BILL ANALYSIS Ó
SB 1004
Page 1
SENATE THIRD READING
SB 1004 (Ed Hernandez)
As Amended August 22, 2014
Majority vote
SENATE VOTE :34-0
HEALTH 18-0 APPROPRIATIONS 12-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bocanegra, |
| |Bonilla, Bonta, Chávez, | |Bradford, |
| |Chesbro, Gomez, Gonzalez, | |Ian Calderon, Campos, |
| |Roger Hernández, | |Eggman, Gomez, Holden, |
| |Lowenthal, Mansoor, | |Pan, Quirk, |
| |Nazarian, Nestande, | |Ridley-Thomas, Weber |
| |Patterson, Ridley-Thomas, | | |
| |Rodriguez, Wagner, | | |
| |Wieckowski | | |
| | | | |
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SUMMARY : Requires DHCS to assist Medi-Cal managed care plans in
delivering palliative care services. Requires DHCS to consult
with stakeholders and directs DHCS to ensure the delivery of
palliative care services in a manner that is cost-neutral to the
General Fund (GF), to the extent practicable.
EXISTING LAW 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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee on the previous version of the bill:
1)One-time staff costs in the range of $150,000 to develop a
palliative care benefit.
2)Uncertain costs of providing palliative care benefits in
Medi-Cal (General Fund (GF)/federal). Palliative care
requires an infrastructure and intensive team-based management
of patients, which does have an up-front cost. Information
from providers of these benefits in a similar pediatric
program suggests reimbursement of about $1,000 per child, per
SB 1004
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month. On the other hand, palliative care has also been shown
to significantly reduce costs for hospital inpatient services.
One study of the pediatric pilot mentioned above reported net
cost savings of $1,700 per child per month.
Thus, Medi-Cal coverage of palliative care benefits does not
appear likely to increase overall net Medi-Cal benefits costs.
But because palliative care benefits are paid out up-front
and the savings results from reduced inpatient utilization,
the actual cost impact to the state is uncertain. It would
depend on how the palliative care benefit is structured, how
the population is defined, how and when services are
reimbursed, where savings are incurred and whether, how, and
when the state captures potential savings. This bill requires
the benefit to be structured to be cost-neutral to the GF to
the maximum extent practicable.
COMMENTS : According to the author, evidence suggests 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. 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.
Palliative care is specialized medical care for people with
serious illnesses. It is intended to provide patients with
relief from the symptoms, pain, and stress of a serious illness.
The goal is to improve quality of life for both the patient and
the family. Palliative care is provided by a team of doctors,
nurses, and other specialists who work together with a patient's
other doctors to provide an extra layer of support. It is
appropriate at any age and at any stage in a serious illness and
can be provided along with curative treatment.
California was one of the first states to respond to the need
for comprehensive pediatric palliative care. Under the Nick
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Snow Children's Hospice and Palliative Care Act of 2006,
established by AB 1745 (Chan), Chapter 330, Statutes of 2006,
eligible children receive in-home coordinated family-centered
care including pain and symptom management, access to a 24/7
nurse line, family education, respite care, expressive therapies
and family counseling. The pilot program was subject to a
preliminary evaluation in the August 2012, University of
California, Los Angeles Center for Health Policy Research brief,
Better Outcomes, Lower Costs: Palliative Care Program Reduces
Stress, Costs of Care for Children with Life-Threatening
Conditions. The preliminary findings include a one-third
reduction in hospital days per child, 11% reduction in average
costs, and survey data showed that families and providers both
reported high levels of satisfaction with the program overall
and with each of the individual services.
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.
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.
This bill has no opposition.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097
FN: 0005325