Smoking-Cessation Treatment Services
- The AARC is an active member of the Coalition for TobaccoFree Kids. Other
key members of this Coalition include the American Heart Association, the
American Lung Association, and the American Cancer Society. Congressional
and regulatory efforts have included:
- requiring new and rotating warning labels on cigarette packages
- increasing cigarette excise taxes
- ensuring that warning labels are on smokeless tobacco products
- enacting original two-hour domestic airline ban on cigarette smoking (As part of the Coalition's efforts to secure congressional support, AARC members undertook a comprehensive airline passenger opinion survey interviewing thousands of airline passengers across the country and soliciting their views on the proposed legislation that would ban cigarette smoking on airlines. The information gathered by respiratory therapists helped solidify congressional support for enacting the cigarette ban).
- working with Congress to extend and expand the original two-hour domestic airline flight ban
- The AARC continues to provide support for the Coalition's efforts to increase FDA regulatory authority over tobacco-related products.
- As part of the Coalition AARC was involved in efforts to negotiate the National Tobacco Settlement.
- In conjunction with the Coalition, the AARC worked with the Environmental Protection Agency to publicize reports on the hazards of secondhand smoke and promote indoor air quality.
- A respiratory therapist, representing the AARC, was a member of the government panel charged with developing the current federal guidelines on smoking cessation as published by the Agency for Healthcare Research & Quality.
- The AARC is in partnership with the National Lung Health Education Program, an organization which develops nationwide education programs to test and identify patients with early stages of Chronic Obstructive Pulmonary Disease (COPD), an illness often caused by smoking. This program coordinates its efforts with the federal agencies, the National Heart, Lung, and Blood Institute, the National Institute of Occupational Safety and Health and the National Cancer Institute.
- The AARC is also an active participant in the national "Great American Smoke-Out Day" and the "Kick-Butts Day". In addition, a major focus of the annual National Respiratory Care Week is smoking-cessation-related activities. The AARC provides T-shirts, buttons, stickers, and posters that focus on the "quit smoking" or "don't start" theme. The AARC also provides brochures to the public on "How to Quit Smoking" and "Test Your IQ on Smoking and Secondhand Smoke".
- Smoking Cessation Links
- Indiana Medicaid Bulletin, October 1999
- AARC Comments to Indiana Medicaid about Smoking Cessation Treatment Services
Smoking Cessation Links
There are a number of excellent Web sites that provide useful information regarding both smoking cessation programs and the use of tobacco settlement money.
- www.ahrq.gov/consumer/index.html#smoking
(this site provides help to the smoker who wishes to quit) - www.ahrq.gov/clinic/notesmok.htm
(this site gives a bibliography on past articles on smoking prevention & issues) - www.cdc.gov/tobacco/
(the Centers for Disease Control's site on tobacco-related issues, providing a clinical/provider focus) - www.surgeongeneral.gov/tobacco/default.htm
(you can find the clinical practice guidelines here) - tobaccofreekids.org
(this is a great site, providing extensive information on the tobacco settlement monies; the implications of the toll of smoking on each state; the status of federal and state lawsuits; and more) - www.lungusa.org/tobacco
(another great site that provides general information on tobacco issues)
Indiana Medicaid Bulletin, October 1999
To: All Medicaid-Enrolled Physicians, Nurse Practitioners, Dentists, Pharmacies, Psychologists, and Clinics
Subject: Implementation of Smoking Cessation Treatment Services
Overview
As you are aware, smoking has proven to be a major contributor to premature death and disease. There is overwhelming evidence that smoking cessation is an important and readily available modality to prevent disease processes. Scientific literature has revealed the following:
- Tobacco use is responsible for more than 420,000 deaths in the United States each year.
- Smoking kills 10,000 Hoosiers each year.
- Indiana ranks in the top ten states in prevalence of smoking among all the states in the United States.
- Indiana has the sixth highest rate of deaths related to smoking among all states in the United States.
- Smoking is a known cause of cancer, heart disease, stroke, and chronic obstructive pulmonary disease.
- Billions of dollars are spent every year on smoking-related medical care.
- Smoking costs every man, woman and child in Indiana $548 per year for health-related costs.
- Recent estimates are that twenty-five percent (25%) of Americans smoke, with thousands of children and adolescents becoming addicted to tobacco each day.
- Studies of people who have quit indicate that counseling is a necessary component of smoking cessation treatment and improves the chance for success.
