Thursday, August 19, 2010

Partnership for Prevention is proud to be one of six groups telling Centers for Medicare and Medicaid Services (CMS), “Medicaid should cover the full range of proven and effective treatment options so that pregnant women can find the particular service or combination of services that will best help them to quit using tobacco and not relapse.” Partnership made these comments in a letter yesterday to CMS on our views on the implementation of Section 4107 of the Patient Protection and Affordable Care Act (PPACA).

This section of the PPACA will be implemented October 1st of this year and will require state Medicaid programs to cover comprehensive tobacco cessation services, including “diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and non-prescription tobacco cessation agents approved by the Food and Drug Administration)”, for pregnant women. While this is certainly an improvement to the Social Security Act, Partnership urges CMS to clarify exactly what states must do to comply with Section 4107.

In its current state, the PPACA does not specify the type of counseling or the amount and duration of counseling sessions that pregnant women should receive. The Public Health Service’s Treating Tobacco Use and Dependence clinical practice guideline (PHS Guideline) found that proactive telephone counseling (quitlines, call-back counseling), individual counseling, and group counseling formats are all effective in reducing tobacco use. The PHS Guideline also confirmed that there is a strong dose-response relationship between the frequency and length of the counseling sessions and successful quit attempts. Furthermore, the PHS Guideline found that an effective strategy for producing high, long-term abstinence rates is “relatively intense cessation counseling (e.g., four or more sessions that are 10 minutes or more in length each)” and recommends that, if possible, clinicians should strive to meet with individuals four or more times.

Based on these guidelines, Partnership feels that the PPACA should require states to cover all three counseling formats: individual, group, and telephone-based. They should also cover a minimum of four counseling sessions per quit attempt and should be strongly encouraged to cover more sessions since accumulating evidence suggests that states cover a minimum of two quit attempts per year.

In terms of cessation medications, the current PHS Guideline does not make recommendations. In the event that a subsequent PHS Guideline does recommend use of cessation medications during pregnancy or if new evidence emerges that cessation medications can be used safely and effectively by pregnant women, Partnership encourages CMS to inform states that they must cover those medications in their Medicaid programs with no cost-sharing requirement.

Partnership for Prevention believes that effective implementation of this new policy will result in fewer health risks and save lives and money.


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