Tobacco Cessation and
Private Insurance under ACA:
New Opportunities for Public Health
September 25, 2014
Want to use the information
in the Presentation?
Please cite The American Lung Association
and/or ClearWay MinnesotaSM
Any questions? Email anne.digiulio@lung.org
Introductions
Erika Sward– Assistant Vice President, National Advocacy
American Lung Association
Speakers
Erika Sward,
Assistant Vice
President, National
Advocacy, American
Lung Association
Amanda Jansen,
Senior Cessation
Manager, ClearWay
MinnesotaSM
Jennifer
Singleterry,
Director, National
Health Policy,
American Lung
Association
Thomas Carr,
Director, National
Policy, American
Lung Association
Agenda
• Introductions & Welcome – Erika Sward, Assistant Vice President,
National Advocacy, American Lung Association
• Background – Jennifer Singleterry, Director, National Health Policy,
American Lung Association
• Cessation Guidance – Jennifer Singleterry
• What States are Doing – Amanda Jansen, Senior Cessation
Manager, ClearWay MinnesotaSM
• Resources for You – Thomas Carr, Director, National Policy, American
Lung Association
• Q&A
Background
Jennifer Singleterry – Director, National Health Policy
American Lung Association
Acronyms
• ACA = Affordable Care Act (healthcare reform)
• HHS = U.S. Dept. of Health & Human Services
• CMS = Centers for Medicare and Medicaid
Services
• USPSTF = United States Preventive Services
Task Force
• FAQ = Frequently Asked Question
• Exchanges/State Health Insurance
Marketplaces
Affordable Care Act
Focus on Prevention
• Prevention and Public Health Fund
• Pilot programs to test prevention strategies
through Medicaid
• Prevention visit in Medicare Part B
• Required coverage for preventive services
with no cost-sharing
Preventive Services Requirement
•
•
•
•
This Requirement
Private plans
Plans sold in
exchanges
Small group and
individual plans
Medicaid expansion
plans
Different Requirements
• Medicare
• Traditional Medicaid
• Grandfathered plans
What are Preventive Services?
• Routine immunizations
• Preventive services for children
& youth
• Preventive services for women
• Preventive services given an
‘A’ or ‘B’ recommendation by
the USPSTF
U.S. Preventive Service Task Force
• An independent, volunteer panel of national
experts in prevention and evidence-based
medicine
• Make evidence-based recommendations for
clinical preventive services for clinicians
– Assigns each recommendation a letter grade
based on the strength of the evidence and
balance of benefits and harms (A, B, C, or D
grade, or I statement)
Preventive Services
• Cancer screenings
– New B recommendation for
lung cancer screenings
•
•
•
•
•
Immunizations
Blood pressure screenings
Cholesterol screenings
STI counseling
Tobacco Cessation
Tobacco
• A Grade: Counseling and
Interventions
– Adults
– Pregnant women
• B Grade: Education and Brief
Counseling for Prevention
– School-aged children &
adolescents
Cessation Guidance
Jennifer Singleterry – Director, National Health Policy
American Lung Association
Guidance Needed
• Tobacco cessation recommendation did not
easily translate into insurance policy
• Evidence showed that plans were interpreting
the requirement differently
• Not covering a comprehensive benefit
• Coverage of tobacco cessation was more varied
than some other preventive services
Tobacco Cessation Guidance
• Departments of Health
and Human Services,
Labor and Treasury
• ACA Implementation
FAQ XIX, Question 5
• Released May 2, 2014
Q5
Tobacco Cessation Guidance
• At least 4 sessions of individual, group and
phone counseling
• At least 90 days of all FDA-approved smoking
cessation medications, when prescribed
• At least 2 quit attempts per year
• No cost-sharing
• No prior authorization
What Now?
Educate and build awareness among:
•
•
•
•
State regulators
Health Plans
Providers
Consumers
Some States Have Already Taken
Action
• Regulators issuing bulletins to health plans:
Illinois, New Mexico
• Regulators enforcing guidance: Minnesota,
Washington
• Issuing consumer alerts: Kansas
Minnesota Case Study
Amanda Jansen – Senior Cessation Manager
ClearWay MinnesotaSM
Mission: Reduce the harm tobacco
causes the people of Minnesota
Grant-making, QUITPLAN® stopsmoking services and statewide
outreach activities
Legacy Goal: Treatment Access
One hundred percent of Minnesota smokers will
have access to comprehensive tobacco
dependence treatment by 2023
State Regulators
Goal: Ensure state regulators are implementing
ACA cessation guidelines comprehensively
– Private Insurance – Use FAQ as educational tool
with departments of Commerce and Health
– Public Programs – Explore opportunities to
strengthen Medicaid benefit with Department of
Human Services
Health Plans
Goal: Encourage health plans to include
comprehensive cessation benefits in all products
– Assess current coverage landscape
– Follow-up meetings with Health Plan Leadership
• Assessment results
• FAQ information
Providers and Health Systems
What does this
mean for our
providers?
What does this mean
for how we’re treating
our patients?
What does this
mean for
reimbursement?
What does this
mean for our
systems and
processes?
Providers and Health Systems
Goal: Support health systems to implement systems
changes for assessing and addressing tobacco use.
– Education and technical assistance opportunities
– Potential to incorporate into provider trainings or
other grant activities
Consumers
Lessons Learned
1. Use the FAQ as a catalyst for relationship building or
reconnecting
2. Gather and share examples from other states
3. Ask for advice and ideas from stakeholders
4. Frame coverage access in relation to other tobacco
control efforts
5. Ensure different state agencies are interpreting the
FAQ consistently
Resources for You
Thomas Carr – Director, National Policy
American Lung Association
New Lung Association Cessation
Guidance Toolkit!
www.lung.org/cessationguidance
American Lung Association
Cessation Guidance Toolkit Categories
Factsheets and Materials
Cessation Guidance Toolkit Categories
Template Letters/Policy Language
Cessation Guidance Toolkit Categories
State Examples
Cessation Guidance Toolkit Categories
Questions
Resources & Contacts
www.lung.org/cessationguidance
Jennifer Singleterry: jennifer.singleterry@lung.org
Amanda Jansen: ajansen@clearwaymn.org
Thomas Carr: thomas.carr@lung.org