HSI Guide for Addressing Tobacco Use Treatment Prescription Denials for New York State Medicaid Patients This guide is designed to help HSI grantees assist Health Care Organizations with issues surrounding Medicaid prescription denials for TUT medication in New York State. It is accompanied by two tools, listed below. A Prescriber Chart entitled Writing Tobacco Use Treatment Prescriptions for New York State Medicaid Patients and a Dear Pharmacist Letter.
Prescriber Chart: Writing Tobacco Use Treatment Prescriptions for New York State Medicaid Patients This tool is meant to assist prescribers when writing prescriptions to treat tobacco use. The first page of the tool includes some tips on how to prescribe TUT medications such as Prescribing the generic product when available and a note that All Tobacco Use Treatment medications including those available over the counter can be prescribed for individuals 18 years or older. The 2nd page of the tool has a chart that includes an outline of the 7 FDA Medications This resource is adapted from the Expanded Medicaid benefit letter signed by New York State Department Of Health and New York City-Department Of Health and Mental Hygiene Health Commissioners. Dear Pharmacist Letter Reimbursement for Tobacco Dependence Treatment: Resource from CAI
New York State Clinical Records Initiative (NSYCRI) This resource is a standardized clinical record system designed for outpatient and residential, mental health, and substance use disorder treatment services. NYSCRI may be utilized in a paper (PDF), e-Word or Electronic Medical Record (EMR) format and is available in the public domain at no cost to users. All documentation data elements and processes were designed to accommodate and comply with the regulations and standards set by New York State Office of Mental Health and New York State Office of Alcoholism and Substance Abuse Services. Resource from the Office of Mental Health and the New York State Office of Alcoholism and Substance Abuse Services
Smoking Cessation Medication Prescribing Chart (2017)
This prescribing chart details the different FDA-approved smoking cessation medications, including suggested regimen, precautions, contraindications, potential adverse effects, and brief instructions. Chart from New York City Department of Health and Mental Hygiene
Behavioral Health Tobacco Dependence Treatment Regulation Crosswalk (2016) This resource assists in developing a set of guidelines for behavioral health organizations to implement best practices in accordance with their regulations. It is intended to support New York State Department of Health Bureau of Tobacco Control Regional Contractors in examining regulations and standards of care that partnering behavioral health sites must adhere to. Guidelines from CAI
New York State (NYS) Smoking Cessation Counseling Information and Billing Codes (2015) This resource documents the billing codes for tobacco dependence treatment delivered to beneficiaries covered by New York State Medicaid, Medicare/Medicare Advantage, TRICARE, and commercial insurance. Guide from New York City Department of Health and Mental Hygiene
Using Health Systems Change to Increase Tobacco Cessation: What Can State Tobacco Control Programs Do? Frequently Asked Questions (2014)
This resource defines health systems, the meaning and importance of health systems change in the tobacco control context, and what health systems look like in practice with regards to delivery system design, clinical information systems and electronic health records (EHR), and decision support systems.
FAQ from Centers for Disease Control and Prevention
Best Practices for Comprehensive Tobacco Control Programs (2014) This resource is an evidence-based guide to help states plan and establish effective tobacco control programs to prevent and reduce tobacco use. This document describes an integrated programmatic structure for implementing interventions proven to be effective and provides levels of state investment to prevent and reduce tobacco use in each state. Resource from Centers for Disease Control and Prevention
Best Practices for Comprehensive Control Programs (2014) This resource details best practice for comprehensive tobacco control programs, including defining the necessary components and funding recommendations. Best Practices from Centers for Disease Control and Prevention
Tobacco use in the Workplace: A Model Policy (2013) This resource provides a framework for employers who are looking to establish and maintain a tobacco-free workplace. Information included includes benefits of a tobacco-free workplace, a model policy, definitions and procedure. Model Policy from American Cancer Society Systems Change: Treating Tobacco Use and Dependence (2012) This resource provides a comprehensive summary of the Public Health Service (PHS) Clinical Practice Guidelines (2008 update), which recommend using systems change for treating tobacco use and dependence. Guidelines from Agency for Healthcare Research and Quality Prevention Agenda Towards the Healthiest State - Priority Area: Tobacco Use (2011) This resource outlines New York State’s Prevention Agenda’s objectives for preventing and reducing the burden of tobacco use and secondhand smoke to improve the health of New Yorkers. Resource from the New York State Department of Health
Healthcare Provider Reminder Systems, Provider Education, and Patient Education (2009) This guide provides an overview of the importance of promoting prevention and treatment of tobacco use followed by 17 action steps to educate and prompt providers to identify and intervene with patients who use tobacco in a sustainable way. Action Guide from Centers for Disease Control and Prevention & Partnership for Prevention Barriers to Accessing Tobacco Cessation Treatment in Medicaid (2014)
This resource documents the current state of Medicaid coverage for tobacco-dependence treatment, including a list of the challenges that Medicaid enrollees face by state in utilizing the smoking cessation benefit.
