Draft Health Plan Survey on Tobacco Screening and ...
RI Health Plan Survey on Tobacco Screening and Cessation Benefits
Background
The Rhode Island Tobacco Control Program of the Department of Public Health (RI HEALTH), in partnership with most of the major RI health insurers, and the RI Smokers’ Helpline vendor has developed this survey tool in an effort to meet the Department’s over-all objective:
To collect aggregate data from each health plans’ fully insured employer accounts for RI policies issued to insured members regardless of where they reside (which are subject to the state mandate, RI Office of the Health Insurance Commissioner Regulation 14 Tobacco Cessation Treatment Coverage), in order to understand: a) How Rhode Island health plans have implemented Regulation 14, which was promulgated into law on August 14, 2009 and which required health insurers to provide smoking cessation benefits to their members, and b) the details of the health plan products offered, cessation benefit offered and member utilization for the period January 01, 2011 to December 31, 2011.
The over-all plan for this project is to administer the survey tool to all major private health plans which have volunteered to participate. RI HEALTH will then collect and review the survey results and will conduct in-person de-briefing sessions with the all participating health plans.
Collaborations
For several months RI Health and members of the Data and Evaluation Work Group (DEWG)[1], a sub-group of the 2011-2012 Statewide Tobacco Cessation Coordinating Committee, met to discuss and design this survey. RI HEALTH is deeply indebted to both the expertise and involvement provided by the DEWG, in particular the health plan members. In addition some survey questions have been adapted from the Colorado Health Department. RI HEALTH is also involved in a Centers for Disease Control (CDC) and North American Quitline Consortium (NAQC) supported national technical assistance project focusing on public private partnerships in the delivery of cessation services.
Tentative Timelines
October 12, 2012 Survey distribution to all participants
November 26, 2012 Survey completion date
December 3-14, 2012 De-briefing sessions with all participants
January 30, 2013 Draft report of findings
Instructions
Dana McCants Derisier, Program Coordinator, Tobacco Control Program, RI Department of Public Health (RI HEALTH) will be contacting your identified health plan liaisons shortly to schedule a phone appointment to review the survey. She may be reached at phone: 401-222-7625 or email: Dana.McCants-Derisier@health..
We appreciate your time and expertise in helping us to acquire this information and look forward to a rewarding and fruitful pilot experience.
We understand that the Regulation 14 mandate is for RI issued policies regardless of where the member resides. For survey purposes we would like to collect information on policies which cover both RI residents and non-residents.
Optional: In addition, in order to assess where there may be gaps in smoking cessation benefit coverage, if information is available, we also request that the survey include information for self-insured groups.
Question responses: The survey consists of mostly questions with Yes/No response options. In addition there are several multiple choice selections and opportunities to explain or describe responses further. For each Yes/No or multiple choice response, please enter the number 1 in the appropriate box/line to make your selections. Please leave blank any response options that you do not select. Please try to answer all of the questions to the best of your ability and call or email Dana McCants Derisier if you have questions at any time so that we can insure correct question interpretation.
Health Plan:
Name of Person Responding: Title:
Address:
Phone: E-mail:
Background
Please tell us about your health plan’s smoking cessation benefit coverage:
The # of fully insured accounts though your health plan: ________
The # of self insured accounts through your health plan: ________
Do you have the following products/lines of business available?
_____Individual _____Group _____Conversion
_____HMO, _____PPO
How many total members does your health plan serve in Rhode Island? _______
How many members are fully insured? _______
Did your health plan implement Regulation 14 for all fully insured lives effective August 14, 2009?
______Yes _____No (Implementing as groups renew their coverage)
Have any changes been made to plan offerings to ensure cessation coverage meets the Patient Protection and Affordable Care Act (ACA) recommendations regarding tobacco use screening and treatment?
