BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 892|
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THIRD READING
Bill No: AB 892
Author: Alquist (D), et al
Amended: 8/23/99 in Senate
Vote: 21
SENATE INSURANCE COMMITTEE : 7-0, 7/14/99
AYES: Speier, Escutia, Figueroa, Hughes, Johnston, Schiff,
Sher
NOT VOTING: Johnson, Leslie, Lewis
SENATE APPROPRIATIONS COMMITTEE : 11-1, 9/3/99
(Roll Call Vote not available)
ASSEMBLY FLOOR : 55-16, 5/20/99 - See last page for vote
SUBJECT : Health care service plans: hospice care
SOURCE : Author
DIGEST : This bill adds hospice care to the basic health
care services required to be provided by health care
service plans (except specialized plans) which are issued,
amended or renewed on or after January 1, 2002, and
requires the State Department of Corporations to adopt
regulations, as specified.
Requires the State Commissioner of Corporations to adopt
regulations for hospice care and requires an annual report
by the commissioner each January 15th, starting in the year
2002, of changes in federal systems that require a change
in state regulations for hospice care.
CONTINUED
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ANALYSIS : Existing law requires health plans to provide
basic health care services, including:
1.Physician services, including consultation and referral;
2.Hospital inpatient services and ambulatory care services;
3.Diagnostic laboratory and diagnostic and therapeutic
radiologic services;
4.Home health services;
5.Preventive health services; and
6.Emergency health care services, including ambulance and
ambulance transport services.
Background
Hospice care is a medically directed, interdisciplinary
team-managed program of services that focus on the
patient/family as the unit of care. The goal of hospice is
to improve the quality of a terminally ill patient's life
by controlling pain, managing symptoms and providing
support -- enabling comfort and dignity at the end of life.
Hospice services have been covered through the Medicare
Hospice Benefit since 1983 and are also covered by
Medi-Cal. CSHA cites one study that compared the relative
costs to Medicare for hospice users and non-users in
California that demonstrated for every dollar Medicare
spent on hospice users in California, it saved $1.57 in
specific expenditures (a net savings of $ .57). In the
last month of life, patients using hospice accrued costs
averaging $3,069 compared to $4,071 for non-hospice users
-- a savings of $1,002.
This bill:
1.Requires each health care service plan to include, on or
after January 1, 2002, as a basic health care service,
hospice care that a minimum is to be equivalent to that
provided by the federal Medicare program.
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2.Requires the State Corporations Commissioner no later
than January 1, 2001, to adopt regulations to implement
the bill. The regulations are to meet the following
requirements.
3.Adds "hospice care" for the terminally ill patient to the
definition of "basic health care services," in the Knox
Keene Act.
4.Requires every group health care service plan contract
issued, amended, renewed after January 1, 2002, to
include a provision for hospice care.
5.Defines hospice care to be, at a minimum, equivalent to
hospice care provided by Medicare and incorporate federal
regulations, excluding those that are applicable only to
Medicare beneficiaries, regarding hospice care into state
law.
6.Requires the State Department of Corporations to adopt
regulations to implement the bill's provisions no later
than January 1, 2001.
7.Requires the State Department of Corporations to report
to the Health Care Service Plan Advisory Committee on
January 15, 2002, and January 15 thereafter, any changes
to the federal regulations regarding hospice care that
differ from the state regulations currently in effect and
proposes changes to the existing state regulations.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
Hospice services are already provided through Medi-Cal.
Research indicates that hospice care in general is
cost-effective, but becomes less cost-effective when
extended for longer lengths of time. Cost-effectiveness of
this bill depends upon changes in patterns of use of
hospice services which is difficult to predict, since
mandating a specifically defined level of care could
increase its use. To the extent that the State is a
purchaser of health benefits for state employees, the State
could experience increased premium costs. However,
provision of this benefit will likely result in overall
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cost savings.
