Provider Support Helping Members

Tobacco Cessation

Comprehensive tobacco cessation services and screening for Medi-Cal patients

The United States Preventive Services Task Force (USPSTF) recommends health care providers ask all individuals ages 18 years and older about tobacco use and offer tobacco cessation interventions to those who use tobacco products. Providers should offer tailored counseling to pregnant women who smoke. Interventions, education or brief counseling should also be offered to prevent initiation of tobacco use in school-aged children and adolescents.

Tobacco Cessation Requirements

Anthem Blue Cross (Anthem) is responsible for ensuring PCPs and their qualified staff implement the interventions outlined in MMCD Policy Letter 16-014:

  1. Assessment and counseling
    • Providers must identify (initially and annually) all members of any age who use tobacco products or are exposed to tobacco smoke and document this information in the member’s medical record. This can be accomplished by using the Staying Healthy Assessment (SHA) or an equivalent, approved assessment. Providers must ask tobacco users about their tobacco status at every visit and document their responses in their medical record.
  2. Approved tobacco medication
    • Provider must offer FDA-approved tobacco cessation medications to nonpregnant adults of any age.
    1. Anthem covers the following without prior authorization: nicotine patches, nicotine gum, nicotine lozenges and bupropion SR (Zyban). It is recommended these over-the-counter medicines are prescribed by the member’s provider and dispensed by the pharmacy.
    2. Anthem covers the following with prior authorization: nicotine nasal spray, nicotine inhaler and varenicline (Chantix).
    3. Anthem members qualify for:
      1. A 90-day treatment regimen of medications without other restrictions (except for quantity limits and days-supply limits).
      2. Medication for at least two separate quit attempts per year (no mandatory break required).
      3. Medication without counseling if the member does not want counseling.
    • Note: Enrollment in tobacco counseling is not required to obtain tobacco cessation materials.
  3. Individual, group and telephonic counseling
    • Providers must refer tobacco users of any age to individual, group and telephonic counseling. Anthem members qualify for four counseling sessions of at least ten minutes for at least two separate quit attempts each year without prior authorization. Providers can:
    1. Refer a member to the California Smokers' Helpline at 1-800-NO-BUTTS or another equivalent line. The California Smokers’ Helpline is available in English, Spanish,Chinese, Vietnamese and Korean. Providers are advised to use its provider referral system.
    2. Use the 5A's model or other validated behavior change model when counseling members.
    3. Review the tobacco-focused SHA questions with the member, which is equivalent to individual counseling.
    4. Refer members to available community programs. Please use the Health Education & Cultural and Linguistic Referral Form to refer members.
    5. Ask all pregnant women if they use tobacco or are exposed to tobacco smoke. If they smoke, offer at least one face-to-face counseling session per quit attempt and refer the member to a tobacco cessation quit line. Counseling services are covered for 60 days after delivery. Members enrolled in Anthem’s Maternity Case Management program who are identified as tobacco users are also offered these individual counseling services. Note: Smoking cessation medications are not recommended during pregnancy.
    6. Provide education, including brief counseling, to school-aged children and adolescents to prevent initiation of tobacco use.
  4. Provider education
    • Review the following provider training information:
    1. U.S. Public Health Services Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update
    2. Smoking Cessation During Pregnancy: Committee Opinion (special requirements for providing services to pregnant tobacco users)
    3. Counseling using the 5A’s model or other validated model for treating tobacco use and dependence
  5. Identifying tobacco users and tracking treatment utilization
    • Anthem conducts ongoing identification of tobacco users through medical record reviews and analysis of claims data for tobacco cessation coding. Anthem will monitor provider performance in implementing these tobacco cessation interventions through various processes including medical record reviews, facility site reviews, and review of claims and pharmacy data.

Additional Provider
Training Resources