SF 490 (LSB 2670SV (4) 88)

SENATE FILE 490

BY  COMMITTEE ON HUMAN RESOURCES

(SUCCESSOR TO SSB 1189)

A BILL FOR

An Act relating to tobacco cessation services under the Medicaid program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  TOBACCO CESSATION SERVICES —— NICOTINE REPLACEMENT THERAPY —— MEDICAID PROGRAM.
   1.  Beginning July 1, 2019, the department of human services shall, contractually and by administrative rules adopted pursuant to chapter 17A, require under Medicaid fee-for-service and Medicaid managed care administration that a Medicaid member, who contacts the member’s Medicaid managed care organization’s tobacco cessation program or Quitline Iowa seeking tobacco cessation services utilizing nicotine replacement therapy, shall be eligible to receive nicotine replacement therapy without prior authorization, unless otherwise provided under subsection 2. However, after two failed attempts by the Medicaid member within a consecutive eighteen-month period, any subsequent request for nicotine replacement therapy by the Medicaid member shall be subject to prior authorization.
   2.  If a Medicaid member is under eighteen years of age, age-appropriate federal food and drug administration guidelines shall be applicable and prior authorization shall be required for approval of nicotine replacement therapy.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill requires the department of human services (DHS) to contractually and by administrative rules adopted pursuant to Code chapter 17A require, under Medicaid fee-for-service and Medicaid managed care administration, that a Medicaid member, who contacts the member’s Medicaid managed care organization’s tobacco cessation program or Quitline Iowa seeking tobacco cessation services utilizing nicotine replacement therapy, shall be eligible to receive nicotine replacement therapy without prior authorization, with some limitations, including if the Medicaid member has had two failed attempts using the nicotine replacement therapy or if the member is under 18 years of age.