Amended in Senate August 31, 2015

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.

LEGISLATIVE COUNSEL’S DIGEST

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 providebegin delete thatend deletebegin insert that, only to the extent that federal financial participation is available and any necessary federal approvals have been obtained,end insert tobacco cessation services are coveredbegin delete benefitsend deletebegin insert benefits, subject to utilization controls,end insert under the Medi-Cal program,begin insert andend insert would requirebegin delete thatend delete those servicesbegin delete include,end deletebegin insert to include all intervention recommendations, as periodically updated, assigned a grade A or B by the United States Preventive Services Task Force, and,end insert at a minimum, 4 quit attempts perbegin delete year, and wouldend deletebegin insert year. The bill wouldend insert alsobegin delete requireend deletebegin insert require, only to the extent consistent with the recommendations of the United States Preventive Services Task Force,end insert tobacco cessation services to include at least 4 counseling sessions per quit attempt and abegin delete 90-dayend deletebegin insert 12-weekend insert treatment regimen of any medication approved by the federal Food and Drug Administration for tobaccobegin delete cessation that is covered under the Medi-Cal program as of January 1, 2015.end deletebegin insert cessation. The bill would require the department to seek any federal approvals necessary to implement those provisions.end insert

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 1.  

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

3

14134.25.  

(a) Tobacco cessation services are covered benefits
4under the Medi-Calbegin delete program and shall, at a minimum, includeend delete
5begin insert program, subject to utilization controls. Tobacco cessation services
6shall include all intervention recommendations, as periodically
7updated,end insert
begin insert assigned a grade A or B by the United States Preventive
8Services Task Force. In addition, tobacco cessation services shall
9include a minimum of end insert
four quit attempts per year, with no required
10break between attempts, forbegin insert allend insert beneficiariesbegin delete of any ageend deletebegin insert 18 years
11of age and olderend insert
who use tobacco.begin insert For beneficiaries under 18
12years of age, tobacco cessation services shall be provided in
13accordance with the American Academy of Pediatrics guidelines
14and the intervention recommendations, as periodically updated,
15assigned a grade A or B by the United States Preventive Services
16Task Force.end insert

17(b) For purposes of this section,begin insert in addition to the services
18described in subdivision (a) and only to the extent consistent with
19the intervention recommendations, as periodically updated, end insert

20begin insertassigned a grade A or B by the United States Preventive Services
21Task Force,end insert
tobacco cessation services shall include:

P3    1(1) At least four tobacco cessation counseling sessions per quit
2attempt, which may be conducted in person or by telephone and
3individually or as part of a group, at the beneficiary’s option.

4(2) (A) Abegin delete 90-dayend deletebegin insert 12-weekend insert treatment regimen of any medication
5approved by the federal Food and Drug Administration for tobacco
6cessation, including prescription and over-the-counter medications.

7(B) At least one prescription medication and all over-the-counter
8medications shall be available without prior authorization.

9(C) A prescription from a provider with authority to prescribe
10and proof of Medi-Cal coverage shall be sufficient documentation
11to fill a prescription for over-the-counter tobacco cessation
12medications.

begin delete

13(D) Except as provided in subparagraph (B), coverage described
14in this paragraph shall not be subject to any barriers, requirements,
15or restrictions.

16(E) This paragraph shall apply to medications approved by the
17federal Food and Drug Administration and that are covered under
18the Medi-Cal program as of January 1, 2015.

end delete

19(c) Beneficiaries who are covered under this section shall not
20be required to receive a particular form of tobacco cessation service
21as a condition of receiving any other form of tobacco cessation
22service.

begin insert

23(d) Effective January 1, 2016, the department shall seek any
24federal approvals necessary to implement this section that the
25department determines are necessary to implement this section.

end insert
begin insert

26(e) This section shall be implemented only to the extent that
27federal financial participation is available, and any necessary
28federal approvals have been obtained.

end insert


O

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