Amended in Senate June 27, 2016

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 BillNo. 1696


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 and would require the department to 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:

P2    1

SECTION 1.  

Section 14134.25 is added to the Welfare and
2Institutions Code
, to read:

3

14134.25.  

(a) Tobacco cessation services are covered benefits
4under the Medi-Cal program, subject to utilization controls.
5Tobacco cessation services shall include all intervention
6recommendations, as periodically updated, assigned a grade A or
7B by the United States Preventive Services Task Force. Tobacco
8cessation services shall include a minimum of four quit attempts
9per year, with no required break between attempts, for all
10beneficiaries 18 years of age and older who use tobacco. For
11beneficiaries under 18 years of age, tobacco cessation services
12shall be provided in accordance with the American Academy of
13Pediatrics guidelines and the intervention recommendations, as
14periodically updated, assigned a grade A or B by the United States
15Preventive Services Task Force.

P3    1(b) For purposes of this section, in addition to the services
2described in subdivision (a) and only to the extent consistent with
3the intervention recommendations, as periodically updated,
4assigned a grade A or B by the United States Preventive Services
5Task Force, tobacco cessation services shall include:

6(1) At least four tobacco cessation counseling sessions per quit
7attempt that may be conducted in person or by telephone and
8individually or as part of a group, at the beneficiary’s option.

9(2) (A) A 12-week treatment regimen of any medication
10approved by the federal Food and Drug Administration for tobacco
11cessation, including prescription and over-the-counter medications.

12(B) At least one prescription medication and all over-the-counter
13medications shall be available without prior authorization.

14(C) A prescription from a provider with authority to prescribe
15and proof of Medi-Cal coverage shall be sufficient documentation
16to fill a prescription for over-the-counter tobacco cessation
17medications.

18(c) Beneficiaries who are covered under this section shall not
19be required to receive a particular form of tobacco cessation service
20as a condition of receiving any other form of tobacco cessation
21service.

22(d) Effective January 1, 2017, the department shall seek any
23federal approvals necessary to implement this section that the
24department determines are necessary to implement this section.

25(e) (1) By December 31, 2017, the department shall issue
26guidelines and enter into an agreement that authorizes the
27California Smokers’ Helpline or its successor, as administered by
28the State Department of Public Health, to directly furnish at least
29one form of over-the-counter nicotine replacement therapy, as
30described by the United States Preventive Services Task Force
31(USPSTF), to Medi-Cal beneficiaries enrolled in smoking cessation
32services provided by the helpline.begin delete At a minimum, the guidelines
33shall address requirements for pharmacists and physicians in
34furnishing nicotine replacement products pursuant to this section,
35which shall be consistent with the requirements of Section 4052.9
36of the Business and Professions Code.end delete

37(2) For purposes of this subdivision, “directly furnish” means
38to provide directly to the beneficiary by mail with no further action
39required on the part of the beneficiary.

P4    1(f) By December 31, 2017, the department shall include medical
2assistance with smoking and tobacco use cessation rates among
3adults enrolled in Medi-Cal managed care plans in its Healthcare
4Effectiveness Data and Information Set (HEDIS). The department
5may use data collected pursuant to this subdivision for quality
6improvement projects to increase cessation by Medi-Cal enrollees
7who use tobacco products. Tobacco use status shall not be used
8by the department or the managed care plan to deny coverage or
9treatment of tobacco-related illnesses.

10(g) This section shall be implemented only to the extent that
11federal financial participation is available and not otherwise
12 jeopardized, and any necessary federal approvals have been
13obtained.



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