BILL NUMBER: AB 1745 CHAPTERED BILL TEXT CHAPTER 330 FILED WITH SECRETARY OF STATE SEPTEMBER 19, 2006 APPROVED BY GOVERNOR SEPTEMBER 19, 2006 PASSED THE ASSEMBLY AUGUST 30, 2006 PASSED THE SENATE AUGUST 24, 2006 AMENDED IN SENATE AUGUST 22, 2006 AMENDED IN SENATE AUGUST 9, 2006 AMENDED IN SENATE JUNE 14, 2006 AMENDED IN SENATE APRIL 6, 2006 INTRODUCED BY Assembly Member Chan (Principal coauthor: Senator Perata) (Coauthors: Assembly Members Berg, Jones, and Laird) (Coauthors: Senators Alquist, Bowen, Figueroa, Kuehl, and Ortiz) MARCH 2, 2005 An act to add Section 14132.74 to the Welfare and Institutions Code, relating to Medi-Cal, and making an appropriation therefor. LEGISLATIVE COUNSEL'S DIGEST AB 1745, Chan Medi-Cal: pediatric palliative care benefit. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Services and under which qualified low-income persons receive health care benefits, including hospice benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. This bill would require the department to develop, as a pilot project, a pediatric palliative care benefit to evaluate whether, and to what extent, such a benefit should be offered under the Medi-Cal program. It would require that the pilot project be implemented only to the extent that federal financial participation is available, and would require the department to submit a waiver application for federal approval. The bill would require that beneficiaries eligible to receive the pediatric palliative care benefit be under 21 years of age, and would allow the department to further limit the population served by the project to make the above evaluation. It would require that the services available under the project include those types of services that are available through the Medi-Cal hospice benefit, and certain other services. The bill would provide that authorized providers under the pilot program shall include licensed hospice agencies and home health agencies licensed to provide hospice care, subject to criteria developed by the department for provider participation. The bill would appropriate $75,000 from the General Fund to the department for these purposes. Appropriation: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. This act shall be known and may be cited as the Nick Snow Children's Hospice and Palliative Care Act of 2006. SEC. 2. Section 14132.74 is added to the Welfare and Institutions Code, to read: 14132.74. (a) The department, in consultation with interested stakeholders, shall develop, as a pilot project, a pediatric palliative care benefit to evaluate whether, and to what extent, such a benefit should be offered under the Medi-Cal program. The pilot project shall be implemented only to the extent that federal financial participation is available. (b) Beneficiaries eligible to receive the pediatric palliative care benefit shall be under 21 years of age. The department may further limit the population served by the pilot project to a size deemed sufficient to make the evaluation required pursuant to subdivision (a). (c) Services covered under the pediatric palliative care benefit shall be designed to meet the unique needs of children, and shall include those types of services that are available through the Medi-Cal hospice benefit. The benefit shall also include the following services, regardless of whether those services are covered under the Medi-Cal hospice benefit: (1) Hospice services that are provided at the same time that curative treatment is available, to the extent that the services are not duplicative. (2) Hospice services provided to individuals whose conditions may result in death, regardless of the estimated length of the individual' s remaining period of life. (3) Any other services that the department determines to be appropriate. (d) The department, in consultation with interested stakeholders, shall determine the medical conditions and prognoses that render a beneficiary eligible for the benefit. (e) Providers authorized to provide services under the pilot program shall include licensed hospice agencies and home health agencies licensed to provide hospice care, subject to criteria developed by the department for provider participation. (f) (1) The department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for a waiver to implement the pilot project described in this section. The department shall determine the form of waiver most appropriate to achieve the purposes of this section. The waiver request shall be included in any waiver application submitted within 12 months after the effective date of this section, or shall be submitted as an independent application within that time period. After federal approval is secured, the department shall implement the waiver within 12 months of the date of approval. (2) The waiver shall be designed to cover a period of time necessary to evaluate the medical necessity for, and cost-effectiveness of, a pediatric palliative care benefit. The results of the pilot project shall be made available to the Legislature and appropriate policy and fiscal committees to determine the effectiveness of the benefit. (g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of provider bulletins or similar instructions, without the adoption of regulations. The department shall notify the fiscal and appropriate policy committees of the Legislature of its intent to issue a provider bulletin or other similar instruction at least five days prior to issuance. (h) (1) Nothing in this section shall result in the elimination or reduction of any covered benefits or services under the Medi-Cal program or the California Children's Services Program. (2) This section shall not affect an individual's eligibility to receive, concurrently with the benefit provided for in this section, any services, including home health services, for which the individual would have been eligible in the absence of this section. SEC. 3. There is hereby appropriated the sum of seventy-five thousand dollars ($75,000) from the General Fund to the State Department of Health Services for expenditure for the purposes of developing and implementing a pilot project, as provided for in Section 14132.74 of the Welfare and Institutions Code, to evaluate whether, and to what extent, a pediatric palliative care benefit should be offered under the Medi-Cal program. These funds may be used to fund staff positions to execute, plan, manage, develop, and implement the pilot project.