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New Tobacco Cessation Benefits for all MassHealth Members Effective
July 1, 2006

Did you know that 36% of MassHealth members are smokers? According to the Massachusetts Department of Public Health, that is almost double the 19.4% smoking rate of the general state population. In light of the serious health implications of these high smoking rates, and of tobacco use in general, MassHealth has created a new benefit to help MassHealth members quit smoking or using tobacco.

Beginning July 1, 2006, individual and group tobacco cessation counseling and pharmacotherapy will be covered. Members eligible to receive physician services, community health center services, outpatient hospital services, and pharmacy services are covered for tobacco cessation services, based on their MassHealth coverage type as described at 130 CMR 450.105. Since stopping tobacco use may require multiple attempts, this benefit is designed to allow members and providers as much flexibility as possible. Members may use up to 16 counseling sessions in any combination of group or individual face-to-face sessions per year, including two intake/assessment sessions. Prior authorization is required for counseling sessions beyond this limit.

Members may obtain a 90-day supply of nicotine patch, gum, or lozenge per cessation attempt; the nicotine inhaler and nasal spray require prior authorization. A maximum of two 90-day treatment regimens are covered per 12-month cycle. Additional nicotine replacement therapy (NRT) medication requires prior authorization. Please see the MassHealth Drug List for further details about other drugs used for tobacco cessation. The MassHealth Drug List can be found at www.mass.gov/druglist. It can also be accessed from the MassHealth Pharmacy Program home page at www.mass.gov/masshealth/pharmacy.

Physicians, registered nurses, physician's assistants, nurse practitioners, and nurse midwives are authorized to provide tobacco cessation counseling. Tobacco cessation counselors who have received the appropriate training (as designated in MassHealth Regulations available online at www.mass.gov/masshealthpubs) may also provide counseling. Any non-physician providers must be under the supervision of a physician. For further details about providing MassHealth Tobacco Cessation services please see the related transmittal letters in the MassHealth on-line provider library.

If you have any questions about this benefit, contact MassHealth Customer Service at 1-800-841-2900.

QuitWorks Continues to Grow

• Over 10,000 clients have been referred to QuitWorks since the program started and 20.5% reported they were quit when called six months later.
• More than 90% of QuitWorks clients reported that they were satisfied with proactive calling and with the Massachusetts Helpline Counselor (93.6% & 91.4%)
• 83.8% reported that their health care provider increased motivation to quit.
• In a recent survey conducted with all Massachusetts hospitals, 43% of those responding reported using QuitWorks.

Blue Cross Demonstration Project

January 2005 -- The University of Massachusetts Medical School is working with 10 community health centers serving cultural and linguistic minorities to implement QuitWorks. This project is supported with funding from Blue Cross Blue Shield of Massachusetts in collaboration with the Massachusetts Department of Public Health and the Try-To-STOP TOBACCO Resource Center at John Snow, Inc.
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