State Medicaid Tobacco Coverage Survey

DRAFT - STATE MEDICAID TOBACCO DEPENDENCE TREATMENT SURVEY, 2008 OMB# 0920-0691, Expiration Date XX/XX/XXXX
OMB# 0920-0691
OMB Expiration Date XX/XX/XXXX
Burden Statement:
Public reporting burden of this collection of information varies from 15 minutes to 1 hour with an estimated average of 30 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden
to CDC/ATSDR Reports Clearance Officer: 1600 Clifton Road NE, MS D-74, Atlanta, GA; ATTN: PRA (0920-0691)
Information collected from the 2007 survey has already been filled in.
Please:
-verify that the 2007 benefits are still covered for the general Medicaid population in 2008,
-fill in any missing information,
-update contact information,
-and mark any changes that have occurred since 2007.
1. Indicate which Medicaid program you are responding for:
Please select one ...

2. Please provide the name and contact information (including phone number and e-mail) for everyone involved in filling out this survey:

3. Are there currently any proposals to change your Medicaid program's coverage policies for tobacco dependence treatments (TDTs)?
Yes, No, Don't Know

If Yes, please describe the proposed changes and time frame:

Any current proposals?

4. Does your state Medicaid program work with the Tobacco Control Division in your state (on tobacco-related issues that affect the Medicaid population)?
Yes, No, Don't
Know

Please describe the interaction between the two agencies:

Please provide us with a contact in the state tobacco control
division:

Coordination between Medicaid and Tobacco Control

5. Please verify below that the benefits information that you provided in the 2007 survey is still valid. Please indicate if the tobacco dependence benefits are covered
in 2008, and if they are, indicate if they are covered for either the entire population of beneficiaries or for pregnant women exclusively.
Medicaid coverage in the FFS population:

Year coverage first offered to the FFS population:

Describe the coverage requirements in the MCO population:

a. Nicotine Gum
b. Nicotine Patch
c. Nicotine Nasal Spray
d. Nicotine Inhaler
e. Nicotine Lozenge
f. Chantix
g. Zyban
h. Wellbutrin for Smoking Cessation
i. Generic Bupropion for Smoking Cessation
j. Individual Face-to-Face Counseling
k. Group Counseling
l. Proactive Telephone Counseling

6. Use this space to describe the relationship between Medicaid FFS and managed care as it relates to TDT coverage:

7. What is the copayment for the following tobacco dependence treatments covered by your Medicaid program?
Generic Copayment

a. Nicotine Gum
b. Nicotine Patch
c. Nicotine Nasal Spray
d. Nicotine Inhaler
e. Nicotine Lozenge
f. Chantix

Brand Copayment

Comments

g. Zyban
h. Wellbutrin for Smoking Cessation
i. Generic Bupropion for Smoking Cessation

8. Use this space to add any comments regarding copayments for tobacco dependence treatments:

9. Please indicate any coverage limitations for the tobacco dependence treatments your Medicaid program covers in 2008:
Any
limits

Weeks of treatment per course

Courses per year

Prior
authorization
required

Other limitations

a. Nicotine Gum
b. Nicotine Patch
c. Nicotine Nasal Spray
d. Nicotine Inhaler
e. Nicotine Lozenge
f. Chantix
g. Zyban
h. Wellbutrin
i. Bupropion SR

10. Use this space to add any comments regarding coverage limitations for tobacco dependence treatments:

11. Does your Medicaid program require stepped-care therapy (i.e. patients are required to try one therapy before beginning another) as part of its TDT coverage
policy?
Yes

No

Don't Know

n/a

please indicate

Please describe your Medicaid program's TDT coverage
policy as it relates to stepped care:

12. Is coverage for pharmacotherapy dependent on enrollment in a behavioral modification program or participation in smoking cessation counseling?
Yes, No, n/a

Please describe requirement:

Require counseling to get coverage for pharmacotherapy?

13. Does your Medicaid program cover TDTs to treat smokeless tobacco-use (i.e. chewing tobacco, snuff, etc.)?
Yes, No, Don't Know, n/a

Describe coverage:

Cover TDTs for smokeless tobacco-use?

