BILL ANALYSIS Ó
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Date of Hearing: June 14, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SCR
117 (Pan) - As Introduced March 7, 2016
SENATE VOTE: 38-0
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 diseases. Specifically, this resolution:
1)Resolves that the Legislature encourage the state to do both
of the following:
a) 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 healthcare
services, and as a way to more effectively spend limited
healthcare dollars; and,
b) Develop solutions, tools, and best practices for
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providing better patient-centered care and information to
individuals with chronic diseases in California.
2)Makes various findings and declarations regarding palliative
care, including the following:
a) Palliative care means patient- and family-centered
medical care that optimizes quality of life by
anticipating, preventing, and treating suffering caused by
serious illness;
b) Patients with complex, chronic health issues should be
offered palliative care as it is appropriate at any age and
can be provided along with curative treatment;
c) Palliative care can provide substantial cost reductions
while improving a patient's quality of life;
d) A population trained about the benefits of palliative
care boosts our medical and social care workforce;
e) 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;
and,
f) The formation of a state palliative care and quality of
life interdisciplinary advisory council and a palliative
care information and education program within the
Department of Public Health (DPH) would maximize the
effectiveness of palliative care initiatives in the state
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by ensuring that comprehensive and accurate information,
education about palliative care is available to the public,
healthcare providers, and healthcare facilities.
EXISTING LAW:
1)Establishes DPH to protect and improve the health of
communities through education, promotion of healthy
lifestyles, and research.
2)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS). 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. Establishes a pediatric palliative care pilot
project for Medi-Cal beneficiaries under age 21.
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.
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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 provide supportive care to the primary caregiver
and the family of the hospice patient, and that meets
specified criteria.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, palliative
care provides us an opportunity to defragment our health care
system and improve both 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)BACKGROUND.
a) Medi-Cal and palliative care. 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. DHCS issued a draft policy paper for SB 1004 in
October 2015 to establish minimum standard palliative care
services and eligible conditions for Medi-Cal
beneficiaries. DHCS received a significant number of
comments from stakeholders and is currently revising the
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policy paper to reflect stakeholder feedback and additional
data analysis.
b) Institute of Medicine (IOM) Report. "Dying in America,"
a 2014 IOM report, noted that improving the quality and
availability of medical and social services for patients
and their families could not only enhance quality of life
through the end of life, but may also contribute to a more
sustainable care system. Among the report's findings and
recommendations were the following:
i) Some evidence suggests that, on average, palliative
care and hospice patients may live longer than similarly
ill patients who do not receive such care;
ii) Although professional guidelines and expert advice
increasingly encourage oncologists, cardiologists, and
other disease-oriented specialists to counsel patients
about palliative care, widespread adoption of timely
referral to palliative care appears slow;
iii) Most people nearing the end of life are not
physically, mentally, or cognitively able to make their
own decisions about care. The majority of these patients
will receive acute hospital care from physicians who do
not know them. Therefore, advance care planning is
essential to ensure that patients receive care reflecting
their values, goals, and preferences;
iv) There is insufficient attention to palliative care
in medical and nursing school curricula;
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v) Palliative care should encompass access to an
interdisciplinary palliative care team; and,
vi) State regulatory agencies should include education
and training in palliative care in licensure requirements
for physicians, nurses, chaplains, social workers, and
others who provide health care to those nearing the end
of life.
c) California Specific Report. In December 2015 the
California HealthCare Foundation and the Coalition for
Compassionate Care of California published a report titled
"Dying in California: A Status Report on
End-of-Life-Care." The report found that 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.
Specialty palliative care is currently unavailable in many
geographic areas and in many care settings. So far,
consumer demand for better care at the end of life has not
created the type of powerful change seen for widespread
adoption of palliative care services.
d) California State University (CSU) Institute for
Palliative Care (Institute). The CSU Institute was founded
in 2012 as America's first statewide educational and
workforce development initiative focused on offering health
care professionals training in high-quality palliative
care. More health care professionals receive training from
the CSU system than any other program in California.
According to CSU, the Institute is integral to
incorporating palliative care curriculum into the training
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of future nurses, social workers, public health, and other
allied professions (such as home health aides). Located on
the CSU San Marcos campus, the Institute also offers
professional development and continuing education courses
to enhance the skills of current health care professionals.
3)SUPPORT. The American Cancer Society Cancer Action Network,
the sponsor for this resolution argues that, while California
has made important strides in palliative care, there is still
more to do in ensuring access and affordability. The
California Catholic Conference writes that 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.
4)PREVIOUS LEGISLATION. AB 1745 (Chan), Chapter 330, Statutes
of 2006, requires the Department of Health Services (now DHCS)
to develop a Medi-Cal pediatric palliative care pilot project.
5)RELATED LEGISLATION.
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a) SB 1002 (Monning) would have required 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 was held in the Senate
Appropriations Committee on the Suspense File.
b) ABX2 15 (Eggman), Chapter 1, Statutes of 2015, Second
Extraordinary Session, establishes the End of Life Option
Act, which permits a competent, qualified individual who is
an adult with a terminal disease to receive a prescription
for an aid-in-dying drug if certain conditions are met.
ABX2 15 became effective on June 9, 2016.
REGISTERED SUPPORT / OPPOSITION:
Support
American Cancer Society Cancer Action Network (sponsor)
Alliance of Catholic Health Care
California Catholic Conference
California Medical Association
California State Retirees
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Alliance of Catholic Health Care
Providence Health & Services
Opposition
None on file.
Analysis Prepared by:John Gilman / HEALTH / (916)
319-2097