Report from American Lung Association
State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2008–2014 (2014) This resource describes the increased prevalence of tobacco use among Medicaid enrollees and outlines the need for consistent policies and comprehensive coverage of cessation treatments. Barriers to accessing treatments persist though many states have adopted policies to increase access since 2008. Report from Centers for Disease Control and Prevention A Hidden Epidemic: Tobacco Use and Mental Illness (2011) This resource details the prevalence of tobacco use among those with mental illness, and identifies strategies for integrating dependence treatment into care at mental health facilities. This resource provides five case studies with lessons-learned.
Report from Legacy
Increases in Smoking Cessation Interventions After a Feedback and Improvement Initiative Using Electronic Health Records — 19 Community Health Centers, New York City, October 2010–March 2012 (2014)
This resource describes the ways in which electronic health records (EHR) can facilitate tobacco dependence treatment. Over the study period, the patients documented as smokers increased 3% and those documented smokers who received tobacco dependence interventions increased over 30% in community health centers.
Report from Centers for Disease Control and Prevention
A Patient-Centered Tobacco Cessation Workflow for Healthcare Clinics (2015) This report provides practical strategies for implementing agency and clinic tobacco cessation services. The workflow outlines needed staffing, as well as their roles and responsibilities. Report from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus Successful Implementation of Tobacco Dependence Treatment Policy in a Behavioral Health Setting Using the “Addressing Tobacco Use Through Organizational Change” (ATTOC) Framework- A Best Practice Story from Ellis Mental Health (2017)
This case study describes an example of successful implementation of Tobacco Dependence Treatment (TDT) policy utilizing the “Addressing Tobacco Use Through Organizational Change” (ATTOC) model; an evidence-based implementation framework that was designed specifically for TDT. The study focuses on Ellis Mental Health’s Clinic and Personalized Recovery Oriented Services (PROS) programs, and their journey through the implementation of TDT and tobacco-free grounds utilizing the ATTOC model. The study aims to provide a best practice example for other healthcare organizations attempting to implement tobacco dependence screening and treatment policies and tobacco-free grounds in a structured, organized way.
Through a series of structured interviews with key individuals from Ellis Mental Health, as well as NYS Health Systems Improvement and Advancing Tobacco Free Communities experts, COE for HSI compiled the information contained within this study to assist those working to implement health systems improvement in the area of TDT.
Case Study from CAI
Lessons Learned From Open Door Family Medical Center (2016) This case study outlines the success of Open Door Family medical Center in successfully integrating systems and policies to promote ongoing assessment of tobacco performance measures. Open Door has been able to implement tobacco dependence screening and treatment best practices into standard delivery of care. Case Study of Open Door Family Medical Center
Case Study: The Effect of Expanding Cessation Coverage–The Massachusetts Medicaid Cessation Benefit (2014)
This case study illustrates how the provision of a comprehensive cessation benefit under Medicaid resulted in the increased utilization of tobacco cessation benefits by Medicaid enrollees in Massachusetts. Increased utilization of cessation benefits led to reduced smoking prevalence and hospitalizations among beneficiaries, and a return on investment.
