BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1004|
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THIRD READING
Bill No: SB 1004
Author: Hernandez (D), et al.
Amended: 5/5/14
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 5/7/14
AYES: Hernandez, Morrell, Beall, De León, DeSaulnier, Evans,
Monning, Nielsen, Wolk
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/14
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : Health facilities: hospice care
SOURCE : Author
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to request a federal Medicaid waiver to conduct
a pilot project and evaluate whether an adult pediatric
palliative care benefit should be offered in the Medi-Cal
program.
ANALYSIS :
Existing law:
1. Establishes the Medi-Cal program, administered by DHCS, which
provides health care to children, seniors, persons with
disabilities, people also eligible for Medicare, and
low-income individuals and families.
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2. Establishes the Nick Snow Children's Hospice and Palliative
Care Act of 2006, which requires DHCS, in consultation with
interested stakeholders, to develop a pediatric palliative
care pilot project to evaluate whether and to what extent
Medi-Cal beneficiaries under age 21 should be offered a
pediatric palliative care benefit. Requires the project to
be implemented only to the extent that federal financial
participation (FFP) is available.
3. Defines "palliative care" as a medical treatment,
interdisciplinary care, or consultation provided to a patient
or family members, or both, that has as its primary purpose
the prevention of, or relief from, suffering and the
enhancement of the quality of life, rather than treatment
aimed at investigation and intervention for the purpose of
cure or prolongation of life as described. In some cases,
disease-targeted treatment may be used in palliative care.
4. Defines "hospice care" as a specialized form of
interdisciplinary health care that is designed to provide
palliative care, alleviate the physical, emotional, social,
and spiritual discomforts of an individual who is
experiencing the last phases of life due to the existence of
a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and
that meets specified criteria.
5. Establishes requirements for licensure as hospice, including
that the licensee provides specified services.
6. Authorizes licensed hospices to provide, in addition to hospice
services, specified preliminary services for any person in
need of those services, as determined by the physician and
surgeon, if any, in charge of the care of a patient, or at
the request of the patient or family.
7. Authorizes preliminary services to be provided concurrently
with curative treatment to a person who does not have a
terminal prognosis or who has not elected to receive hospice
services only by licensed and certified hospices. Requires
these services to be subject to the schedule of benefits
under the Medi-Cal program.
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This bill:
1. Requires DHCS, in consultation with interested stakeholders, to
develop, as a pilot project, a palliative care benefit to
evaluate whether and to what extent, such a benefit should be
offered under the Medi-Cal program. Requires the project to
be implemented only to the extent that FFP is available.
2. Requires beneficiaries eligible to receive the palliative care
benefit to be 21 years of age or older, and authorizes DHCS
to further limit the population served by the pilot project
to a size deemed sufficient to evaluate the project.
3. Requires services covered under the palliative care benefit to
include those types of services that are available through
the Medi-Cal hospice benefit, and also include:
A. Hospice services that are provided at the same time that
curative treatment is available, to the extent that the
services are not duplicative;
B. Hospice services provided to individual's whose
conditions may result in death, regardless of the
estimated length of the individual's remaining period of
life; and
C. Any other services that DHCS determines to be
appropriate.
4. Requires DHCS, in consultation with interested stakeholders, to
determine the medical conditions and prognoses that render a
beneficiary eligible for the benefit.
5. Requires providers authorized to provide services under the
pilot to include licensed hospice agencies and home health
agencies licensed to provide hospice care, subject to
criteria developed by DHCS for provider participation.
6. Requires DHCS to submit any necessary application to the
federal Center for Medicaid and Medicare Services (CMS) for a
waiver to implement the pilot. Requires DHCS to determine
the most appropriate form of waiver, and submit a request or
application within 12 months after the effective date of this
bill. Requires DHCS to implement the waiver within 12 months
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of the date of approval.
7. Requires the waiver to be designed to cover a period of time
necessary to evaluate the medical necessity for, and
cost-effectiveness of, a palliative care benefit, and
requires the result of the pilot to be made available to the
Legislature and appropriate policy and fiscal committees to
determine effectiveness of the benefit.
8. Authorizes DHCS to implement the waiver by provider bulletin.
9. Prohibits this bill from resulting in the elimination or
reduction of any covered benefits or services under the
Medi-Cal program.
10.Prohibits this bill from affecting an individual's eligibility
to receive, concurrently with the palliative care benefit,
any services, including home health services, for which the
individual would have been eligible in the absence of this
bill.
