BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1696|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: AB 1696
Author: Holden (D), et al.
Amended: 8/15/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-1, 6/22/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth,
Wolk
NOES: Nielsen
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/11/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 63-14, 6/2/16 - See last page for vote
SUBJECT: Medi-Cal: tobacco cessation services
SOURCE: American Cancer Society Cancer Action Network
American Heart Association/American Stroke
Association
American Lung Association
DIGEST: This bill requires tobacco cessation services to be a
covered benefit under the Medi-Cal program, subject to
utilization controls. Requires tobacco cessation services to
include all intervention recommendations assigned a grade A or B
by the United States Preventive Services Task Force (USPSTF).
ANALYSIS:
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Existing law:
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS) under which basic
health care services are provided to qualified low-income
persons.
2)Establishes a schedule of benefits under the Medi-Cal program,
which includes the purchase of prescribed drugs, subject to
the Medi-Cal List of Contract Drugs and utilization controls.
3)Requires that preventive services assigned a grade of A or B
by the USPSTF 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.
4)Authorizes a pharmacist to furnish nicotine replacement
products approved by the federal Food and Drug Administration
(FDA) for use by prescription only, in accordance with
standardized procedures and protocols developed and approved
by both the California Board of Pharmacy and the Medical Board
of California in consultation with other appropriate entities,
if specified conditions are met.
This bill:
1)Requires that tobacco cessation services are covered benefits
under the Medi-Cal program, subject to utilization controls.
Requires tobacco cessation services to include all
intervention recommendations assigned a grade A or B by the
USPSTF, as periodically updated.
2)Requires tobacco cessation services to include quit attempts
based on medical necessity and consistent with the USPSTF
grade A and B recommendations, with no required break between
attempts, for all beneficiaries 18 years of age and older who
use tobacco.
3)Requires tobacco cessation services to be provided in
accordance with both the American Academy of Pediatrics Bright
Futures periodicity schedule and anticipate guidance, as
services as periodically updated, as well as services assigned
a grade A or B by the USPSTF for Medi-Cal beneficiaries under
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18 years of age.
4)Requires, in addition to the services described above, and
only to the extent consistent with the intervention
recommendations assigned a grade A or B by the USPSTF, tobacco
cessation services for beneficiaries 18 years of age and older
to include:
a) 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;
b) A tobacco cessation treatment regimen of any medication
approved by the FDA and that is a covered Medi-Cal benefit
for tobacco cessation, including prescription and
over-the-counter (OTC) medications, in accordance with the
USPSTF grade A and B recommendations.
1)Prohibits Medi-Cal beneficiaries from being required to
receive a particular form of tobacco cessation service as a
condition of receiving any other form of tobacco cessation
service.
2)Requires DHCS, effective January 1, 2017, to seek any federal
approvals necessary to implement this bill that DHCS
determines are necessary.
3)Requires this bill to be implemented only to the extent that
federal financial participation is available and not otherwise
jeopardized, and any necessary federal approvals have been
obtained.
Background
According to the Centers for Disease Control and Prevention
(CDC), tobacco use is the leading preventable cause of death in
the United States. Every year, smoking kills 480,000 Americans
and costs the nation at least $130 billion in medical care costs
for adults and more than $150 billion in lost productivity,
imposing a heavy economic burden on private employers, private
health plans, and federal, state, and local governments. The
cost of tobacco use to California is estimated to be $18.1
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billion annually. According to data from 2001 to 2010 published
by the CDC in 2011, most smokers want to quit smoking (69%), and
over half (52%) tried to quit in the previous year, but only 6%
were successful.
Current Medi-Cal prescription drug coverage for tobacco
cessation. DHCS indicates the current contract drug list for
fee-for-service (FFS) Medi-Cal includes all seven FDA-approved
tobacco cessation medications, but such medication is limited to
specific manufacturers, who offer rebates and are contracted
with DHCS in an effort to reduce costs. FFS Medi-Cal covers five
FDA-approved tobacco cessation medications without treatment
authorization: the Nicotine Patch (OTC); Nicotine Gum (OTC);
Nicotine Lozenge (OTC), Buproprion, and Varenicline - and two
FDA-approved tobacco cessation medications with treatment
authorization, Nicotine Nasal (Prescription Only) and Nicotine
Inhaler (Prescription Only).
In Medi-Cal Managed Care, under existing policy and contract
terms, Medi-Cal managed care plans must cover all seven
FDA-approved tobacco cessation medications and at least one must
be available without prior authorization.
