The Public Health Emergency declaration and diabetes coverage

With the Public Health Emergency (PHE) declaration making continuous glucose monitoring (CGM) — a lifesaving tool for diabetes management — more accessible, there has been a bit of a silver lining amidst the multitude of challenges that the pandemic has presented for patients living with diabetes. From reimbursement for telehealth appointments to more coverage for CGM devices, diabetes care opportunities were increased by the PHE when it was initially declared as a result of COVID-19 in 2020.

Extended opportunities for coverage through programs like the Children's Health Insurance Program (CHIP) and Medicaid helped more patients, including those living with diabetes, receive health insurance. Because of rules that were put into place, which prohibit the disenrollment of folks who were already receiving coverage from these programs, more people remain covered and were able to receive health care throughout the pandemic. With the recent extension of the PHE by Secretary of Health and Human Services Xavier Becerra, patients whose care is impacted by the PHE can expect to have continued coverage through January 11, 2023, which experts predict may extend further into 2023.

The impact of the PHE on CGM coverage

The Centers for Medicare & Medicaid Services (CMS) issued special rules establishing that certain requirements for face-to-face appointments would not apply during the COVID-19 public health emergency. These policies are effective for claims with dates of service on or before March 1, 2020, and for the duration of the COVID-19 Public Health Emergency. Since the PHE has been extended every 90 days since the initial declaration, most recently in late November 2022, the rules that impact CGM coverage are still in place. The PHE and associated legislation and policies made a difference in coverage for CGM most significantly by the way that coverage was extended for so many Americans. Additionally, the emergency provisions removed some of the high barriers to care that patients previously faced, including travel to in-person appointments, and more cumbersome paperwork for patients, providers, pharmacy benefit managers, and insurance companies.

Pending changes due to PHE expiration

Since the PHE has been extended through January 11 of 2023, Americans can expect that the provisions will last until at least April of next year. The Department of Health and Human Services (HHS) has said that they will give states 60 days' notice before expiration so that entities and states will have time to make a plan to handle the unwinding of the current coverage situation.

For patients living with diabetes, this means provisions that have increased the ability to access CGM are still in effect. This also means that telehealth appointments and other associated benefits that were established or increased as part of the PHE are still covered. Patients who have received CGM coverage as a result of the PHE should be made aware that these are still temporary allowances attached to the PHE. This means that when the PHE is over and/or HHS declines to renew (with or without the 60 days' forewarning that has been promised), barriers to coverage and access may return.

Making things better for patients with diabetes

Throughout the various stages of the pandemic, it has continued to be a particularly difficult time for patients living with diabetes, both because of the increased risk to those with the condition and also because of the financial and administrative burdens associated with healthcare for people with chronic illness. Fortunately, some of the interim policies that have been enacted as part of the PHE have helped make things easier and more equitable for patients who can benefit from CGM use.

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