(1) MassHealth covers a
total of 16 group and individual counseling sessions per member per 12-month
cycle, without prior authorization. These sessions may be any combination of
group and individual counseling. All individual counseling sessions must be at
least 30 minutes, except for intake sessions, which must be at least 45
minutes. Intake sessions are limited to two per member per 12-month cycle,
without prior authorization.
(a) Individual
counseling consists of face-to-face tobacco-cessation counseling services
provided to an individual member by a MassHealth-qualified provider of
tobacco-cessation services as set forth in
130 CMR 405.472(B) and
(C).
(b) Group tobacco treatment counseling
consists of a scheduled professional counseling session with a minimum of three
and a maximum of 12 members, and has a duration of at least 60 to 90
minutes.
(c) Individual and group
counseling also includes collaboration with and facilitating referrals to other
healthcare providers to coordinate the appropriate use of medications,
especially in the presence of medical or psychiatric comorbidities.
(2) The individual and group
tobacco-cessation counseling services must include the following:
(a) education on proven methods for stopping
the use of tobacco, including:
1. a review of
the health consequences of tobacco use and the benefits of quitting;
2. a description of how tobacco dependence
develops and an explanation of the biological, psychological, and social causes
of tobacco dependence; and
3. a
review of evidence-based treatment strategies and the advantages and
disadvantages of each strategy;
(b) collaborative development of a treatment
plan that uses evidence-based strategies to assist the member to attempt to
quit, to continue to abstain from tobacco, and to prevent relapse, including:
1. identification of personal risk factors
for relapse and incorporation into the treatment plan;
2. strategies and coping skills to reduce
relapse risk; and
3. a plan for
continued aftercare following initial treatment; and
(c) information and advice on the benefits of
nicotine replacement therapy or other proven pharmaceutical or behavioral
adjuncts to quitting smoking, including:
1.
the correct use, efficacy, adverse events, contraindications, known side
effects, and exclusions for all tobacco dependence medications; and
2. the possible adverse reactions and
complications related to the use of pharmacotherapy for tobacco
dependence.
