BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SCR 117
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|AUTHOR: |Pan |
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|VERSION: |March 7, 2016 |
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|HEARING DATE: |April 13, 2016 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : Palliative care
SUMMARY : Encourages the state to study the status and importance of
coordinated palliative care and to develop solutions, tools, and
best practices for providing better patient-centered care and
information to individuals with chronic disease in California.
Existing law:
1)Establishes the Department of Public Health (DPH) to protect
and improve the health of communities through education,
promotion of healthy lifestyles, and, research for disease and
injury prevention; and provides DPH with the authority to
perform activities that protect, preserve, and advance public
health, including studies and dissemination of information.
2)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), which provides
health care to children, seniors, persons with disabilities,
people also eligible for Medicare, and low-income individuals
and families.
3)Establishes 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.
4)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,
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disease-targeted treatment may be used in palliative care.
5)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 provide supportive care to the primary caregiver
and the family of the hospice patient, and that meets
specified criteria.
6)Requires DHCS, in consultation with interested stakeholders,
to establish standards and provide technical assistance for
Medi-Cal managed care plans to ensure delivery of palliative
care services.
This resolution states:
1)All patients who are experiencing complex, chronic health
issues that affect their quality of life should be offered
palliative care.
2)When palliative care programs are provided, a larger
percentage of hospice patients are identified earlier in their
eligibility window, which enables them to take advantage of
these valuable services for a longer period of time.
3)The California Health and Human Services Agency's Let's Get
Healthy California Task Force identified palliative care as
one of its top priorities and indicators for all Californians
to enjoy optimal health in its 2012 report.
4)The formation of a state palliative care and quality of life
interdisciplinary advisory council and palliative care
information and education program within DPH would maximize
the effectiveness of palliative care initiatives in the state.
5)The Legislature encourages the state to study the status and
importance of coordinated palliative care as a patient quality
of life issue, as a way to improve the quality and delivery of
health care services, and as a way to more effectively spend
limited health care dollars.
6)The Legislature encourages the state to develop solutions,
tools, and best practices for providing better
patient-centered care and information to individuals with
SCR 117 (Pan) Page 3 of ?
chronic diseases in California.
FISCAL
EFFECT : This resolution has not been analyzed by a fiscal
committee.
COMMENTS :
1)Author's statement. According to the author, palliative care
provides us an opportunity to defragment our health care
system and improve the lives of those who suffer from serious
illness, such as cancer, and the lives of those who care for
them. It is important that we study the status and importance
of coordinated palliative care to develop solutions and best
practices for providing better patient-centered care and
information to individuals with chronic disease.
2)Medi-Cal and palliative care. According to DHCS' web site,
under SB 1004 (Hernandez, Chapter 574, Statutes of 2014) DHCS
must establish standards and provide technical assistance for
Medi-Cal managed care plans to ensure delivery of palliative
care services. This effort is consistent with the DHCS'
Strategic Plan, Quality Strategy, the principles of the Triple
Aim, and with DHCS's ongoing efforts to develop and promote
best practices to improve the care experience. SB 1004 will be
implemented in consultation with a wide range of stakeholders
and partners, and will promote person-centered and
choice-focused policies. Specifically, DHCS will work with
consumers and consumer representatives, recognized experts,
providers, and health plans, to increase the availability of
palliative care services for Medi-Cal consumers.
Implementation of SB 1004 will be informed by related efforts
under the Coordinated Care Initiative, the Delivery System
Reform Incentive Payments program, and the Section 2703 Health
Home Initiative. In addition, DHCS established a Pediatric
Palliative Care Waiver Program that was approved in April of
2009. DHCS will consult with stakeholders to develop the
palliative care definition to be used for SB 1004 guidance.
DHCS held four meetings in 2015 and released a draft policy
paper and performance measures. In the draft paper, DHCS
indicates that its policy for implementing SB 1004 will be
guided by the Centers for Medicare and Medicaid Services (CMS)
definition of palliative care, which is: "patient and
family-centered care that optimizes quality of life by
anticipating, preventing, and treating suffering. Palliative
care throughout the continuum of illness involves addressing
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physical, intellectual, emotional, social, and spiritual needs
and to facilitate patient autonomy, access to information, and
choice." However, DHCS more specific definitions of eligible
conditions, services, and providers. DHCS indicates the
purpose of defining Medi-Cal palliative care more narrowly,
for a specific set of conditions, is to meet the requirements
of SB 1004 and the department's quality strategy, and to
recognize that long-term success in implementing palliative
care in Medi-Cal is more likely through an incremental
approach. At the same time, some Medi-Cal managed care health
plans and providers are already incorporating broader
palliative care principles and strategies such as advance care
planning into their models of care.
