Quit Because of COVID–19 Act

II 116TH CONGRESS 2D SESSION S. 4524 To amend titles XIX and XXI of the Social Security Act to provide coverage of comprehensive tobacco cessation services under such titles, and for other purposes. IN THE SENATE OF THE UNITED STATES AUGUST 12, 2020 Mr. CARPER introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend titles XIX and XXI of the Social Security Act to provide coverage of comprehensive tobacco cessation services under such titles, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Quit Because of 4 COVID–19 Act’’. 5 SEC. 2. COVERAGE OF COMPREHENSIVE TOBACCO CES- 6 SATION SERVICES IN MEDICAID. 7 (a) REQUIRING MEDICAID COVERAGE OF COUN- 8 SELING AND PHARMACOTHERAPY FOR CESSATION OF TO- 9 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 4524 IS BACCO USE AND DEPENDENCE.—Section 1905 of the So- 1 cial Security Act (42 U.S.C. 1396d) is amended— 2 (1) in subsection (a)(4)— 3 (A) by striking ‘‘and (D)’’ and inserting 4 ‘‘(D)’’; and 5 (B) by inserting before the semicolon at 6 the end the following: ‘‘; and (E) counseling 7 and pharmacotherapy for cessation of tobacco 8 use and dependence by individuals who are eli- 9 gible under the State plan (as defined in sub- 10 section (gg)) during the period beginning on the 11 first day of the emergency period described in 12 section 1135(g)(1)(B) and ending on the last 13 day of the 2-year period that begins with the 14 day after the last day of such emergency pe- 15 riod’’; and 16 (2) by adding at the end the following new sub- 17 section: 18 ‘‘(gg) COUNSELING AND PHARMACOTHERAPY FOR 19 CESSATION OF TOBACCO USE AND DEPENDENCE.— 20 ‘‘(1) IN GENERAL.—For purposes of this title, 21 the term ‘counseling and pharmacotherapy for ces- 22 sation of tobacco use and dependence’ means diag- 23 nostic, therapy, and counseling services and 24 pharmacotherapy (including the coverage of pre- 25 VerDate Sep 11 2014 19:00 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 4524 IS scription and nonprescription tobacco cessation 1 agents approved by the Food and Drug Administra- 2 tion) for the cessation of tobacco use and depend- 3 ence by individuals who use tobacco products or who 4 are being treated for tobacco use and dependence 5 that are furnished— 6 ‘‘(A) by or under the supervision of a phy- 7 sician; or 8 ‘‘(B) by any other health care professional 9 who— 10 ‘‘(i) is legally authorized to furnish 11 such services under State law (or the State 12 regulatory mechanism provided by State 13 law) of the State in which the services are 14 furnished; and 15 ‘‘(ii) is authorized to receive payment 16 for other services under this title or is des- 17 ignated by the Secretary for this purpose. 18 ‘‘(2) LIMITATION.—Such term is limited to— 19 ‘‘(A) services that are recommended— 20 ‘‘(i) in the guideline entitled, ‘Treat- 21 ing Tobacco Use and Dependence: 2008 22 Update: A Clinical Practice Guideline’ pub- 23 lished by the Public Health Service in May 24 VerDate Sep 11 2014 19:00 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 4524 IS 2008 (or any subsequent modification of 1 such guideline); or 2 ‘‘(ii) for the cessation of tobacco use 3 and dependence by the United States Pre- 4 ventive Services Task Force; or 5 ‘‘(B) any additional interventions approved 6 by the Food and Drug Administration as safe 7 and effective in the cessation of tobacco use and 8 dependence by individuals who use tobacco 9 products or who are being treated for tobacco 10 use and dependence.’’. 11 (b) NO COST SHARING.— 12 (1) IN GENERAL.—Subsections (a)(2) and 13 (b)(2) of section 1916 of the Social Security Act (42 14 U.S.C. 1396o) are each amended— 15 (A) in subparagraph (F), by striking ‘‘or’’ 16 at the end; 17 (B) in subparagraph (G), by striking ‘‘; 18 and’’ and inserting ‘‘, or’’; and 19 (C) by adding at the end the following new 20 subparagraph: 21 ‘‘(H) counseling and pharmacotherapy for 22 cessation of tobacco use and dependence (as de- 23 fined in section 1905(gg)) and covered out- 24 patient drugs (as defined in subsection (k)(2) of 25 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 4524 IS section 1927 and including nonprescription 1 drugs described in subsection (d)(2) of such 2 section) that are prescribed for purposes of pro- 3 moting, and when used to promote, tobacco ces- 4 sation in accordance with a guideline, rec- 5 ommendation, or approval specified in section 6 1905(gg)(2) (as applicable) furnished during 7 the period beginning on the first day of the 8 emergency period described in section 9 1135(g)(1)(B) and ending on the last day of 10 the 2-year period that begins with the day after 11 the last day of such emergency period; and’’. 