Legislature(2011 - 2012)CAPITOL 106
02/14/2012 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB209 | |
| HB310 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 310 | TELECONFERENCED | |
| += | HB 209 | TELECONFERENCED | |
HB 209-INSURANCE COVERAGE FOR TOBACCO CESSATION
3:07:38 PM
CHAIR KELLER announced that the first order of business would be
HOUSE BILL NO. 209, "An Act requiring a health care insurer to
provide coverage for tobacco cessation treatment."
3:08:13 PM
REPRESENTATIVE HERRON, introducing HB 209 as the prime sponsor
of the bill, emphasized that dependence on tobacco was chronic,
and it negatively affected the health, productivity, and well-
being of all Alaskans who indulged in its use. He reported that
tobacco was a leading cause of death for Alaskans, more than
suicide, motor vehicle crashes, and liver disease combined. He
added that the negative economic impact was huge, as it cost
Alaskans more than $300 million in direct medical expenditures,
with an additional $177 million in lost productivity. He
declared "it's a hard habit to kick." He clarified that the
proposed bill offered Alaskans an opportunity for the resources
to end their tobacco addiction, through cessation treatments
offered by insurance companies. He offered to listen to
testimony whether to mandate this.
3:11:28 PM
CHAIR KELLER expressed his concern with a mandate for private
insurance. He asked to clarify that Representative Herron would
offer proposed HB 209 as an insurance policy option to buy, not
as a mandated coverage.
3:12:03 PM
REPRESENTATIVE HERRON confirmed that testimony would determine
if it was practical to delete "provide", and insert "offer," in
the bill.
3:12:48 PM
CHAIR KELLER asked if there was other insurance coverage which
had to be available, but was not mandated.
REPRESENTATIVE HERRON replied that he would research this.
CHAIR KELLER offered his belief that there was other coverage,
and he expressed a desire to know how this had been received.
3:13:28 PM
REPRESENTATIVE SEATON directed attention to the proposed bill,
page 2, Section 1, subsection (c)(3), which read: "Coverage for
tobacco cessation treatment may not require an individual to
participate in a counseling session in order to receive coverage
for medication;" and asked for clarification with page 1,
proposed Section 1, subsection (b)(1), which read: "coverage
for a course of tobacco cessation treatment must include the
cost of not less than four tobacco cessation counseling sessions
provided by a qualified counselor ...."
3:14:36 PM
LIZ CLEMENTS, Staff, Representative Bob Herron, Alaska State
Legislature, replied that the insurance company would be
required to cover at least four counseling sessions per course
of treatment, but that individual consumers would not be forced
to attend counseling sessions as a condition of the treatment
coverage. She declared that experience had shown that success
was higher when the participant was able to determine "how they
choose to quit."
3:18:10 PM
REPRESENTATIVE SEATON, directing attention to page 1, line 9,
proposed Section 1(b)(1), "not less than four tobacco cessation
counseling sessions provided by a qualified counselor," asked if
there was a limit to the number of counseling sessions.
Directing attention to proposed Section 1(b)(2), "over the
counter medication or prescribed medication," he asked if the
transition between paragraphs (1) and (2) was for "and," "or,"
or "and/or."
3:19:04 PM
MS. CLEMENTS, in response to Representative Seaton, agreed that
the minimum number of counseling sessions requiring coverage
would be four. She offered her belief that proposed HB 209
should include "and" between Section 1(b)(1) and (2).
3:19:51 PM
CHAIR KELLER suggested a similar review for the transitions
between paragraphs (1), (2), (3), and (4) of proposed Section
1(c) as well.
REPRESENTATIVE SEATON suggested that Legislative Legal and
Research Services be consulted.
3:20:35 PM
REPRESENTATIVE HERRON clarified that proposed HB 209 did not
want to legislate over the counter medications.
3:20:57 PM
CHAIR KELLER opened public testimony.
3:21:11 PM
LOIS KEITHLY, Director, Massachusetts Tobacco Control Program,
Surveillance and Evaluation Director, Tobacco Control Program,
Massachusetts Department of Public Health, reported that, in
2006, a cessation benefit had been developed for the Medicaid
population. She declared that access to all FDA-approved
medications, "with 16 face to face counseling sessions," and low
co-payments, had resulted in 40 percent use of the benefit, and
a smoking prevalence decrease of 10 percent. She relayed that a
review of the claims data from those smokers utilizing the
benefit found a 46 percent decrease in the possibility of
hospitalization for heart attack and a 49 percent decrease in
the probability of hospitalization for acute coronary heart
disease. She directed attention to a recent return of
investment study by George Washington University which applied
the findings of the aforementioned Medicaid benefit. The report
estimated that every dollar spent for the benefit resulted in a
$3.12 savings for decreased cardiac hospitalization. She opined
that this was strong evidence that encouraging smokers to quit
could offset health care costs.
3:25:33 PM
REPRESENTATIVE SEATON asked to have the George Washington
University study forwarded to the committee.
3:25:57 PM
REPRESENTATIVE MILLER asked to clarify the savings.
3:26:33 PM
MS. KEITHLY, in response to Representative Miller, replied that
the savings reflected every dollar spent, which included
medications, counseling, promotion, and staff time, which
compared to the costs of the aforementioned acute cardiac
conditions.
REPRESENTATIVE MILLER summarized that "it was profitable."
3:27:35 PM
REPRESENTATIVE SEATON asked if the counseling sessions were
local, or centralized, and if the project paid the participants'
transportation costs.
MS. KEITHLY replied that, in Massachusetts, transportation was
never considered a cost. She reported that only 1 - 3 percent
of the claims were for counseling, and the claims could only be
submitted if the counseling was conducted in a hospital or
community health setting.
