{"data":{"id":"us-il/305-ilcs-5-5-16.8a","jurisdiction":"us-il","citation":"305 ILCS 5/5-16.8a","heading":"Rules concerning continuous glucose monitor coverage.","body":"The Department shall adopt rules to implement the changes made to Section 356z.59 of the Illinois Insurance Code, as applied to the medical assistance program. The rules shall, at a minimum, provide that:\n(1) the ordering provider must be a physician licensed under the Medical Practice Act of 1987 or a certified nurse practitioner or physician assistant with a collaborative agreement with the physician; the ordering provider is not required to obtain continuing medical education in order to prescribe a continuous glucose monitor;\n(2) continuous glucose monitors are not required to have an alarm when glucose levels are outside the predetermined range; the capacity to generate predictive alerts in case of impending hypoglycemia; or the ability to transmit real-time glucose values and alerts to the patient and designated other persons;\n(3) the beneficiary is not required to need intensive insulin therapy;\n(4) the beneficiary is not required to have a recent history of emergency room visits or hospitalizations related to hypoglycemia, hyperglycemia, or ketoacidosis;\n(5) if the beneficiary has gestational diabetes, the beneficiary is not required to have suboptimal glycemic control that is likely to harm the beneficiary or the fetus;\n(6) if a beneficiary has diabetes mellitus and the beneficiary does not meet the coverage requirements or if the beneficiary is in a population in which continuous glucose monitor usage has not been well-studied, requests shall be reviewed, on a case-by-case basis, for medical necessity and approved if appropriate; and\n(7) prior authorization is required for a prescription of a continuous glucose monitor; once a continuous glucose monitor is prescribed, the prior authorization shall be approved for a 12-month period.","path":["CHAPTER 305 PUBLIC AID","Illinois Public Aid Code."],"source_url":"https://www.ilga.gov/legislation/ILCS/details?ActID=1413\u0026ChapterID=28\u0026ChapAct=FullText\u0026Print=True","current_through":"at least Public Act 104-790","vintage":"","retrieved_at":"2026-09-15T04:46:32Z","sha256":"ca3991704ec7d745c60c3af36f026e531553949396f35ffdceb347e118c78e11","source_id":"us-il","stale":false,"prev":"us-il/305-ilcs-5-5-16.8","next":"us-il/305-ilcs-5-5-16.9"},"notice":"GroundRules: Original legal text. Not legal advice."}