People with type 1 diabetes age 21 years and older who have valid concessional status, and have a high clinical need
To be eligible to access subsidised CGM products through the NDSS:
- the person is expected to benefit clinically from the use of CGM; and
- the person or family/carer has the willingness and capability to use CGM; and
- the person or family/carer has the commitment to actively participate in a diabetes management plan which incorporates CGM.
In addition, the person must be 21 years or older, have a valid concessional status as listed below, and have a high risk/clinical need that would include evidence that the person has both:
- a history of at least one episode of severe hypoglycaemia within the last 12 months, with evidence of significant cognitive impairment requiring external third-party assistance for recovery; and
- an assessment of significantly impaired awareness of hypoglycaemia using the Clarke Survey - with a score of four (4) or above indicating significantly impaired awareness of hypoglycaemia.
The certifying health professional must confirm they have taken reasonable steps to assure themselves that their patient required the assistance of an external third-party for recovery, involving either:
- attendance by an ambulance; or
- hospital admission.
In certain circumstances, an authorised health professional may believe that the person has an equivalent level of high risk/high clinical need but does not satisfy both eligibility criteria above. This may include some people who have a history of multiple episodes of severe hypoglycaemia with evidence of significant cognitive impairment requiring external third-party assistance for recovery as well as impaired awareness of hypoglycaemia, though no episodes within the last 12 months as since that time, they may have already been using CGM products as part of their diabetes management to prevent reoccurrence of severe hypoglycaemia episodes. To learn more about submitting a special consideration application, please contact the NDSS Helpline on 1300 136 588.
In these exceptional circumstances, consideration may be given on a case-by-case basis, noting these will be:
- considered by an appropriately constituted expert panel established by Diabetes Australia that will provide a recommendation to the Department of Health; and
- the Department of Health will be the deciding body for all of these cases.
To submit an application, a completed eligibility assessment form and supporting documentation outlining the assessment of equivalent level of high risk/high clinical need prepared and certified by an authorised health professional should be emailed to the NDSS at firstname.lastname@example.org, or alternatively posted to GPO Box 9824 in your capital city, or faxed to 1300 536 953. For more information, please call the NDSS Helpline on 1300 136 588.
This is a new initiative and in this context, each application for special consideration requires careful review to determine if the eligibility and the criteria have been met in order to be granted access. The expert committee handling requests for special consideration will need time to consider applications before arriving at any outcome. The Department of Health will also be monitoring the progress of the initiative to facilitate consideration for those with the greatest clinical need.
The required concessional status for this eligibility group is consistent with existing NDSS concessional arrangements but excludes the Safety Net Concession Card (SNCC) and the Safety Net Entitlement Card (SNEC) categories. People with the following valid concessional types will be eligible for the initiative (if they also meet the other eligibility criteria):
- Commonwealth Seniors Health Card (as issued by DHS* or DVA**)
- Commonwealth Pensioner Concession Card (as issued by DHS or DVA)
- Commonwealth Health Care Card (as issued by DHS or DVA)
- DVA Gold Card
- DVA White Card
- Identifies as Aboriginal and/or Torres Strait Islander person
*DHS Department of Human Services
**DVA Department of Veterans’ Affairs
For more information read the CGM FAQs.
Find the CGM eligibility assessment form for Type 1 diabetes; Age 21 Years and Over; Eligible Concessional Status; High Clinical Need here.