Blood Pressure MATTERS Act

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(A) in subsection (a)—

(i) in paragraph (31), by striking and at the end;

(ii) by redesignating paragraph (32) as paragraph (33); and

(iii) by inserting after paragraph (31) the following new paragraph:

(32) self-measured blood pressure monitoring for pregnant and postpartum individuals (as defined in subsection (ll)(1)); and; and

(B) by adding at the end the following new subsection:

For purposes of subsection (a)(32), the term self-measured blood pressure monitoring for pregnant and postpartum individuals —

(A) means a specified blood pressure measurement device furnished to an individual during pregnancy (and during the 12-month period beginning on the last day of the pregnancy, or, in the case of an individual who is eligible for medical assistance under the State plan under paragraph (5) or (16) of section 1902(e), during the period for which such individual remains so eligible), without regard to whether such individual is diagnosed with a hypertensive disorder; and

(B) does not include more than 1 such device furnished to an individual during a 2-year period.

In this subsection, the term specified blood pressure management device means a device that—

(A) can be used by an individual to measure their own blood pressure without the assistance of a health care provider;

(B) has been cleared for market under section 510(k) of the Federal Food, Drug, and Cosmetic Act; and

(C) is listed as a validated device on the Validated Device Listing website maintained by the American Medical Association.

Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by striking and (30) and inserting (30), and (32).

Section 1937(b) of the Social Security Act (42 U.S.C. 1396u–7(b)) is amended by adding at the end the following new paragraph:

Notwithstanding the previous provisions of this section, a State may not provide for medical assistance through enrollment of an individual with benchmark coverage or benchmark-equivalent coverage under this section unless, beginning on the date that is 120 days after the date of enactment of this paragraph, such coverage includes, for any pregnant or postpartum individual, medical assistance for self-measured blood pressure monitoring in accordance with section 1905(ll).

Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o) are each amended—

(i) in subparagraph (I), by striking or at the end;

(ii) in subparagraph (J), by striking; and and inserting, or; and

(iii) by adding at the end the following subparagraph:

(K) self-measured blood pressure monitoring for pregnant and postpartum individuals (as defined in section 1905(ll)(1)); and.

Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by adding at the end the following new clause:

(xv) Self-measured blood pressure monitoring for pregnant and postpartum individuals (as defined in section 1905(ll)(1)).

Subject to subparagraph (B), the amendments made by this subsection shall apply with respect to items and services furnished on or after the date that is 120 days after the date of enactment of this section.

In the case of a State plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this subsection. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

Section 2103(c) of the Social Security Act (42 U.S.C. 1397cc(c)) is amended by adding at the end the following new paragraph:

Regardless of the type of coverage elected by a State under subsection (a), in the case of a State that elects to provide pregnancy-related assistance pursuant to section 2112, the pregnancy-related assistance provided for a targeted low-income pregnant woman (as such terms are defined for purposes of such section), shall include coverage of self-measured blood pressure monitoring in accordance with section 1905(ll).

Subject to subparagraph (B), the amendments made by this subsection shall apply with respect to items and services furnished on or after the date that is 120 days after the date of enactment of this section.

In the case of a State child health plan for child health assistance under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this subsection. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following new section:

Subject to the limitation under subsection (b), a group health plan, and a health insurance issuer offering group or individual health insurance coverage—

(1) shall provide coverage of, and may not impose any cost sharing requirements for, specified blood pressure management devices furnished to an individual during pregnancy (and during the 12-month period beginning on the last day of the pregnancy); and

(2) may not require that such individual be diagnosed with a hypertensive disorder as a condition of such coverage.

A group health plan or health insurance issuer offering group or individual health insurance coverage is not required under this section to provide coverage of more than 1 specified blood pressure management device furnished to an individual during a 2-year period.

In this section, the term specified blood pressure management device has the meaning given such term in section 1905(ll)(2) of the Social Security Act.

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:

Subject to the limitation under subsection (b), a group health plan, and a health insurance issuer offering group health insurance coverage—

(1) shall provide coverage of, and may not impose any cost sharing requirements for, specified blood pressure management devices furnished to an individual during pregnancy (and during the 12-month period beginning on the last day of the pregnancy); and

(2) may not require that such individual be diagnosed with a hypertensive disorder as a condition of such coverage.

A group health plan or health insurance issuer offering group health insurance coverage is not required under this section to provide coverage of more than 1 specified blood pressure management device furnished to an individual during a 2-year period.

In this section, the term specified blood pressure management device has the meaning given such term in section 1905(ll)(2) of the Social Security Act.

The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 726 the following:

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

Subject to the limitation under subsection (b), a group health plan—

(1) shall provide coverage of, and may not impose any cost sharing requirements for, specified blood pressure management devices furnished to an individual during pregnancy (and during the 12-month period beginning on the last day of the pregnancy); and

(2) may not require that such individual be diagnosed with a hypertensive disorder as a condition of such coverage.

A group health plan is not required under this section to provide coverage of more than 1 specified blood pressure management device furnished to an individual during a 2-year period.

In this section, the term specified blood pressure management device has the meaning given such term in section 1905(ll)(2) of the Social Security Act.

The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:

The amendments made by this subsection shall apply with respect to plan years beginning on or after the date that is 120 days after the date of enactment of this section.