Policy
Advocacy: Aligning health policy with hypertension science
AHA and AMA are working together to align health policy with hypertension science to improve blood pressure control across the country. Our policy work focuses on federal, state, local, community and institution-level blood pressure control efforts that support:
- Patient coverage and access for equitable and satisfactory guideline-driven hypertension care
- Provider, care team and health care organization reimbursement and incentives that facilitate sustainable, evidence-based care
- Communities and institutions promoting heart health and best practices in healthcare
Target: BP federal advocacy priorities include optimizing Medicare beneficiary coverage and provider/care-team reimbursement for evidence-based hypertension care.
Device Coverage for SMBP
The team is advocating for expanded coverage of validated self-monitored blood pressure (SMBP) devices to support the diagnosis, treatment and monitoring of high blood pressure. In 2021, AHA and AMA submitted a National Coverage Determination (NCD) Request to the Centers for Medicare and Medicaid Services (CMMS) to cover validated SMBP devices for Medicare Beneficiaries.
Care Reimbursement for SMBP monitoring – Policy Win!
In 2019, we advocated to expand CPT® code options for providers and care teams that prepare patients to use SMBP devices, review SMBP readings and make treatment recommendations based upon those readings. Effective in 2020, these new codes expanded the available options for billing, creating incentives and sustainability for this evidence-based practice among Medicare beneficiaries when patients use a validated blood pressure device.
Healthy Living & Social Determinants of Health
We continue to advocate for federal policies that improve heart health, reduce cardiovascular risk and make healthy living and equitable health outcomes possible. Efforts include sodium reduction, physical activity assessments and prescriptions, tobacco control and clean air standards.
USCDI Average Blood Pressure Inclusion – Policy Win!
The United States Core Data for Interoperability (USCDI) sets data standards for electronic health records. The AHA , AMA, and others advocated for the inclusion of an average blood pressure data element in Version 4 to create a standardized place for care teams to document average readings, a guideline-recommended practice for the diagnosis and management of hypertension. This change was reviewed and approved by the Office of the National Coordinator.
Support State Medicaid Coverage & Reimbursement for SMBP Monitoring
Our advocacy efforts at the state level focus on improving patient access to validated SMBP devices that are:
- Accessible, from both a financial and usability perspective
- Available and easily acquired
- Adequate in terms of quality and functionality, accommodating patients of all sizes
In addition, we are advocating for reimbursement to providers for SMBP monitoring and related care. An assessment of coverage by state was conducted to identify SMBP gaps in care for Medicaid beneficiaries at the state level. An issue brief outlines key considerations for creating or improving Medicaid coverage and reimbursement for SMBP.
Healthy Living & Social Determinants of Health
AHA and AMA continue to advocate for policies that improve and support heart health, reduce cardiovascular risk and make healthy living possible.
Learn more about AHA state policy and advocacy opportunities.
Our Target: BP community and institutional priorities encourage local adoption of policies that reflect a commitment to providing evidenced-based care to patients, heart healthy work environments for employees and heart healthy living conditions for community members.
Institutional policy adoption and implementation by individual organizations can be:
- a powerful means to improve health equity by addressing social determinants of health.
- a speedier approach to realizing impact
- leveraged at state and federal levels to encourage environmental change for supporting heart health.
-
Related Resources
Blood Pressure Measurement Policy & Procedure TemplateThis template document addresses BP device procurement and maintenance, health care team training and skills testing, and BP measurement processes and workflow.
Modifiable Lifestyle Risk Factor Policy & Procedure TemplateThis resource is a modifiable template designed for an outpatient setting to help create a systematic approach to data collection, assessment, and intervention for modifiable lifestyle risk factors as an overall approach to lower blood pressure.
Validated Device ListingThe US Blood Pressure Validated Device Listing (VDL) is the first U.S. list of BP measurement devices developed to assist physicians and patients in identifying BP devices that have been validated for clinical accuracy.
New CPT Codes to Cover Self-Measured Blood Pressure (SMBP)Overview of new CPT codes for providers that offer SMBP related clinical services
SMBP Coverage Insights: MedicaidThe AMA recently released SMBP Coverage Insights: Medicaid which reflects a State-specific of summary including the level of coverage, requirements for preauthorization, and inclusion of an appropriately-sized cuff.
Validated BP Device Procurement Policy & Procedure TemplateIntended uses: Health care organizations and employers are encouraged to use this model policy developed by the American Heart Association (AHA) and American Medical Association (AMA)