BILL NUMBER: AB 1696 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 7, 2016
INTRODUCED BY Assembly Member Holden
JANUARY 21, 2016
An act to add Section 14134.25 to the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1696, as amended, Holden. Medi-Cal: tobacco cessation services.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Care Services, under which basic
health care services are provided to qualified low-income persons.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid provisions. Existing law provides for a schedule of benefits
under the Medi-Cal program. Existing law requires that preventive
services assigned a grade of A or B by the United States Preventive
Services Task Force be provided to Medi-Cal beneficiaries without any
cost sharing by the beneficiary in order for the state to receive
increased federal contributions for those services, as specified.
This bill would provide that, only to the extent that federal
financial participation is available and not otherwise jeopardized,
and any necessary federal approvals have been obtained, tobacco
cessation services are covered benefits, subject to utilization
controls, under the Medi-Cal program and would require those services
to include all intervention recommendations, as periodically
updated, assigned a grade A or B by the United States Preventive
Services Task Force, and, at a minimum, 4 quit attempts per year. The
bill would also also would require,
only to the extent consistent with the recommendations of the United
States Preventive Services Task Force, tobacco cessation services to
include at least 4 counseling sessions per quit attempt and a 12-week
treatment regimen of any medication approved by the federal Food and
Drug Administration for tobacco cessation. The
The bill would require the department to issue guidelines and
enter into agreements to allow a specified state smoker's helpline
to furnish nicotine replacement therapy to beneficiaries
participating in the helpline's smoking cessation services, and would
require the department to issue other guidelines to
beneficiaries and managed care programs in connection with the
provision and evaluation of tobacco cessation services pursuant to
the bill. The bill would require the department to seek any
federal approvals necessary to implement those provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14134.25 is added to the Welfare and
Institutions Code, to read:
14134.25. (a) Tobacco cessation services are covered benefits
under the Medi-Cal program, subject to utilization controls. Tobacco
cessation services shall include all intervention recommendations, as
periodically updated, assigned a grade A or B by the United States
Preventive Services Task Force. Tobacco cessation services shall
include a minimum of four quit attempts per year, with no required
break between attempts, for all beneficiaries 18 years of age and
older who use tobacco. For beneficiaries under 18 years of age,
tobacco cessation services shall be provided in accordance with the
American Academy of Pediatrics guidelines and the intervention
recommendations, as periodically updated, assigned a grade A or B by
the United States Preventive Services Task Force.
(b) For purposes of this section, in addition to the services
described in subdivision (a) and only to the extent consistent with
the intervention recommendations, as periodically updated, assigned a
grade A or B by the United States Preventive Services Task Force,
tobacco cessation services shall include:
(1) At least four tobacco cessation counseling sessions per quit
attempt that may be conducted in person or by telephone and
individually or as part of a group, at the beneficiary's option.
(2) (A) A 12-week treatment regimen of any medication approved by
the federal Food and Drug Administration for tobacco cessation,
including prescription and over-the-counter medications.
(B) At least one prescription medication and all over-the-counter
medications shall be available without prior authorization.
(C) A prescription from a provider with authority to prescribe and
proof of Medi-Cal coverage shall be sufficient documentation to fill
a prescription for over-the-counter tobacco cessation medications.
(c) Beneficiaries who are covered under this section shall not be
required to receive a particular form of tobacco cessation service as
a condition of receiving any other form of tobacco cessation
service.
(d) Effective January 1, 2017, the department shall seek any
federal approvals necessary to implement this section that the
department determines are necessary to implement this section.
(e) By December 31, 2017, the department shall issue guidelines
and enter into an agreement that authorizes the California Smokers'
Helpline or its successor, as administered by the State Department of
Public Health, to directly furnish over-the-counter nicotine
replacement therapy to Medi-Cal beneficiaries enrolled in smoking
cessation services provided by the helpline.
(f) By July 1, 2018, the department shall issue guidelines to
provide incentives to adult Medi-Cal beneficiaries who use tobacco
products in order to motivate them to enroll in and participate in
evidence-based tobacco use cessation services.
(g) By December 31, 2017, the department shall issue guidelines to
managed care plans that provide instructions on requirements to
annually report tobacco use rates among adults enrolled in the
Medi-Cal managed care plan.
(1) Tobacco use status may be collected at the time of enrollment
in the managed care plan. Tobacco use status of other adult family
members may be reported via proxy by the primary enrollee.
(2) The department shall publish and post on its Internet Web site
annual adult tobacco use rates for each managed care plan.
(3) Tobacco use status shall not be used by the department or the
managed care plan to deny coverage or treatment of tobacco-related
illnesses.
(e)
(h) This section shall be implemented only to the
extent that federal financial participation is available and not
otherwise jeopardized, and any necessary federal approvals have been
obtained.