• Views: in the last
  • 14Week
  • 9Month
  • 97Total


  • NJ A1454
  • Provides for Medicaid coverage of comprehensive tobacco cessation services and prohibits certain restrictions on coverage.
Introduced
(1/27/2016)
In Committee
(1/27/2016)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill requires the State Medicaid program to provide coverage of comprehensive tobacco cessation services. The required tobacco cessation services, include, but are not limited to, individual counseling, group counseling, telephone counseling, nicotine patches, nicotine gum, nicotine lozenges, nicotine nasal sprays, nicotine inhalers, bupropion, varenicline, and any other tobacco cessation treatments approved by the federal Food and Drug Administration (FDA) or recommended by the most recently published U.S. Public Health Service clinical practice guidelines on treating tobacco use and dependence. The bill stipulates that the tobacco cessation services shall be covered by Medicaid subject to the approval of the Secretary of the federal Department of Health and Human Services for federal reimbursement. The bill further stipulates that, except as otherwise provided by section 6 of P.L.1968, c.413, coverage for these tobacco cessation services shall be provided to: all individuals eligible for Medicaid pursuant to section 3 of P.L.1968, c.413; and all other individuals eligible for Medicaid pursuant to the most recent federally approved Medicaid State plan, including, but not limited to, "newly eligible" adults meeting the eligibility criteria set forth in section 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act, pursuant to the federal "Patient Protection and Affordable Care Act," Pub.L.111-148, as amended by the "Health Care and Education Reconciliation Act of 2010," Pub.L.111-152 (ACA). The bill also amends current statutory provisions to include certain individuals who are eligible for Medicaid as "medically needy individuals," including certain pregnant women, dependent children, persons 65 years of age or older, and persons who are blind or disabled, among the individuals authorized to receive the Medicaid tobacco cessation services. In addition, the bill prohibits the following conditions from being imposed on the Medicaid tobacco cessation services: copayments or any other forms of cost-sharing, including deductibles; counseling requirements for medication; stepped care therapy or similar restrictions requiring the use of one service prior to another; limits on the duration of services; or annual or lifetime limits on the amount, frequency, or cost of services, including, but not limited to, annual or lifetime limits on the number of covered attempts to quit. The bill also prohibits prior authorization requirements from being imposed on these services, except for: treatments that exceed the duration recommended by the U.S. Public Health Service clinical practice guidelines; or services associated with more than two attempts to quit within a 12-month period. The bill requires that information regarding the availability of the Medicaid tobacco cessation services be provided to all individuals authorized to receive these services at the following times: no later than 30 days after the bill's effective date; upon the establishment of an individual's eligibility for Medicaid; and upon the redetermination of an individual's eligibility for Medicaid. Finally, the bill requires the Commissioner of Human Services to apply for any necessary Medicaid State plan amendments or waivers to provide coverage for the tobacco cessation services and to secure federal financial participation for associated State Medicaid expenditures under the federal Medicaid program. Section 2502 of the federal "Patient Protection and Affordable Care Act" prevents states from excluding FDA-approved tobacco cessation medications from Medicaid coverage, effective January 1, 2014, and states are in the process of bringing their Medicaid programs into compliance with this ACA requirement. According to a March 2014 report by the American Lung Association and the federal Centers for Disease Control and Prevention (CDC), which was based on data collected prior to states' implementation of the new ACA requirement, New Jersey provided coverage to all Medicaid enrollees for nicotine gum, nicotine patches, and bupropion, but coverage for nicotine lozenges, nicotine nasal sprays, nicotine inhalers, and varenicline varied by Medicaid managed care plan and no Medicaid coverage was provided for individual or group counseling. Further, the American Lung Association/CDC report found that some Medicaid managed care plans in New Jersey applied conditions to tobacco cessation coverage that represented potential "barriers" to services, such as copayments, prior authorization requirements, limits on the duration of services, and annual and lifetime limits on the amounts of services authorized. This bill intends to provide New Jersey's Medicaid enrollees with coverage for all of the aforementioned tobacco cessation services and to minimize potential barriers for enrollees attempting to access these services. Expanding, and improving access to, tobacco cessation services has the potential to improve health outcomes among Medicaid enrollees while reducing Medicaid expenditures on hospitalizations and other services. For example, recent studies sponsored by the CDC have found that comprehensive Medicaid tobacco cessation services in Massachusetts were associated with substantial decreases in smoking prevalence and decreases in hospital admissions for cardiovascular conditions. Moreover, researchers from The George Washington University School of Public Health and Health Services found, over the first 2.5 years of Massachusetts' comprehensive Medicaid tobacco cessation coverage, that every $1.00 expended on tobacco cessation services was associated with $3.12 in Medicaid savings, on average. This bill would allow New Jersey to realize a similar return on investment while improving health outcomes among the State's most vulnerable residents.
Health and Senior Services
Introduced, Referred to Assembly Health and Senior Services Committee  (on 1/27/2016)
 
 
Date Chamber Action Description
1/27/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
None specified