[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 4524 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 4524

   To amend titles XIX and XXI of the Social Security Act to provide 
coverage of comprehensive tobacco cessation services under such titles, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            August 12, 2020

  Mr. Carper introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To amend titles XIX and XXI of the Social Security Act to provide 
coverage of comprehensive tobacco cessation services under such titles, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Quit Because of COVID-19 Act''.

SEC. 2. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN 
              MEDICAID.

    (a) Requiring Medicaid Coverage of Counseling and Pharmacotherapy 
for Cessation of Tobacco Use and Dependence.--Section 1905 of the 
Social Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (a)(4)--
                    (A) by striking ``and (D)'' and inserting ``(D)''; 
                and
                    (B) by inserting before the semicolon at the end 
                the following: ``; and (E) counseling and 
                pharmacotherapy for cessation of tobacco use and 
                dependence by individuals who are eligible under the 
                State plan (as defined in subsection (gg)) during the 
                period beginning on the first day of the emergency 
                period described in section 1135(g)(1)(B) and ending on 
                the last day of the 2-year period that begins with the 
                day after the last day of such emergency period''; and
            (2) by adding at the end the following new subsection:
    ``(gg) Counseling and Pharmacotherapy for Cessation of Tobacco Use 
and Dependence.--
            ``(1) In general.--For purposes of this title, the term 
        `counseling and pharmacotherapy for cessation of tobacco use 
        and dependence' 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 the cessation 
        of tobacco use and dependence by individuals who use tobacco 
        products or who are being treated for tobacco use and 
        dependence that are 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) Limitation.--Such term is limited to--
                    ``(A) services that are recommended--
                            ``(i) in the guideline entitled, `Treating 
                        Tobacco Use and Dependence: 2008 Update: A 
                        Clinical Practice Guideline' published by the 
                        Public Health Service in May 2008 (or any 
                        subsequent modification of such guideline); or
                            ``(ii) for the cessation of tobacco use and 
                        dependence by the United States Preventive 
                        Services Task Force; or
                    ``(B) any additional interventions approved by the 
                Food and Drug Administration as safe and effective in 
                the cessation of tobacco use and dependence by 
                individuals who use tobacco products or who are being 
                treated for tobacco use and dependence.''.
    (b) No Cost Sharing.--
            (1) In general.--Subsections (a)(2) and (b)(2) of section 
        1916 of the Social Security Act (42 U.S.C. 1396o) are each 
        amended--
                    (A) in subparagraph (F), by striking ``or'' at the 
                end;
                    (B) in subparagraph (G), by striking ``; and'' and 
                inserting ``, or''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(H) counseling and pharmacotherapy for cessation 
                of tobacco use and dependence (as defined in section 
                1905(gg)) 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 
                in accordance with a guideline, recommendation, or 
                approval specified in section 1905(gg)(2) (as 
                applicable) furnished during the period beginning on 
                the first day of the emergency period described in 
                section 1135(g)(1)(B) and ending on the last day of the 
                2-year period that begins with the day after the last 
                day of such emergency period; and''.
            (2) Application to alternative cost sharing.--Section 
        1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o-
        1(b)(3)(B)) is amended by adding at the end the following new 
        clause:
                            ``(xii) Counseling and pharmacotherapy for 
                        cessation of tobacco use and dependence (as 
                        defined in section 1905(gg)) 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 in accordance with a 
                        guideline, recommendation, or approval 
                        specified in section 1905(gg)(2) (as 
                        applicable) furnished during the period 
                        beginning on the first day of the emergency 
                        period described in section 1135(g)(1)(B) and 
                        ending on the last day of the 2-year period 
                        that begins with the day after the last day of 
                        such emergency period.''.
    (c) Exception From Optional Restriction Under Medicaid Prescription 
Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42 
U.S.C. 1396r-8(d)(2)(F)) is amended to read as follows:
                    ``(F) Nonprescription drugs, except, in the case of 