3)U.S. End of Life Care. A 2014 publication of the Institute of
Medicine (IOM), Dying in America: Improving quality and
Honoring individual preferences near the end of life. the IOM
Committee on Approaching Death: Addressing Key End-of-Life
Issues (committee) identified persistent major gaps in care
near the end of life that require urgent attention.
Understanding and perceptions of death and dying vary
considerably across the population and are influenced by
culture, socioeconomic status, and education, as well as by
misinformation and fear. Engaging people in defining their own
values, goals, and preferences concerning care at the end of
life and ensuring that their care team understands their
wishes has proven remarkably elusive and challenging. While
the clinical fields of hospice and palliative care have become
more established, the number of specialists in these fields is
too small, and too few clinicians in primary and specialty
fields that entail caring for individuals with advanced
serious illnesses are proficient in basic palliative care.
Often, clinicians are reluctant to have honest and direct
conversations with patients and families about end of life
issues. Patients and families face additional difficulties
presented by the health care system itself, which does not
provide adequate financial or organizational support for the
kinds of health care and social services that might truly make
a difference to them. The committee believes a
patient-centered, family-oriented approach to care near the
end of life should be a high national priority and that
compassionate, affordable, and effective care for these
patients is an achievable goal.
4)Dying in California. According to a December 2015 report
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titled Dying in California. A Status Report on
End-of-Life-Care, overall California has made significant
strides in creating a supportive framework for end-of-life
care but significant challenges remain. Growing demand far
outpaces the capacity of services. Palliative care
specialists are in short supply, and certification programs
are limited. Reliable funding streams do not yet exist.
While knowledge is growing about best practices and quality
standards, they have not yet been broadly implemented. People
with serious advanced illness and their families could benefit
from all clinicians having a basic level of competence in
addressing palliative care needs. Some patients may also
require the involvement of interdisciplinary teams of
professionals trained in palliative care. However, specialty
palliative care is currently unavailable in many geographic
areas and in many care settings.
5)Related legislation. SB 1002 (Monning) would require DPH to
establish and maintain a toll-free telephone number for the
purpose of receiving and responding to inquiries regarding the
End of Life Option Act. SB 1002 is pending in the Senate
Appropriations Committee.
ABX2 15 (Eggman, Chapter 1, Statutes of 2015), Second
Extraordinary Session, established the End of Life Option Act,
which will take effect on June 9, 2016.
SB 128 (Wolk and Monning) is similar to ABX2 15. SB 128 is
pending in the Assembly Health Committee.
6)Prior legislation. SB 1004 (Hernandez, Chapter 574, Statutes
of 2014), requires DHCS to establish standards and provide
technical assistance for Medi-Cal managed care plans to ensure
delivery of palliative care services.
AB 1745 (Chan, Chapter 330, Statutes of 2006), requires the
Department of Health Services (now 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.
7)Support. The California Catholic Conference writes that
access to palliative and hospice care in our state is both
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limited and costly. Significant changes in current law are
needed in order to address the needs of patients with chronic
disease and/or nearing the end of life and raise their
standard of care. A comprehensive approach is needed and
should include, for example, expanding instruction in
palliative care at medical schools and other institutions
providing health care instruction, and ensuring increased
access to palliative care for patients, and providing safe and
appropriate levels of staffing and salary scales in care
facilities serving elderly persons and persons with
life-threatening chronic illnesses. The Alliance of Catholic
Health Care writes Catholic hospitals are leaders in the
provision of palliative care. Over 95% of our Catholic and
affiliated community hospitals operate palliative care
programs, compared to a little more than 50% of California
hospitals as a whole. Palliative care improves the quality of
life for patients and their families facing chronic and
life-threatening illness by preventing and relieving
suffering.
SUPPORT AND OPPOSITION :
Support: American Cancer Society Cancer Action Network
(sponsor)
California Catholic Conference
Alliance of Catholic Health Care
Providence Health & Services
Oppose: None on file
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