Amended in Senate July 14, 2015

Amended in Assembly June 1, 2015

Amended in Assembly April 23, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 1162

Introduced by Assembly Member Holden

February 27, 2015

An act to add Section 14134.25 to the Welfare and Institutions Code, relating to Medi-Cal.


AB 1162, as amended, Holden. Medi-Cal: tobacco cessation.

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 tobacco cessation services are covered benefits under the Medi-Calbegin delete program andend deletebegin insert program,end insert would require that those services include, at a minimum,begin delete unlimitedend deletebegin insert 4end insert quitbegin delete attempts,end deletebegin insert attempts per year,end insert and would also require tobacco cessation services to include at least 4 counseling sessions per quit attempt and a 90-day treatment regimen of any medication approved by the federal Food and Drug Administration for tobacco cessation that is covered under the Medi-Cal program as of January 1, 2015.

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 14134.25 is added to the Welfare and
2Institutions Code
, to read:



(a) Tobacco cessation services are covered benefits
4under the Medi-Cal program and shall, at a minimum, include
5begin delete unlimitedend deletebegin insert fourend insert quitbegin delete attempts,end deletebegin insert attempts per year,end insert with no required
6break between attempts, for beneficiaries of any age who use

8(b) For purposes of this section, tobacco cessation services shall
9 include:

10(1) At least four tobacco cessation counseling sessions per quit
11attempt, which may be conducted in person or by telephone and
12individually or as part of a group, at the beneficiary’s option.

13(2) begin insert(A)end insertbegin insertend insertA 90-day treatment regimen of any medication approved
14by the federal Food and Drug Administration for tobacco cessation,
15 including prescription and over-the-counter medications.begin delete Aend delete

begin insert

16(B) At least one prescription medication and all over-the-counter
17medications shall be available without prior authorization.

end insert

18begin insert(C)end insertbegin insertend insertbegin insertAend insert prescription from a provider with authority to prescribe
19and proof of Medi-Cal coverage shall be sufficient documentation
20to fill a prescription for over-the-counter tobacco cessation
21medications.begin delete Theend delete

22begin insert(D)end insertbegin insertend insertbegin insertExcept as provided in subparagraph (B),end insert coverage described
23in this paragraph shall not be subject to any barriers, requirements,
24orbegin delete restrictions, including, but not limited to, prior authorization.
25Thisend delete
begin insert restrictions.end insert

26begin insert(E)end insertbegin insertend insertbegin insertThisend insert paragraph shall apply to medications approved by the
27federal Food and Drug Administration and that are covered under
28the Medi-Cal program as of January 1, 2015.

29(c) Beneficiaries who are covered under this section shall not
30be required to receive a particular form of tobacco cessation service
P3    1as a condition of receiving any other form of tobacco cessation