Provider Alert! Smoking Cessation BenefitsTexas Children's Health Plan
Call to action: This notice is regarding the risk of severe lung disease among individuals who vape. Providers are reminded that screening and information on smoking cessation should be included as part of any routine patient visit. In addition to the services and support available through CHIP and Medicaid Texas Children’s Health Plan offers value added smoking cessation benefits to its active members.
How this impacts providers: Providers should educate susceptible patients presenting with respiratory symptoms or other related health conditions on the severe health risks associated with vaping and tobacco use in general if they are a user. As part of the education, providers should direct patients to utilize the resources that are available to their patients.
Texas Children’s Health Plan Tobacco Cessation Value-added Benefits
If a member has an asthma diagnosis, they are eligible to receive coaching and up to $75 of tobacco cessation products each month.
How do I claim my extra benefit?
Members should contact their Case Manager or Service Coordinator to claim this extra benefit. Members can receive a referral to the Texas Children’s Health Plan Case Management Program from their primary care provider (PCP). Once Texas Children’s Health Plan confirms that the membership is currently enrolled, they will be able to pick up their tobacco cessation products at an in-network pharmacy.
Who is eligible?
Tobacco-dependent parents of CHIP members under the age of 19 and STAR and STAR Kids members under the age of 20 years who have an asthma diagnosis.
This benefit is available in Harris, Jefferson, and Northeast service areas.
Tobacco Cessation Benefits in Medicaid
Medicaid provides tobacco cessation counseling (procedure code 99406 & 99407) individually and in group settings to members 10 years and older with a diagnosis of nicotine dependence.
Adolescents with a diagnosis of nicotine dependency related to aerosolized nicotine delivered by vape device are eligible for tobacco cessation counseling as well.
The Medicaid formulary in the link below includes select medications and nicotine replacement products to support tobacco cessation. https://txstarchip.navitus.com/pages/formulary.aspx
Tobacco Cessation Benefits in CHIP
A TCHP provider or health plan-approved tobacco cessation benefit is covered of up to $100 limit per 12-month coverage period. The health plan may require prior authorization and use of a formulary. See link below for requirements.
CHIP Perinatal Program:
- Tobacco cessation programs are not a covered benefit for the unborn child.
- Coverage for the CHIP Perinatal newborn is the same as coverage for traditional CHIP clients.
The CHIP formulary includes select medications to support tobacco cessation.
Next steps for providers: Recommendations for Providers include the following.
- Ask patients presenting with respiratory symptoms about vaping history. If possible, inquire about the types of products used and methods of use.
- If vaping fluid commonly used by the patient is available, ask that an unused sample is available in case it is needed for testing.
- Be aware that some suspect cases have required high-level intensive care and respiratory support.
- Additional resources:
Texas Children’s Health Plan Value-added Benefits: https://www.texaschildrenshealthplan.org/what-we-offer/extra-benefits, https://www.dshs.texas.gov/vaping/ , https://www.dshs.texas.gov/tobacco/
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers