California Assembly Bill AB1696 Amended / Bill

 BILL NUMBER: AB 1696AMENDED BILL TEXT 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. 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,   services  and would require the department to  issue other guidelines to beneficiaries and managed care programs in connection with the provision and evaluation of tobacco cessation services pursuant to the bill.   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: 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, 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 the American Academy of Pediatrics guidelines and the intervention recommendations, as periodically updated, 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 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 treatment regimen of any medication approved by the federal Food and Drug Administration for tobacco cessation, including prescription and over-the-counter medications. (B) At least one prescription medication and all over-the-counter medications shall be available without prior authorization. (C) 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   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.  At a minimum, the guidelines shall address requirements for pharmacists and physicians in furnishing nicotine replacement products pursuant to this section, which shall be consistent with the requirements of Section 4052.9 of the Business and Professions Code.   (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 July 1, 2018, the department shall issue guidelines to provide incentives to adult Medi-Cal beneficiaries who use tobacco products in order to motivate them to enroll in and participate in evidence-based tobacco use cessation services.   (g) By December 31, 2017, the department shall issue guidelines to managed care plans that provide instructions on requirements to annually report tobacco use rates among adults enrolled in the Medi-Cal managed care plan.   (1) Tobacco use status may be collected at the time of enrollment in the managed care plan. Tobacco use status of other adult family members may be reported via proxy by the primary enrollee.   (2) The department shall publish and post on its Internet Web site adult tobacco use rates for each managed care plan on an annual basis.   (3) Tobacco   (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 an   d 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.  (h)   (g)  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.