12 (2) APPLICATION TO ALTERNATIVE COST SHAR- 13 ING.—Section 1916A(b)(3)(B) of the Social Security 14 Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended by 15 adding at the end the following new clause: 16 ‘‘(xii) Counseling and 17 pharmacotherapy for cessation of tobacco 18 use and dependence (as defined in section 19 1905(gg)) and covered outpatient drugs 20 (as defined in subsection (k)(2) of section 21 1927 and including nonprescription drugs 22 described in subsection (d)(2) of such sec- 23 tion) that are prescribed for purposes of 24 promoting, and when used to promote, to- 25 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 4524 IS bacco cessation in accordance with a guide- 1 line, recommendation, or approval specified 2 in section 1905(gg)(2) (as applicable) fur- 3 nished during the period beginning on the 4 first day of the emergency period described 5 in section 1135(g)(1)(B) and ending on 6 the last day of the 2-year period that be- 7 gins with the day after the last day of such 8 emergency period.’’. 9 (c) EXCEPTION FROM OPTIONAL RESTRICTION 10 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 11 Section 1927(d)(2)(F) of the Social Security Act (42 12 U.S.C. 1396r–8(d)(2)(F)) is amended to read as follows: 13 ‘‘(F) Nonprescription drugs, except, in the 14 case of pregnant women (and, during the period 15 beginning on the first day of the emergency pe- 16 riod described in section 1135(g)(1)(B) and 17 ending on the last day of the 2-year period that 18 begins with the day after the last day of such 19 emergency period, other individuals who use to- 20 bacco products or are being treated for tobacco 21 use and dependence), when recommended in ac- 22 cordance with the guideline specified in section 23 1905(bb)(2)(A) (or in accordance with a guide- 24 line, recommendation, or approval specified in 25 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 4524 IS section 1905(gg)(2), if applicable), agents ap- 1 proved by the Food and Drug Administration 2 under the over-the-counter monograph process 3 for purposes of promoting, and when used to 4 promote, tobacco cessation.’’. 5 (d) STATE MONITORING AND PROMOTING OF COM- 6 PREHENSIVE TOBACCO CESSATION SERVICES UNDER 7 MEDICAID.—Section 1902(a) of the Social Security Act 8 (42 U.S.C. 1396a) is amended— 9 (1) in paragraph (85), by striking at the end 10 ‘‘and’’; 11 (2) in paragraph (86), by striking the period at 12 the end and inserting ‘‘; and’’; and 13 (3) by inserting after paragraph (86) the fol- 14 lowing new paragraph: 15 ‘‘(87) during the period beginning on the first 16 day of the emergency period described in section 17 1135(g)(1)(B) and ending on the last day of the 2- 18 year period that begins with the day after the last 19 day of such emergency period, provide that the State 20 will monitor and promote the use of comprehensive 21 tobacco cessation services under the State plan (in- 22 cluding by conducting an outreach campaign to in- 23 crease awareness of the benefits of using such serv- 24 ices) among— 25 VerDate Sep 11 2014 19:00 Aug 29, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 4524 IS ‘‘(A) individuals entitled to medical assist- 1 ance under the State plan who use tobacco 2 products; and 3 ‘‘(B) clinicians and others who provide 4 services to individuals entitled to medical assist- 5 ance under the State plan.’’. 6 (e) FEDERAL REIMBURSEMENT FOR COVERAGE OF 7 TOBACCO CESSATION SERVICES AND OUTREACH CAM- 8 PAIGN.— 9 (1) COVERAGE OF TOBACCO CESSATION SERV- 10 ICES.—Section 1905 of the Social Security Act (42 11 U.S.C. 1396d), as amended by subsection (a), is 12 amended— 13 (A) in subsection (b), by striking ‘‘and 14 (ff)’’ and inserting ‘‘(ff), and (gg)(3)’’; and 15 (B) in subsection (gg), as added by sub- 16 section (a), by adding at the end the following 17 new paragraph: 18 ‘‘(3) INCREASED FMAP.—Notwithstanding sub- 19 section (b), the Federal medical assistance percent- 20 age for a State, with respect to amounts expended 21 by such State for medical assistance furnished dur- 22 ing the emergency period described in section 23 1135(g)(1)(B) for counseling and pharmacotherapy 24 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 4524 IS for cessation of tobacco use and dependence by eligi- 1 ble individuals, shall be equal to 100 percent.’’. 2 (2) OUTREACH CAMPAIGN.