Bills › 88th General Assembly
Relating to tobacco cessation services under the Medicaid program
Sponsored by the Senate Human Resources Committee
Topics:Health careMedicaid
Same legislation: SSB 1189
Where it is now
- Done: IntroducedMarch 6, 2019
- Done: SubcommitteeJanuary 16, 2020
- Done: Senate committeeMarch 6, 2019
- Stopped: Passes the SenateDied when the General Assembly ended
- Next: House committee
- Next: Passes the House
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2020 session adjourned on June 14, 2020, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary People on Medicaid who want to quit smoking can get nicotine replacement therapy without needing special permission first. This change applies when members contact their managed care organization or Quitline Iowa for help. There are still some limits, such as rules for people under a certain age or those who have already tried the therapy twice without success.1
Read the official explanation
This bill requires the department of human services (DHS) to contractually and by administrative rules adopted pursuant to Code chapter 17A require, under Medicaid fee-for-service and Medicaid managed care administration, that a Medicaid member, who contacts the member’s Medicaid managed care organization’s tobacco cessation program or Quitline Iowa seeking tobacco cessation services utilizing nicotine replacement therapy, shall be eligible to receive nicotine replacement therapy without prior authorization, with some limitations, including if the Medicaid member has had two failed attempts using the nicotine replacement therapy or if the member is under years of age.
Senate subcommittee
Named January 16, 2020. It hasn’t reported yet.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
Fiscal note
Cost: up to $275,000 Compare with other bills
AI summary This bill requires the Department of Human Services to remove the requirement that Medicaid members get counseling before they can receive smoking cessation products. It is estimated to cost the Medicaid Program $275,000 in fiscal year 2020 and subsequent fiscal years. While a decrease in smoking might reduce future medical costs for tobacco-related diseases, the impact of any savings cannot be estimated.3
Read the fiscal note
Description
Senate File 490 requires the Department of Human Services (DHS) to contractually and by administrative rules remove prior authorization (PA) requirements under fee-for-service (FFS) and managed care for a Medicaid member who contacts a tobacco cessation program.
Background
Medicaid members are currently required to participate in counseling services in order to obtain smoking cessation products through PA criteria for FFS and managed care. Counseling services are currently provided via Quitline (administered by the Department of Public Health ) for FFS. The managed care organizations (MCOs) have cessation counseling services either internally or through an outside contract; these services also require completion of a PA.
Assumptions
- Under the Bill, smoking cessation counseling will be optional rather than mandatory. This will result in increased utilization of smoking cessation products and may reduce call volumes for smoking cessation counseling services.
- There will be minimal programming changes required to remove the smoking cessation PA criteria from the FFS point-of-sale system, and these changes will be covered under the current contract.
- The FFS program does not project an increase in expenditures due to the low volume of members under FFS and the fact that the current PA process does not appear to hinder access for these services.
- An August FY 2017 analysis by the MCOs estimated that removing the PA requirement would increase expenditures for smoking cessation products by $918,000. Any increase in MCO expenditures due to this change would be reflected in future capitation payments to the MCOs.
- The Federal Medical Assistance Percentage (FMAP) rate is 70.0% federal and 30.0% State based on a blended rate between Medicaid and the Iowa Health and Wellness Plan.
Fiscal Impact
Senate File 490 is estimated to cost the Medicaid Program $275,000 in FY 2020 and subsequent fiscal years. A decrease in smoking would likely reduce future pharmacy and medical expenditures for tobacco-related diseases such as chronic obstructive pulmonary disease or myocardial infarction, but the impact of any savings cannot be estimated.
Source
- Department of Human Services
- Preauthorization for Tobacco Cessation · March 18, 2019 · $275,000
Lobbying
23 for · 0 against · 12 undecided · Who →
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88th General Assembly