                pregnant women (and, during the period beginning on the 
                first day of the emergency period described in section 
                1135(g)(1)(B) and ending on the last day of the 2-year 
                period that begins with the day after the last day of 
                such emergency period, other individuals who use 
                tobacco products or are being treated for tobacco use 
                and dependence), when recommended in accordance with 
                the guideline specified in section 1905(bb)(2)(A) (or 
                in accordance with a guideline, recommendation, or 
                approval specified in section 1905(gg)(2), if 
                applicable), agents approved by the Food and Drug 
                Administration under the over-the-counter monograph 
                process for purposes of promoting, and when used to 
                promote, tobacco cessation.''.
    (d) State Monitoring and Promoting of Comprehensive Tobacco 
Cessation Services Under Medicaid.--Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a) is amended--
            (1) in paragraph (85), by striking at the end ``and'';
            (2) in paragraph (86), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (86) the following new 
        paragraph:
            ``(87) during the period beginning on the first day of the 
        emergency period described in section 1135(g)(1)(B) and ending 
        on the last day of the 2-year period that begins with the day 
        after the last day of such emergency period, provide that the 
        State will monitor and promote the use of comprehensive tobacco 
        cessation services under the State plan (including by 
        conducting an outreach campaign to increase awareness of the 
        benefits of using such services) among--
                    ``(A) individuals entitled to medical assistance 
                under the State plan who use tobacco products; and
                    ``(B) clinicians and others who provide services to 
                individuals entitled to medical assistance under the 
                State plan.''.
    (e) Federal Reimbursement for Coverage of Tobacco Cessation 
Services and Outreach Campaign.--
            (1) Coverage of tobacco cessation services.--Section 1905 
        of the Social Security Act (42 U.S.C. 1396d), as amended by 
        subsection (a), is amended--
                    (A) in subsection (b), by striking ``and (ff)'' and 
                inserting ``(ff), and (gg)(3)''; and
                    (B) in subsection (gg), as added by subsection (a), 
                by adding at the end the following new paragraph:
            ``(3) Increased fmap.--Notwithstanding subsection (b), the 
        Federal medical assistance percentage for a State, with respect 
        to amounts expended by such State for medical assistance 
        furnished during the emergency period described in section 
        1135(g)(1)(B) for counseling and pharmacotherapy for cessation 
        of tobacco use and dependence by eligible individuals, shall be 
        equal to 100 percent.''.
            (2) Outreach campaign.--Section 1903(a) of the Social 
        Security Act (42 U.S.C 1396b(a)) is amended--
                    (A) by striking the period at the end of paragraph 
                (7) and inserting ``; plus''; and
                    (B) by inserting after paragraph (7) the following 
                new paragraph:
            ``(8) an amount equal to 100 percent of the sums expended 
        in a quarter that occurs during the emergency period described 
        in section 1135(g)(1)(B) which are attributable to the 
        development, implementation, and evaluation of the outreach 
        campaign required under section 1902(a)(87).''.
    (f) No Prior Authorization for Tobacco Cessation Drugs Under 
Medicaid.--Section 1927(d) of the Social Security Act (42 U.S.C. 1396r-
8(d)) is amended--
            (1) in paragraph (1)(A), by striking ``A State'' and 
        inserting ``Subject to paragraph (8), a State''; and
            (2) by adding at the end the following new paragraph:
            ``(8) No prior authorization programs for tobacco cessation 
        drugs.--During the period beginning on the first day of the 
        emergency period described in section 1135(g)(1)(B) and ending 
        on the last day of the 2-year period after the last day of such 
        emergency period, a State plan may not require, as a condition 
        of coverage or payment for a covered outpatient drug that is an 
        agent to promote smoking cessation (including agents approved 
        by the Food and Drug Administration) or tobacco cessation, the 
        approval of such drug before its dispensing.''.
    (g) Exclusion of Enhanced Payments From Territorial Caps.--
Notwithstanding any other provision of law, for purposes of section 
1108 of the Social Security Act (42 U.S.C. 1308), with respect to any 
additional amount paid to a territory as a result of the application of 
paragraph (8) of section 1903(a) or subsection (gg)(3) of section 1905 
of the Social Security Act (42 U.S.C. 1396b(a), 1396d)--
            (1) the limitation on payments to territories under 
        subsections (f) and (g) of such section 1108 shall not apply to 
        such additional amounts; and
            (2) such additional amounts shall be disregarded in 
        applying such subsections.

SEC. 3. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN CHIP.

