{
  "_comment": "Wear-day rules by device type and payer. Updated 2026-06-07. Run quarterly review per compliance checklist.",
  "devices": {
    "dexcom_g6": {
      "display_name": "Dexcom G6",
      "sensor_wear_days": 10,
      "transmitter_wear_days": 90,
      "components": ["sensor", "transmitter"]
    },
    "dexcom_g7": {
      "display_name": "Dexcom G7",
      "sensor_wear_days": 10,
      "components": ["sensor"]
    },
    "freestyle_libre_2": {
      "display_name": "FreeStyle Libre 2",
      "sensor_wear_days": 14,
      "components": ["sensor"]
    },
    "freestyle_libre_3": {
      "display_name": "FreeStyle Libre 3",
      "sensor_wear_days": 14,
      "components": ["sensor"]
    },
    "omnipod_5": {
      "display_name": "Omnipod 5",
      "pod_wear_days": 3,
      "sensor_wear_days": 14,
      "components": ["pod", "sensor"]
    }
  },
  "payer_rules": {
    "medicare": {
      "visit_renewal_days": 180,
      "refill_window_days": 30,
      "pa_required": false,
      "pecos_required": true,
      "_note": "Medicare FFS. PA not required (CGM coverage expansion 2023). Face-to-face visit required every 6 months. CMS-1828-F: suppliers at >=90% affirmation rate may qualify for PA exemption from June 1, 2026.",
      "covered_devices": ["dexcom_g6", "dexcom_g7", "freestyle_libre_2", "freestyle_libre_3"]
    },
    "medicare_advantage": {
      "visit_renewal_days": 180,
      "refill_window_days": 30,
      "pa_required": true,
      "pecos_required": true,
      "_note": "Medicare Advantage — PA required, varies by plan. Verify plan-specific rules.",
      "covered_devices": ["dexcom_g6", "dexcom_g7", "freestyle_libre_2", "freestyle_libre_3"]
    },
    "medicaid": {
      "visit_renewal_days": 180,
      "refill_window_days": 30,
      "pa_required": true,
      "pecos_required": false,
      "_note": "PA required — Keystone First, UPMC Health Plan, Highmark BCBS require PA. NJ FamilyCare, Horizon BCBS NJ require PA.",
      "covered_devices": []
    },
    "commercial": {
      "visit_renewal_days": 180,
      "refill_window_days": 30,
      "pa_required": true,
      "pecos_required": false,
      "_note": "Commercial payer rules vary by plan. PA required by default — verify per plan.",
      "covered_devices": []
    },
    "default": {
      "visit_renewal_days": 180,
      "refill_window_days": 30,
      "pa_required": true,
      "pecos_required": false,
      "covered_devices": []
    }
  }
}
