July 1, 2010

In a proposed decision memo the Centers for Medicare and Medicaid Services (CMS) has concluded that “the evidence is adequate to conclude that counseling to prevent tobacco use, which is recommended with a grade of A by the U.S. Preventive Services Task Force (USPSTF) for all adults and pregnant women who use tobacco, is reasonable and necessary for prevention of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.”

CMS is proposing to cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries who use tobacco, regardless of whether the patient has signs and symptoms of tobacco-related disease.  Current Medicare language limits reimbursement for tobacco cessation counseling to patients who have a tobacco-related disease.

Under the proposal, the counseling would be provided by a qualified physician or other Medicare-recognized practitioner and include two individual tobacco cessation counseling interventions per year.  Each attempt may include a maximum of four intermediate or intensive sessions, with the total annual benefit thus covering up to eight sessions per Medicare beneficiary who uses tobacco. 

The practitioner and patient have the flexibility to choose between intermediate (more than three minutes) or intensive (more than ten minutes) cessation counseling sessions for each attempt.  This proposed decision does not modify existing coverage for minimal individual cessation counseling (three minutes or less), which is already covered, and is included in evaluation visits.
The comment period for this proposal ran through the end of June.  After evaluation of the comments, CMS will make a final determination and issue a final decision memorandum.
Partnership for Prevention submitted comments stating, “It is Partnership for Prevention’s position that this policy will help many tobacco users break free from a deadly behavior, people who otherwise would have been unable to do so. Undoubtedly, many lives will be extended and much money saved if this decision is enacted.”  Partnership issued a request for all interested parties to weigh in about this important step forward by CMS.

The full proposed decision memo can be seen here. http://www.cms.gov/mcd/viewdraftdecisionmemo.asp?id=242