______Yes _____No
Member Benefits
Do you offer employer “Buy-ups” so that extra benefits are offered to self-insured plans? ________________
How many cessation sessions are offered annually to members? _________________________
Do you have a member co-pay policy on quit medications? ____ Yes, ______ No
Do you have a member co-pay policy on counseling? ____ Yes, ______ No
Do you have annual lifetime limits for your benefit package? _____yes, _____ No
Please complete the chart for each health plan product that has cessation benefits by answering the following, including the number of members that have used the benefit from the time period (January 01, 2011 to December 31, 2011):
|Health Plan Cessation Benefit Coverage Chart |# Members Utilizing Benefit |
|Name of health plan product | | |
|Over-the counter stop-smoking medicines covered | |
| | | |
|Benefit information phone line | | |
| |Insert Tel. # here | |
|Nicotine Patch |YES/NO | |
|Nicotine Gum |YES/NO | |
|Nicotine Lozenge |YES/NO | |
|Is a prescription required? |YES/NO | |
|Duration of treatment | | |
| | | |
| |Example: 30 day supply or 90 day supply; allowed twice per year | |
|Co-pay |$6 ($1 per box; each box is usually a 14-day supply) | |
|Deductible required? |YES/NO | |
|Comments |Prescription required to receive medication with the covered co-pay. | |
| | | |
|Prescription stop-smoking medicines covered | |
| | | |
|Zyban |YES/NO | |
|Wellbutrin SR (Brand) |YES/NO | |
|Bupropion (Generic) |YES/NO | |
|Chantix |YES/NO | |
|Nicotine inhaler |YES/NO | |
|Nicotine nasal spray |YES/NO | |
|Duration of treatment |90-day supply; can get twice a year | |
| Co-Pay for 90-day supply | |
|Zyban |$9 in person | |
|Wellbutrin SR (Brand) |$9 in person | |
|Bupropion (Generic) |$3 in person | |
|Chantix |$9 in person | |
|Nicotine inhaler | | |
|Nicotine nasal spray | | |
|Deductible Required? |YES/NO | |
|Comments | | |
| | | |
|Counseling support to stop smoking covered | |
| | | |
|Counseling support to stop smoking |YES/NO | |
|covered | | |
|What is covered? |Individual counseling, group or telephonic counseling? | |
|Duration of treatment |# of counseling sessions allowed per year | |
|How is the counseling benefit |Intervention provided through an in-house quitline, provider network, integrated into a | |
|administered? |wellness program or case management? | |
| |Please describe: | |
|Who provides counseling services? |_____ Physician, _____ Social Worker, | |
| |____Tobacco Treatment Specialist, | |
| |_____ Other, please describe: | |
| | | |
|Co-pay | | |
|Deductible Required? | | |
|Comments |Counseling sessions with any provider with the exception of mental health and substance | |
| |abuse counselors. | |
Communication Strategies
We would like to understand the member experience of your cessation benefit. Can you please describe how members become aware of and access your benefits?
Has your health plan communicated the cessation benefit to members as a result of Regulation 14?
_____Yes, through the following: ______Plan Website, ______Employer Mailing, _____ Health Plan Mailing,
____ In-person, _____ Member Services Call-Center, ____ Other
Can you provide (attach) copies of communications?
_____ Yes, Attached
_____No, not available
When do you provide benefit information?
_____during enrollment to member _____ during enrollment to employer
_____ during renewal to member _____ during renewal to employer
In what format do you provide benefit information?
_____sheet of paper/flyer _____ email
_____ brochure _____ other please specify:
Has the Plan communicated to providers the tobacco cessation benefits that is offered to members?
_____Yes, Can you provide (attach) a copy of the latest communication?
_____No
Collaboration Plan
Has the plan referred members to the RI Smokers’ Helpline or QuitWorks RI Program to support its members?
______ Yes - If yes, are samples of referrals or promotion materials available? Please attach any copies available
_____ No
Has the Plan made additional tobacco cessation counseling services available to its members beyond that provided by the RI Helpline/QuitWorks?
______ Yes – Has your plan purchased any of the following cessation services from private commercial vendors:
_____ In-person counseling ______Telephonic counseling via quitline ______Web-based information site
______Web-based interactive cessation service ______Texting program ______ Self Help materials
______Cessation services are provided in RI, _________Cessation services are provided outside of RI
_____ No
Are there restrictions to your medication benefit: _____ Yes, _____ No, Please describe:
Are incentives available to your members for any of the following:
_____Using services
_____ Completing a cessation program
_____ Quitting tobacco use
Please describe:
Provider Support
Does your Plan reimburse providers for Tobacco use screenings of adults and tobacco cessation interventions and counseling? Please reply “yes” or “no” in each cell for all of your fully insured members (group and individual policies).
|Provider Reimbursement |
|CPT 99406 (Tobacco) |CPT 99407 (Tobacco) |Other tobacco codes |
Cessation Tracking (measure # of smokers identified compared to the expected rate for the population covered by the Plan and with the Plan can measure the success of identification, referral and treatment programs.)
Does your Plan track quit rates, and if so, how?
Does your Plan reimburse providers for tracking tobacco use status?
Cessation Outcomes (measure effectiveness of identification and treatment programs to report to employers)
Does your measure the impact of smoking cessation on your members’ use of other benefits?
Affirmation
To the best of my knowledge, this information is true and accurate for majority of fully insured Rhode Island members. The plan is willing for its name to be released in association with specific results of this survey.
__________________________________________ __________________
Signature of Project Manager Date
RIHPSurvey.doc.9/12
-----------------------
[1] DEWG members include: RI Health staff, State Representative Eileen S. Naughton, JSI Research & Training Institute, Inc., vendor for the RI Smokers’ Helpline and QuitWorks RI operations, and representatives from the following health insurers: Aetna Life Insurance Company, Blue Cross Blue Shield RI, Tufts Health Plan, and United Healthcare.
-----------------------
(Optional)
The federal Employee Retirement Income Security Act (ERISA) requires self-insured plans to offer cessation counseling
The # of self insured accounts:
With cessation coverage ________
Without cessation coverage ______
With cessation prescription benefits ______
Without cessation prescription benefits ______
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