SB 672 — Requiring coverage of home blood pressure monitoring devices for certain Medicaid recipients

WEST VIRGINIA LEGISLATURE REGULAR SESSION IntroducedCommittee Substitute for Senate Bill 672 By Senators Grady, Phillips, and Chapman [Introduced[Originating Februaryin 6,the 2024;Committee on Health and Human Resources;

referredand then to the Committee on HealthFinance; and Human Resources;

andreported thenFebruary to21, the2024] CommitteeCS onfor Finance] Intr SB 2024R3629672 A BILL to amend and reenact §9-5-20 of the Code of West Virginia, 1931, as amended, relating to Medicaid coverage for blood pressure monitoring devices to be offered to certain persons who have been diagnosed with hypertension;

(a) Any enrollee in Medicaid who is eligible for services and who has a diagnosis of diabetes or hypertensionhypertension, or,or who has a family history of kidney disease, shall receive coverage for an evaluation for chronic kidney disease through routine clinical laboratory assessments of kidney function.

(b) Any enrollee in Medicaid who is eligible for services and who has been diagnosed with diabetes or hypertensionhypertension, or who has a family history of kidney diseasedisease, and who has received a diagnosis of kidney disease shall be classified as a chronic kidney patient.

(c) The diagnostic criteria used to define chronic kidney disease should be those generally recognized through clinical practice guidelines which identify chronic kidney disease or its complicationscomplications, based on the presence of kidney damage and level of kidney function.

(i) (1) Managing risk factors, which prolong kidney function or delay progression to kidney replacement therapy;

(ii) (2) Managing risk factors for bone disease and cardiovascular disease associated with chronic kidney disease;

(iii) (3) Improving nutritional status of chronic kidney disease patients;

and Intr1 CS for SB 2024R3629672 (iv) (4) Correcting anemia associated with chronic kidney disease.

(e) A Medicaid enrollee,enrollee who at the time of diagnosis of uncontrolled hypertension is pregnanteligible orfor immediatelyservices post-partumshall pregnancy, is eligible to receive a validatedself-measured blood pressure monitoringvalidated device.device:

TheProvided, BureauThat ofthe Medicalenrollee Servicesis shallpregnant amendor within the State12-month Planpost- topartum revisepregnancy thetime homeframe bloodand pressurehas monitorbeen coveragediagnosed requirementswith touncontrolled includehypertension. specific requirements for:

(1)(f) CoverageThe determinationBureau for hypertension;Medical Services shall draft a state plan amendment to include coverage for home blood pressure monitoring, which shall have specific requirements for the following:

(2)(1) InclusionProviding ofcoverage for a validated self-measured blood pressure device;device validated by the United States Blood Pressure Validated Listing;

(3)(2) ReplacementProviding frequencycoverage offor self-measuredan extra blood pressure device;cuff;

(4)and Reimbursement(3) Providing reimbursement for a self-measured blood pressure validated device and related services;services, including, but not limited to, training patients, interpretation of readings, and the costs of delivering co-interventions.

including training patients, transmission of blood pressure data, interpretation of readings and costs of delivering co-interventions.

(f) The Bureau of Medical Services shall create a policy to enable data integration, storage and transfer, and enable clinical oversight and compliance with this section.

NOTE:

The purpose of this bill is to require coverage and reimbursement for home blood pressure monitoring devices for certain persons diagnosed with hypertension.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.