HB 648-FN - AS INTRODUCED
2025 SESSION
25-0120
05/11
HOUSE BILL 648-FN
AN ACT relative to insurance coverage for glucose monitoring.
SPONSORS: Rep. Damon, Sull. 8; Rep. Balboni, Rock. 38; Rep. Beauchemin, Hills. 3; Rep. Newell, Ches. 4; Rep. Selig, Straf. 10; Rep. Spier, Hills. 6; Rep. Mandelbaum, Rock. 21; Rep. Nagel, Belk. 6; Rep. Rollins, Sull. 3; Sen. Gannon, Dist 23; Sen. Prentiss, Dist 5; Sen. Ward, Dist 8; Sen. Rochefort, Dist 1
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill requires health insurance providers to cover glucose monitoring devices and supplies for individuals with diabetes.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
25-0120
05/11
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACT relative to insurance coverage for glucose monitoring.
Be it Enacted by the Senate and House of Representatives in General Court convened:
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 [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 traditional blood glucose monitors and continuous glucose monitoring systems (CGMS) and the necessary supplies for any person with a diagnosis of Type 2 diabetes or gestational diabetes. In this paragraph, a “continuous glucose monitoring system” means an instrument or device designed for the purpose of measuring glucose levels continuously through an in-dwelling sensor and the necessary supplies. "Supplies" shall include, but are not limited to, sensors, transmitters, receivers, lancets, 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 or CGMS. 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) Glucose monitoring devices and supplies shall be covered without being subject to a deductible. Nothing in this paragraph shall prevent an insurer from reducing an insured’s copayment or coinsurance.
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 [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 traditional blood glucose monitors and continuous glucose monitoring systems (CGMS) and the necessary supplies for any person with a diagnosis of Type 2 diabetes or gestational diabetes. In this paragraph, a “continuous glucose monitoring system” means an instrument or device designed for the purpose of measuring glucose levels continuously through an in-dwelling sensor and the necessary supplies. "Supplies" shall include, but are not limited to, sensors, transmitters, receivers, lancets, 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 or CGMS. 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) Glucose monitoring devices and supplies shall be covered without being subject to a deductible. Nothing in this paragraph shall prevent an insurer from reducing an insured’s copayment or coinsurance.
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 traditional blood glucose monitors and continuous glucose monitoring systems (CGMS) and the necessary supplies for any person with a diagnosis of Type 2 diabetes or gestational diabetes. In this paragraph, a “continuous glucose monitoring system” means an instrument or device designed for the purpose of measuring glucose levels continuously through an in-dwelling sensor and the necessary supplies. "Supplies" shall include, but are not limited to, sensors, transmitters, receivers, lancets, 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 or CGMS. 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) Glucose monitoring devices and supplies shall be covered without being subject to a deductible. Nothing in this paragraph shall prevent an insurer from reducing an insured’s copayment or coinsurance.
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 traditional blood glucose monitors and continuous glucose monitoring systems (CGMS) and the necessary supplies for any person with a diagnosis of Type 2 diabetes or gestational diabetes. In this paragraph, a “continuous glucose monitoring system” means an instrument or device designed for the purpose of measuring glucose levels continuously through an in-dwelling sensor and the necessary supplies. "Supplies" shall include, but are not limited to, sensors, transmitters, receivers, lancets, 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 or CGMS. 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) Glucose monitoring devices and supplies shall be covered without being subject to a deductible. Nothing in this paragraph shall prevent an insurer from reducing an insured’s copayment or coinsurance.
5 Effective Date. This act shall take effect 60 days after its passage.
25-0120
Revised 1/27/25
HB 648-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to insurance coverage for glucose monitoring.
FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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Estimated State Impact | ||||||
| FY 2025 | FY 2026 | FY 2027 | FY 2028 | ||
Revenue | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Revenue Fund(s) | General Fund and Various Agency Funds | |||||
Expenditures* | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Funding Source(s) | NHID Operating Fund | |||||
Appropriations* | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
*Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill | ||||||
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The Office of Legislative Budget Assistant is unable to provide a complete fiscal note for this bill, as introduced, as it is awaiting information from the Department of Administrative Services. The Department was originally contacted on 12/31/24 for a fiscal note worksheet. When completed, the fiscal note will be forwarded to the House Clerk's Office.
METHODOLOGY:
This bill requires insurance coverage for glucose monitoring devices for people with diabetes. The Insurance Department indicates this bill seeks to expand coverage for diabetes monitoring supplies and equipment for individuals living with diabetes. The bill would amend RSAs 415:6-e, 415:18-f, 420-A:17-a, and 420-B:8-k, to require insurers issuing health plans to individuals, groups, health service organizations (HSOs), and health maintenance organizations (HMOs) respectively, to cover continuous glucose monitoring devices and sensors (CGMS), as well as associated follow-up care for the first 6, 12, and 18 months of use. Coverage would be required for all forms of diabetes therapy, including insulin therapy.
The Department assumes this bill would increase the frequency, unit cost, and total cost of claims. The Department expects the extent of this increase to be non-trivial, but indeterminable at this time. This may result in upward pressure on premiums and increased premium tax revenues. To the extent insurance premiums increase county and local expenditures for health insurance would also increase.
The Department states this is a new coverage requirement that could be subject to cost defrayal of state-mandated requirements pursuant to 45 CFR §155.170. Under this federal regulation, passage of this bill could be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits (EHB) offered in the Exchange Marketplace. This could be the case even though the specific coverage required is already subsumed under existing categories of EHB coverage. Under this regulation, the State may be required to defray the cost of the additional required benefits to Qualified Health Plan enrollees or to QHP issuers. This would represent a general fund expense which is indeterminable at this time. However, under RSA 400-A:39-b, the legislative committee, having jurisdiction over this bill, may refer the proposed mandated coverage to the Insurance Department which is authorized to retain an external actuarial to review the costs and benefits of the proposed mandate. In this manner, a qualified opinion of the cost of this bill could be obtained. The historical cost of this actuarial review is between $20,000 to $40,000 which would be covered under the Insurance Department's Operating Fund (NHID Operating Fund).
AGENCIES CONTACTED:
Department of Administrative Services and Insurance Department
| Date | Body | Type |
|---|---|---|
| Jan. 29, 2025 | House | Hearing |
Jan. 23, 2025: Public Hearing: 01/29/2025 10:30 am LOB 302-304
Jan. 21, 2025: Introduced (in recess of) 01/09/2025 and referred to Commerce and Consumer Affairs HJ 3