1. Tobacco Cessation and Private Insurance under ACA: New Opportunities for Public Health September 25, 2014

2. Want to use the information in the Presentation? Please cite The American Lung Association and/or ClearWay Minnesota SM Any questions? Email anne.digiulio@lung.organne.digiulio@lung.org

3. Introductions Erika Sward– Assistant Vice President, National Advocacy American Lung Association

4. Speakers Erika Sward, Assistant Vice President, National Advocacy, American Lung Association Jennifer Singleterry, Director, National Health Policy, American Lung Association Amanda Jansen, Senior Cessation Manager, ClearWay Minnesota SM Thomas Carr, Director, National Policy, American Lung Association

5. Agenda Introductions & Welcome – Erika Sward, Assistant Vice President, National Advocacy, American Lung Association Background – Jennifer Singleterry, Director, National Health Policy, American Lung Association Cessation Guidance – Jennifer Singleterry What States are Doing – Amanda Jansen, Senior Cessation Manager, ClearWay Minnesota SM Resources for You – Thomas Carr, Director, National Policy, American Lung Association Q&A

6. Background Jennifer Singleterry – Director, National Health Policy American Lung Association

7. Acronyms ACA = Affordable Care Act (healthcare reform) HHS = U.S. Dept. of Health & Human Services CMS = Centers for Medicare and Medicaid Services USPSTF = United States Preventive Services Task Force FAQ = Frequently Asked Question Exchanges/State Health Insurance Marketplaces

8. Affordable Care Act Focus on Prevention Prevention and Public Health Fund Pilot programs to test prevention strategies through Medicaid Prevention visit in Medicare Part B Required coverage for preventive services with no cost-sharing

9. Preventive Services Requirement This Requirement Private plans Plans sold in exchanges Small group and individual plans Medicaid expansion plans Different Requirements Medicare Traditional Medicaid Grandfathered plans

10. What are Preventive Services? Routine immunizations Preventive services for children & youth Preventive services for women Preventive services given an ‘A’ or ‘B’ recommendation by the USPSTF

11. U.S. Preventive Service Task Force An independent, volunteer panel of national experts in prevention and evidence-based medicine Make evidence-based recommendations for clinical preventive services for clinicians –Assigns each recommendation a letter grade based on the strength of the evidence and balance of benefits and harms (A, B, C, or D grade, or I statement)

12. Preventive Services Cancer screenings –New B recommendation for lung cancer screenings Immunizations Blood pressure screenings Cholesterol screenings STI counseling Tobacco Cessation

13. Tobacco A Grade: Counseling and Interventions –Adults –Pregnant women B Grade: Education and Brief Counseling for Prevention –School-aged children & adolescents

14. Cessation Guidance Jennifer Singleterry – Director, National Health Policy American Lung Association

15. Guidance Needed Tobacco cessation recommendation did not easily translate into insurance policy Evidence showed that plans were interpreting the requirement differently Not covering a comprehensive benefit Coverage of tobacco cessation was more varied than some other preventive services

16. Tobacco Cessation Guidance Departments of Health and Human Services, Labor and Treasury ACA Implementation FAQ XIX, Question 5 Released May 2, 2014 Q5

17. Tobacco Cessation Guidance At least 4 sessions of individual, group and phone counseling At least 90 days of all FDA-approved smoking cessation medications, when prescribed At least 2 quit attempts per year No cost-sharing No prior authorization

18. What Now? Educate and build awareness among: State regulators Health Plans Providers Consumers

19. Some States Have Already Taken Action Regulators issuing bulletins to health plans: Illinois, New Mexico Regulators enforcing guidance: Minnesota, Washington Issuing consumer alerts: Kansas

20. Minnesota Case Study Amanda Jansen – Senior Cessation Manager ClearWay Minnesota SM

21. Mission: Reduce the harm tobacco causes the people of Minnesota Grant-making, QUITPLAN® stop- smoking services and statewide outreach activities

22. Legacy Goal: Treatment Access One hundred percent of Minnesota smokers will have access to comprehensive tobacco dependence treatment by 2023

23. State Regulators Goal: Ensure state regulators are implementing ACA cessation guidelines comprehensively – Private Insurance – Use FAQ as educational tool with departments of Commerce and Health – Public Programs – Explore opportunities to strengthen Medicaid benefit with Department of Human Services

24. Health Plans Goal: Encourage health plans to include comprehensive cessation benefits in all products – Assess current coverage landscape – Follow-up meetings with Health Plan Leadership Assessment results FAQ information

25. What does this mean for our providers? Providers and Health Systems What does this mean for reimbursement? What does this mean for how we’re treating our patients? What does this mean for our systems and processes?

26. Providers and Health Systems Goal: Support health systems to implement systems changes for assessing and addressing tobacco use. – Education and technical assistance opportunities – Potential to incorporate into provider trainings or other grant activities

27. Consumers

28. Lessons Learned 1.Use the FAQ as a catalyst for relationship building or reconnecting 2.Gather and share examples from other states 3.Ask for advice and ideas from stakeholders 4.Frame coverage access in relation to other tobacco control efforts 5.Ensure different state agencies are interpreting the FAQ consistently

29. Resources for You Thomas Carr – Director, National Policy American Lung Association

30. New Lung Association Cessation Guidance Toolkit! www.lung.org/cessationguidance

31. American Lung Association Cessation Guidance Toolkit Categories Factsheets and Materials

32. Cessation Guidance Toolkit Categories Template Letters/Policy Language

33. Cessation Guidance Toolkit Categories State Examples

34. Cessation Guidance Toolkit Categories

35. Questions

36. Resources & Contacts www.lung.org/cessationguidance Jennifer Singleterry: jennifer.singleterry@lung.orgjennifer.singleterry@lung.org Amanda Jansen: ajansen@clearwaymn.orgajansen@clearwaymn.org Thomas Carr: thomas.carr@lung.orgthomas.carr@lung.org