Case study from Centers for Disease Control and Prevention
Addressing Tobacco Use Through Healthcare Systems: A Policy Brief (2013) This case study highlights the use of health systems to promote the standardized delivery of tobacco dependence treatment. Detailed within this case study are the positive outcomes garnered through addressing tobacco dependence in this way: reduced smoking, improved health, and return-on-investment. Policy Brief from Partnership for Prevention, Multi-State Collaborative for Health Systems Change, and Action to Quit
Saving Money: The Massachusetts Tobacco Cessation Medicaid Benefit (2012) This document details the high burden of tobacco use, especially among Medicaid populations, and makes a case that implementing comprehensive tobacco cessation programs can save lives and money. Massachusetts’ Comprehensive Tobacco Cessation and Prevention Program is used to demonstrate successful implementation that garnered return-on-investment for both health care facilities and Medicaid plans. Policy Paper from Partnership for Prevention, George Washington University School of Public Health and Health Services, and Action to Quit
- Tuberculosis & Tobacco Factsheet (2018)
The World Health Organization has published a factsheet regarding the association between smoking and tuberculosis. The factsheet includes WHO-recommended actions that public health workers can take to address tobacco cessation.
Vital Signs, Adult Smoking: Focusing on People with Mental Illness (2013)This resource provides detail on the increased burden of smoking on populations with mental illness, including statistics, information on the relationship between smoking and mental illness and opportunities to reach these populations.Factsheet from Centers for Disease Control and Prevention
Smoking and Mental Health (2013) This UK-based resource addresses the burden of tobacco on those with mental illness. Delving into the consequences of tobacco use on individuals with stress, depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), schizophrenia, Alzheimer’s disease and dementia, and post-traumatic stress disorder (PTSD), the authors reiterate policy recommendations of the Royal College of Physicians, which articulate the need for mental health service settings to be smoke-free and to prioritize the delivery of evidence-based cessation interventions. Factsheet from Action on Smoking and Health Integrating Tobacco Cessation Into Electronic Health Records This resource encourages the integration of prompts into electronic health records (EHR) to record smoking status. Additionally, it details meaningful use and provides a template of prompts that should be included. Factsheet with Template from American Academy of Family Physicians Literature Review Factsheet: Emerging Practices for Tobacco Dependence Interventions and Treatments for Individuals with Serious Mental Illness (2015) This resource, developed by the COE for HSI, summarizes the key findings of a literature review examining literature on emerging and best practices for tobacco dependence interventions and treatments for individuals with serious mental illness to inform the Health Systems for a Tobacco-Free New York project’s objective of decreasing the prevalence of tobacco use among this population. Factsheet from CAI Tobacco Control: A Winnable Battle (2014)
This resource defines tobacco control as a winnable battle using the World Health Organization's MPOWER model, while establishing the relationship between tobacco and chronic disease. This resource draws on CDC Best Practices for Comprehensive Tobacco Control Programs.
Report from United States Department of Health and Human Services and Centers for Disease Control and Prevention
Help Your Patients Quit Tobacco Use: An Implementation Guide for Community Health Centers (2013) This implementation guide includes background information about the burden of tobacco use. There are also case studies from Massachusetts, North Carolina, Oregon, and Utah included. Implementation Guide from Legacy and Partnership for Prevention Help Your Patients Quit Smoking: A Coaching Guide (2013) This resource walks providers through how to administer the 5 A’s in the clinical setting, including guidance on working with patients who are not ready to quit, preparing to quit, dealing with smoking triggers, and dealing with and expecting to deal with withdrawal symptoms. Guide from New York City Department of Health and Mental Hygiene
Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Setttings (2018)
A tobacco cessation toolkit created by the Substance Abuse and Mental Health Services Administration (SAMHSA) specifically for substance use disorder (SUD) treatment programs. It provides an overview of the challenges associated with tobacco cessation and the benefits of being tobacco-free for substance use disorder (SUD) treatment settings. SUD sites can use the Quick Guide (included in the toolkit) to assist with implementing their own tobacco cessation programs.
