Education & TrainingMedicaidOctober 1, 2024

Enhancing health: tobacco cessation requirements for Medi-Cal Managed Care providers

At a glance:

  • Medi-Cal providers are required to conduct and document annual tobacco assessments.
  • Prescribing FDA-approved quit aids and arranging counseling are part of the mandate.
  • Implementation will be monitored by Anthem via health record and claims data reviews.

Primary care physicians (PCP) 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:
  • 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.
  • 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 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 EX Program here. The EX Program features:
      • A tailored quit plan based on their tobacco use type and stage in quitting.
      • Quit medication delivered right to the member’s home.
      • Live chat coaching with tobacco treatment experts, and more.
      • To learn more about the EX Program, a recording of the webinar can be found on the Provider Training Academy website.
  • Refer a member to Kick It California at Kickitca.org or by calling 800-300-8086. Kick It California is available in various languages.
  • California Center for Tobacco Cessation provides training and technical assistance to engage and build the capacity of organizations, clinicians, and community stakeholders to advocate for and put into effect tobacco-use assessments and cessation services within their communities and systems.
  • 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 email the regional health plan office:

  • Northern California: northproviderrelationsmedicaid@anthem.com
  • Central California: centralproviderrelationsmedicaid@anthem.com
  • Southern California: southproviderrelationsmedicaid@anthem.com

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: October 2024 Provider Newsletter