BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 1004
Author: Hernandez (D), et al.
Amended: 8/22/14
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
SENATE FLOOR : 34-0, 5/27/14
AYES: Anderson, Beall, Block, Cannella, Corbett, Correa, De
León, DeSaulnier, Evans, Fuller, Gaines, Galgiani, Hancock,
Hernandez, Hill, Hueso, Huff, Jackson, Knight, Lara, Leno,
Lieu, Mitchell, Monning, Morrell, Nielsen, Padilla, Pavley,
Roth, Steinberg, Vidak, Walters, Wolk, Wyland
NO VOTE RECORDED: Berryhill, Calderon, Liu, Torres, Wright, Yee
ASSEMBLY FLOOR : 77-0, 8/26/14 - See last page for vote
SUBJECT : Health facilities: hospice care
SOURCE : Author
DIGEST : This bill requires the Department of Health Care
Services (DHCS) to assist Medi-Cal managed care plans in
delivering palliative care services, and requires DHCS to
consult with stakeholders and directs DHCS to ensure the
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delivery of palliative care services in a manner that is
cost-neutral to the General Fund (GF), to the extent
practicable.
Assembly Amendments revise and recast the bill by deleting the
requirement for DHCS conduct a pilot program, and instead
require DHCS consult with interested stakeholders to establish
standards and provide technical assistance for Medi-Cal managed
plans to ensure delivery of palliative care services, as
specified, in a manner that is cost neutral on the GF.
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.
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
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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.
This bill:
1.Requires DHCS, in consultation with interested stakeholders,
establish standards and provide technical assistance for
Medi-Cal managed care plans to ensure delivery of palliative
care services.
2.Requires covered services include, but are not limited to,
those types of services that are available through the
Medi-Cal hospice benefit and include the following, regardless
of whether these services are covered under the Medi-Cal
hospice benefit:
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 individuals whose
conditions may result in death, regardless of the estimated
length of the individual's remaining period of life.
C. Any other services that the DHCS determines to be
appropriate.
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3.Requires DHCS, in consultation with interested stakeholders,
establish guidance on the medical conditions and prognoses
that render a beneficiary eligible for the palliative care
services.
4.Requires providers authorized to provide services include
licensed hospice agencies and home health agencies licensed to
provide hospice care that are contracted with Medi-Cal managed
care plans to provide palliative care services.
5.Requires DHCS, to the extent practicable, ensure that the
delivery of palliative care services in a manner that is cost
neutral to GF on an ongoing basis.
6.Prohibits this bill from resulting in the elimination or
reduction of any covered benefits or services under the
Medi-Cal program.
7.Specifies this bill does not affect an individual's
eligibility to receive, concurrently with the services
provided for in this bill, 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
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serious illness.
SHIP . SHIP was prepared in response to a federal State
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 the federal Center for Medicaid and Medicare Services
to implement the pilot project.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
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 (GF/federal). Palliative care requires an
infrastructure and intensive team-based management of
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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 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.
SUPPORT : (Verified 8/26/14)
Alliance of Catholic Health Care
Association of Northern California Oncologists
California Hospice and Palliative Care Association
California Hospital Association
Children's Hospice and Palliative Care Coalition
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
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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
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.
ASSEMBLY FLOOR : 77-0, 8/26/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox,
Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon,
Gorell, Gray, Grove, Hagman, Hall, Harkey, Roger Hernández,
Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Mansoor, Medina, Melendez, Mullin, Nazarian,
Nestande, Olsen, Pan, Patterson, Perea, John A. Pérez, V.
Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas,
Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron,
Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Holden, Muratsuchi, Vacancy
JL/JA:kd 8/27/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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