BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Kevin de León, Chair SB 1357 (Wolk) - Physician Orders for Life Sustaining Treatment form: statewide registry. Amended: May 6, 2014 Policy Vote: Health 8-0, Judic. 5-1 Urgency: No Mandate: No Hearing Date: May 19, 2014 Consultant: Brendan McCarthy This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 1357 would require the Health and Human Services Agency to create a statewide registry for Physician Orders for Life Sustaining Treatment forms. Fiscal Impact: Start-up costs of about $2.5 million over the first three years to develop the system (General Fund). The California Health Care Foundation has commissioned a feasibility report to examine the concept of a POLST registry. According to a draft of the report, it will cost about $2.5 million to develop the information technology system for an online-accessible registry and set up the program. Ongoing costs of about $1.3 million per year to maintain the system, assist health care providers trying to access a POLST form for a patient, and market the system (General Fund). Background: Under current law, a health care provider can complete a Physician Orders for Life Sustaining Treatment (POLST) form based on patient preferences and medical indications. A POLST form must be signed by the patient and the health care provider. The POLST form gives information to future health care providers about the patient's wishes for medical care at the end of life. The POLST form allows the patient to specify the level of care that he or she wishes to be provided. A POLST form is a more detailed set of instructions for health care provides than a Do Not Resuscitate form. Also authorized under current law, an individual may create and advance care directive. An advance care directive is a legal SB 1357 (Wolk) Page 1 document through which an individual can appoint someone else to make health care decisions, if the individual is not able to make his or her own decisions. An advance care directive can also give instructions for making health care decisions, for example by giving instructions to family members about a patient's wishes, should he or she be unable to make health care decisions. The Secretary of State's Office currently maintains an advance care directive registry. That system is paper based and is not widely marketed. There are only about 4,000 records in the system and the Secretary's Office receives about 40 requests per month for directives in the system. Because it is a paper-based system with limited funding, requests can only be responded to during normal business hours. Proposed Law: SB 1357 would require the Health and Human Services Agency to create a statewide registry for Physician Orders for Life Sustaining Treatment forms. Specific provisions of the bill would: Require the Health and Human Services Agency to create a statewide POLST registry, before January 1, 2016; Require the registry to accept electronic submissions; Require standards for verifying users and protecting information in the registry; Require other privacy and accuracy protections; Require a health care provider who completes a POLST form to include it in the patient's medical record; Provide that a health care provider, acting in good faith upon information in a POLST form, would be protected from criminal or civil liability or other sanctions. Related Legislation: AB 2452 (Pan) would require the Secretary of State to develop an online registry for advance health care directives. That bill is on the Assembly Appropriations Committee's Suspense File. Staff Comments: Under both the federal American Recovery and Reinvestment Act and the Affordable Care Act, funding has been made available to state governments and health care providers for improvements to health-related information technology systems. It is possible that the state may be able to secure funding from the federal government under those bills or through SB 1357 (Wolk) Page 2 the Medi-Cal program to offset some of the costs to develop the system required under this bill.