Evidence-Based Tobacco Dependence Screening & Treatment - Behavioral Health Settings Training Toolkit (2017)
Toolkit from CAI
Evidence-Based Tobacco Dependence Screening & Treatment - Medical Training Toolkit (2016)
Toolkit from CAI
Leading through Health System Change: A Public Health Opportunity (2013)
This planning toolkit was designed to help providers understand changes associated with the Affordable Care Act and support them in leveraging current opportunities to promote health systems improvements.
Toolkit from Georgia Health Policy Center at Georgia State University National Network of Public Health Institutes
DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers (2013) This toolkit details the relationship between tobacco use and health, especially among those with behavioral health conditions. Questions are raised regarding the timing of tobacco dependence treatment with this population and about tobacco dependence treatment and behavioral health conditions. Toolkit from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus Smoking Cessation for Persons with Mental Illnesses: A toolkit for Mental Health Providers (2009) This toolkit was developed for a broad continuum of mental health providers. Materials are intended for direct providers, as well as administrators and behavioral health organizations. Many of the materials are also appropriate for primary care and substance abuse providers. Toolkit from Behavioral Health and Wellness Program University of Colorado Anschutz Medical Campus The American Cancer Society Quit Tobacco and Smoking Tool Kit This toolkit provides information and messages to help employers assist their employees in quitting smoking. Resources will help raise awareness about the importance of not using tobacco and the steps employees can take to stay well, get well if they are facing cancer, fight back against the disease, and help the Society find cures. Toolkit from the American Cancer Society State and County Indicators For Tracking Public Health Priority Areas (2012)
This website provides indicators for tracking priority area progress by county across New York State.
Interactive Website from New York State Department of Health
New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center This website provides a function to look up whether drugs are covered by Medicaid Managed Care plans, which clinical providers can use to determine the tobacco dependence treatment options that will be covered for patients. Interactive Website from New York State Department of Health 2014 Health Center Profile (2014) This website provides information on the Federally Qualified Health Centers (FQHC) in New York State and nationwide. The FQHC profiles include indicators on tobacco use screening and tobacco cessation counseling for tobacco users. Interactive Website from Health Resources and Services Administration Adults who are Current Smokers by NYS County, 2013‐2014 (2015) This resource details the 2013-2014 Expanded Behavioral Risk Factor Surveillance System (eBRFSS) assessment, which estimates the number and percentages of adult smokers in New York State, both by county and statewide. Data from New York State Department of Health Office of Mental Health Patient Characteristics Survey The Patient Characteristics Survey (PCS) is conducted every two years, and collect demographics, clinical, and service-related information for each person who receives a public mental health service during a specified one-week period. The PCS receives data from approximately 5,000 mental health programs providing direct services to 175,000 people during the survey week. All programs licenses or funded by the NYS Office of Mental Health (OMH) are required to complete the survey. Resource from the Office of Mental Health The Effect of Systematic Clinical Interventions with Cigarette Smokers on Quit Status and the Rates of Smoking-Related Primary Care Office Visits (2012)This article describes the practical application and evaluation of the 2008 update to the Public Health Service (PHS) Guidelines to Treating Tobacco Use and Dependence in Massachusetts. Findings indicate there was a decreased likelihood of office visits for smoking-related diagnoses for smokers following systems change. Please see Massachusetts Case Study below for more information.Article from PLOS ONE
Medicaid Coverage and Utilization of Covered Tobacco-Cessation Treatments (2012) This article discusses the use of Medicaid coverage for tobacco dependence treatment in Arkansas. The authors suggest that low awareness and perceived ineffectiveness could be linked to lack of utilization of Medicaid benefits. Article from Robert Wood Johnson Foundation The Return on Investment of a Medicaid Tobacco Cessation Program in Massachusetts (2012) This resource details the return-on-investment achieved by taking a systems-level approach to addressing tobacco dependence among low-income populations, including Medicaid enrollees. Article from PLOS ONE Literature Review: Emerging Practices for Tobacco Dependence Interventions and Treatments for Individuals with Serious Mental Illness (2015) This resource, developed by the COE for HSI, examines literature on emerging and best practices for tobacco dependence interventions and treatments for individuals with serious mental illness to inform the Health Systems for a Tobacco-Free New York project’s objective of decreasing the prevalence of tobacco use among this population. Article from CAI Evidence-Based Treatment for Tobacco Dependence (Webinar by Michael Steinberg, MD, MPH; Rutgers Robert Wood Johnson Medical School Tobacco Dependence Program, 2018)
Target Audience: Tobacco Cessation and Health Systems Improvement staff, Care Providers
The goal of this training is to provide in-depth, clinical training on the seven FDA-recommended cessation aides/medication and their proper dispensing to improve tobacco cessation attempt outcomes.
