BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session SB 19 (Wolk) - Physician Orders for Life Sustaining Treatment form: statewide registry ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: May 5, 2015 |Policy Vote: HEALTH 9 - 0, JUD. | | | 6 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 18, 2015 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 19 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 or other unknown fund source). 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 SB 19 (Wolk) Page 1 of ? 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 or other unknown fund source). Unknown potential cost savings due to avoided unwanted medical care (various fund sources). The primary purpose of a POLST and the POLST registry proposed in this bill is to ensure that individuals do not receive medical care they do not wish to receive. By creating a registry of POLST forms, the bill will improve access to POLST forms by emergency medical services and hospitals. In turn, this will lead to fewer emergency health care services for individuals who do not want those services. The size of this impact is unknown. Background: Under current law, a physician 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 physician. The POLST form gives information to other 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 (across a wide range of treatment options). A POLST form is a more detailed set of instructions for health care providers than a Do Not Resuscitate form. Importantly, because a POLST form is signed by a physician, other health care providers can use the POLST form as a physician's order, allowing them to provide or withhold treatment based on the direction of the form. Also authorized under current law, an individual may create an advance care directive. An advance care directive is a legal 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 SB 19 (Wolk) Page 2 of ? 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 19 would require the Health and Human Services Agency to create a statewide registry for Physician Orders for Life Sustaining Treatment (POLST) forms. Specific provisions of the bill would: Require the Health and Human Services Agency to establish a statewide POLST registry; 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: SB 128 (Wolk and Monning) would permit a competent individual who has been diagnosed with a terminal illness to request a prescription for aid in dying medication. That bill is on this committee's Suspense File. SB 1357 (Wolk, 2014) was substantially similar to this bill. That bill was held on this committee's Suspense File. AB 2452 (Pan, 2014) would have required the Secretary of State to develop an online registry for advance health care directives. That bill was held in the Senate Judiciary Committee. Staff Comments: Under both the federal American Recovery and Reinvestment Act and the Affordable Care Act, funding has been made available to SB 19 (Wolk) Page 3 of ? state governments and health care providers for improvements to health-related information technology systems. Based on information provided by the Health and Human Services Agency, it does not seem likely that such federal funding would be available to provide significant funding for the POLST registry proposed in this bill. For example, federal Medicaid funding for information technology systems authorized in the Affordable Care Act is limited to the adoption and/or meaningful use of electronic health records for Medicaid programs. While some users of the proposed POLST system will certainly be Medi-Cal beneficiaries, the Agency indicates that this connection to the Medi-Cal program is likely not strong enough to secure federal funds. Similarly, funding available under the American Recovery and Reinvestment Act is available to advance health information exchange efforts that are already under way. -- END --