Legislative and Executive Branch

Activity on Cessation - What’s Going On and What’s Next?

Matt Barry

Senior Policy Analyst

Campaign for Tobacco Free Kids

December 11, 2003

Overview

• Medicaid

• Medicare

• 108th Congress

• Other Federal Activities

• Taking Action/Next Steps

Current CMS Policy On Cessation: Medicaid

General Policy -

• Smoking cessation benefits, such as counseling and drug therapy, are optional benefits under Medicaid (except for kids covered under EPSDT).

• Smoking cessation drugs are specifically classified as those drugs that may be excluded from coverage under Medicaid.

• Smoking cessation counseling services may be provided under a variety of Medicaid benefit categories.

Pregnant Women - There are no mandatory smoking cessation benefits for pregnant women under Medicaid. A state may elect to provide smoking cessation services in a State plan.

Current CMS Policy On Cessation: Medicare

• Medicare does not currently provide coverage for tobacco cessation services under Part B.

• Congress passed H.R. 1, The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 that includes coverage of prescription smoking cessation drugs (nicotine nasal spray, nicotine inhaler, bupropion SR - question over coverage of prescription OTC NRTs). Coverage begins 2006.

• Medicare does provide coverage for tobacco cessation, where medically necessary, in the context of Part A inpatient hospital services.

• There is an ongoing Medicare Stop Smoking Program tobacco cessation demonstration project in 7 States (Alabama, Florida, Missouri, Ohio, Oklahoma, Nebraska, and Wyoming).

What’s Going On In Congress??

Cessation bills in 108th Congress• H.R. 2876 - Quit Smoking Incentive and Opportunity Act

of 2003 (LaTourette, Platts, Meehan, Jones) - Provides for refundable tax credit for “qualified” cessation expenses, including drugs and counseling, up to

$400 annually.

• H. R. 2383 - To amend the Internal Revenue Code of 1986 to clarify the tax treatment of smoking cessation costs (Ramstad) - Adds cessation drugs to list of medicines/drugs eligible for limitations on tax liability.

• H.R.3293 - Prevent Prematurity and Improve Child Health Act of 2003 (DeGette) - Deletes exception of cessation drug coverage under SSA, requires coverage of counseling for pregnant women, evaluates performance measures on MCH grant for cessation, and adds language noting cessation is part of a quality MCH program..

• S.1734 - Prevent Prematurity and Improve Child Health Act of 2003 (Lincoln, Lugar, Bingaman, Murray, Miller) - Same as H.R. 3293.

Cessation bills in 108th Congress

• S.1238 - Improving Women's Health Act of 2003 (Lincoln, Murray, Landrieu, Cantwell, Bingaman) - Deletes exception of cessation drug coverage under SSA, requires coverage of counseling for pregnant women, adds language noting cessation is part of a quality MCH program.

• H.R.1860 - Medicare Wellness Act of 2003 (Levin, Foley) - Provides for therapy and counseling services for cessation to all beneficiaries (does not include drugs).

• S.1101 - National Cancer Act of 2003 (Feinstein, Smith, Daschle, Jeffords, Kennedy, Collins, Landrieu, Hutchison, Johnson, Corzine, Lincoln, Cantwell, Clinton, Lautenberg, Murray, Dodd, Boxer, Stabenow, Nelson, Schumer, Hollings, Reed, Kerry, Mikulkski, Leahy) - Requires coverage by most health plans of therapy and counseling services for cessation (drugs limited to those already available under plan for cessation).

• H.R.2741- National Cancer Act of 2003 (Capps, Miller, Maloney, Frost, Towns) - Same as S. 1101.

For latest information on legislation - http://thomas.loc.gov/

Other Activity At Federal Level

Final report of the Cessation Subcommittee was sent to Secretary Tommy Thompson March 2003, no further action to report (for more information see http://www.cdc.gov/tobacco/ICSH/subcommittee.htm).

Federal Employees Health Benefit Plan - In August 7, 2003 memo to Rep. Meehan, OPM Director Kay Cole James stated:

“I continue to encourage FEHBP plans to provide benefits for programs aimed at health promotion and disease prevention, including smoking cessation programs … While we urge plans to cover special benefits and programs, we do not mandate that they do so …”

For more information on FEHBP, see http://www.opm.gov/insure/health/index.asp.

Turning Dreams Into Reality:

How Do We Make Access to

Cessation Services a Reality?

Need to be clear and unambiguous about goals

“Damn the torpedoes, full speed ahead!”

Avoid inconsistency ...

Avoid confusion …

Abbott: Who's on first, What's on second, I Don't Know's on third -

Costello: You know the fellows' names?

Abbott: Certainly!

Costello: Well then who's on first?

Abbott: Yes!

Costello: I mean the fellow's name!

Abbott: Who!

Costello: The guy on first!

Abbott: Who!

Costello: The first baseman!

Abbott: Who!

Costello: The guy playing first!

Abbott: Who is on first!

Costello: Now whaddya askin' me for?

Abbott: I'm telling you Who is on first.

Costello: Well, I'm asking YOU who's on first!

Abbott: That's the man's name.

Credibility Persistence

Stop Wasting Money Save Money

Safe Effective

This isn’t a mystery ...

CESSATION WORKS!!!