On October 27, 2020, the Centers for Medicare and Medicaid Services proposed expanding coverage of continuous glucose monitors (CGMs) for individuals with diabetes. This proposal is open to comment. See the proposal here. https://www.federalregister.gov/documents/2020/11/04/2020-24194/medicare-program-durable-medical-equipment-prosthetics-orthotics-and-supplies-dmepos-policy-issues
As conceded in the proposed rule, the Secretary’s proposal to extend Medicare coverage of CGMs is the result of loses in the District Courts that found Medicare’s non-coverage position to not be reasonable and not supported by the evidence. Indeed, five different District Courts found Medicare’s position at odds with the evidence that is supposed to underpin Medicare coverage analyses. One District Court found Medicare’s logic in not covering CGM “head-scratching” at best. The Medicare Administrative Contractors for Durable Medical Equipment (Noridian Solutions and CGS Administrators) had maintained the position that CGM served no medical purpose although CGMs are only prescribed to individuals who have diabetes and a CGM serves no purpose but a medical purpose. This position was so unsupported that attorney fees were awarded.
Notwithstanding the proposed coverage of CGM, a sixth District Court case remains pending. In that case, the Medicare contractor denied coverage of a CGM to a Medicare beneficiary who may lose his transplant without a CGM.
Parrish Law Offices represented the Medicare beneficiaries who sued for Medicare coverage of CGM devices in six different jurisdictions. Parrish Law Offices also has filed a class action in the District of Columbia seeking coverage going back to 2012 for Medicare beneficiaries whose CGM claims were denied based upon a flawed policy.