BILL NUMBER: SB 1004	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  AUGUST 18, 2014
	AMENDED IN SENATE  MAY 5, 2014

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 to  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 offered   develop a
palliative care benefit  under the Medi-Cal program. 
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.  The bill would require that authorized
providers  under the pilot program  include licensed
hospice agencies and home health agencies licensed to provide
hospice care, subject to criteria developed by the department for
provider participation.  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. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14132.75 is added to the Welfare and
Institutions Code, to read:
   14132.75.  (a) In enacting this section, it is the intent of the
Legislature that  the  palliative care 
pilot project developed pursuant to this section  include,
but not be limited to, all of the following:
   (1) Specialized medical care and emotional and spiritual support
for people with serious advanced illnesses.
   (2) Relief of symptoms, pain, and stress of serious illness.
   (3) Improvement of quality of life for both the patient and
family.
   (4) Appropriate care for any age and for any stage of serious
illness, along with curative treatment.
   (b) The department, in consultation with interested stakeholders,
shall  develop, as a pilot project, a palliative care benefit
to evaluate whether, and to what extent, that 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.   develop a palliative care benefit under
the Medi-Cal program.  
   (c) Beneficiaries eligible to receive the palliative care benefit
shall be 21 years of age or older. 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
(b).  
   (d) 
    (   c)  Services covered under the palliative
care benefit shall include  , but are not limited to,  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. 
   (e) 
    (   d)  The department, in consultation with
interested stakeholders, shall determine the medical conditions and
prognoses that render a beneficiary eligible for the benefit.

   (f) 
    (   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. 
   (g) (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 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.  
   (f) The department shall, to the extent practicable, 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.
Before implementing the palliative care benefit developed pursuant
to this section, the department shall provide the fiscal and
appropriate policy committees of the Legislature with estimates of
costs and projected savings associated with providing the benefit.
 
   (h) 
    (   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 
stakeholders and  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.

   (i) 
    (   h)  (1) Nothing in this section shall
result in the elimination or reduction of any covered benefits or
services under the Medi-Cal 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.