Amended in Assembly May 31, 2016

Amended in Assembly March 28, 2016

Amended in Assembly March 7, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1696

Introduced by Assembly Member Holden

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(Coauthor: Assembly Member Wood)

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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 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 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 begin delete services, end delete begin insert services end insert and would require the department to begin delete issue other guidelines to beneficiaries and managed care programs in connection with the provision and evaluation of tobacco cessation services pursuant to the bill. end delete begin insert include medical assistance with smoking and tobacco use cessation rates among adult Medi-Cal enrollees in its Healthcare Effectiveness Data and Information Set, as specified. end insert 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)  begin insert (1) end insert begin insert   end insert 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 begin insert at least
one form of end insert over-the-counter nicotine replacement begin delete therapy end delete begin insert therapy,
as described by the United States Preventive Services Task Force
(USPSTF), end insert to Medi-Cal beneficiaries enrolled in smoking cessation
services provided by the helpline. begin insert At a minimum, the guidelines
shall address requirements for pharmacists and physicians in
furnishing nicotine replacement products pursuant to this section,
which shall be consistent with the requirements of Section 4052.9
of the Business and Professions Code. end insert

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(2) For purposes of this subdivision, “directly furnish” means
to provide directly to the beneficiary by mail with no further action
required on the part of the beneficiary.

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(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 adult tobacco use rates for each managed care plan on an
annual basis.

(3) Tobacco

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begin insert (f) end insert begin insert   end insert begin insert By December 31, 2017, the department shall include medical
assistance with smoking and tobacco use cessation rates among
adults enrolled in Medi-Cal managed care plans in its Healthcare
Effectiveness Data and Information Set (HEDIS). The department
may use data collected pursuant to this subdivision for quality
improvement projects to increase cessation by Medi-Cal enrollees
who use tobacco products. Tobacco end insert use status shall not be used
by the department or the managed care plan to deny coverage or
treatment of tobacco-related illnesses.

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(h)

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begin insert (g) end insert  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.