WEST virginia legislature

2024 regular session

Committee Substitute

for

Senate Bill 672

By Senators Grady, Phillips, and Chapman

[Originating in the Committee on Health and Human Resources; and then to the Committee on Finance; reported February 21, 2024]

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; requiring benefits be provided; and requiring reimbursement for related costs.

Be it enacted by the Legislature of West Virginia:

ARTICLE 5. MISCELLANEOUS PROVISIONS.

§9-5-20. Medicaid program; chronic kidney disease and hypertension; evaluation and classification; blood pressure monitors.

(a) Any enrollee in Medicaid who is eligible for services and who has a diagnosis of diabetes or hypertension, 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 hypertension, or who has a family history of kidney disease, 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 complications, based on the presence of kidney damage and level of kidney function.

(d) Medicaid providers shall be educated by the Bureau for Public Health in an effort to increase the rate of evaluation and treatment for chronic kidney disease. Providers should be made aware of:

(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

(iv) (4) Correcting anemia associated with chronic kidney disease.

(e) A Medicaid enrollee who is eligible for services shall receive a self-measured blood pressure validated device: Provided, That the enrollee is pregnant or within the 12-month post-partum pregnancy time frame and has been diagnosed with uncontrolled hypertension.

(f) The Bureau for Medical Services shall draft a state plan amendment to include coverage for home blood pressure monitoring, which shall have specific requirements for the following:

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

(2) Providing coverage for an extra blood pressure cuff; and

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