In recognition of both the need and availability of treatment to facilitate smoking cessation, the Indiana Medicaid Program is providing reimbursement for these services, effective October 27, 1999. This bulletin fully describes the Program’s coverage and reimbursement policies for this service and includes the following sections: Coverage and Limitation, Products, Counseling and Billing Instructions.
Coverage/Limitations
Coverage of Smoking Cessation Treatment services is for dates of service on or after October 27, 1999.
Reimbursement for smoking cessation is available for one (1) twelve (12) week course of treatment per recipient per calendar year.
Treatment may include prescription of any combination of smoking cessation products and counseling. One (1) or more modalities of treatment may be prescribed. Counseling must be included in any combination of treatment.
Prior authorization is not required for reimbursement for smoking cessation products or counseling.
Hoosier Healthwise
Providers of smoking cessation treatment services must obtain the Primary Medical Provider (PMP) certification for Hoosier Healthwise enrollees.
Smoking Cessation Products
Reimbursement is available to pharmacy providers for smoking cessation products when prescribed by a licensed practitioner within the scope of his/her license under Indiana law.
Only patients who agree to participate in smoking cessation counseling are to receive prescriptions for smoking cessation products. The prescribing practitioner may want to have the patient sign a commitment to establish a "quit date" and to participate in counseling as the first step in smoking cessation treatment. A prescription for such products will serve as documentation that the prescribing practitioner has prescribed or obtained assurance from the patient that counseling will concomitantly occur with the receipt of smoking cessation products.
Products covered by Indiana Medicaid include, but are not limited to:
- Sustained release buproprion products.
- Nicotine replacement drug products (patch, gum, inhaler).
Smoking Cessation Counseling
Counseling services must be prescribed by a licensed practitioner within the scope of his/her license under Indiana law. Reimbursement is available for smoking cessation counseling services rendered by the following licensed practitioners participating in the Indiana Medicaid Program.
- A physician.
- A physician’s assistant.
- A nurse practitioner.
- A registered nurse.
- A psychologist.
- A pharmacist.
Counseling must be provided as follows: A minimum of thirty (30) minutes [two (2) units] and a maximum of one hundred fifty (150) minutes [ten (10) units] within the twelve (12) weeks. Counseling will be billed in fifteen (15) minute increments.
Billing Instructions and Reimbursement
Counseling Services
Providers/practitioners of counseling services must bill only on the HCFA 1500 claim form (please see applicable provider manual section for full details), utilizing procedure code Z5064 (smoking cessation treatment counseling) with a primary diagnosis code of 305.1 (Tobacco use disorder). As previously noted herein, one unit of Z5064 will be considered as fifteen (15) minutes of service. Fractional units of service cannot be billed on the HCFA 1500, so providers/practitioners should accumulate billable time equivalent to whole units, before billing. Counseling must be provided within the twelve (12) week course of treatment and must be a minimum of thirty (30) minutes [two (2) units] with a maximum of one hundred fifty (150) minutes [ten (10) units].
The Indiana Medicaid maximum allowable rate for code Z5064, smoking cessation treatment counseling services is $22.08 per unit, regardless of the type of practitioner rendering the service. PLEASE NOTE: Providers/practitioners are to bill their "usual and customary charge" for the units of service rendered, and Medicaid will calculate the final reimbursement amount.
Practitioners eligible to provide smoking cessation treatment counseling services, but not currently enrolled as an Indiana Medicaid provider, should contact the BDS Customer Assistance Unit for instructions on how to proceed. Eligible practitioners such as pharmacists, who work for or own Medicaid-enrolled pharmacies, will bill for counseling services they render through the enrolled entity in which they provide services. Physician’s assistants, registered nurses, and psychologists who are not health service providers in psychology (HSPP) will bill for counseling services they render through the enrolled entity in which they provide services.
Providers/practitioners are reminded that they are NOT entitled to Medicaid reimbursement for a service in which they provide to the general public at no charge, including smoking cessation counseling service. The Health Care Excel (HCE) Surveillance Utilization and Review (SUR) Department will closely monitor adherence to this program limitation.
Both ordering and rendering practitioners should maintain sufficient documentation of their respective functions to substantiate the medical necessity of the service rendered, and the provision of the service itself; this requirement is consistent with existing Medicaid policies and regulations.
Smoking Cessation Products
Smoking cessation products, previously mentioned herein, will be covered under the Indiana Medicaid Program for products provided on October 27, 1999, and later.
