt rules under RSA 541-A relative to the Medicaid benefit and shall provide an annual report to the oversight committee on health and human services regarding its implementation. Medicaid coverage for diabetes services and supplies shall apply to all 3 Medicaid populations: (i) fee for services; (ii) managed care; and (iii) Medicaid expansion, and coverage for each population.

6 Effective Date. This act shall take effect 60 days after its passage.

1 Accident and Health Insurance; Individual; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 415:6-e to read as follows:

415:6-e Coverage for Diabetes Services and Supplies.

I. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section .

II. Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

III. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph . Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

2 Accident and Health Insurance; Group; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 415:18-f to read as follows:

415:18-f Coverage for Diabetes Services and Supplies.

I. Each insurer that issues or renews any policy, plan, or contract of group accident or health insurance providing benefits for medical or hospital expenses, shall provide each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each insurer that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section .

II. Each insurer that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

III. Each insurer that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

3 Health Service Corporation; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 420-A:17-a to read as follows:

420-A:17-a Coverage for Diabetes Services and Supplies.

I. Every health service corporation and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group accident or health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health service corporation that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.

II. Each health service corporation that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

III. Each health service corporation that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

4 Health Maintenance Organizations; Coverage for Diabetes Services and Supplies; Glucose Monitoring Devices. Amend RSA 420-B:8-k to read as follows:

420-B:8-k Coverage for Diabetes Services and Supplies.

I. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including, but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy and this section.

II. Each health maintenance organization that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible.

III. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides pharmacy or durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this paragraph. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage under this paragraph shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under this paragraph, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

(e) If the application of the cap on equipment or supplies before a covered person has met their plan's deductible would result in health saving account ineligibility, then the cap would only apply to that specific item of equipment or supply after the covered person has met their plan's deductible.

5 New Section; Coverage for Diabetes Services and Supplies. Amend RSA 126-A by inserting after section 4-i the following new section:

126-A:4-j Medicaid Coverage for Diabetes Services and Supplies.

I. The commissioner of the department of health and human services shall submit a Title XIX Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services for the purpose of establishing a Medicaid benefit for diabetes services and supplies. The Medicaid benefit shall be in all respects equivalent to the terms of coverage established in RSA 420-B:8-k, including, but not limited to coverage relative to insulin and glucose monitoring devices.

II. The Medicaid benefit shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy and this section. Equipment shall include continuous and traditional blood glucose monitors and the necessary supplies for any person with a diagnosis of diabetes, including Type 1 diabetes, Type 2 diabetes, gestational diabetes or any other type of diabetes or hypoglycemia. In this paragraph, a "continuous glucose monitor" means an instrument or device designed for the purpose of measuring glucose levels continually through a sensor. "Supplies" shall include, but are not limited to, sensors and test strips.

(a) Coverage shall be provided without regard to the form of treatment. Insulin utilization, frequency of administration of insulin, or frequency of blood glucose testing shall not be a requirement for coverage of blood glucose monitoring. Preferred providers or formularies shall include at least 2 of each kind of device. An endocrinology referral or prescription shall not be required. Prior authorization shall not be required.

(b) To qualify for continued coverage under Medicaid, the recipient must participate in follow-up care with their treating licensed health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months of the glucose monitoring, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur a minimum of once every 12 months.

(c) Upon approval of new or improved glucose monitoring devices and supplies by the Food and Drug Administration, all policies governed by this section shall guarantee coverage of new diabetes equipment and supplies when medically appropriate and prescribed by a licensed health care practitioner qualified to treat diabetes.

(d) Beginning July 1, 2024, coverage for glucose monitoring equipment and supplies shall have a limit on the total amount that an insured is required to pay for a 30- day supply of all medically necessary covered diabetes devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $30. These devices shall be covered without being subject to a deductible. Nothing in this paragraph prevents an insurer from reducing an insured's copayment or coinsurance.

III. The commissioner shall adopt rules under RSA 541-A relative to the Medicaid benefit and shall provide an annual report to the oversight committee on health and human services regarding its implementation. Medicaid coverage for diabetes services and supplies shall apply to all 3 Medicaid populations: (i) fee for services; (ii) managed care; and (iii) Medicaid expansion, and coverage for each population.

6 Effective Date. This act shall take effect 60 days after its passage.