Bill Text: PA SB959 | 2011-2012 | Regular Session | Introduced

---

Bill Title: Requiring health insurance policies to provide coverage for tobacco cessation programs and drugs.

Spectrum: Slight Partisan Bill (Democrat 4-2)

Status: (Introduced - Dead) 2011-04-13 - Referred to BANKING AND INSURANCE [SB959 Detail]

Download: Pennsylvania-2011-SB959-Introduced.html

---

PRINTER'S NO. 1052
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 959 Session of2011
INTRODUCED BY GREENLEAF, ALLOWAY, BREWSTER, WASHINGTON AND LEACH, APRIL 13, 2011
REFERRED TO BANKING AND INSURANCE, APRIL 13, 2011
AN ACT
Requiring health insurance policies to provide coverage for
tobacco cessation programs and drugs.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Tobacco
Cessation Treatment Act.
Section 2. Findings.
The General Assembly finds and declares as follows:
(1) Providing tobacco cessation counseling and
medication is one of the most clinically effective and cost-
effective health services available, according to the
National Commission on Prevention Priorities. Tobacco
cessation is 5 to 80 times more cost effective than
pharmacologic interventions used to prevent heart attacks.
(2) More than 70% of smokers wish they could quit
tobacco and each year one of every two smokers attempts to
quit. However, the unassisted successful tobacco quit rate
has remained constant at less than 5%. Access to counseling
and pharmaceutical benefits doubles the successful quit rate
and has achieved quit rates of 25% to 30%. Experience in
health plans indicates that access to all cessation services
saves $4 for every dollar invested.
(3) Each adult smoker costs employers $1,760 in lost
productivity and $1,623 in excess medical expenditures. Men
who smoke incur $15,800 more in lifetime medical expenses
than do men who do not smoke. For employers, the ultimate
financial return is between $5 and $6 for every dollar spent
on tobacco cessation.
(4) Because of member transfers between plans, financial
savings and tobacco-related disease reductions are effective
only if universally available to the entire insured
population. Therefore, a mandate on all plans and insurers to
provide cost-effective treatment is necessary and beneficial.
(5) It is the intent of the General Assembly that this
act diminish the Statewide economic and personal cost of
tobacco addiction by making tobacco cessation treatments
available to all smokers. Approximately 20,000 Pennsylvania
adults die annually, at a rate of 16%, from smoking-related
causes. Tobacco-related personal health care costs total
approximately $4.7 billion annually in Pennsylvania.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Course of treatment." One of the following:
(1) In the case of counseling, treatment consisting of
at least four sessions of counseling lasting at least ten
20110SB0959PN1052 - 2 -
minutes.
(2) In the case of a prescription or over-the-counter
medication, the duration of treatment approved by the Food
and Drug Administration for that medication.
"Health insurance policy."
(1) An individual or group health insurance policy that
is delivered, issued for delivery, renewed, extended or
modified in this Commonwealth.
(2) The term does not include any of the following types
of insurance or a combination of any of the following types
of insurance:
(i) Short-term travel.
(ii) Accident-only.
(iii) Workers' compensation.
(iv) Short-term nonrenewable policies of not more
than six months' duration.
(v) Hospital indemnity.
(vi) Specified disease.
(vii) Disability income.
(viii) Dental.
(ix) Vision.
(x) Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement.
(xi) Medicare or Medicaid supplemental contract.
(xii) Long-term care.
Section 4. Mandated coverage.
(a) General rule.--Every health insurance policy that is
delivered, issued for delivery, renewed, extended or modified in
this Commonwealth on or after the effective date of this section
shall provide for tobacco cessation services that follow
20110SB0959PN1052 - 3 -
recommendations in the Public Health Service-sponsored 2008
clinical practice guideline, "Treating Tobacco Use and
Dependence: 2008 Update," or its successors. The coverage shall
include at least two courses of treatment in a 12-month period
including personal counseling, which may be telephone, group or
individual counseling, and all medications approved by the Food
and Drug Administration for the purpose of tobacco cessation,
including all prescription and over-the-counter medications.
(b) Copayment, coinsurance or deductible.--No copayment,
coinsurance or deductible may be applied to benefits under this
section.
(c) Contracting.--A health insurer may contract with
qualified local, Statewide or national providers, whether for
profit or nonprofit, for the provision of services under this
section.
(d) Disclosure.--An insurer shall disclose the benefits
under this section in its evidence of coverage and disclosure
forms and communicate the availability of coverage to all
insureds at least once per year.
(e) Counseling.--No patient may be required to enter
counseling in order to receive medications for tobacco cessation
treatment.
(f) Prior authorization.--No health care plan may impose
prior authorization or stepped care requirements on tobacco
cessation treatment.
Section 5. Effective date.
This act shall take effect in 60 days.
20110SB0959PN1052 - 4 -