There’s good news and bad news for people who live with hypertension and have low incomes.
The bad news: High blood pressure affects one in three people enrolled in Medicaid, including an estimated 9 million nonpregnant adults with low incomes.
The good news: Hypertension can be controlled, and complications from it can be prevented through lifestyle changes and medication, especially when diagnosed early.
Still, there’s a wrinkle. The only way to effectively diagnose and monitor hypertension is through accurate BP measurement, whether in an office setting or at home. For many people the BP measurements taken in a doctor’s office differ greatly from those taken outside of a clinical setting. Using validated home blood-pressure measurement devices with the correct technique, patients can accurately monitor their blood pressure and report their measurements back to their physicians. But Medicaid coverage for devices and services is often insufficient and remains a key barrier to the adoption of self-measured blood pressure (SMBP).
The stakes are high
“We want patients to use accurate devices so they are correctly diagnosed,” said Nar Ramkissoon, senior manager of ecosystem development at the AMA. “And physicians and patients need to be able to trust the readings if they’re going to take action to help treat or manage their blood pressure to goal. It’s both a diagnosis issue as well as a management issue.”
The US Blood Pressure Validated Device Listing (VDL™) details which BP measurement devices have been validated for clinical accuracy.
“Several states have extended the ability of pregnant women to be on Medicaid for 12 months postpartum, and states are also covering blood-pressure devices for pregnant women,” Ramkissoon said, noting that Michigan is one of the states that provides SMBP coverage through its Medicaid program. While validated devices are included in the coverage policy, it doesn’t require a device to be validated to be covered in the benefit.
Then there are the millions of nonpregnant adults on Medicaid.
“The current focus on maternal and child health is absolutely needed, and in addition we need to extend that coverage to everyone else,” he added. “The population that’s enrolled in Medicaid programs has all kinds of challenges related to access and engagement.”
Transportation barriers in visiting the physician’s office are just the beginning of it.
“SMBP enables patients to take their readings at home and communicate them back to a doctor without having to take time off work or find child care,” Ramkissoon said, adding that Medicaid patients may have trouble affording even a low-cost device. “If we can remove that cost barrier and get them covered, validated devices, then SMBP becomes a lot more viable and even more effective.”
What needs to happen
An AMA issue brief (PDF) lays out a road map. State Medicaid programs should expand coverage for:
- SMBP clinical services to encourage provider adoption and use. Include SMBP clinical services—under CPT® codes 99473 and 99474—in the Medicaid provider fee schedule as covered benefits.
- Validated automated blood-pressure devices for home use to enable beneficiaries to do SMBP. Include validated automated blood pressure devices, A4670, and an appropriately sized cuff, A4663, in the Medicaid durable medical equipment fee schedule as covered benefits.
Medicaid programs also should:
- Address health inequities by ensuring every member has access to a validated device and an appropriately sized blood pressure cuff as necessary. Remove patient exclusions, eligibility requirements and prior authorization for an automated device and an appropriately sized cuff (medical necessity reviews should not be required if there is a physician order). Ensure adequate reimbursement for validated automated blood pressure devices and clinical services.
The VDL now includes more than 60 home, office, office automated, remote patient monitoring, ambulatory, kiosk and wrist devices. The list also specifies which cuff sizes have been validated for each device.
