BILL ANALYSIS Ó
AB 1696
Page 1
ASSEMBLY THIRD READING
AB
1696 (Holden)
As Amended May 31, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |17-1 |Wood, Maienschein, |Patterson |
| | |Bonilla, Burke, | |
| | |Campos, Dababneh, | |
| | |Cooley, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Olsen, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-6 |Gonzalez, Bloom, |Bigelow, Chang, |
| | |Bonilla, Bonta, |Gallagher, Jones, |
| | |Calderon, Daly, |Obernolte, Wagner |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Quirk, Santiago, | |
| | |Weber, Wood | |
AB 1696
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SUMMARY: Requires Medi-Cal to cover tobacco cessation services.
Specifically, this bill:
1)Requires that the tobacco cessation services covered under
Medi-Cal be subject to utilization controls.
2)Requires tobacco cessation services to include all
intervention recommendations assigned a grade A or B by the
United States Preventive Services Task Force (USPSTF).
3)Requires tobacco cessation services to include the following:
a) A minimum of four quit attempts per year, with no
required break between attempts, for all beneficiaries 18
years of age or older who use tobacco;
b) For beneficiaries under 18 years of age, be provided
services in accordance with the American Academy of
Pediatrics guidelines and intervention recommendations,
assigned a grade A or B by the USPSTF;
c) At least four tobacco cessation counseling sessions per
quit attempt, as specified, at the option of the
beneficiary; and,
d) A 12-week treatment regimen of any medication approved
by the federal Food and Drug Administration (FDA) for
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tobacco cessation, including prescription and
over-the-counter (OTC) medications, with at least one
prescription and all OTC medications made available without
prior authorization, as specified.
4)Specifies that beneficiaries who are covered under this bill
shall not be required to receive a particular form of tobacco
cessation service as a condition of receiving any form or
tobacco cessation service.
5)Requires the Department of Health Care Services (DHCS) to seek
any federal approvals necessary to implement the provisions of
this bill. Provides that this bill is only to be implemented
to the extent that federal financial participation is
available and not otherwise jeopardized and that the state has
obtained all necessary federal approvals.
6)Requires DHCS, by December 31, 2017, to issue guidelines and
enter into an agreement that authorizes the California
Smokers' Helpline or its successor, as administered by the
Department of Public Health, to directly furnish at least one
form of OTC nicotine replacement therapy as described by
USPSTF to Medi-Cal beneficiaries enrolled in smoking cessation
services provided by the state tobacco use cessation quit
line.
7)Requires the guidelines specified in 5) above to address
requirements for pharmacists and physicians in furnishing
nicotine replacement products under this bill to be consistent
with existing requirements that applies to pharmacists.
8)Requires DHCS, by December 1, 2017, to include medical
assistance with smoking and tobacco use cessation rates among
adults enrolled in Medi-Cal managed care plans in its
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Healthcare Effectiveness Data and Information Set (HEDIS).
Authorizes DHCS to use data collected under this bill for
quality improvement projects to increase cessation by Medi-Cal
enrollees who use tobacco products.
9)Prohibits tobacco status to be used by DHCS or MCPs to deny
coverage or treatment of tobacco-related illnesses.
10)Provides that this bill will be implemented only to the
extent federal financial participation is available, as
specified.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Increased costs due to increased utilization of smoking
cessation services. Under current practice, about 30,000
Medi-Cal beneficiaries access smoking cessation services at a
total annual cost of about $4 million per year. Assuming that
the expanded benefits required in the bill result in increased
demand for smoking cessation services of 10% to 20%, the bill
would result in increased costs of $400,000 to $800,000 per
year (General Fund (GF)/federal).
2)Short term cost savings due to reduced smoking-related health
care costs for Medi-Cal beneficiaries. A review of a smoking
cessation benefit in the Massachusetts Medicaid program
indicates that reducing smoking by beneficiaries led to a net
reduction in health care costs of about $2 for each $1 spent
on the program. Using the assumptions for utilization
increase above, potential cost savings of $800,000 to $1.6
million per year. The long-term health care spending impacts
of reduced tobacco use are less clear, because reduced health
care spending on smoking-related conditions will be offset by
AB 1696
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people living longer, though such "costs" are generally
considered societally beneficial.
3)Minor administrative costs to update existing Medi-Cal
policies for the provision of smoking cessation services (GF/
federal).
4)If a new billing process is required to administer the
provision of over-the-counter nicotine patches to Medi-Cal
beneficiaries, potentially significant administrative costs to
DHCS (GF/federal).
5)Unknown, potentially significant costs to DHCS to add a
tobacco-related measure to the HEDIS survey that is
administered for health plans (GF/federal).
COMMENTS: According to the author, quitting tobacco products is
a difficult feat that many individuals attempt every year with
little success on their own. The author states tobacco products
can cause cancer, respiratory and heart diseases, and birth
defects, and their use is still the leading preventable cause of
death in the United States. The author contends that though the
dangers of smoking are better understood now than 50 years ago,
cigarettes are addictive and smoking rates in the Medi-Cal
population are still too high. The author asserts this bill
provides smokers with the tools necessary to fight their
addiction to tobacco products by mandating Medi-Cal coverage to
clinically proven treatments. The author maintains that studies
have shown that the comprehensive coverage of these treatments
has led to decreases in the population of smokers. The author
concludes that the state must remove all barriers to treatments
that make quitting the use of tobacco products possible.
On September 3, 2014, DHCS released policy letter 14-006 to
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provide managed care plans (MCPs) with minimum requirements for
comprehensive tobacco cessation services. The requirements,
similar to federal guidance on the issue, are for the following:
1)Coverage of all seven FDA-approved tobacco cessation
medications, at least one of which must be available without
prior authorization - a cost-containment procedure that
requires a prescriber to obtain permission to prescribe a
medication prior to prescribing it - and any additional
tobacco cessation medications once approved by the FDA;
2)Coverage of a 90-day treatment regimen of medications with
other requirements, restrictions, or barriers; and a minimum
of two separate quit attempts per year, with no mandatory
break required between quit attempts;
3)MCPs may not require members to attend counseling sessions or
classes prior to receiving a prescription for an FDA-approved
tobacco cessation medication;
4)MCPs must ensure that individual, group, and telephone
counseling is offered to members who wish to quit smoking,
whether or not those members opt to use tobacco cessation
medications; and,
5)Four counseling sessions of at least 10 minutes each in length
for at least two separate quit attempts a year without prior
authorization.
The DHCS policy letter also specified requirements for annual
assessments, services for pregnant tobacco users, provider
training, and referral to the California Smokers' Helpline.
Notable differences between the requirements of this bill and
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the requirements under DHCS' policy on coverage of tobacco
cessation products include a minimum requirement under the DHCS
policy and federal guidance for the length of counseling
sessions, and a modestly increased treatment regimen (90 days
under federal guidance and DHCS policy vs. 84 days under this
bill). This bill also requires coverage for a minimum of four
quit attempts per year, with no required break between attempts,
for all Medi-Cal beneficiaries 18 years of age and older who use
tobacco, whereas federal guidance and DHCS policy states
coverage should be for at least two quit attempts. Finally,
this bill requires all OTC medications and at least one
prescription medication be available without prior
authorization, whereas the DHCS policy is to cover all seven
FDA-approved tobacco cessation products, at least one of which
must be available without prior authorization.
Analysis Prepared by:
Rosielyn Pulmano / HEALTH / (916) 319-2097 FN:
0003274