Leveraging the American Lung Association's Hospital Community Benefit and Tobacco Cessation Toolkit for Health Systems Improvement- 8/29/2018 Target Audience: Population Health and Health Systems Improvement workers
The Goal of this webinar is to assist Health Systems Improvement Grantees in understanding the intent of the American Lung Association’s “Hospital Community Benefit and Tobacco Cessation Toolkit” and how it can assist with making the case for tobacco cessation work within hospital systems.
Webinar from CAI Tobacco Screening and Treatment Workflow in Epic EHR - A Best Practice Example from NYC Health + Hospitals (H+H) - 8/16/2018 Target Audience- Administrative, Clinical, and Technical Staff from organizations in NY State that use Epic EHR (including Epic-Certified Technicians), as well as Population Health, Quality Improvement, and Health Systems Improvement experts.
The Goal of this webinar is to to educate Health Systems Improvement experts and staff from Epic EHR sites in NY State about NYC Health and Hospitals’ use of Epic EHR to create a streamlined approach to Tobacco Screening and Treatment using the "5As" Methodology.
Webinar from CAI Billing and Coding for Tobacco Dependence Treatment: Smoking Cessation Services Considerations for Sustainability and Population Management - 5/10/2018 Target Audience: Finance Department Leadership and Staff, Administrators, Providers, and Coders from Healthcare and Behavioral Health Organizations, and Health Systems Improvement experts.
The goal of this webinar is to review best practices in documenting, coding, and billing Tobacco Dependence Treatment services in order to assist organizations in maximizing financial reimbursement.
Upon completing this webinar, participants will be able to:
- Describe best practices for documentation of Tobacco Dependence Treatment (TDT) services
- Identify ways in which to maximize reimbursement for TDT through appropriate use of coding
- Explore opportunities to work with payers in New York State to maximize reimbursement for TDT
Webinar from CAI Treatment Planning for Tobacco Cessation in Behavioral Health and Substance Abuse Treatment Settings - 3/27/2018 This webinar offers 1.0 CME/CNE/SW/CASAC continuing education credits and will address the importance of effective Treatment Planning for Tobacco Cessation within Behavioral Health and Substance Abuse Treatment settings.
During this 60-minute Technical Assistance session, presenters will:
- Discuss how tobacco-use effects treatment and outcomes for Behavioral Health and Substance Abuse conditions
- Introduce the basis of a Treatment Plan and its purpose and rationale
- Discuss the necessary components of a Treatment Plan, and the most common and effective interventions that may be included within one
- Present a Case Study on Treatment Planning that is interactive and audience-driven
To obtain Continuing Education Credits, viewers must view the entire webinar and complete a post-test with a passing score of at least 80%.
Webinar from CAI Treating Tobacco Dependence - Co-occurring Behavioral Health & Substance Abuse Conditions - 2/1/2018 The goal of this Webinar is for participants to better understand the role that co-occurring behavioral health and substance abuse conditions play in treating tobacco dependence.