14. Does your Medicaid program cover dental care for adults?
Please select one ...

15. If your Medicaid program covers dental care for adults, do you require dental providers to screen and/or counsel smokers for smokeless tobacco use?
Yes, No, Don't Know, n/a

Please describe:

Dental screening/counseling for smokeless tobacco-use?

16. Please provide the following additional information regarding pharmacotherapy coverage:
Yes, No, n/a

a. Will Medicaid pay for only one smoking cessation pharmacotherapy at a time?
b. Is a prescription required for coverage of Nicotine Gum?
c. Is a prescription required for coverage of Nicotine Patch?
d. Is a prescription required for coverage of Nicotine Lozenge?
e. Can Wellbutrin be prescribed for smoking cessation?
f. Can bupropion SR be prescribed for smoking cessation?

17. Do tobacco cessation treatments count towards a general prescription limit? (please indicate prescription limit in space provided)
Yes, No, n/a

Prescription limit:

TDTs count towards prescription limit?

18. Will your Medicaid program cover the following combinations of TDTs to be used simultaneously?
Yes, No, Don't Know, n/a

Comments:

a. Long term (>14 weeks) nicotine patch and nicotine gum
b. Long term (>14 weeks) nicotine patch and nicotine spray
c. Nicotine patch and nicotine inhaler
d. Nicotine patch and bupropion SR

19. Please indicate any coverage limitations for tobacco-specific counseling services:
Copayment

Providers that may bill for
counseling

Sessions per year

Minutes per session

Other limitations

a. Individual face-to-face counseling
b. Group counseling
c. Proactive telephone counseling

20. Use this space to add any comments regarding coverage of tobacco-specific counseling services:

21. Please answer the following questions regarding the telephone counseling provided by your state quitline to Medicaid enrollees:
Yes, No, Don't Know

If Yes, provide details:

a. Does your state operate a telephone quitline?
b. Are Medicaid enrollees informed about the quitline?
c. Does the Medicaid program contribute to the financing of
the quitline?
d. When people call into the quitline, are they told about
Medicaid TDTs for which they may be eligible?
e. Are Medicaid enrollees able to get TDTs through the
quitline when they call?

22. If TDTs are provided through the state quitline please indicate: 1) what medications are provided, 2) how much are provided, 3) how are they provided to
enrollees, and 4) what limitations are placed on use.

23. Does your Medicaid program coordinate with the state quitline on tobacco-related issues that affect the Medicaid population?
Yes, No, Don't Know

Describe the nature of the coordination:

Contact for the administrator of the quit-line:

Coordination between Medicaid and quitline

24. Does your Medicaid program offer any tobacco dependence treatment programs exclusively for pregnant women? (Do not answer "Yes" if your programs cover
the general Medicaid population).
Yes, No, Don't Know

If Yes, please describe the program(s):

Offer programs exclusively for pregnant women?

25. How familiar are you with the recommendations made in the Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence
updated in May of 2008?
Please select one ...

26. Has your Medicaid program used the recommendations in the 2008 PHS Clinical Practice Guideline to change your coverage for TDTs in any way?
Select one:

Changes in TDT Coverage?

If Yes, Indicate what changes occurred:

27. Has your Medicaid program used the Public Health Service (PHS) "Clinical Practice Guideline: Treating Tobacco Use and Dependence" in any of the following
ways?
2000 PHS Guideline

2008 PHS Guideline

If so, how:

a. Design tobacco use and dependence treatment benefits?
b. Design tobacco use and dependence treatment programs?
c. Train healthcare professionals in tobacco-use cessation?
d. Any other use?

28. Does your Medicaid program support/encourage provider provision of the 5 A's of brief clinical intervention in a primary care setting (i.e. Ask, Advise, Assess,
Assist, Arrange). If so, please specify what is done.

29. Does your Medicaid program contractually require providers or health plans with which Medicaid contracts to document tobacco-use status in the medical record
of every patient?
Providers

Health Plans

Contractually require documentation of tobacco-use status:

30. Please describe any strategies used to document Medicaid enrollee tobacco-use status.

31. Does your Medicaid program routinely conduct patient chart audits to determine if tobacco use is documented?
Please select one ...