    (a) Requiring CHIP Coverage of Counseling and Pharmacotherapy for 
Cessation of Tobacco Use and Dependence.--
            (1) In general.--Section 2103(c)(2) of the Social Security 
        Act (42 U.S.C. 1397cc(c)(2)) is amended by adding at the end 
        the following new subparagraph:
                    ``(D) Counseling and pharmacotherapy for cessation 
                of tobacco use and dependence by individuals who are 
                eligible under the State child health plan during the 
                period beginning on the first day of the emergency 
                period described in section 1135(g)(1)(B) and ending on 
                the last day of the 2-year period that begins with the 
                day after the last day of such emergency period.''.
            (2) Counseling and pharmacotherapy for cessation of tobacco 
        use and dependence defined.--Section 2110(c) of the Social 
        Security Act (42 U.S.C. 1397jj(c)) is amended by adding at the 
        end the following new paragraph:
            ``(10) Counseling and pharmacotherapy for cessation of 
        tobacco use and dependence.--
                    ``(A) In general.--The term `counseling and 
                pharmacotherapy for cessation of tobacco use and 
                dependence' 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 the cessation of tobacco use and dependence by 
                individuals who use tobacco products or who are being 
                treated for tobacco use and dependence that are 
                furnished--
                            ``(i) by or under the supervision of a 
                        physician; or
                            ``(ii) 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.
                    ``(B) Limitation.--Such term is limited to--
                            ``(i) services that are recommended--
                                    ``(I) in the guideline entitled, 
                                `Treating Tobacco Use and Dependence: 
                                2008 Update: A Clinical Practice 
                                Guideline' published by the Public 
                                Health Service in May 2008 (or any 
                                subsequent modification of such 
                                guideline); or
                                    ``(II) for the cessation of tobacco 
                                use and dependence by the United States 
                                Preventive Services Task Force; or
                            ``(ii) any additional interventions 
                        approved by the Food and Drug Administration as 
                        safe and effective in the cessation of tobacco 
                        use and dependence by individuals who use 
                        tobacco products or who are being treated for 
                        tobacco use and dependence.''.
    (b) No Cost Sharing.--Section 2103(e) of the Social Security Act 
(42 U.S.C. 1397cc(e)) is amended by adding at the end the following new 
paragraph:
            ``(5) No cost sharing on benefits for counseling and 
        pharmacotherapy for cessation of tobacco use and dependence.--
        The State child health plan may not impose deductibles, 
        coinsurance, or other cost sharing with respect to benefits for 
        counseling and pharmacotherapy for cessation of tobacco use and 
        dependence (as defined in section 2110(c)(10)) and prescription 
        drugs that are covered under a State child health plan that are 
        prescribed for purposes of promoting tobacco cessation in 
        accordance with a guideline, recommendation, or approval 
        specified in section 2110(c)(10)(B) furnished during the period 
        beginning on the first day of the emergency period described in 
        section 1135(g)(1)(B) and ending on the last day of the 2-year 
        period that begins with the day after the last day of such 
        emergency period.''.
    (c) Exception From Optional Restriction Under CHIP Prescription 
Drug Coverage.--Section 2103 of the Social Security Act (42 U.S.C. 
1397cc) is amended by adding at the end the following new subsection:
    ``(g) Exception From Optional Restriction Under CHIP Prescription 
Drug Coverage.--The State child health plan may exclude or otherwise 
restrict nonprescription drugs, except--
            ``(1) in the case of pregnant women, when recommended in 
        accordance with a guideline, recommendation, or approval 
        specified in section 2110(c)(10)(B), agents approved by the 
        Food and Drug Administration under the over-the-counter 
        monograph process for purposes of promoting, and when used to 
        promote, tobacco cessation; and
            ``(2) in the case of individuals who are eligible under the 
        State child health plan, when recommended in accordance with a 
        guideline, recommendation, or approval specified in section 
        2110(c)(10)(B) referred to in section 2110(c)(10)(B), agents 
        approved by the Food and Drug Administration under the over-
        the-counter monograph process for purposes of promoting, and 
        when used to promote, tobacco cessation during the period 
        beginning on the first day of the emergency period described in 
        section 1135(g)(1)(B) and ending on the last day of the 2-year 
        period that begins on the day after the last day of such 
        emergency period.''.
    (d) State Monitoring and Promoting of Comprehensive Tobacco 
Cessation Services Under CHIP.--Section 2102 of the Social Security Act 
