Medicare improves smoking cessation coverage

Washington -- Physicians who long have clamored for more federal help in getting elderly patients to quit smoking are finally getting their wish.

Medicare will now cover smoking cessation counseling for beneficiaries who have tobacco-related diseases or are on drug regimens that are adversely affected by smoking. The Centers for Medicare & Medicaid Services estimates that roughly 4 million U.S. seniors fit this profile.

Eligible beneficiaries who smoke or use tobacco products will be covered for two attempts to quit per year, each consisting of up to four counseling sessions. Conditions that trigger coverage include heart disease, cancer and stroke, while the list of eligible drug treatments includes certain insulins and hypertensive medicines.

The agency's national coverage determination was applauded by members of the Partnership for Prevention, a coalition that formally requested the policy change nearly a year ago. The American Medical Association, one of the partnership's members, called the CMS move a big win for beneficiaries and their doctors.

"Medicare's final decision to pay for counseling to help seniors stop smoking is a public health victory," said AMA Trustee Ronald M. Davis, MD. "These counseling services target those who are suffering the most and have a strong potential for improved health."

Federal officials predicted that other payers that do not cover smoking cessation counseling will do so now that Medicare has expanded its coverage.

"Federal policy has acknowledged tobacco as the No. 1 cause of preventable death for decades now, and CMS has taken the lead in implementing coverage policy for our seniors to deal directly with this critical health problem," said Sean Tunis, MD, the agency's chief medical officer.

CMS nevertheless declined a recommendation by the AMA and others to expand the number of seniors who would be eligible for the counseling coverage. The Association made its suggestion in comments on the proposed rule, which the agency released in December 2004. Covering all seniors who smoke is not "reasonable and necessary" for diagnosing or treating illness, federal officials said.

The agency did heed another recommendation from the AMA and other medical groups by removing a requirement that professionals administering the counseling receive standardized training. CMS said that instead, the government would "encourage clinicians to become appropriately credentialed" until a consensus on national standards emerges that can become part of the Medicare coverage rules.