Expanding coverage under Medicaid of Counseling and Pharmacotherapy for Cessation of Tobacco Use to all Medicaid individuals

(a) In general Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1) in subsection (a)(4)(D)— (A) by striking by pregnant women; and (B) by inserting without regard to prior authorization after (as defined in subsection (bb)); and (2) in subsection (bb)— (A) in paragraph (1)— (i) by striking the first place it appears by pregnant women; and (ii) by striking by pregnant women who and inserting by individuals who; (B) in paragraph (2)(A), by striking with respect to pregnant women; and (C) in paragraph (2)(B), by striking by pregnant women. (b) Conforming amendments (1) Section 1927(d)(2)(F) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)(F)) is amended by striking, in the case of pregnant women. (2) Section 1916 of the Social Security Act (42 U.S.C. 1396o), as amended by section 1, is further amended in each of subsections (a)(2) and (b)(2)— (A) in subparagraph (B), by striking, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation by pregnant women in accordance with the Guideline referred to in section 1905(bb)(2)(A); (B) in subparagraph (H), at the end by adding or; and (C) by adding at the end the following new subparagraph: (I) counseling and pharmacotherapy for cessation of tobacco use (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting, and when used to promote, tobacco cessation in accordance with the Guideline referred to in section 1905(bb)(2)(A); and. (3) Section 1916A(b)(3)(B) of such Act (42 U.S.C. 1396o–1(b)(3)(B)), as amended by section 1, is further amended— (A) in clause (iii), by striking, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(bb)); and (B) by adding at the end the following new clause: (xv) Counseling and pharmacotherapy for cessation of tobacco use (as defined in section 1905(bb)).. (c) Application to Medicaid managed care organizations Section 1932(b) of the Social Security Act (42 U.S.C. 1396u–2(b)), as amended by section 1, is further amended by adding at the end the following new paragraph: (10) Cessation of Tobacco Use Each contract with a medicaid managed care organization under section 1903(m) shall require the organization to provide coverage for counseling and pharmacotherapy for cessation of tobacco use without regard to prior authorization.. (d) Effective date (1) In general Subject to paragraph (2), the amendments made by this section shall apply with respect to items and services furnished on or after January 1, 2026. (2) Exception if State legislation required In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.