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Obscure ACA provision offers reimbursement for smoking cessation
e-Reports, Jan. 12, 2015
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A little-known provision in the Affordable Care Act (ACA) offers good news for your patients who want to quit smoking. Under the ACA, non-grandfathered private health plans are required to cover tobacco-cessation counseling and intervention.

Guidance from the Department of Labor states that insurers are in compliance for the following without cost sharing or prior authorization:

  • Screening of all patients for tobacco use
  • At least two tobacco-cessation attempts per year, with coveragevof each quit attempt including:
    1. Four tobacco-cessation counseling sessions (telephone, group, individual), each at least 10 minutes long
    2. Any FDA-approved tobacco-cessation medications (prescription or over the counter) for a 90-day treatment regimen when prescribed by a health care provider. Approved medications include: patch, gum, lozenge, nasal spray and inhaler, and two non-nicotine pills, such as bupropion and varenicline.

Additionally, tobacco-cessation coverage under the ACA is extended to Medicaid and Medicare beneficiaries as part of preventive services with no cost sharing. However, the ISMA advises you to review your agreements for terms of reimbursement.

Read about tobacco-cessation interventions covered by the ACA discussed in Q5 here.

Find guidance in treating tobacco use and dependence from the Agency for Healthcare research and Quality.

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