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Federal Cessation Treatment Coverage

The cessation treatment coverage criteria used in the American Lung Association's "State of Tobacco Control" 2020 report are based on the coverage of tobacco cessation treatments provided by the federal government through its four main public insurance programs:

  1. Medicare (for Americans over age 65),
  2. Medicaid (for low-income and/or disabled Americans),
  3. TRICARE (for members of the military and their families), and
  4. Federal Employee Health Benefits Program (for federal employees and their families).

A fifth category covers federal requirements for tobacco cessation treatment coverage in state health insurance marketplaces under the Patient Protection and Affordable Care Act or health care reform law. Providing help to quit through these programs and state health insurance exchanges will reach large numbers of tobacco users, improve health, prevent unnecessary death, save taxpayer money and set an example for other health plans. The federal government must lead by example and cover a comprehensive benefit for everyone to whom it provides health care.

The definition of a comprehensive tobacco cessation benefit used in these criteria follows the recommendations in the Clinical Practice Guideline entitled Treating Tobacco Use and Dependence. In this Guideline, published in 2008 the U.S. Public Health Service recommends the use of seven medications and three types of counseling as effective for helping tobacco users quit. This definition has been reaffirmed in the 2015 United States Preventive Services Task Force (USPSTF) recommendation.

The Federal Cessation Coverage grade breaks down as follows:

Grade

Points Earned

A

18 to 20 Total Points

B

16 to 17 Total Points

C

14 to 15 Total Points

D

12 to 13 Total Points

F

Under 12 Total Points

Medicare (4 points)

Target is all Medicare recipients have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Medicaid (4 points)

Target is all Medicaid enrollees have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are required to be covered.
  • +3 points: At least 4 medications and 1 type of counseling are required to be covered.
  • +2 points: At least 2 medications and 1 type of counseling are required to be covered.
  • +1 point: At least 1 treatment is required to be covered.
  • +0 points: No required coverage.

TRICARE (4 points)

Target is all TRICARE enrollees have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Federal Employee Health Benefits (FEHB) (4 points)

Target is all federal employees & dependents have easy access to a comprehensive cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are covered.
  • +3 points: At least 4 medications and 1 type of counseling are covered.
  • +2 points: At least 2 medications and 1 type of counseling are covered.
  • +1 point: At least 1 treatment is covered.
  • +0 points: No coverage.

Federal Requirements for State Health Insurance Exchanges (4 points)

Target is all plans in marketplaces cover a comprehensive tobacco cessation benefit.

  • +4 points: All Guideline-recommended medications and counseling are required to be covered.
  • +3 points: Administration releases guidance outlining coverage of a comprehensive tobacco cessation benefit as a preventive service.
  • +2 points:  Administration requires that all plans sold in the State Health Insurance Marketplaces cover tobacco cessation treatment as part of the preventive services requirement.
  • +1 points: Administration proposes new regulations that no longer require all plans in the State Health Insurance Marketplaces to provide tobacco cessation.
  • +0 points: Administration finalizes new regulations or issues guidance that no longer require all plans in the State Health Insurance Marketplaces to provide tobacco cessation.

Bonus Points: 1 bonus point in each category is awarded if coverage is provided with minimal barriers to access.

Page last updated: March 17, 2020

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