Amended in Senate August 15, 2016

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,begin delete and, at a minimum, 4 quit attempts per year.end deletebegin insert and include quit attempts based upon medical necessity, as specified.end insert 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 abegin delete 12-weekend delete treatment regimen of any medication approved by the federal Food and Drug Administrationbegin insert and that is a covered Medi-Cal benefitend insert for tobacco cessation.

begin deleteThe 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. end deleteThe bill would require the department to seek any federal approvals necessary to implementbegin delete thoseend deletebegin insert itsend insert 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 includebegin delete a minimum of fourend delete quit attempts
9begin deleteper year,end deletebegin insert based on medical necessity, as defined in Section 14059.5,
10and consistent with United States Preventive Services Task Force
11grade A and B recommendations,end insert
with no required break between
P3    1attempts, for all beneficiaries 18 years of age and older who use
2tobacco. For beneficiaries under 18 years of age, tobacco cessation
3services shall be provided in accordance withbegin insert bothend insert the American
4Academy of Pediatricsbegin delete guidelines and the intervention
5recommendations,end delete
begin insert Bright Futures periodicity schedule and
6anticipatory guidanceend insert
as periodically updated, begin insertas well as services end insert
7assigned a grade A or B by the United States Preventive Services
8Task Force.

9(b) For purposes of this section, in addition to the services
10described in subdivision (a) and only to the extent consistent with
11the intervention recommendations, as periodically updated,
12assigned a grade A or B by the United States Preventive Services
13Task Force, tobacco cessation servicesbegin insert for beneficiaries 18 years
14of age and olderend insert
shall include:

15(1) At least four tobacco cessation counseling sessions per quit
16attempt that may be conducted in person or by telephone and
17individually or as part of a group, at the beneficiary’s option.

18(2) (A) Abegin delete 12-weekend deletebegin insert tobacco cessationend insert treatment regimen of any
19medication approved by the federal Food and Drugbegin delete Administrationend delete
20begin insert Administration, and that is a covered Medi-Cal benefit,end insert for tobacco
21cessation, including prescription and over-the-counterbegin delete medications.end delete
22
begin insert medications, in accordance with United States Preventive Services
23Task Force grade A and B recommendations.end insert

begin delete

24(B) At least one prescription medication and all over-the-counter
25medications shall be available without prior authorization.

end delete
begin delete

26(C)

end delete

27begin insert(B)end insert A prescription from a provider with authority to prescribe
28and proof of Medi-Cal coverage shall be sufficient documentation
29to fill a prescription for over-the-counter tobacco cessation
30medications.

31(c) Beneficiaries who are covered under this section shall not
32be required to receive a particular form of tobacco cessation service
33as a condition of receiving any other form of tobacco cessation
34service.

35(d) Effective January 1, 2017, the department shall seek any
36federal approvals necessary to implement this section that the
37department determines are necessary to implement this section.

begin delete

38(e) (1) By December 31, 2017, the department shall issue
39guidelines and enter into an agreement that authorizes the
40California Smokers’ Helpline or its successor, as administered by
P4    1the State Department of Public Health, to directly furnish at least
2one form of over-the-counter nicotine replacement therapy, as
3described by the United States Preventive Services Task Force
4(USPSTF), to Medi-Cal beneficiaries enrolled in smoking cessation
5services provided by the helpline.

end delete
begin delete

6(2) For purposes of this subdivision, “directly furnish” means
7to provide directly to the beneficiary by mail with no further action
8required on the part of the beneficiary.

end delete
begin delete

9(f) By December 31, 2017, the department shall include medical
10assistance with smoking and tobacco use cessation rates among
11adults enrolled in Medi-Cal managed care plans in its Healthcare
12Effectiveness Data and Information Set (HEDIS). The department
13may use data collected pursuant to this subdivision for quality
14improvement projects to increase cessation by Medi-Cal enrollees
15who use tobacco products. Tobacco use status shall not be used
16by the department or the managed care plan to deny coverage or
17treatment of tobacco-related illnesses.

end delete
begin delete

18(g)

end delete

19begin insert(e)end insert This section shall be implemented only to the extent that
20federal financial participation is available and not otherwise
21 jeopardized, and any necessary federal approvals have been
22obtained.



O

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