Update for CMS Guidelines for CGM Coverage | Tech Thursday

Last week we posted a blog titled “CMS Updates For CGM Coverage,” which on the surface seemed like very exciting, impactful changes on CMS regulations for CGM coverage during the COVID-19 pandemic.

After sharing this post, members of our community let us know that although CMS guidelines have been relaxed in writing, this hasn’t translated into better access on the ground.

What do these changes actually mean?

To learn more we dove into the interim final rule with comment period (IFC) that was released by the Department of Health & Human Services – Centers for Medicare & Medicaid Services.

 In the March 31st COVID-19 IFC, we finalized on an interim basis that we will not enforce the clinical indications for coverage across respiratory, home anticoagulation management, and infusion pump NCDs (Nation Coverage Determinations) and LCDs (Local Coverage Determinations) (including articles) allowing for more flexibility for practitioners to care for their patients. This enforcement discretion will only apply during the PHE for the COVID-19 pandemic. 

The language in the IFC is vague and ambiguous regarding what it means to have less stringent and “more flexible” requirements of obtaining a CGM in the time of the COVID-19 for people with diabetes. Though we have found a few highlights from the document based on feedback by our community on what is unclear.

The Highlights

  1. These changes are only applicable to those who are COVID-19 positive and living with diabetes.
  2. The type of diabetes one has is no longer relevant in coverage determinations.
  3. These guidelines do not automatically expand to Medicaid coverage. For more details on Medicaid coverage, contact your local state.

In this IFC, we are finalizing on an interim basis that we will not enforce the clinical indications for therapeutic continuous glucose monitors in LCDs. For example, we will not enforce the current clinical indications restricting the type of diabetes that a beneficiary must have or relating to the demonstrated need for frequent blood glucose testing in order to permit COVID-19 infected patients with diabetes to receive a Medicare-covered therapeutic continuous glucose monitor.  

Overall, there is still much to learn about these changes as they apply to real-life situations. This is an unprecedented time for all of us and there is a lot of unknowing. We hope as things develop to keep you informed.

To read the full IFC click here. For more information about Medicaid Guidelines, click here.

If you have any more information on these changes, please click here to visit our survey to update us.

Update from Michael Christian breaking down the CMS changes.

Written by Catherine Cullinane RN, CDCES, our resident Tech Thursday Content Writer


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