An act relating to health care coverage.
THE PEOPLE OF THE STATE OF [INSERT STATE] DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares the following:
(a) Providing tobacco cessation counseling and medication is one of the most clinically effective and cost-effective health services available, according to the National Commission on Prevention Priorities. Tobacco cessation is five to 80 times more cost effective than pharmacologic interventions used to prevent heart attacks.
(b) More than 70 percent of smokers wish they could quit tobacco, and each year one of every two smokers attempts to quit. However, the unassisted successful tobacco quit rate has remained constant at less than five percent. Access to counseling and pharmaceutical benefits doubles the successful quit rate and has achieved quit rates of 25 to 30 percent. Experience in health plans indicates that access to all cessation services saves four dollars ($4) for every dollar ($1) invested.
(c) Each adult smoker costs employers one thousand seven hundred sixty dollars ($1,760) in lost productivity and one thousand six hundred twenty-three dollars ($1,623) in excess medical expenditures. Men who smoke incur fifteen thousand eight hundred dollars ($15,800) more in lifetime medical expenses than do men who do not smoke. For employers, the ultimate financial return is between five dollars ($5) and six dollars ($6) for every dollar spent on tobacco cessation.
(d) Because of member transfers between plans, financial savings and tobacco-related disease reductions are effective only if universally available to the entire insured population. Therefore, a mandate on all plans and insurers to provide cost-effective treatment is necessary and beneficial.
(e) It is the intent of the Legislature that this act diminish the statewide economic and personal cost of tobacco addiction by making tobacco cessation treatments available to all smokers. [INSERT INFO ABOUT TOBACCO’S IMPACT IN THE STATE – HOW MANY SMOKERS? WHAT IS THE COST?]
SEC. 2. Section [XXX] is added to the Insurance Code [XXX], to read:
[XXX] (a) Every individual or group health insurance policy that is issued, amended, delivered, or renewed on or after [INSERT DATE IF APPLICABLE], shall include coverage for tobacco cessation services that follow recommendations in the Public Health Service sponsored 2008 clinical practice guideline, “Treating Tobacco Use and Dependence: 2008 Update,” or its successors. Such coverage shall include at least two courses of treatment in a 12-month period including personal counseling, which may be telephone, group or individual counseling, and all medications approved by the FDA for the purpose of tobacco cessation, including all prescription and over-the-counter medications.
(b) No copayment, coinsurance or deductible shall be applied to benefits under this section.
(c) A health insurer may contract with qualified local, statewide, or national providers, whether for profit or nonprofit, for the provision of services under this section.
(d) An insurer shall disclose the benefits under this section in its evidence of coverage and disclosure forms and communicate the availability of coverage to all insureds at least once per year.
(e) This section shall not apply to a Medicare supplement, short-term limited duration health insurance, vision-only, dental-only, or Champus-supplement insurance, or to hospital indemnity, hospital-only, accident-only, or specified disease insurance that does not pay benefits on a fixed benefit, cash payment only basis.
(f) As used in this section, course of treatment is defined as: (1) in the case of counseling, the course of treatment shall consist of at least 4 sessions of counseling lasting at least 10 minutes; (2) in the case of a prescription or over-the-counter medication, the course of treatment shall be the duration of treatment approved by the FDA for that medication.
(g) Patients shall not be required to enter counseling in order to receive medications.
(h) A health care service plan shall not impose prior authorization or stepped care requirements on tobacco cessation treatment.