(42 U.S.C. 1397bb) is amended by adding at the end the following new 
subsection:
    ``(d) State Monitoring and Promoting of Comprehensive Tobacco 
Cessation Services Under CHIP.--A State child health plan shall include 
a description of the procedures to be used by the State during the 
period beginning on the first day of the emergency period described in 
section 1135(g)(1)(B) and ending on the last day of the 2-year period 
after the last day of such emergency period to monitor and promote the 
use of comprehensive tobacco cessation services under the State plan 
(including conducting an outreach campaign to increase awareness of the 
benefits of using such services) among--
            ``(1) individuals entitled to child health assistance under 
        the State child health plan who use tobacco products; and
            ``(2) clinicians and others who provide services to 
        individuals entitled to child health assistance under the State 
        child health plan.''.
    (e) Federal Reimbursement for CHIP Coverage and Outreach 
Campaign.--Section 2105(a) of the Social Security Act (42 U.S.C. 
1397ee(a)) is amended by adding at the end the following new paragraph:
            ``(5) Federal reimbursement for chip coverage of 
        comprehensive tobacco cessation services and outreach 
        campaign.--In addition to the payments made under paragraph (1) 
        (and, in the case of a payment that may be made both under 
        paragraph (1) and under this paragraph, instead of a payment 
        under paragraph (1)), for the period beginning on the first day 
        of the emergency period described in section 1135(g)(1)(B) and 
        ending on the last day of the 2-year period that begins on the 
        day after the last day of such emergency period, the Secretary 
        shall pay--
                    ``(A) an amount equal to 100 percent of the sums 
                expended during each quarter which are attributable to 
                the cost of furnishing counseling and pharmacotherapy 
                for cessation of tobacco use and dependence by 
                individuals who are eligible under the State child 
                health plan; plus
                    ``(B) an amount equal to 100 percent of the sums 
                expended during each quarter which are attributable to 
                the development, implementation, and evaluation of an 
                outreach campaign to--
                            ``(i) increase awareness of comprehensive 
                        tobacco cessation services covered in the State 
                        child health plan among--
                                    ``(I) individuals who are likely to 
                                be eligible for medical assistance 
                                under the State child health plan; and
                                    ``(II) clinicians and others who 
                                provide services to individuals who are 
                                likely to be eligible for medical 
                                assistance under the State child health 
                                plan; and
                            ``(ii) increase awareness of the benefits 
                        of using comprehensive tobacco cessation 
                        services covered in the State child health plan 
                        among--
                                    ``(I) individuals who are likely to 
                                be eligible for medical assistance 
                                under the State child health plan; and
                                    ``(II) clinicians and others who 
                                provide services to individuals who are 
                                likely to be eligible for medical 
                                assistance under the State child health 
                                plan about the benefits of using 
                                comprehensive tobacco cessation 
                                services.''.
    (f) No Prior Authorization for Tobacco Cessation Drugs Under 
CHIP.--Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as 
amended by subsection (c), is further amended--
            (1) in subsection (c)(2)(A), by inserting ``(in accordance 
        with subsection (h))'' after ``Coverage of prescription 
        drugs''; and
            (2) by adding at the end the following new subsection:
    ``(h) No Prior Authorization Programs for Tobacco Cessation 
Drugs.--During the period beginning on the first day of the emergency 
period described in section 1135(g)(1)(B) and ending on the last day of 
the 2-year period that begins with the day after the last day of such 
emergency period, a State child health plan may not require, as a 
condition of coverage or payment for a prescription drug that is an 
agent to promote smoking cessation (including agents approved by the 
Food and Drug Administration) or tobacco cessation, the approval of 
such drug before its dispensing.''.

SEC. 4. CONFORMING AMENDMENTS.

    Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended in each of sections 1905(a)(4)(D), 1905(bb)(1), 1905(bb)(2)(B), 
1916(a)(2)(B), 1916(b)(2)(B), and 1916A(b)(3)(B)(iii) by striking 
``tobacco use'' each place it appears and inserting ``tobacco use and 
dependence''.

SEC. 5. RULE OF CONSTRUCTION.

    None of the amendments made by this Act shall be construed to limit 
coverage of any counseling or pharmacotherapy for individuals under 18 
years of age.
                                 <all>