BILL ANALYSIS Ó
AB 1162
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CONCURRENCE IN SENATE AMENDMENTS
AB
1162 (Holden)
As Amended September 4, 2015
Majority vote
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|ASSEMBLY: |67-12 |(June 3, 2015) |SENATE: |30-10 |(September 9, |
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Original Committee Reference: HEALTH
SUMMARY: Requires tobacco cessation services to be a covered
benefit under the Medi-Cal program, as specified.
The Senate amendments:
1)Require that the tobacco cessation services covered benefit
under the Medi-Cal program be subject to utilization controls.
2)Require tobacco cessation services to include all intervention
recommendations assigned a grade A or B by the United States
Preventive Services Task Force (USPSTF).
3)Strikes the inclusion of an unlimited number of quit attempts
per year for all Medi-Cal beneficiaries for tobacco cessation
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services, and instead limits services to include a minimum of
four quit attempt per year for beneficiaries 18 years of age
and older. For beneficiaries less than 18 years of age,
requires tobacco cessation services to be provided in
accordance with the American Academy of Pediatrics guidelines
and intervention recommendations assigned a grade A or B by
the USPSTF.
4)Requires the definition of tobacco cessation services to be
consistent with the intervention recommendations assigned a
grade A or B by the USPSTF.
5)Expands the definition of tobacco cessation services to
include a 12-week treatment regimen of any medication approved
by the federal Food and Drug Administration (FDA) for tobacco
cessation, including prescription and over-the-counter
medications, and requires at least one prescription medication
and all over-the-counter medications to be available without
prior authorization.
6)Strikes from the definition of tobacco cessation services a
90-day treatment regimen of any medication approved by the
federal FDA for tobacco cessation, including prescription and
over-the-counter medications.
7)Requires the Department of Health Care Services (DHCS) to seek
any federal approvals necessary, and that DHCS determines are
necessary, to implement this bill. Requires this bill to only
be implemented to the extent that federal financial
participation is available and not otherwise jeopardized, and
any necessary federal approvals have been obtained.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)Minor administrative costs to update existing Medi-Cal
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policies for the provision of smoking cessation services
(General Fund (GF) and federal funds).
2)Unknown costs due to increased utilization of smoking
cessation services. Under current practice, about 30,000
Medi-Cal beneficiaries access smoking cessation services at a
total annual cost of about $4 million per year. Assuming that
the expanded benefits required in the bill result in increased
demand for smoking cessation services of 10% to 20%, the bill
would result in increased costs of $400,000 to $800,000 per
year (GF and federal funds).
3)Unknown short term cost savings due to reduced smoking-related
health care costs for Medi-Cal beneficiaries. A review of a
new smoking cessation benefit in the Massachusetts Medicaid
program indicates that reducing smoking by beneficiaries led
to a net reduction in health care costs of about $2 for each
$1 spent on the program. Using the assumptions for
utilization increase above, potential cost savings of $800,000
to $1.7 million per year. The long-term health care spending
impacts of reduced tobacco use are less clear, because reduced
health care spending on smoking-related conditions will be
offset by increased longevity.
COMMENTS: According to the author, tobacco use is the leading
preventable cause of death in the United States and, though the
dangers of smoking are better understood now than 50 years ago,
smoking rates in the Medi-Cal population are still too high.
The author states the low success rate of quitting is due to the
fact that smokers often try quit without help, which is
typically ineffective. The author asserts that FDA-approved
tobacco cessation medications and counseling are very effective
methods of having smokers quit, yet maintains that access to
these services is sometimes difficult for Medi-Cal recipients
due to the many barriers to access including requiring
prior-authorization and step therapy. The author concludes that
these barriers, along with the inherent difficulty of quitting,
lead many to give up before they even get started.
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On a previous version of this bill, the American Heart
Association/American Stroke Association, the American Lung
Association, and the American Cancer Society Cancer Action
Network, the sponsors of this bill, stated that the success rate
of smokers quitting their addiction to tobacco is still very
low, due in part because many smokers try to quit without the
assistance of tobacco cessation services. The sponsors noted
that although the Patient Protection and Affordable Care Act has
made tobacco cessation treatments more accessible, current
guidelines as to how to implement these treatments are unclear,
thereby resulting in differences in coverage between health
plans. In addition, the sponsors stated that Medi-Cal patients
face barriers to treatment services due to prior authorization
and step therapy treatment requirements. Supporters stated this
bill provides needed clarity for Medi-Cal participants on
tobacco cessation services and ensures access to comprehensive
insurance coverage for these services.
On a previous version of this bill, the California Association
of Health Plans stated this bill will increase costs to the
state by requiring Medi-Cal managed care plans to pay for
tobacco cessation drugs in a manner that is inconsistent with
policies of both DHCS and sound medical management. The
association also stated MCPs already comply with the
requirements of the DHCS Policy letter. Opposition also
asserted that removing all prior authorization protocols and
requiring plans to cover all specific medications would create a
new benefit mandate, which would result in higher state costs in
Medi-Cal reimbursement rates to plans in order to reflect the
benefit expansion.
Analysis Prepared by:
An-Chi Tsou / HEALTH / (916) 319-2097 FN:
0002302
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