Amended in Assembly August 18, 2014

Amended in Senate May 5, 2014

Senate BillNo. 1004


Introduced by Senator Hernandez

(Coauthor: Senator Wolk)

February 13, 2014


An act to add Section 14132.75 to the Welfare and Institutions Code, relating to health care.

LEGISLATIVE COUNSEL’S DIGEST

SB 1004, as amended, Hernandez. Health care: palliative care.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care 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.

Existing law requires 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. Existing law requires that the pilot project be implemented only to the extent that federal financial participation is available, and requires the department to submit a waiver application for federal approval.

Existing law requires that beneficiaries eligible to receive the pediatric palliative care benefit be under 21 years of age, and allows the department to further limit the population served by the project to make the above evaluation. Existing law requires 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.

This bill would require the department tobegin delete develop, as a pilot project, a similar palliative care benefit for beneficiaries who are 21 years of age or older, and to evaluate whether, and to what extent, that benefit should be offeredend deletebegin insert develop a palliative care benefitend insert under the Medi-Cal program.begin delete The bill 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.end delete The bill would require that authorized providersbegin delete under the pilot programend delete include licensed hospice agencies and home health agencies licensed to provide hospice care, subject to criteria developed by the department for provider participation.begin insert This bill would require the department, to the extent practicable, to structure the delivery of the palliative care benefit in a manner that is projected to be cost neutral to the General Fund on an ongoing basis. The bill would also require the department, before implementing the benefit, to provide the fiscal and appropriate policy committees of the Legislature with estimates of costs and projected savings associated with providing the benefit.end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 14132.75 is added to the Welfare and
2Institutions Code
, to read:

3

14132.75.  

(a) In enacting this section, it is the intent of the
4Legislature thatbegin delete theend delete palliative carebegin delete pilot project developed pursuant
5to this sectionend delete
include, but not be limited to, all of the following:

6(1) Specialized medical care and emotional and spiritual support
7for people with serious advanced illnesses.

8(2) Relief of symptoms, pain, and stress of serious illness.

9(3) Improvement of quality of life for both the patient and
10family.

11(4) Appropriate care for any age and for any stage of serious
12illness, along with curative treatment.

13(b) The department, in consultation with interested stakeholders,
14shallbegin delete develop, as a pilot project, a palliative care benefit to evaluate
15whether, and to what extent, that benefit should be offered under
16the Medi-Cal program. The pilot project shall be implemented
17only to the extent that federal financial participation is available.end delete

18begin insert develop a palliative care benefit under the Medi-Cal program.end insert

begin delete

P3    1(c) Beneficiaries eligible to receive the palliative care benefit
2shall be 21 years of age or older. The department may further limit
3the population served by the pilot project to a size deemed
4sufficient to make the evaluation required pursuant to subdivision
5(b).

end delete
begin delete

6(d)

end delete

7begin insert(end insertbegin insertc)end insert Services covered under the palliative care benefit shall
8includebegin insert, but are not limited to,end insert those types of services that are
9available through the Medi-Cal hospice benefit. The benefit shall
10also include the following services, regardless of whether those
11services are covered under the Medi-Cal hospice benefit:

12(1) Hospice services that are provided at the same time that
13curative treatment is available, to the extent that the services are
14not duplicative.

15(2) Hospice services provided to individuals whose conditions
16may result in death, regardless of the estimated length of the
17individual’s remaining period of life.

18(3) Any other services that the department determines to be
19appropriate.

begin delete

20(e)

end delete

21begin insert(end insertbegin insertd)end insert The department, in consultation with interested stakeholders,
22shall determine the medical conditions and prognoses that render
23a beneficiary eligible for the benefit.

begin delete

24(f)

end delete

25begin insert(end insertbegin inserte)end insert Providers authorized to provide servicesbegin delete under the pilot
26programend delete
shall include licensed hospice agencies and home health
27agencies licensed to provide hospice care, subject to criteria
28developed by the department for provider participation.

begin delete

29(g) (1)   The department shall submit any necessary application
30to the federal Centers for Medicare and Medicaid Services for a
31waiver to implement the pilot project described in this section.
32The department shall determine the form of waiver most
33appropriate to achieve the purposes of this section. The waiver
34request shall be included in any waiver application submitted
35within 12 months after the effective date of this section, or shall
36be submitted as an independent application within that time period.
37After federal approval is secured, the department shall implement
38the waiver within 12 months of the date of approval.

end delete
begin delete

39(2) The waiver shall be designed to cover a period of time
40necessary to evaluate the medical necessity for, and
P4    1cost-effectiveness of, a palliative care benefit. The results of the
2pilot project shall be made available to the Legislature and
3appropriate policy and fiscal committees to determine the
4effectiveness of the benefit.

end delete
begin insert

5(f) The department shall, to the extent practicable, structure the
6delivery of the palliative care benefit in a manner that is projected
7to be cost neutral to the General Fund on an ongoing basis. Before
8implementing the palliative care benefit developed pursuant to
9this section, the department shall provide the fiscal and appropriate
10policy committees of the Legislature with estimates of costs and
11projected savings associated with providing the benefit.

end insert
begin delete

12(h)

end delete

13begin insert(end insertbegin insertg)end insert Notwithstanding Chapter 3.5 (commencing with Section
1411340) of Part 1 of Division 3 of Title 2 of the Government Code,
15the department may implement the provisions of this section by
16means of provider bulletins or similar instructions, without the
17adoption of regulations. The department shall notifybegin insert stakeholders
18andend insert
the fiscal and appropriate policy committees of the Legislature
19of its intent to issue a provider bulletin or other similar instruction
20at least five days prior to issuance.

begin delete

21(i)

end delete

22begin insert(end insertbegin inserth)end insert (1) Nothing in this section shall result in the elimination or
23reduction of any covered benefits or services under the Medi-Cal
24program.

25(2) This section shall not affect an individual’s eligibility to
26receive, concurrently with the benefit provided for in this section,
27any services, including home health services, for which the
28individual would have been eligible in the absence of this section.



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