Tobacco use is the leading preventable cause of death in the United States and Medi-Cal members have a higher prevalence of tobacco use than the general California population.
The Department of Health Care Services (DHCS) requires Medi-Cal Managed Care Plans to provide all preventive services identified by the United States Preventive Services Task Force (USPSTF). DHCS also recommends that health care providers ask all individuals ages 18 and older about tobacco use and offer cessation interventions to those who use tobacco products.
Requirements for SCFHP Providers: Effective November 1, 2014, all SCFHP providers are required to implement the following interventions with all SCFHP tobacco using members.
Initial and annual assessment of tobacco use for each adolescent and adult tobacco user
Providers MUST identify (initially and annually) all members (of any age) who use tobacco products and note this use in the member's medical record. Providers MUST do and document the following:
- Provide a completed Individual Comprehensive Health Assessment, which includes the Individual Health Education Behavioral Assessment (IHEBA), for all new members within 120 days of enrollment. The Staying Healthy Assessment(SHA) is DHCS's revised IHEBA. Each age-appropriate SHA questionnaire asks about smoking status and/or exposure to tobacco smoke. Click here for more information about SHA.
- Document tobacco use status for every member at least once per year. The SHA must be reviewed or re-administered on an annual basis. Smoking status can be reassessed through the use of the SHA.
- Ask tobacco users about tobacco use at every visit.
- Refer tobacco users to the California Smokers' Helpline (1-800-NO-BUTTS), a free statewide quit smoking service operated by the University of California San Diego, Medical Incentive to Quit Smoking Project: nobutts.org
Services for Pregnant Tobacco Users
At a minimum, Providers are required to:
- Ask all pregnant women if they use tobacco or are exposed to tobacco smoke, and document this use in the member's medical record.
- Offer all pregnant smokers at least one face-to-face counseling session per quit attempt and refer pregnant women to a tobacco cessation quit line (1-800-NO-BUTTS).
- Since smoking cessation medication is not recommended during pregnancy, providers should refer to the tobacco cessation guidelines from the American College of Obstetrics and Gynecology before considering offering tobacco cessation medication during pregnancy.
Prevention of tobacco use in children and adolescents
Providers MUST provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. Anticipatory guidance as outlined in the American Academy of Pediatrics Bright Futures is recommended.
Monitoring and Evaluation by SCFHP
To strengthen tobacco use screening and cessation interventions, SCFHP will monitor providers' performance in implementing the new tobacco requirements and interventions through the Facility Site Medical Record Review. During the medical record review, an SCFHP DHCS-certified nurse will review provider records for proper documentation of member tobacco use.