SUPPORT : (Verified 8/30/99)
California State Hospice Association (source)
American Cancer Society
California Association for Health Services at Home (CAHSAH)
California Association of Catholic Hospitals
California Catholic Conference
California Health Care Association
California Home Care and Hospice
California Medical Association
California Nurses Association
California Professional Firefighters
California School Employees Association
Community Residential Care Association of California
Hoffman Hospice of the Valley
Hospice Care
Hospice of the Central Coast
Hospice of the Foothills
Hospice of Marin
Hospice of the Valley
Hospice of the Valleys
Hospice Services of Lake County
Lutheran Social Services of Northern California
Madrone Hospice
Older Women's League
Pathways Volunteer Hospice
San Diego Hospice
Snowline Hospice
Southern California Cancer Plan Initiative
TrinityCare Hospice
Visiting Nurse Association and Hospice of Northern
California
The Elizabeth Hospice
ZG International Health Care
OPPOSITION : (Verified 8/30/99)
Californians for Affordable Health Reform
Printing Industries of California
ARGUMENTS IN SUPPORT : This bill is sponsored by the
California State Hospice Association (CSHA) which reports
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that many health plans are limiting the hospice benefit and
that although the physical, emotional and financial
benefits of hospice care are proven, a more concerted
effort must be made to ensure that hospice care is
available for terminally ill patients in California. Also,
while hospice is a widely covered elective benefit among
employer-sponsored plans, it receives less attention than
other types of coverage, largely because it is
misunderstood and the need for it is unrecognized. Many
employers see little need for hospice care since a majority
of workers are under 55. However, studies have shown that
32 percent of male and 28 percent of female hospice
patients were under 65.
The California Nurses Association (CNA) states that hospice
care provides compassionate care that allows hospice
patients to benefit from an interdisciplinary approach to
end-of-life care, especially when provided by registered
nurses who are experts at pain and symptom management.
These nurses provide psychological and spiritual support as
well as grief and bereavement support. CNA further states
that hospice nurses report that too often patients are not
aware of the benefits of hospice services and are admitted
too late.
ARGUMENTS IN OPPOSITION : Californians for Affordable
Health Reform (CAHR) state that California employers and
employees spend over $35 billion annually for health care
-- more than one-third of all health care dollars spent in
the State. As such, it is CAHR's policy to oppose all
measures that mandate specific coverages that increase
premiums and jeopardize the ability of employers and
employees alike to maintain comprehensive medical
insurance. The Printing Industries of California (PIC)
state that existing law that provides for the coverage of
basic health care services has stretched the definition of
basic services such that the cost of health care coverage
is becoming out of reach for most employees and employers.
PIC additionally states that while the addition of hospice
care will undoubtedly benefit some patients; unfortunately,
it will raise the cost of health insurance for everyone
else who have no need for such a service.
ASSEMBLY FLOOR : 55-16, 5/20/99
AYES: Aanestad, Alquist, Aroner, Bates, Bock, Brewer,
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Calderon, Cardenas, Cardoza, Corbett, Correa, Cox,
Cunneen, Davis, Ducheny, Dutra, Florez, Floyd, Gallegos,
Granlund, Havice, Hertzberg, Honda, House, Jackson,
Keeley, Kuehl, Leach, Lempert, Longville, Lowenthal,
Machado, Maddox, Maldonado, Mazzoni, Migden, Nakano,
Papan, Pescetti, Reyes, Romero, Scott, Shelley, Soto,
Steinberg, Strom-Martin, Thomson, Torlakson, Washington,
Wayne, Wesson, Wiggins, Wildman, Wright, Villaraigosa
NOES: Ackerman, Ashburn, Baldwin, Baugh, Briggs,
Dickerson, Frusetta, Kaloogian, Leonard, Margett,
McClintock, Olberg, Oller, Rod Pacheco, Runner, Thompson
NOT VOTING: Battin, Campbell, Cedillo, Firebaugh, Knox,
Robert Pacheco, Strickland, Vincent, Zettel
DLW:kb 9/4/99 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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