Tobacco cessation requirements for Medi-Cal Managed Care providers
PCPs and their qualified staff are required to implement tobacco cessation interventions as outlined in the California Department of Health Care Services All Plan Letter 16-014 dated November 30, 2016. These interventions include:
- Conducting initial and annual assessments of all members, of any age, who use tobacco products or are exposed to tobacco smoke and documenting this information in the member’s medical record. Per the United States Preventive Services Task Force recommendations, this can be accomplished by instituting a tobacco user identification system by:
- Using the Staying Healthy Assessment or other Individual Health Education Behavior Assessments.
- Adding tobacco use as a vital sign in the chart or electronic health record, or by use of the
ICD-10 codes in the medical record to record tobacco use. Refer to the Coding Guide for Tobacco Use for codes that can be used.
- Placing a stamp or sticker on the chart when the member indicates he or she uses tobacco.
- Prescribing FDA-approved tobacco cessation medications to nonpregnant adults of any age. Members enrolled in Medi-Cal will be covered for all FDA-approved tobacco cessation medications for adults who use tobacco products. This includes over‑the‑counter medications with a prescription from the provider.
- Referring tobacco users of any age to available individual, group and telephone counseling. Anthem Blue Cross (Anthem) members qualify for four counseling sessions, each for a minimum of 10 minutes, for at least two separate quit attempts each year without prior authorization. Providers can:
- Use the 5A’s model or other validated behavior change model when counseling members.
- Refer a member to the CA Smokers Helpline at 1-800-NO-BUTTS (1‑800‑662‑8887) or another equivalent line. The CA Smokers Helpline is available in various languages.
- Refer to available community programs. For help locating community programs, use the Health Education & Cultural and Linguistic Referral Form located on the provider website at https://providers.anthem.com/ca > Patient Care > Primary Care > Health education classes.
- Asking all pregnant women if they use tobacco or are exposed to tobacco smoke. If they smoke, offer at least one face-to-face counseling session per quit attempt and refer to a tobacco cessation quit line. Counseling services will be covered for 60 days post‑delivery. Smoking cessation medications are not recommended during pregnancy.
- Providing education, including brief counseling, to school-age children and adolescents to prevent initiation of tobacco.
Anthem will monitor provider performance in implementing these tobacco cessation interventions through various processes comprised of medical record review, facility site review, and review of medical or pharmacy claims data.
If your office would like tobacco education materials or more information about the revised policy letter, please call the regional health plan office:
- Northern region: 1-888-252-6331
- Central region: 1-559-353-3500
- Southern region: 1-818-291-6914
April 2021 Anthem Blue Cross Provider News - California