108th CONGRESS
2d Session
S. 2730
To amend titles V, XVIII, and XIX of the Social Security Act to promote
cessation of tobacco use under the medicare program, the medicaid program,
and the maternal and child health services block grant program.
IN THE SENATE OF THE UNITED STATES
July 22, 2004
Mr. DURBIN introduced the following bill; which was read twice and referred
to the Committee on Finance
A BILL
To amend titles V, XVIII, and XIX of the Social Security Act to promote
cessation of tobacco use under the medicare program, the medicaid program,
and the maternal and child health services block grant program.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Medicare, Medicaid, and MCH Tobacco Cessation
Promotion Act of 2004'.
SEC. 2. MEDICARE COVERAGE OF COUNSELING FOR CESSATION OF TOBACCO USE.
(a) COVERAGE- Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2))
is amended--
(1) in subparagraph (Y), by striking `and' at the end;
(2) in subparagraph (Z), by inserting `and' at the end; and
(3) by adding at the end the following new subparagraph:
`(AA) counseling for cessation of tobacco use (as defined in subsection
(bbb));'.
(b) SERVICES DESCRIBED- Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended by adding at the end the following new subsection:
`Counseling for Cessation of Tobacco Use
`(bbb)(1)(A) Subject to subparagraph (B), the term `counseling for cessation
of tobacco use' means diagnostic, therapy, and counseling services for cessation
of tobacco use for individuals who use tobacco products or who are being treated
for tobacco use which are furnished--
`(i) by or under the supervision of a physician;
`(ii) by a practitioner described in clause (i), (iii), (iv), (v) or (vi)
of section 1842(b)(18)(C); or
`(iii) by a licensed tobacco cessation counselor (as defined in paragraph
(2)).
`(B) Such term is limited to--
`(i) services recommended in `Treating Tobacco Use and Dependence: A Clinical
Practice Guideline', published by the Public Health Service in June 2000,
or any subsequent modification of such Guideline; and
`(ii) such other services that the Secretary recognizes to be effective.
`(2) In this subsection, the term `licensed tobacco cessation counselor' means
a tobacco cessation counselor who--
`(A) is licensed as such by the State (or in a State which does not license
tobacco cessation counselors as such, is legally authorized to perform the
services of a tobacco cessation counselor in the jurisdiction in which the
counselor performs such services); and
`(B) meets uniform minimum standards relating to basic knowledge, qualification
training, continuing education, and documentation that are established by
the Secretary for purposes of this subsection.'.
(c) PAYMENT AND ELIMINATION OF COST-SHARING FOR COUNSELING FOR CESSATION OF
TOBACCO USE-
(1) PAYMENT AND ELIMINATION OF COINSURANCE- Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking `and' before `(V)'; and
(B) by inserting before the semicolon at the end the following: `, and
(W) with respect to counseling for cessation of tobacco use (as defined
in section 1861(ww)), the amount paid shall be 100 percent of the lesser
of the actual charge for the service or the amount determined by a fee
schedule established by the Secretary for purposes of this subparagraph'.
(2) ELIMINATION OF COINSURANCE IN OUTPATIENT HOSPITAL SETTINGS-
(A) EXCLUSION FROM OPD FEE SCHEDULE- Section 1833(t)(1)(B)(iv) of the
Social Security Act (42 U.S.C. 1395l(t)(1)(B)(iv)) is amended by striking
`and diagnostic mammography' and inserting `, diagnostic mammography,
or counseling for cessation of tobacco use (as defined in section 1861(bbb))'.
(B) CONFORMING AMENDMENTS- Section 1833(a)(2) of the Social Security Act
(42 U.S.C. 1395l(a)(2)) is amended--
(i) in subparagraph (F), by striking `and' after the semicolon at the
end;
(ii) in subparagraph (G)(ii), by striking the comma at the end and inserting
`; and'; and
(iii) by inserting after subparagraph (G)(ii) the following new subparagraph:
`(H) with respect to counseling for cessation of tobacco use (as defined
in section 1861(bbb)) furnished by an outpatient department of a hospital,
the amount determined under paragraph (1)(W),'.
(3) ELIMINATION OF DEDUCTIBLE- The first sentence of section 1833(b) of
the Social Security Act (42 U.S.C. 1395l(b)) is amended--
(A) by striking `and' before `(6)'; and
(B) by inserting before the period the following: `, and (7) such deductible
shall not apply with respect to counseling for cessation of tobacco use
(as defined in section 1861(bbb))'.
(d) APPLICATION OF LIMITS ON BILLING- Section 1842(b)(18)(C) of the Social
Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the
following new clause:
`(vii) A licensed tobacco cessation counselor (as defined in section 1861(bbb)(2)).'.
(e) INCLUSION AS PART OF INITIAL PREVENTIVE PHYSICAL EXAMINATION- Section
1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) is amended
by adding at the end the following new subparagraph:
`(L) Counseling for cessation of tobacco use (as defined in subsection (bbb)).'.
(f) EFFECTIVE DATE- The amendments made by this section shall apply to services
furnished on or after the date that is 1 year after the date of enactment
of this Act.
SEC. 3. MEDICARE COVERAGE OF TOBACCO CESSATION PHARMACOTHERAPY.
