BILL NUMBER: AB 1696 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 31, 2016
AMENDED IN ASSEMBLY MARCH 28, 2016
AMENDED IN ASSEMBLY MARCH 7, 2016
INTRODUCED BY Assembly Member Holden
( Coauthor: Assembly Member
Wood )
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 services,
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. 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. 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) (1) 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 at
least one form of over-the-counter nicotine replacement
therapy therapy, as described by the United
States Preventive Services Task Force (USPSTF), to Medi-Cal
beneficiaries enrolled in smoking cessation services provided by the
helpline. 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.
(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.
(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
(f) 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 an d
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 use status shall not be used by the department or the
managed care plan to deny coverage or treatment of tobacco-related
illnesses.
(h)
(g) 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.