23 Miss. Code. R. 209-1.31 - Insulin Pumps

A. Medicaid defines an insulin pump as a small battery-driven pump that delivers insulin subcutaneously. The pump can be programmed to deliver varying doses of insulin in accordance with changes in need for insulin during different conditions such as eating, exercise, sleep, or at a specific time of day.

B. Medicaid covers insulin pumps for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity, for rental up to purchase amount, or purchase when ordered by an endocrinologist or other physician experienced in the treatment of diabetes and in the management of the insulin pump therapy and when one (1) or more of the following criteria is met:

1. The beneficiary has insulin dependent diabetes where control has been difficult to achieve, or

2. The beneficiary has fluctuating blood sugars and is on three (3) or more injections per twenty four (24) hours, or

3. The beneficiary is receiving treatment of secondary diabetic complications that require closer blood glucose control.

C. Medicaid requires the prescribing provider, with experience in the use of the pump and in a position to monitor the clinical course of the beneficiary, to document that the beneficiary and/or caregiver demonstrates:

1. Motivation to control the diabetes and to comply with the pump regiment,

2. The ability to learn how to use the pump effectively and the ability to comply with the regimen of the pump care, and

3. A commitment to comply with diet, exercise, medications, and frequent self-monitoring of blood glucose.

D. The prescribing provider and supplier of the pump must also ensure that the beneficiary and/or caregiver are fully educated about the beneficiary's diabetic condition and use of the insulin pump.

Notes

23 Miss. Code. R. 209-1.31

42U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17), 43-13-121.

Amended 9/1/2018