Reimbursement is available to pharmacy providers for smoking cessation products when prescribed by a licensed practitioner within the scope of his/her license under Indiana law.
Over-the-counter smoking cessation products must still be prescribed by a licensed practitioner in order for the pharmacy to be reimbursed by Medicaid. All smoking cessation products must be prescribed by a licensed practitioner for use, along with counseling, within the twelve (12) week treatment timeframe.
Pharmacies will bill for reimbursement according to the normal procedures as outlined in the provider manual (please see applicable provider manual section for full details).
Please Note
The Office of Medicaid Policy and Planning is hopeful that practitioners’ efforts in assisting their patients with smoking cessation will ultimately lead to a more healthy patient population. We welcome any comments you may have about this new program, which may assist our efforts to implement it practically and efficiently.
Additional Assistance
Please direct any questions you may have regarding this bulletin and the policies to Health Care Excel, Medical Policy Department, at 317-347-4500. Questions regarding billing procedures referenced herein may be directed to the EDS Customer
Assistance Unit at 1-800-577-1278.
Indiana’s Smoking Cessation Program is in concert with the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines. These guidelines may be obtained by calling 1-800-358-9295, by writing to the Agency for Health Care Policy and Research, Publication Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907, or through their Web site at http://www.ahcpr.gov/.
AARC Comments to Indiana Medicaid about Smoking Cessation Treatment Services
February 1, 2000
Ms. Kathleen D. Gifford
Assistant Secretary
Office of Medicaid Policy and Planning
Family and Social Services Administration
Indiana Government Center South
402 W. Washington Street, Room W461
Indianapolis, IN 46204-7083
RE: Indiana Medicaid Bulletin BT199933
Implementation of Smoking Cessation Treatment Services
Dear Ms. Gifford:
I am writing on behalf of the American Association for Respiratory Care (AARC) regarding an Indiana Medicaid Bulletin (BT199933, issued October 15, 1999) on the implementation of smoking cessation treatment services. The AARC is a national professional association representing approximately 31,000 respiratory therapists across the country.
The AARC commends Indiana State policymakers for providing smoking cessation treatment services to Medicaid patients. In this regard, we suggest amending this policy to allow Medicaid patients access to the expertise of respiratory therapists. By the very nature of their profession, respiratory therapists are uniquely qualified to provide smoking cessation treatment services to Indiana’s Medicaid patients.
Respiratory therapists treat patients with acute and chronic respiratory problems, many of which are due to smoking. They encounter patients in all health care settings, including hospitals, physicians’ offices, nursing homes, rehabilitation facilities, subacute care sites, and the home. Because they treat patients with lung cancer, asthma, emphysema, acute and chronic bronchitis, and other respiratory problems, respiratory therapists have frequent access over long periods to patients who may smoke.
Respiratory therapists are skilled health care professionals who receive comprehensive formal education, clinical training, and validated competency testing in respiratory therapy. In collaboration with physicians, respiratory therapists design, implement and modify respiratory therapy treatment plans. They assess the status of a patient’s health, and teach patients about their conditions. Many respiratory therapists are currently providing smoking cessation treatment services. As a matter of fact, the Program Coordinator for the Nicotine Dependence Program at the Indiana University Cancer Center is a respiratory therapist.
The October 15, 1999, Medicaid Bulletin states that Indiana’s Smoking Cessation Program is in concert with the Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guidelines [formerly the Agency for Health Care Policy and Research]. AHRQ’s Clinical Practice Guideline on Smoking Cessation (#18) includes respiratory therapists among the providers of smoking cessation services. According to this guideline:
" . . . virtually all types of clinicians — physicians, nurses, nurse practitioners, dentists, psychologists, pharmacists, respiratory and physical therapists, physicians’ assistants, and many others — can effectively deliver tobacco cessation treatments."
In addition, one of the guideline’s recommendations states, "Smoking cessation interventions delivered by a variety of clinicians and health care personnel increase cessation rates. Clinician involvement in smoking cessation interventions should be based on factors such as access to smokers, level of training, and interest, rather than on membership in a specific professional discipline."
Given respiratory therapists’ expertise and their focus on the treatment of many smoking-related diseases, we believe Indiana’s Medicaid patients would benefit from smoking cessation treatment services from respiratory therapists.
The AARC appreciates the opportunity to comment on this policy. If you have any questions, please contact.
Sincerely,
Garry W. Kauffman, MPA, RRT, CHE
President
