Tobacco Cessation Program. The CONTRACTOR shall operate a tobacco cessation program to assist Members with tobacco cessation. The tobacco cessation program shall include, at a minimum, the following: Cessation Quitline; Group counseling; Individual counseling; and U.S. Food and Drug Administration (FDA) approved pharmacotherapies and/or nicotine replacement therapies such as Bupropion, Varenicline, nicotine patch, chewing gum, nasal spray, inhaler, and lozenges. The CONTRACTOR shall not require prior authorization for tobacco cessation services, including counseling, or nicotine replacement products or therapies. The CONTRACTOR shall have no limits on length of treatment or quit attempts per year and no step therapy requirements, and shall encourage but not require enrollment in counseling as part of the tobacco cessation program. The CONTRACTOR shall establish and implement a UM program that follows NCQA UM standards and promotes quality of care, adherence to standards of care, the efficient use of resources, Member choice, and the identification of service gaps within the service system. The CONTRACTOR’s UM program shall: Ensure that Members receive services based on their current condition and effectiveness of previous treatment; Ensure that services are based on the history of the problem/illness, its context, and desired outcomes; Assist Members and/or their Representatives in choosing among Providers and available treatments and services; Ensure the use of the least restrictive setting for crisis response and stabilization, emphasizing relapse and crisis prevention, not just crisis intervention; Detect over- and under-utilization of services to assess the quality and appropriateness of services furnished to Members with special health care needs, and to identify health care disparities for remediation; Inform Population Health Management strategies and activities; Accept the New Mexico Uniform Prior Authorization Form for non-emergency medical and pharmaceutical benefits, as required per the 2019 New Mexico Health Insurance Prior Authorization Act; Respond to prescription drug prior authorization requests in accordance with NMAC 8.308.9.26.E(7)(a)(b); Ensure that prior authorization requirements comply with the requirements for parity in mental health and SUD benefits as specified in 42 C.F.R. § 438.910(d); and Ensure that prior authorization is not required for service codes specified by HCA. The CONTRACTOR shall comply with State and federal requirements for Utilization Mana...
Tobacco Cessation Program. Covered employees can also meet this requirement if they participate in, and complete, a County-approved tobacco cessation program between January 1st and November 30th in the calendar year preceding the health insurance renewal.
Tobacco Cessation Program. 4.8.7.1. Data collected about tobacco dependence and cessation will inform program design efforts, monitoring, and evaluation of cessation programming to ensure program- and cost- effectiveness.
4.8.7.1.1. HCPF will provide quarterly reports to DPHE, by the 15th Business Day of the following month, of claims data concerning the utilization of tobacco cessation procedures and pharmacotherapy.
4.8.7.1.1.1. HCPF will provide de-identified summary data covering utilization rates and units of service of tobacco cessation counseling provided to Medicaid Members. Data will include provider/facility name and location and de-identified client-level information, aggregated as necessary to comply with patient privacy regulations, including Member county, age group, gender, and race/ethnicity.
4.8.7.1.1.2. HCPF will provide de-identified summary data covering utilization rates and units of service of tobacco cessation counseling provided to pregnant Medicaid Members. Data will include provider/facility name and location and de-identified client-level information, aggregated as necessary to comply with patient privacy regulations, including Member county, age group, gender, and race/ethnicity.
4.8.7.1.1.3. HCPF will provide de-identified summary data covering rates of tobacco cessation pharmacotherapy and nicotine replacement therapy prescriptions filled by Medicaid Members. Data will include provider/facility name and location and de-identified client-level information, aggregated as necessary to comply with patient privacy regulations, including Member county, age group, gender, and race/ethnicity.
4.8.7.1.2. HCPF will provide annual reports to DPHE, by the 15th Business Day of the following month, of claims data concerning the prevalence of tobacco dependence.
4.8.7.1.2.1. HCPF will provide de-identified summary data covering prevalence of tobacco dependence. Data will include diagnosing provider/facility name and location and de-identified client-level information, aggregated as necessary to comply with patient privacy regulations, including Member county, age group, gender, and race/ethnicity.
4.8.7.2. Cancer Program
4.8.7.3. Data collected about cancer in Colorado will inform the development and evaluation of public health programs that will improve access to disease prevention and management. Measures will include those endorsed by the National Quality Forum (NQF) and United States Preventive Services Task Force (USPSTF) related to screening recommendations.
4.8...
