Bill Text: CA SB694 | 2023-2024 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Amended.html
for the treatment of high blood pressure (hypertension). subject to utilization controls.
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-Amended.html
|
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, as amended, 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 for the
treatment of high blood pressure. subject to utilization controls. The bill would state the intent of the Legislature that those covered devices and services be consistent in scope with 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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
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. Those benefits are billed using the established billing codes of Healthcare Common Procedure Coding System (HCPCS) Codes A4670 and A4663 and Current Procedural Terminology (CPT) Codes
99473 and 99474.
(c) The Legislature seeks to statutorily cover, as benefits under the Medi-Cal program, not only SMBP devices but also SMBP services, for purposes of promoting the health of Medi-Cal beneficiaries with high blood pressure (hypertension).
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 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.
(3) It is the intent of the Legislature that these covered SMBP devices be consistent in scope with
no less in scope than the devices that are recognized under Healthcare Common Procedure Coding System (HCPCS) Code A4670 or A4663, or their respective successors.
(b) (1) SMBP services shall be a covered benefit under the Medi-Cal program for the treatment of high blood pressure (hypertension). subject to utilization controls.
(2) For purposes of this section, “SMBP service” includes, but is not limited to, staff time for SMBP using a device validated for clinical accuracy, patient education and training, device calibration, 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.
(3) It is the intent of the Legislature that covered SMBP services be consistent in scope with 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.
