Tobacco cessation services and screening for Medi-Cal patients
The United States Preventive Services Task Force (USPSTF) recommends that healthcare providers ask all individuals ages 18 years and older about tobacco use, and that providers offer tobacco cessation interventions to users. Providers should also offer tailored counseling to pregnant women who smoke. Finally, interventions, education, or brief counseling should be offered to prevent initiation of tobacco use in school-aged children and adolescents.
Blue Shield of California Promise Health Plan is responsible for ensuring that primary care physicians (PCP) and their qualified staff implement the interventions outlined in California Department of Health Care Services, Health and Human Services Agency's Policy Letter 16-014 (PDF, 122 KB).
How can I help my patients stop tobacco use?
1. Identify, initially and thereafter 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. You may use the Staying Healthy Assessment (SHA) or an equivalent approved assessment.
2. Offer FDA-approved tobacco cessation medications to non-pregnant adults of any age. The medications include:
- Bupropion SR (without prior authorization)
- Varenicline
- nicotine gum, inhaler, lozenge, nasal spray, and patch
Members qualify for:
- A 90-day treatment regimen of medications without other restrictions.
- Medication for at least two separate quit attempts per year, with no mandatory break required.
- Medication without counseling if the member does not want counseling.
3. Refer tobacco users of any age to individual, group, and telephone counseling. Members qualify for four counseling sessions of at least ten minutes for at least two separate quit attempts each year, without prior authorization. You may:
- Refer members to the CA Smokers Helpline at (800) NO-BUTTS or another equivalent quit line.
- Use the 5A's model (PDF, 115 KB) or other validated behavior change model when counseling patients
- Refer members to community group programs. Find a program via the County Cessation Program Listings
4. Ask all pregnant women if they use tobacco or are exposed to tobacco smoke. If a smoker, offer at least one face-to-face counseling session per quit attempt, and refer the member to a tobacco cessation quit line.
Counseling services cover 60 days post-delivery, plus any additional needed days to end the respective month. Smoking cessation medications are not recommended during pregnancy.
5. Provide education, including brief counseling to children and adolescents, to prevent tobacco initiation in school-aged children and adolescents, in accordance with AAP Bright Futures periodicity schedule and anticipatory guidance.
6. Review the following provider training information:
- United States Public Health Service (USPHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence.
- Special requirements for providing services for pregnant tobacco users: Smoking Cessation During Pregnancy: Committee Opinion
- Counseling using the 5A's model (PDF, 115 KB) or other validated model for treating tobacco use and dependence.
Blue Shield of California Promise Health Plan monitors provider performance in implementing these tobacco cessation interventions through a number of processes, including Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, medical record review, and the Facility Site Review process (PDF, 17 MB).
What additional provider training resources are available?
- Continuing Medical Education (CME)-accredited training on tobacco cessation and behavioral health
- University of California San Francisco’s (UCSF) Smoking Cessation Leader Center's tools and resources
- UCSF's Smoking Cessation Leadership Center Webinars for CME/Continuing Education Unit credit
- Other tobacco cessation free online trainings
Where can I find other resources?
- CA Smokers Helpline (available in English, Spanish, Chinese, Vietnamese, and Korean)
- Los Angeles County tobacco cessation and education resources
- San Diego County Quit Smoking help and resources
What resources are available to my patients?
Download and print the "You can stop smoking" brochure:
For additional resources, patients should review materials available under the “Smoking cessation” topic on the Health education materials page or call Member Services and ask for the Health Education Department.
How do I get more information?
Contact Blue Shield Promise Health Education Department:
Phone: (323) 827-6036, 8 a.m. to 5 p.m., Monday through Friday
Email: BlueShieldofCAHealthEducation@blueshieldca.com
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