—Section 1903(a) of 3 the Social Security Act (42 U.S.C 1396b(a)) is 4 amended— 5 (A) by striking the period at the end of 6 paragraph (7) and inserting ‘‘; plus’’; and 7 (B) by inserting after paragraph (7) the 8 following new paragraph: 9 ‘‘(8) an amount equal to 100 percent of the 10 sums expended in a quarter that occurs during the 11 emergency period described in section 1135(g)(1)(B) 12 which are attributable to the development, imple- 13 mentation, and evaluation of the outreach campaign 14 required under section 1902(a)(87).’’. 15 (f) NO PRIOR AUTHORIZATION FOR TOBACCO CES- 16 SATION DRUGS UNDER MEDICAID.—Section 1927(d) of 17 the Social Security Act (42 U.S.C. 1396r–8(d)) is amend- 18 ed— 19 (1) in paragraph (1)(A), by striking ‘‘A State’’ 20 and inserting ‘‘Subject to paragraph (8), a State’’; 21 and 22 (2) by adding at the end the following new 23 paragraph: 24 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 4524 IS ‘‘(8) NO PRIOR AUTHORIZATION PROGRAMS FOR 1 TOBACCO CESSATION DRUGS.—During the period be- 2 ginning on the first day of the emergency period de- 3 scribed in section 1135(g)(1)(B) and ending on the 4 last day of the 2-year period after the last day of 5 such emergency period, a State plan may not re- 6 quire, as a condition of coverage or payment for a 7 covered outpatient drug that is an agent to promote 8 smoking cessation (including agents approved by the 9 Food and Drug Administration) or tobacco ces- 10 sation, the approval of such drug before its dis- 11 pensing.’’. 12 (g) EXCLUSION OF ENHANCED PAYMENTS FROM 13 TERRITORIAL CAPS.—Notwithstanding any other provi- 14 sion of law, for purposes of section 1108 of the Social Se- 15 curity Act (42 U.S.C. 1308), with respect to any addi- 16 tional amount paid to a territory as a result of the applica- 17 tion of paragraph (8) of section 1903(a) or subsection 18 (gg)(3) of section 1905 of the Social Security Act (42 19 U.S.C. 1396b(a), 1396d)— 20 (1) the limitation on payments to territories 21 under subsections (f) and (g) of such section 1108 22 shall not apply to such additional amounts; and 23 (2) such additional amounts shall be dis- 24 regarded in applying such subsections. 25 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 4524 IS SEC. 3. COVERAGE OF COMPREHENSIVE TOBACCO CES- 1 SATION SERVICES IN CHIP. 2 (a) REQUIRING CHIP COVERAGE OF COUNSELING 3 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO 4 USE AND DEPENDENCE.— 5 (1) IN GENERAL.—Section 2103(c)(2) of the 6 Social Security Act (42 U.S.C. 1397cc(c)(2)) is 7 amended by adding at the end the following new 8 subparagraph: 9 ‘‘(D) Counseling and pharmacotherapy for 10 cessation of tobacco use and dependence by in- 11 dividuals who are eligible under the State child 12 health plan during the period beginning on the 13 first day of the emergency period described in 14 section 1135(g)(1)(B) and ending on the last 15 day of the 2-year period that begins with the 16 day after the last day of such emergency pe- 17 riod.’’. 18 (2) COUNSELING AND PHARMACOTHERAPY FOR 19 CESSATION OF TOBACCO USE AND DEPENDENCE DE- 20 FINED.—Section 2110(c) of the Social Security Act 21 (42 U.S.C. 1397jj(c)) is amended by adding at the 22 end the following new paragraph: 23 ‘‘(10) COUNSELING AND PHARMACOTHERAPY 24 FOR CESSATION OF TOBACCO USE AND DEPEND- 25 ENCE.— 26 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 4524 IS ‘‘(A) IN GENERAL.—The term ‘counseling 1 and pharmacotherapy for cessation of tobacco 2 use and dependence’ means diagnostic, therapy, 3 and counseling services and pharmacotherapy 4 (including the coverage of prescription and non- 5 prescription tobacco cessation agents approved 6 by the Food and Drug Administration) for the 7 cessation of tobacco use and dependence by in- 8 dividuals who use tobacco products or who are 9 being treated for tobacco use and dependence 10 that are furnished— 11 ‘‘(i) by or under the supervision of a 12 physician; or 13 ‘‘(ii) by any other health care profes- 14 sional who— 15 ‘‘(I) is legally authorized to fur- 16 nish such services under State law (or 17 the State regulatory mechanism pro- 18 vided by State law) of the State in 19 which the services are furnished; and 20 ‘‘(II) is authorized to receive pay- 21 ment for other services under this title 22 or is designated by the Secretary for 23 this purpose. 24 VerDate Sep 11 2014 01:41 Aug 28, 2020 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524 pamtmann on DSKBC07HB2PROD with BILLS 13 •S 4524 IS [Text truncated for display. 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