BILL ANALYSIS
AB 950
Page 1
Date of Hearing: May 20, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 950 (Hernandez) - As Amended: April 22, 2009
Policy Committee: HealthVote:17-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill establishes a new licensing category under the
jurisdiction of the California Department of Public Health (DPH)
Licensing and Certification Division (L & C) for hospice
facilities (hospices). Specifically, this bill:
1)Establishes hospice as a DPH licensing category for
free-standing facilities that meet minimum service
requirements established in the bill and requires licensed
hospices to also be certified for payment under the Medicare
program.
2)Requires DPH to promulgate related regulations unless the
California Hospice and Palliative Care Association drafts the
regulations in consultation with DPH and stakeholders and
submits the draft regulations for review under the
Administrative Procedures Act (APA).
FISCAL EFFECT
1)One-time fee-supported special fund costs of $250,000 to DPH
to promulgate regulations and to license 5 to 10 free-standing
hospice facilities. Annual costs will depend on the number of
initial and renewal licenses issued by DPH.
2)Unknown potential savings to Medi-Cal to the extent patients
shift from in-patient medical intervention-heavy settings to
hospice which reduces and eliminates medical intervention per
patient and family wishes. Research shows expenditures are 50%
lower in the last month of life and 30% lower in the last year
of life for patients in hospice vs. non-hospice care.
AB 950
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COMMENTS
1)Rationale . This bill is sponsored by the California Hospital
and Palliative Care Association, which represents hospice
programs statewide. Under current law, hospice programs are
licensed as service providers, but are not issued a facility
license. Free-standing hospice programs under current law are
licensed as a type of skilled nursing facility (SNF). The
author indicates current law licensure processes and
regulations create conflicts for some hospices. This bill
creates a new category of license to reduce such conflicts.
2)Hospice is one type of palliative care. Palliative care is
provided to reduce the severity of illness instead of delaying
or stopping the progression of the disease or attempting to
find a cure. Hospice care is palliative care for patients at
the end-of-life. More than 100,000 Californians utilize
hospice services each year and 70% of hospice services are
provided in a patient's home. This bill addresses hospice
services outside of a patient's home. To be eligible for
hospice care, patients typically need a physician to document
that a patient is within six months of passing away. Social
and spiritual support as well as pain management is provided
to patients and their families to relieve suffering at the
end-of-life. Hospice care is a covered benefit under Medi-Cal
and Medicare. Many private health insurance policies also
cover hospice. Hospice may be provided in a patient's home, a
licensed and/or certified SNF, an intermediate care facility,
a general acute care hospital, or a licensed residential care
facility licensed by the Department of Social Services. Some
agencies licensed as home health agencies are certified to
provide hospice services.
3)Focus on End-of-Life Care . This bill adds to a continued
effort in California to provide more support for individuals
and families facing end-of-life issues. The California
HealthCare Foundation (CHCF) has recently increased support in
this area by providing a focus on palliative care through a
number of patient settings, including California's public
hospitals. Under the CHCF Spreading Palliative Care in Public
Hospitals initiative, the foundation is providing $2.5 million
in grants to support a three-year expansion and enhancement of
current public hospital palliative care programs including
planning, implementation, and expansion grants. Another recent
CHCF initiative includes $2 million in grants to work with
AB 950
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nursing homes, physicians, and emergency medical providers on
implementing Physicians Orders for Life Sustaining Treatment
(POLST). POLST helps patients and families document
end-of-life wishes with regard to medical and palliative care.
4)DPH Licensure . The Division of Licensing and Certification (L
&C) within DPH is responsible for ensuring a standard of care
in approximately 7,000 public and private health care
facilities throughout the state. These facilities include
surgical centers, hospitals, skilled nursing facilities, and
home health agencies. The L & C primary responsibilities are
to conduct annual reviews of facilities that receive payment
under Medicare and Medi-Cal; conduct licensure reviews to
ensure compliance with state laws; investigate complaints made
related to patient care; and impose sanctions on facilities
failing to meet certain requirements. Nursing homes and acute
care hospitals accounts for almost 70 percent of L & C
workload.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081