Bill Text: CA SB694 | 2023-2024 | Regular Session | Enrolled

California Senate Bill 694

Bill Title: Medi-Cal: self-measured blood pressure devices and services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2024-01-25 - Veto sustained. [SB694 Detail]

Download: California-2023-SB694-Enrolled.html

Enrolled September 15, 2023

Passed IN Senate September 13, 2023

Passed IN Assembly September 12, 2023

Amended IN Assembly September 01, 2023

Amended IN Assembly June 12, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 694

Introduced by Senator Eggman

February 16, 2023

An act to add Section 14132.967 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

SB 694, Eggman. Medi-Cal: self-measured blood pressure devices and services.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law sets forth a schedule of benefits under the Medi-Cal program, including pharmacy benefits (Medi-Cal Rx) and durable medical equipment. The department announced that, effective June 1, 2022, personal home blood pressure monitoring devices, and blood pressure cuffs for use with those devices, are a covered benefit under Medi-Cal Rx as a pharmacy-billed item.

This bill would make self-measured blood pressure (SMBP) devices and SMBP services, as defined, covered benefits under the Medi-Cal program subject to utilization controls, as specified. The bill would state the intent of the Legislature that those covered devices and services be no less in scope than the devices and services that are recognized under specified existing billing codes or their successors. The bill would condition implementation of that coverage on receipt of any necessary federal approvals and the availability of federal financial participation.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO

The people of the State of California do enact as follows:

SECTION 1.

The Legislature finds and declares all of the following:

(a) In May 2022, the State Department of Health Care Services announced that, effective June 1, 2022, personal home blood pressure monitoring devices, and blood pressure cuffs for use with those devices, would be a covered benefit under Medi-Cal Rx as a pharmacy-billed item.

(b) Various states across the country provide coverage under their Medicaid state plans for self-measured blood pressure (SMBP) devices or SMBP services, or both.

(c) The Legislature seeks to statutorily cover, as benefits under the Medi-Cal program, not only SMBP devices as a medical supplies pharmacy benefit under Medi-Cal, but also SMBP services, for purposes of promoting the health of Medi-Cal beneficiaries with hypertension or another diagnosis that supports the use of an at-home blood pressure monitor as aligned with current coverage requirements.

SEC. 2.

Section 14132.967 is added to the Welfare and Institutions Code, immediately following Section 14132.966, to read:

14132.967.

(a) (1) Self-measured blood pressure (SMBP) devices shall be a covered medical supplies pharmacy benefit under the Medi-Cal program subject to utilization controls. Section 14105.47 shall apply to these SMBP devices when covered as a medical supplies pharmacy benefit under the Medi-Cal program.

(2) For purposes of this section, “SMBP device” includes, but is not limited to, an automated blood pressure monitor or a blood pressure cuff. For purposes of covering an SMBP device under this section, the SMBP device shall be designed for home use and shall meet current device requirements for safety and efficacy as set forth by the United States Food and Drug Administration.

(3) It is the intent of the Legislature that these covered SMBP devices be no less in scope than the devices that are recognized under Healthcare Common Procedure Coding System (HCPCS) Code A4660, A4663, or A4670, or their respective successors.

(b) (1) SMBP services shall be a covered benefit under the Medi-Cal program subject to utilization controls.

(2) For purposes of this section, “SMBP service” includes, but is not limited to, staff time for SMBP, patient education and training, separate self-measurements, collection of daily reports by the patient or caregiver to the health care provider, or communication of blood pressure readings and treatment plans to the patient, only to the extent that additional support and education are required and documented by the prescriber.

(3) It is the intent of the Legislature that covered SMBP services be no less in scope than the services that are recognized under Current Procedural Terminology (CPT) Code 99473 or 99474, or their respective successors.

(c) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available.