CGM coverage under Medi-Cal Hearing

A coalition was formed after Governor Brown’s veto of AB 447 by Assembly Member Gray, which was widely supported and passed the California Legislature unanimously in 2017. AB 447 would have amended Section 14132 of the Welfare and Institutions Code, to add continuous glucose monitors and related supplies required for use with those monitors, to the schedule of benefits under the Medi-Cal program for the treatment of diabetes when medically necessary, subject to utilization controls. In addition, AB 447 would have allowed the Department of Health Care Services to require manufacturers of continuous glucose monitors to enter into a rebate agreement with the department.

The coalition, comprised of Endocrinologists (CA-AACE), Diabetes Educators (AADE), diabetes patients and caregivers (DPAC) and the nation’s leading organization fighting against diabetes (ADA), requested time on the Agenda of the Assembly Budget Subcommittee No. 1 on Health and Human Services to consider a proposal to add continuous glucose monitors for the treatment of diabetes to the schedule of covered benefits in the Medi-Cal program.

Specifically, the coalition requests trailer bill language to amend Section 14132 of the Welfare and Institutions Code, to the extent that federal financial participation is available, and any necessary federal approvals have been obtained, to add continuous glucose monitors and related supplies to the schedule of benefits under the Medi-Cal program for the treatment of diabetes when medically necessary, subject to utilization controls. The trailer bill language would also authorize the Department of Health Care Services to require the manufacturer of continuous glucose monitors to enter into a rebate agreement with the department. In addition, the coalition requests any necessary funding to implement the proposed trailer bill language.

Without access to this technology, Medi-Cal patients are denied access to a standard of care available to Californians in virtually all commercial health plans. Moreover, continuity of care is jeopardized for patients with diabetes in the California Children’s’ Services (CCS) program. CCS covers continuous glucose monitors. Diabetes patients who are well managed and in control will lose access once they transition to Medi-Cal as adults, leading to poorer outcomes and higher costs.

The coalition believes that continuous glucose monitors could help lower costs associated with adults treated for diabetes in the Medi-Cal program by aiding patients and their caregivers in making optimal treatment decisions for the diabetic patient.

We need your help.  The hearing is set for April 30 at 2:30 pm and meetings are set up with Members of the Assembly Budget Subcommittee on Health and Human Services in the morning.  We are looking for additional people, both educators and patients, to join us at both these meetings and the hearing.  If you are unable to make it to Sacramento on this very important day, please contact your assembly member before April 30 and voice your support for this effort.      

 

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How to Find Your Local Assembly Member

March 20, 2018 12:33 PM by Ms. Rebekah Curtis, RN, CDE

http://assembly.ca.gov/assemblymembers

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