Comments
Author's statement. According to the author, quitting tobacco
products is a difficult feat that many attempt every year.
Tobacco products are still the leading preventable cause of
death in the United States. Though the dangers of smoking are
better understood now than 50 years ago, cigarettes are more
addictive and smoking rates in the Medi-Cal population are still
too high. In addition to efforts to discourage people from
smoking. This bill gives smokers the tools to fight the
addiction. The coverage ensured by this bill guarantees Medi-Cal
patients have access to clinically proven treatments. Studies
have shown that the comprehensive coverage of these treatments
has led to decreases in the smoking population. As a state, we
must remove barriers to treatments that make quitting possible.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
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According to the Senate Appropriations Committee:
Minor costs to the Medi-Cal program (General Fund and federal
funds) as the most recent amendments largely conform the
requirements of the bill to existing Medi-Cal policy for
smoking cessation services.
SUPPORT: (Verified 8/12/16)
American Cancer Society Cancer Action Network (co-source)
American Heart Association/American Stroke Association
(co-source)
American Lung Association (co-source)
Association of California Healthcare Districts
California Academy of Physician Assistants
California Academy of Preventive Medicine
California Black Health Network
California Chapter of the American College of Emergency
Physicians
California Dental Association
California Life Sciences Association
California Optometric Association
California Phamacists Association
California Tobacco Education and Research Oversight Committee
County Health Executives Association
First 5 Association of California
Health Access California
Health Officers Association of California
March of Dimes
Mental Health America of California
Two individuals
OPPOSITION: (Verified 8/12/16)
California Association of Health Plans
Department of Finance
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Local Health Plans of California
ARGUMENTS IN SUPPORT: This bill is jointly sponsored by the
American Heart Association/American Stroke Association, the
American Lung Association, and the American Cancer Society
Cancer Action Network to ensure all Medi-Cal patients are able
to access tobacco cessation treatments. The sponsors argue that
the success rate of smokers quitting their addiction to tobacco
is still very low, due in part because many smokers try to quit
without the assistance of tobacco cessation services. The
sponsors noted that although the Affordable Care Act has made
tobacco cessation treatments more accessible, current guidelines
as to how to implement these treatments are unclear, thereby
resulting in differences in coverage between health plans. In
addition, the sponsors state that Medi-Cal patients face
barriers to treatment services due to prior authorization and
step therapy treatment requirements. Supporters argue this bill
provides needed clarity for Medi-Cal participants on tobacco
cessation services and ensures access to comprehensive insurance
coverage for these services. Supporters conclude that increased
access to smoking cessation treatments and eliminating barriers
will reduce the incidence of tobacco-related diseases and will
lower health care costs.
ARGUMENTS IN OPPOSITION: The California Association of Health
Plans (CAHP) writes in opposition to the previous version of
this bill that the bill will increase costs to the state by
requiring Medi-Cal managed care plans to pay for tobacco
cessation drugs in a manner that is inconsistent with policies
of DHCS. CAHP argues Medi-Cal managed care plans already comply
with the requirements of the DHCS policy letter, and that
weakening prior authorization requirements designated to ensure
the right care is delivered under appropriate circumstances will
drive up costs. CAHP also argues tracking tobacco rates of
enrollees would be difficult and an unnecessary administrative
burden. Finally, CAHP objects to the provision in this bill
making counseling sessions at patient option may leave out some
beneficiaries who need the help most, including patients who
have tried and failed therapies several times.
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ASSEMBLY FLOOR: 63-14, 6/2/16
AYES: Achadjian, Alejo, Arambula, Atkins, Baker, Bloom,
Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chau, Chávez,
Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd, Eggman,
Frazier, Cristina Garcia, Eduardo Garcia, Gatto, Gipson,
Gomez, Gonzalez, Gordon, Gray, Hadley, Roger Hernández,
Holden, Irwin, Jones-Sawyer, Lackey, Levine, Linder, Lopez,
Low, Maienschein, McCarty, Medina, Mullin, Nazarian,
O'Donnell, Olsen, Quirk, Ridley-Thomas, Rodriguez, Salas,
Santiago, Steinorth, Mark Stone, Thurmond, Ting, Waldron,
Weber, Wilk, Williams, Wood, Rendon
NOES: Travis Allen, Brough, Chang, Dahle, Gallagher, Grove,
Harper, Jones, Mathis, Mayes, Melendez, Obernolte, Patterson,
Wagner
NO VOTE RECORDED: Bigelow, Beth Gaines, Kim
Prepared by:Scott Bain / HEALTH / (916) 651-4111
8/15/16 20:33:21
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