Findings

Congress makes the following findings: (1)At least 1 out of every 10 pregnant women in the United States smokes, which accounts for over 400,000 births per year. (2)Tobacco use during pregnancy causes serious harm to the fetus. Fetal mortality rates are 35 percent higher among pregnant women who smoke than among nonsmokers and the Surgeon General reports that a pregnant woman who smokes is 1.5 to 3.5 times more likely than a nonsmoker to have a low birth weight baby. (3)Studies have found that smoking and exposure to secondhand smoke among pregnant women is a major cause of miscarriage, stillbirths, and sudden infant death syndrome (SIDS). (4)A single percentage point decline in smoking prevalence among pregnant women would prevent 1,300 cases of low birth weight among babies annually and save at least $21,000,000 in direct medical costs. (5)For every $1 spent on smoking cessation for pregnant women, an estimated $3 in neonatal intensive care costs could be avoided. (6)Such costs have a disproportionate impact on Medicaid, with estimates indicating that pregnant women on Medicaid are more likely to smoke than pregnant women not on Medicaid. Smoking-attributable neonatal health care costs for Medicaid total almost $228,000,000, more than $700 per pregnant smoker. (7)In fiscal year 2008, States collected a record $24,400,000,000 from settlement agreements with the tobacco industry and tobacco taxes (an increase from $22,300,000,000 in fiscal year 2007). In fiscal year 2008, States spent just 2.9 percent of their tobacco-related revenue on tobacco prevention and cessation. (8)Evidence shows that the cuts States have made in tobacco prevention funding since 2002 have slowed or possibly stalled recent declines in youth smoking, putting further progress at risk.

Promoting cessation of tobacco use by pregnant women under the medicaid program

(a)

Requiring coverage of counseling and pharmacotherapy for cessation of tobacco use by pregnant women

Section 1905 of the Social Security Act (42 U.S.C. 1396d(a)(4)) is amended— (1)in subsection (a)(4)— (A)by striking and before (C); and (B)by inserting before the semicolon at the end the following new subparagraph: ; and (D) counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in subsection (y)); and (2)by adding at the end the following:

(y)(1)For purposes of this title, the term counseling and pharmacotherapy for cessation of tobacco use by pregnant women means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for cessation of tobacco use by pregnant women who use tobacco products or who are being treated for tobacco use that is furnished— (A)by or under the supervision of a physician; or (B)by any other health care professional who— (i)is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and (ii)is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose. (2)Subject to paragraph (3), such term is limited to— (A)services recommended with respect to pregnant women 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 (B)such other services that the Secretary recognizes to be effective for cessation of tobacco use by pregnant women. (3)Such term shall not include coverage for drugs or biologicals that are not otherwise covered under this title.

(b)

Exception from optional restriction under medicaid prescription drug coverage

Section 1927(d)(2) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)) is amended— (1)in subparagraph (E), by inserting before the period at the end the following: , except in the case of pregnant women when recommended in accordance with the Guideline referred to in section 1905(y)(2)(A); and (2)in subparagraph (G), by inserting before the period at the end the following: , except, in the case of pregnant women when recommended in accordance with the Guideline referred to in section 1905(y)(2)(A), 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 counseling and pharmacotherapy for cessation of tobacco use by pregnant women

(1)

General cost-sharing limitations

Section 1916 of the Social Security Act (42 U.S.C. 1396o) is amended in each of subsections (a)(2)(B) and (b)(2)(B) by inserting , and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(y)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation by pregnant women in accordance with the Guideline referred to in section 1905(y)(2)(A) after complicate the pregnancy. (2)

Application to alternative cost-sharing

Section 1916A(b)(3)(B)(iii) of such Act (42 U.S.C. 1396o–1(b)(3)(B)(iii)) is amended by inserting , and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(y)) after complicate the pregnancy. (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 by inserting the following before the period: , and medical assistance provided for counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in subsection (y)) and for covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation by pregnant women in accordance with the Guideline referred to in subsection (y)(2)(A). (e)

Effective date

(1)

In general

Except as provided in paragraph (2), the amendments made by this section shall apply to services furnished on or after the first fiscal year quarter that begins after the date of enactment of this Act. (2)

Extension of effective date for State law amendment

In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirement imposed by the amendment made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.