(a) INCLUSION OF TOBACCO CESSATION AGENTS AS COVERED DRUGS- Section 1860D-2(e)(1)
of the Social Security Act (42 U.S.C. 1395w-102(e)(1)) is amended--
(1) in subparagraph (A), by striking `or' after the semicolon at the end;
(2) in subparagraph (B), by striking the comma at the end and inserting
`; or'; and
(3) by inserting after subparagraph (B) the following new subparagraph:
`(C) any agent approved by the Food and Drug Administration for purposes
of promoting, and when used to promote, tobacco cessation that may be
dispensed without a prescription (commonly referred to as an `over-the-counter'
drug), but only if such an agent is prescribed by a physician (or other
person authorized to prescribe under State law),'.
(b) ESTABLISHMENT OF CATEGORIES AND CLASSES CONSISTING OF TOBACCO CESSATION
AGENTS- Section 1860D-4(b)(3)(C) of the Social Security Act (42 U.S.C. 1395w-104(b)(3)(C))
is amended by adding at the end the following new clause:
`(iv) CATEGORIES AND CLASSES OF TOBACCO CESSATION AGENTS- There shall
be a therapeutic category or class of covered part D drugs consisting
of agents approved by the Food and Drug Administration for cessation
of tobacco use. Such category or class shall include tobacco cessation
agents described in subparagraphs (A) and (C) of section 1860D-2(e)(1).'.
(c) CONFORMING AMENDMENT- Section 1860D-2(e)(2)(A) of the Social Security
Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended by striking `, other than subparagraph
(E) of such section (relating to smoking cessation agents),'.
SEC. 4. PROMOTING CESSATION OF TOBACCO USE UNDER THE MEDICAID PROGRAM.
(a) COVERAGE OF TOBACCO CESSATION COUNSELING SERVICES-
(1) IN GENERAL- Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a))
is amended--
(A) in paragraph (26), by striking `and' after the semicolon at the end;
(B) by redesignating paragraph (27) as paragraph (28); and
(C) by inserting after paragraph (26) the following new paragraph:
`(27) at the option of the State, counseling for cessation of tobacco use
(as defined in section 1861(bbb)); and'.
(2) CONFORMING AMENDMENT- Section 1902(a)(10)(C)(iv) of the Social Security
Act (42 U.S.C. 1396a(a)(10)(C)(iv)) is amended by inserting `or (27)' after
`(24)'.
(b) ELIMINATION OF OPTIONAL EXCLUSION FROM MEDICAID PRESCRIPTION DRUG COVERAGE
FOR TOBACCO CESSATION MEDICATIONS- Section 1927(d)(2) of the Social Security
Act (42 U.S.C. 1396r-8(d)(2)) is amended--
(1) by striking subparagraph (E);
(2) by redesignating subparagraphs (F) through (J) as subparagraphs (E)
through (I), respectively; and
(3) in subparagraph (F) (as redesignated by paragraph (2)), by inserting
before the period at the end the following: `, other than agents approved
by the Food and Drug Administration for purposes of promoting, and when
used to promote, tobacco cessation'.
(c) REMOVAL OF COST-SHARING FOR TOBACCO CESSATION COUNSELING SERVICES AND
MEDICATIONS- Subsections (a)(2) and (b)(2) of section 1916 of the Social Security
Act (42 U.S.C. 1396o) are each amended--
(1) in subparagraph (D), by striking `or' after the comma at the end;
(2) in subparagraph (E), by striking `; and' and inserting `, or'; and
(3) by adding at the end the following new subparagraph:
`(F)(i) counseling for cessation of tobacco use described in section 1905(a)(27);
or
`(ii) covered outpatient drugs (as defined in paragraph (2) of section
1927(k), and including nonprescription drugs described in paragraph (4)
of such section) that are prescribed for purposes of promoting, and when
used to promote, tobacco cessation; and'.
(d) INCREASED FMAP FOR TOBACCO CESSATION COUNSELING SERVICES AND MEDICATIONS-
The first sentence of section 1905(b) of the Social Security Act (42 U.S.C.
1396d(b)) is amended--
(1) by striking `and' before `(4)'; and
(2) by inserting before the period the following: `, and (5) for purposes
of this title, the Federal medical assistance percentage shall be 80 percent
with respect to amounts expended as medical assistance for counseling for
cessation of tobacco use described in subsection (a)(27) and for covered
outpatient drugs (as defined in paragraph (2) of section 1927(k), and including
nonprescription drugs described in paragraph (4) of such section) that are
prescribed for purposes of promoting, and when used to promote, tobacco
cessation'.
(e) EFFECTIVE DATE- The amendments made by this section shall apply to services
furnished on or after the date that is 1 year after the date of enactment
of this Act.
SEC. 5. PROMOTING CESSATION OF TOBACCO USE UNDER THE MATERNAL AND CHILD
HEALTH SERVICES BLOCK GRANT PROGRAM.
(a) QUALITY MATERNAL AND CHILD HEALTH SERVICES INCLUDES TOBACCO CESSATION
COUNSELING AND MEDICATIONS- Section 501 of the Social Security Act (42 U.S.C.
701) is amended by adding at the end the following new subsection:
`(c) For purposes of this title, quality maternal and child health services
include the following:
`(1) Counseling for cessation of tobacco use (as defined in section 1861(bbb)).
`(2) The encouragement of the prescribing and use of agents approved by
the Food and Drug Administration for purposes of tobacco cessation.
`(3) The inclusion of messages that discourage tobacco use in health promotion
counseling.'.
(b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect
on the date that is 1 year after the date of enactment of this Act.
END
