BILL NUMBER: AB 1696 AMENDED
BILL TEXT
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
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. and include quit attempts based upon medical
necessity, as specified. 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 and that is a covered
Medi-Cal benefit 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 its
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, based on medical necessity, as defined in
Section 14059.5, and consistent with United States Preventive
Services Task Force grade A and B recommendations, 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
both the American Academy of Pediatrics
guidelines and the intervention recommendations,
Bright Futures periodicity schedule and anticipatory guidance
as periodically updated, as well as services 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 for beneficiaries 18 years of age and
older 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 tobacco cessation
treatment regimen of any medication approved by the federal Food and
Drug Administration Administration, and that
is a covered Medi-Cal benefit, for tobacco cessation, including
prescription and over-the-counter medications.
medications, in accordance with United States Preventive
Services Task Force grade A and B recommendations.
(B) At least one prescription medication and all over-the-counter
medications shall be available without prior authorization.
(C)
(B) 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, as described by the
United States Preventive Services Task Force (USPSTF), to Medi-Cal
beneficiaries enrolled in smoking cessation services provided by the
helpline.
(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 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 use status shall not be used by the
department or the managed care plan to deny coverage or treatment of
tobacco-related illnesses.
(g)
(e) 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.