UHC - 2021 BP Cuff Coverage Grid from State of MI

March 30, 2021

Provided to you from United Healthcare:

Please review the attached Medicaid home blood pressure cuff coverage grid that has been created by the State of MI.   The grid can be used by providers to check inclusion criteria, preauthorization requirements, and special instructions specific to each to the UHC managed care plan prior to prescribing blood pressure cuffs to patients with hypertension for blood pressure self-monitoring.    .    

 

Michigan Department of Health and Human Services (MDHHS) Blood Pressure Cuff Coverage Grid

Uncontrolled hypertension is a major modifiable risk factor for cardiovascular disease (CVD) and is associated with increased CVD morbidity and mortality as well as increased health care utilization.   46% of Americans have hypertension, and the condition is uncontrolled in approximately half of these individuals.  It is projected that the total direct costs of hypertension could increase to approximately $221 billion by 2035.  An estimated 12% of annual spending by Medicaid nationally can be attributed to treatment of CVD.

In an effort to improve control of hypertension, reduce associated comorbidities, and decrease costs associated with health care resource utilization, the MDHHS Heart Disease and Stroke Prevention Unit promotes the use of self-measured blood pressure monitoring (SMBP).  SMBP is the regular measurement of blood pressure by the patient outside the clinical setting, usually in the home.  SMBP tied with clinical support has been shown to improve blood pressure in patients with hypertension.  This requires the use of a home blood pressure measurement device (cuff) by the patient to measure blood pressure in their usual environment. 

To facilitate patient access to home blood pressure cuffs and understanding of cuff coverage benefits, a Medicaid home blood pressure cuff coverage grid has been created.  The grid can be used by providers to check inclusion criteria, preauthorization requirements, and special instructions specific to each managed care plan prior to prescribing blood pressure cuffs to patients with hypertension for blood pressure self-monitoring.  The grid is available on-line:  Medicaid BP Cuff Coverage Grid.

If you have any questions or comments, please contact Michele Kawabe at KawabeM@michigan.gov