CLC APPLAUDS MEDICARE COVERAGE OF
SMOKING CESSATION COUNSELING
(January 21, 2005)
January 21, 2005
RE: Draft Decision
Memo for Smoking & Tobacco Use Cessation Counseling
Dear Dr. McClellan:
The undersigned patient, provider, and research organizations are writing in strong support of the Centers for Medicare and Medicaid Services (CMS) decision to provide Medicare coverage for smoking cessation counseling services. Counseling is widely recognized as contributing to the success of smoking cessation efforts, and the agency action will ensure that Medicare beneficiaries enjoy the advantages of comprehensive cessation services.
We recommend that cessation counseling be covered for all Medicare beneficiaries, rather than only for beneficiaries who have been diagnosed with a tobacco-related illness or who are taking medications whose metabolism or dosing is affected by tobacco use, as proposed by CMS. We believe this change will ensure access to cessation counseling for all beneficiaries who might be undertaking smoking "quit attempts." The data support this expansion, as the data reviewed by the agency establish the effectiveness of counseling services when utilized by senior citizens, including but not limited to those who have co-morbidities associated with smoking. The agency has concluded that cessation counseling is a cost-effective intervention, and an expansion of the proposed benefit to include smokers who may not have a smoking-related diagnosis should pose no financial burden for the program.
There is some evidence
that older smokers, because of the length of time they have smoked and
the strength of their addiction, may require more quit attempts and more
intensive services during their quit attempts. Therefore, the proposed
coverage of two quit attempts, with four counseling services (intermediate
or intensive services) during each quit attempt, may not be adequate for
older smokers. In its decision, the agency has cited evidence that supports
a dose-response relationship between the length of time spent on each
counseling session, number of sessions, and total length of counseling
(the dose) and the effectiveness of counseling (the response), and the
dose-response relationship should be carefully monitored for the older
smokers who will be the primary target for this benefit.
The proposal would allow payment only for services provided by individuals trained in tobacco use cessation counseling. We recommend that training according to the 2000 Clinical Guideline of the United States Public Health Service be the standard for providers. Adherence to this clinical guideline would ensure that beneficiaries are receiving appropriate services but would not unreasonably restrict access to services.
We commend CMS for its decision to cover tobacco cessation counseling, and we look forward to working with the agency to educate beneficiaries and health care professionals regarding the availability of this new service.
Cancer Leadership Council
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