Comments
According to the author's office, as noted in the California
State Health Care Innovation Plan (SHIP), an abundance of recent
evidence suggests that an expansion of patient and family
centered palliative care has the potential to change health
outcomes for many Californians, while reducing costs associated
with inpatient care. Palliative care is designed to better
address patient preferences for patients facing advanced
illness. California has already demonstrated success in
Medi-Cal with pediatric palliative care where a preliminary
analysis indicates that the program improves quality of life for
the child and family, average days in the hospital fell by
one-third, and shifting care from the hospital to in-home
community based care resulted in cost savings of $1,677 per
child per month on average. With palliative care, patients can
live longer with a higher quality of life and fewer
hospitalizations. Establishing a Medi-Cal palliative care
program for patients with serious advanced illness is good
policy and promotes better health outcomes for patients with a
serious illness.
SHIP . SHIP was prepared in response to a federal State
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Innovation Model design grant. The California Health and Human
Services Agency Let's Get Healthy California Task Force set an
overall target of bringing California's health care expenditures
growth rate in line with that of the gross state product by
2022, along with establishing targets for 38 health indicators.
SHIP centers around four initiatives, which focus on different
aspects of the health care system that experience particularly
high costs-uncoordinated care for people with complex chronic
conditions, maternity care, end of life care, and accountable
care communities. Through the greater use of team-based care
and care coordination (including linking with community and
social services), implementation of best practices,
incorporation of lower-cost health providers where appropriate,
and respecting patient preferences for care options, these
initiatives will lower costs while improving health outcomes.
SHIP includes a recommendation for a palliative care initiative,
together with a Health Homes for Complex Patients Initiative,
which aims to identify patients in hospitals, long-term care
facilities, or the community, who may benefit from and desire
palliative care services, and offer them comprehensive
palliative care by people who are trained in this area.
Prior legislation . AB 1745 (Chan, Chapter 330, Statutes of
2006) required the Department of Health Services (now known as
DHCS) to develop, as a pilot project, a pediatric palliative
care benefit covered under Medi-Cal. Requires DHCS to submit a
waiver to CMS to implement the pilot project.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Likely costs of about $900,000 over two years to design the
pilot project and negotiate a waiver with the federal
government (General Fund and federal funds). Based on the
workload to engage with stakeholders, design the pilot
project, and negotiate an agreement with the federal
government, staff estimates that DHCS would need about three
additional staff positions for one to two years.
One-time costs, likely in the range of $150,000 to $300,000 to
conduct an evaluation of the pilot project once enough data
has been collected (General Fund and federal funds).
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Unknown potential for cost savings from the pilot project
(General Fund and federal funds). The state created a pilot
project for pediatric palliative care in the Medi-Cal program
from 2009 to 2012. According to a preliminary analysis of the
pilot project, total spending for participants was about
$1,700 per month less than it would have been under standard
Medi-Cal pediatric benefits. Similarly, an analysis of a
pilot project to provide adult palliative care benefits in New
York State indicated that hospitalization costs were
substantially reduced for program participants.
SUPPORT : (Verified 5/23/14)
AFSCME, AFL-CIO
Alliance of Catholic Health Care
Association of Northern California Oncologists
California Commission on Aging
California Dialysis Council
California Hospice and Palliative Care Association
California Hospital Association
Children's Hospice
Health Access California
Medical Oncology Association of Southern California
Providence Health & Services, Southern California and Providence
TrinityCare Hospice
ARGUMENTS IN SUPPORT : The Association of Northern California
Oncologists believes this bill proposes a meaningful solution to
help ease the pain and suffering of cancer patients who are
seriously and terminally ill, and will support curative
treatment concurrently with hospice services for all eligible
beneficiaries. The Alliance of Catholic Health Care writes that
Catholic hospitals are leaders in the provision of palliative
care and pain management, helping improve the quality of life
for seriously ill patients. Among several important provisions,
this bill includes hospice services that are provided at the
same time that curative treatment is available, to the extent
the services are not duplicative, and are provided regardless of
the estimated length of time a beneficiary may be expected to
live. This bill proposes a meaningful solution to help ease the
pain and suffering of patients who are seriously and terminally
ill, and will support curative/life prolonging treatment
concurrently with hospice services for all eligible
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beneficiaries. The California Hospital Association supports
this bill as an excellent opportunity to evaluate the potential
benefit of access to palliative care for Medi-Cal beneficiaries.
JL:k 5/25/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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