CHAIR KELLER asked if the program was provided by a government
or a private insurance plan.
MS. KEITHLY replied that this was a Medicaid program, which had
been mandated by the Massachusetts State Legislature.
3:30:07 PM
CHAIR KELLER agreed to the benefits for tobacco cessation, but
acknowledged the question of who would pay for the program.
3:30:22 PM
CHAIR KELLER closed public testimony.
3:30:42 PM
REPRESENTATIVE SEATON asked if a program benefit would include
transportation for the tobacco counseling sessions.
REPRESENTATIVE HERRON offered to clarify this in proposed HB
209.
3:31:59 PM
CHAIR KELLER asked if other private medical insurance would
cover counseling for similar programs.
MS. CLEMENTS replied that she would research this.
REPRESENTATIVE MILLETT asked if the State of Alaska covered
tobacco cessation programs.
MS. CLEMENTS replied that she would defer to the Department of
Health and Social Services.
3:33:23 PM
CHAIR KELLER asked if there was medical insurance coverage for
over the counter medications. Directing attention to proposed
Section 2, he offered his belief that lack of a requirement for
pre-authorization implied that a person "could buy a tobacco
cessation medication and then just directly submit the bill for
the coverage. It just seems like that's out of the norm."
REPRESENTATIVE HERRON replied that he would research this.
3:35:02 PM
REPRESENTATIVE MILLETT, directing attention to the over the
counter medication, asked if cost was an issue for tobacco
cessation.
MS. CLEMENTS replied that several people had indicated that cost
was a primary impediment.
3:35:41 PM
REPRESENTATIVE MILLETT asked if there was any money from the
1998 Tobacco Master Settlement Agreement award to offer for
payment toward over the counter tobacco cessation products.
MS. CLEMENTS replied that she would research this.
3:36:32 PM
CHAIR KELLER opened public testimony.
3:36:46 PM
JAMIE MORGAN, Senior Government Relations Director, American
Heart Association (AHA), Western States Affiliate, testified
that the AHA supported proposed HB 209. She said that
addressing the problem of smoking was a core component of the
AHA mission, and that "unrestricted access to smoking cessation
treatment dramatically improves the success of the patient
attempts, in some cases more than a doubling of the odds for
successfully quitting." She reported that after one year of
smoking cessation, the excess risk of coronary disease caused by
smoking was reduced by half, and after 15 years, these coronary
disease risks were similar to those who had never smoked. She
stated that smoking was the leading cause of preventable death
and a major risk factor for heart disease, stroke, and cancer.
She said that unrestricted access to evidence based cessation
treatment lead to a greater likelihood for successfully quitting
smoking. She offered her belief that proposed HB 209 would
"mean improved public health, cost reduction for treating
chronic disease, and it will result in widespread economic
gain." She urged support for proposed HB 209.
3:38:53 PM
REPRESENTATIVE MILLER, reflecting that many ailments were
negatively impacted by tobacco use, asked if smoking increased
the incidence of miscarriages.
MS. MORGAN replied that this was correct.
3:40:25 PM
PAT REYNAGA, Nurse, Lead Advocacy Volunteer, American Cancer
Society, Cancer Action Network, stated that "tobacco has had and
continues to have devastating, adverse health effects on
Alaskans." She shared that in prior years, the legislature had
supported comprehensive programs, and she stated that tobacco
cessation coverage was one of the most cost effective health
insurance benefits, and that cessation was possible with
evidence based programs.
3:41:13 PM
CHAIR KELLER asked how many times a smoker would try to quit
before success.
MS. REYNAGA replied that there were up to 10 attempts, and she
pointed out that 71 percent of Alaskan adult smokers wanted to
quit.
3:42:24 PM
SHEELA TALLMAN, Premera Blue Cross, testified that Premera Blue
Cross was in opposition to the current proposed version of HB
209. She said that Premera had submitted a letter outlining its
concerns, and offering suggested amendments to the proposed
bill. She reported that Premera currently provided
comprehensive coverage to programs focused on wellness and
prevention. She relayed that the majority of Premera plans
covered tobacco cessation counseling and treatment programs, as
well as certain prescription drugs. She said that the federal
Patient Protection and Affordable Care law declared that insured
and self-insured health plans must include preventive services
such as tobacco cessation and counseling without cost sharing.
She expressed concern that the proposed bill removed cost
control tools such as prior authorization. She pointed out that
federal law stated that nothing would prohibit insurers from
implementing reasonable medical management techniques, and that
the proposed bill went against this.
3:45:07 PM
REPRESENTATIVE MILLER asked for specifics about the cost sharing
and cost control measures.
MS. TALLMAN, in response, said that cost sharing referenced any
out of pocket cost to a member. She defined cost control tools
as medical management techniques which included pre-
authorization and frequency of services and treatments, in order
for insurers to manage overall costs.
3:47:10 PM
REPRESENTATIVE MILLETT asked if insurance plans covered over the
counter drugs.
MS. TALLMAN replied that she was not sure with respect to
smoking cessation. She offered her belief that many of these
could also be paid for through health care flexible spending
accounts.
3:48:03 PM
REPRESENTATIVE MILLETT asked whether Premera supported that the
proposed bill contained no connection between mandatory tobacco
cessation counseling and use of over the counter medications.
MS. TALLMAN replied that the majority of the Premera plans
covered cessation counseling and treatment programs.
REPRESENTATIVE MILLETT opined that the two should go hand in
hand.
3:50:29 PM
CHAIR KELLER closed public testimony.
[HB 209 was held over.]