TennCare

Plain English Breakdown

Checked against official source text during the last sync.

TennCare Continuous Glucose Monitoring Coverage

This bill requires TennCare to cover continuous glucose monitors (CGMs) for certain individuals with diabetes or related conditions.

What This Bill Does

• Requires the bureau of TennCare to provide coverage for CGMs if a patient has Type 1 diabetes, gestational diabetes, problematic hypoglycemia, or needs insulin.
• Provides coverage for CGMs if a person with Type 2 diabetes meets specific criteria such as high hemoglobin A1C levels, frequent hypoglycemic episodes, history of hypoglycemic unawareness, dawn phenomenon, or hospitalizations due to ketoacidosis or hypoglycemia.
• Limits mandatory coverage to CGMs prescribed by an endocrinologist or a healthcare practitioner experienced in diabetes management who documents the patient's eligibility.

Who It Names or Affects

• Individuals enrolled in TennCare with Type 1, gestational, or Type 2 diabetes meeting specific criteria.
• Healthcare providers such as endocrinologists and practitioners managing diabetes care.

Terms To Know

Continuous Glucose Monitor (CGM)

A device that continuously monitors a person's blood glucose levels through a sensor on the body, allowing users to read their blood sugar levels.

Enrollee

An individual who is enrolled in TennCare, Tennessee’s Medicaid program.

Limits and Unknowns

• The bill does not specify how many individuals will be eligible for CGM coverage.
• It is unclear what the exact financial impact on TennCare and federal funding will be beyond the initial estimates provided.

Official Summary Text

This bill requires

t
he bureau
of TennCare

to
provide coverage on behalf of an individual enrolled in TennCare
("
enrollee
")
for a
continuous glucose monitor ("
CGM
")
if
either of the following criteria is met
:



The patient
(i) h
as a diagnosis of Type 1 diabetes mellitus;

(ii) has a diagnosis of gestational diabetes;

(iii) has a history of problematic hypoglycemia; or

(iv) requires the use of insulin
.



The patient has a diagnosis of Type 2 diabetes mellitus and meets at least one of the following criteria:
(i) d
ocumented hemoglobin A1C greater than or equal to 7% measured within 6 months of a request for laboratory blood work;

(ii) documented frequent hypoglycemia or nocturnal hypoglycemia episodes with blood glucose levels of less than
50
milligrams per deciliter;

(iii) documented history of hypoglycemic unawareness;

(iv) dawn phenomenon with fasting blood sugars frequently exceeding
200
milligrams per deciliter; or

(v) history of emergency room visits or hospitalizations related to ketoacidosis or hypoglycemia.

This bill provides that such
mandatory c
overage is
only
required if the CGM is prescribed by or in consultation with an endocrinologist or healthcare practitioner with experience in diabetes management who documents that the enrollee meets the criteria
described above
.

Current Bill Text

SENATE BILL 610
By Massey

HOUSE BILL 428
By Davis

HB0428
001606
- 1 -

AN ACT to amend Tennessee Code Annotated, Title 56
and Title 71, relative to continuous glucose
monitoring.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 71, Chapter 5, Part 1, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Bureau" means the bureau of TennCare;
(2) "Continuous glucose monitor" or "CGM" means a device that
automatically and continuously monitors a user's blood glucose levels through
the use of a sensor on the user's body, and enables the user to read the blood
glucose level; and
(3) "Enrollee" means an individual enrolled in TennCare.
(b) The bureau shall provide coverage on behalf of an enrollee for a CGM if:
(1) The patient:
(A) Has a diagnosis of Type 1 diabetes mellitus;
(B) Has a diagnosis of gestational diabetes;
(C) Has a history of problematic hypoglycemia; or
(D) Requires the use of insulin; or
(2) The patient has a diagnosis of Type 2 diabetes mellitus and the
patient meets at least one (1) of the following criteria:

- 2 - 001606

(A) Documented hemoglobin A1C greater than or equal to seven
percent (7%) measured within six (6) months of a request for laboratory
blood work;
(B) Documented frequent hypoglycemia or nocturnal
hypoglycemia episodes with blood glucose levels of less than fifty
milligrams per deciliter (50 mg/dl);
(C) Documented history of hypoglycemic unawareness;
(D) Dawn phenomenon with fasting blood sugars frequently
exceeding two hundred milligrams per deciliter (200 mg/dl); or
(E) History of emergency room visits or hospitalizations related to
ketoacidosis or hypoglycemia.
(c) The mandatory coverage under subsection (b) is required only if the CGM is
prescribed by or in consultation with an endocrinologist or healthcare practitioner with
experience in diabetes management who documents that the enrollee meets the criteria
under subdivision (b)(1) or subdivision (b)(2).
SECTION 2. This act takes effect January 1, 2026, the public welfare requiring it.