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 28, 2015 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
SUSPENSE FILE. AS AMENDED.
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 (as approved on May 28,
2015):
Start-up costs of about $2.5 million over the first three
years to develop the system (private funds). 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.
SB 19 (Wolk) Page 1 of
?
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
care directive registry. That system is paper based and is not
SB 19 (Wolk) Page 2 of
?
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
state governments and health care providers for improvements to
SB 19 (Wolk) Page 3 of
?
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.
Committee amendments (as adopted May 28, 2015): would require
the initial development costs to be paid for with non-state
funds.
-- END --