Amended in Senate September 4, 2015

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

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(Coauthor: Assembly Member Levine)

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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 provide that, only to the extent that federal financial participation is availablebegin insert and not otherwise jeopardized,end insert 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 would also 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 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:

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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-Cal program, subject to utilization controls.
5Tobacco cessation services shall include all intervention
6recommendations, as periodically updated, assigned a grade A or
7B by the United States Preventive Services Task Force. In addition,
8tobacco cessation services shall include a minimum of four quit
9attempts per year, with no required break between attempts, for
10all beneficiaries 18 years of age and older who use tobacco. For
11beneficiaries under 18 years of age, tobacco cessation services
12shall be provided in accordance with the American Academy of
13Pediatrics guidelines and the intervention recommendations, as
14periodically updated, assigned a grade A or B by the United States
15Preventive Services Task Force.

16(b) For purposes of this section, in addition to the services
17described in subdivision (a) and only to the extent consistent with
18the intervention recommendations, as periodically updated,
19assigned a grade A or B by the United States Preventive Services
20Task Force, 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) A 12-week 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.

13(c) Beneficiaries who are covered under this section shall not
14be required to receive a particular form of tobacco cessation service
15as a condition of receiving any other form of tobacco cessation
16service.

17(d) Effective January 1, 2016, the department shall seek any
18federal approvals necessary to implement this section that the
19department determines are necessary to implement this section.

20(e) This section shall be implemented only to the extent that
21federal financial participation isbegin delete available,end deletebegin insert available and not
22otherwise jeopardized,end insert
and any necessary federal approvals have
23been obtained.



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