32. Does your Medicaid program do any of the following to support provider or health plan tobacco dependence treatment practices?
Providers

Health Plans

a. Communicate to contracted providers/health plans their roles in the
delivery of tobacco dependence treatment services
b. Distribute written materials on pharmacotherapy
c. Distribute written materials on tobacco dependence treatment counseling
d. Distribute patient self-help materials
e. Distribute nicotine replacement "starter kits'
f. Distribute the 1-800 cessation quitline phone number
g. Provide feedback to providers on their performance in the area of
tobacco dependence treatment
h. Inform, Train, Encourage, or Require providers and/or health plans to
utilize the “5 A’s” – ask, assess, advise, assist, arrange.
(Please check “YES” if you do any of the four options.)
i. Any other methods to support TDT practices (insert text below)

33. Please describe any other support your Medicaid program gives to providers or health plans:

34. Does your Medicaid program assess the degree to which contracted providers or health plans deliver tobacco dependence treatment interventions using any of
the following methods?
Providers

a. Chart audits
b. Electronic medical records
c. Computerized patient databases
d. Claims data
e. Pharmacy data
f. Encounter data
g. Health Plan and Employer Data Information Set (HEDIS)
Measures
h. Another method of assessing provision of TDTs

Health Plans

35. Please describe other assessments used:

36. Does your Medicaid program measure overall smoking rates among Medicaid recipients?
Select one:

Provide rate (indicate year), trend, or method used:

a. Does Medicaid measure smoking rates?
b. Does Medicaid measure trends in smoking rates?
c. How are the data collected (indicate in comments)?

37. Please indicate if your Medicaid program does any of the following:
Yes, No, Don't Know

a. Reimburse providers for treating tobaco dependence?
b. Inform clinicians and specialists that they will be reimbursed for providing effective tobacco dependence treatments?
c. Contractually require health plans to include tobacco dependence intervention
in the job descriptions and performance evaluations of salaried clinicians and specialists?

38. Have you estimated the cost of covering tobacco dependence treatments as a Medicaid benefit?
Yes, No, Don't Know

If Yes, what was the cost per member per month (indicate year of
data)

Estimated cost of TDTs?

39. Does your Medicaid program routinely measure and report on the following subgroups?
Yes, No, Don't Know

If Yes, please provide rate or number:

a. HEDIS – advice to quit smoking rates
b. HEDIS – offered counseling or pharmacotherapy
c. Adult tobacco users who received brief counseling from their providers
d. Pregnant tobacco users who received brief counseling from their providers
e. Adult tobacco users who are using pharmacotherapy to treat tobacco dependence
f. Adult tobacco users who have received counseling for tobacco dependence

40. Please describe how Medicaid physicians are informed of Medicaid coverage for TDTs (please give web address (if relevant) of most recent provider bulletin,
manual, letter etc.)

41. During 2008, has your Medicaid program conducted any outreach activities to inform tobacco users of the availability of Medicaid-covered tobacco dependence
treatments and/or encouraged them to use these benefits? (CHECK ALL THAT APPLY)
Yes, No, n/a

If Yes, indicate how often outreach is conducted:

Website
E-mail
Newsletter/Magazine
Mailings
Television Spots
Radio Spots
Billboards
Through Primary Care
Physicians
Information Line/ Member
Services
New Member Packet
Health Fairs
Pharmacies
Through Health Plans
Other

42. Please provide a contact who can discuss your Medicaid program's outreach approach:

Provide a description of the outreach:

Please submit a copy of the benefits language for the smoking cessation treatments covered by your Medicaid program.

Click here to print your results.

DRAFT VERSION
OMB# 0920-0691
OMB Expiration Date XX/XX/XXXX
State Medicaid Tobacco Dependence Treatment Survey, 2008
Center for Health and Public Policy Studies
University of California, Berkeley
Phone: 510-643-1675
m_tobaccosurvey@berkeley.edu