The long-term learning outcome is that providers working in Behavioral Health and Substance Abuse settings will increase their screening and treatment of patients for tobacco use.
CME/CNE/SW Continuing Education Credits available for viewing this webinar and successfully completing the accompanying post-test.
Webinar from CAI
Make the Business Case - Modeling Cost and Reimbursement for Providing TDT Services - 12/6/2017
Target Audience: Health Systems Improvement Grantees The goal of this Webinar is to provide an overview and demonstration of the Tobacco Dependence Treatment (TDT) Financial Modeling Tool to Health Systems Improvement Grantees.
The TDT Financial Modeling Tool will help you assist the health care organizations you work with in examining assumptions about the affordability of providing on-site TDT, and enable them to examine anticipated revenue from providing this important service to clients.
Webinar from CAI
Treating Tobacco Dependence: Implementing Evidence Based Practices for Behavioral Health Populations - 6/29/2017
The goal of this Webinar is to review best practices in prescribing the seven Food and Drug Administration (FDA)-approved tobacco cessation medications for Behavioral Health populations. Additionally, this Webinar will discuss behavioral counseling and interventions, avoidance of relapse, and Medicaid coverage for Pharmacotherapy, with the aim of assisting Behavioral Health facilities in treating their patients for tobacco dependence.
Webinar from CAI
Note: To access to the Q&A Summary for this Webinar click here.
Prescribing Tobacco Cessation Pharmacotherapy: Implementing Evidence-Based Practices- 6/8/2016 This webinar highlights best practices for prescribing the seven FDA-approved tobacco cessation medications. Continuing medical education and continuing nursing education credits are available to participants at no charge. Webinar from CAI Planning & Implementing: Partnering with Population Health Improvement Program (PHIP) Contractors to Advance Mutual Goals - 6/18/2015
This webinar discusses the New York State Population Health Improvement Program (PHIP), provides an overview of the role of the PHIP contractors, and identifies opportunities for collaboration between the Health Systems for a Tobacco-Free New York contractors and the PHIP contractors.
Webinar from CAI
Decreasing Tobacco Use in Patients with Serious Mental Illness: Strategies for Implementing Best Practices in Mental Health Treatment Settings - 3/23/2015 This webinar highlights best practices for implementing tobacco-free policies and integrating the delivery of evidence-based tobacco dependence treatment into care within health care settings serving individuals with serious mental illness. Webinar from CAI
Background on Comprehensive Tobacco Dependence Treatment Policy
A case example detailing how one FQHC within the Hudson-Valley region was able to successfully create and implement a TDT policy that is aligned with the U.S. Public Health Service Clinical Practice Guidelines.
Sample TDT Policy
A de-identified sample Tobacco Dependence Treatment (TDT) Policy that can be utilized by other healthcare organizations as a template or starting-point for creating their own comprehensive TDT policy. The policy template includes the “5 A’s” Tobacco Dependence Intervention that was developed by the U.S. Public Health Service (PHS) as a best-practice guideline, as well as the brief intervention technique to promote motivation to quit known as the “5 R’s”.
Treating Tobacco Use This online learning module, for which continuing medical education credits are available, explains the 5 A’s in tobacco dependence treatment, discusses the different FDA-approved medications and combined therapy, and explains coverage through New York State Medicaid. Online Learning Module from New York City Department of Health and Mental Hygiene Focus on Integrated Treatment (FIT) These online modules help programs implement integrated treatment for co-occurring mental health and substance use disorders, a proven strategy for helping people sustain and maintain recovery. Online modules focused on tobacco dependence treatment are included and emphasizes the importance of people setting their own recovery goals. Webinar from Center for Practice Innovations at Columbia Psychiatry Rx for Change: Clinician-Assisted Tobacco Cessation This series of webinars is a comprehensive tobacco cessation training program that equips health professional students and practicing clinicians, of all disciplines, with evidence-based knowledge and skills for assisting patients with quitting. Program draws heavily from the U.S. Public Health Service Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Webinars from the University of California, San Francisco