Blood Pressure MATTERS Act

Summary of HR 8716: Blood Pressure MATTERS Act

• Purpose and intent

  • The Blood Pressure MATTERS Act aims to ensure access to and coverage for self-measured blood pressure monitoring (SMBP) devices and related services for pregnant and postpartum individuals. It seeks to expand coverage across multiple health coverage programs and private plans, with the goal of improving monitoring and early detection of hypertensive conditions during and after pregnancy.

• Key provisions and changes

  • Coverage across programs
  • Medicare/Medicaid: Adds SMBP for pregnant and postpartum individuals to the list of covered items under Medicaid (Title XIX) and adjusts related provisions to implement mandatory coverage.
  • CHIP: Extends SMBP coverage to children and pregnant individuals under the Children’s Health Insurance Program (Title XXI).
  • Private health insurance: Requires group health plans and health insurance issuers offering group or individual coverage to cover SMBP devices for pregnant and postpartum individuals, with no or limited cost sharing.
  • Coverage specifics
  • A “specified blood pressure management device” is defined as a device that:
    • Allows self-measurement of blood pressure without a clinician present,
    • Is cleared for market under the FDA 510(k) pathway,
    • Is listed as a validated device on the AMA’s Validated Device Listing.
  • Limits: No more than one such device may be furnished to an individual during a two-year period.
  • Cost-sharing prohibition
  • Prohibits cost-sharing for SMBP devices under Medicare/Medicaid, CHIP, and private plans for the covered population.
  • Plan design and timing
  • State flexibility: States may need to enact related legislation to align with the new requirements; there are transitional rules related to the effective date.
  • Effective date: The SMBP coverage changes generally take effect for items and services furnished on or after 120 days after enactment, with certain state-level phase-in considerations and exceptions if state legislation is required.
  • Administrative and procedural elements
  • The bill amends multiple major health programs and the Internal Revenue Code to ensure uniform treatment and to embed SMBP coverage within:
    • Federal programs: Medicaid, CHIP, and private health coverage requirements via the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code.
  • It includes specific cross-references and definitions to harmonize coverage across programs and to prevent discrimination based on hypertensive disorder diagnosis status.

• Who is affected

  • Pregnant and postpartum individuals who are eligible for Medicaid, CHIP, or private health insurance coverage (group or individual plans) would gain access to SMBP devices without cost sharing, subject to the 2-year device cap.
  • States administering Medicaid and CHIP plans would implement the new coverage requirements, with transitional provisions if state legislation is required.
  • Employers and health insurers offering group health coverage would need to provide SMBP devices and remove cost-sharing for covered individuals.
  • Manufacturers and providers of SMBP devices would be affected by the market-entry, validation, and listing criteria (FDA clearance and AMA-listed validation).

• Significance and potential impact

  • Aims to enhance blood pressure monitoring during and after pregnancy, potentially reducing complications related to hypertensive disorders.
  • Seeks to standardize access to SMBP devices across federal and private coverage, reducing out-of-pocket costs for pregnant and postpartum individuals.
  • The “one device per two-year” cap and validation requirements may influence device utilization and market dynamics.

Note: This summary reflects the bill’s text as introduced (May 7, 2026) and focuses on its substantive coverage, device criteria, cost-sharing provisions, and effective-date structure.