Amended in Assembly August 22, 2014

Amended in Assembly August 18, 2014

Amended in Senate May 5, 2014

Senate Bill No. 1004

Introduced by Senator Hernandez

(Coauthor: Senator Wolk)

February 13, 2014

An act to add Section 14132.75 to the Welfare and Institutions Code, relating to health care.

LEGISLATIVE COUNSEL’S DIGEST

SB 1004, as amended, Hernandez. Health care: palliative care.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits, including hospice benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. begin insert One of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed health care plans. end insert

Existing law requires the department to develop, as a pilot project, a pediatric palliative care benefit to evaluate whether, and to what extent, such a benefit should be offered under the Medi-Cal program. Existing law requires that the pilot project be implemented only to the extent that federal financial participation is available, and requires the department to submit a waiver application for federal approval.

Existing law requires that beneficiaries eligible to receive the pediatric palliative care benefit be under 21 years of age, and allows the department to further limit the population served by the project to make the above evaluation. Existing law requires that the services available under the project include those types of services that are available through the Medi-Cal hospice benefit, and certain other services.

This bill would require the department to begin delete develop a palliative care benefit under the Medi-Cal program. end delete begin insert establish standards and provide technical assistance for Medi-Cal managed care plans to ensure delivery of palliative care services, which would include specified hospice services and any other services determined appropriate by the department. end insert The bill would require that authorized providers include licensed hospice agencies and home health agencies licensed to provide hospice begin delete care, subject to criteria developed by the department for provider participation. end delete begin insert care that are contracted with Medi-Cal managed care plans to provide palliative care services. end insert This bill would require the department, to the extent practicable, to begin delete structure the delivery of the palliative care benefit in a manner that is projected to be end delete begin insert ensure that the delivery of palliative care services under these provisions is provided in a manner that is end insert cost neutral to the General Fund on an ongoing basis. begin delete The bill would also require the department, before implementing the benefit, to provide the fiscal and appropriate policy committees of the Legislature with estimates of costs and projected savings associated with providing the benefit. end delete begin insert This bill would authorize the department to implement these provisions through all plan letters or similar instructions. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 14132.75 is added to the Welfare and
Institutions Code, to read:

14132.75.  

(a) In enacting this section, it is the intent of the
Legislature that palliative care include, but not be limited to, all
of the following:

(1) Specialized medical care and emotional and spiritual support
for people with serious advanced illnesses.

(2) Relief of symptoms, pain, and stress of serious illness.

(3) Improvement of quality of life for both the patient and
family.

(4) Appropriate care for any age and for any stage of serious
illness, along with curative treatment.

(b) The department, in consultation with interested stakeholders,
shall begin delete develop a palliative care benefit under the Medi-Cal program. end delete
begin insert establish standards and provide technical assistance for Medi-Cal
managed care plans to ensure delivery of palliative care services. end insert

(c)  begin delete Services covered under the palliative care benefit end delete begin insert Covered
services end insert shall include, but are not limited to, those types of services
that are available through the Medi-Cal hospice benefit. begin delete The benefit end delete
begin insert These services end insert shall begin delete also end delete include the begin delete following services, end delete begin insert following, end insert
regardless of whether begin delete those end delete begin insert these end insert services are covered under the
Medi-Cal hospice benefit:

(1) Hospice services that are provided at the same time that
curative treatment is available, to the extent that the services are
not duplicative.

(2) Hospice services provided to individuals whose conditions
may result in death, regardless of the estimated length of the
individual’s remaining period of life.

(3) Any other services that the department determines to be
appropriate.

(d) The department, in consultation with interested stakeholders,
shall begin delete determine end delete begin insert establish guidance on end insert the medical conditions and
prognoses that render a beneficiary eligible for the begin delete benefit. end delete
begin insert palliative care services. end insert

(e) Providers authorized to provide services shall include
licensed hospice agencies and home health agencies licensed to
provide hospice begin delete care, subject to criteria developed by the
department for provider participation. end delete begin insert care that are contracted
with Medi-Cal managed care plans to provide palliative care
services. end insert

(f) The department shall, to the extent practicable, begin delete structure the
delivery of the palliative care benefit in a manner that is projected
to be end delete begin insert ensure that the delivery of palliative care services under this
section is provided in a manner that is end insert cost neutral to the General
Fund on an ongoing basis. begin delete Before implementing the palliative care
benefit developed pursuant to this section, the department shall
provide the fiscal and appropriate policy committees of the
Legislature with estimates of costs and projected savings associated
with providing the benefit. end delete

(g) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement the provisions of this section by
means of begin delete provider bulletins end delete begin insert all plan letters end insert or similar instructions,
without the adoption of regulations. The department shall notify
stakeholders and the fiscal and appropriate policy committees of
the Legislature of its intent to issue begin delete a provider bulletin end delete begin insert all plan
letters end insert or other similar begin delete instruction at least five days end delete begin insert instructions end insert
prior to issuance.

(h) (1) Nothing in this section shall result in the elimination or
reduction of any covered benefits or services under the Medi-Cal
program.

(2) This section shall not affect an individual’s eligibility to
receive, concurrently with the begin delete benefit end delete begin insert services end insert provided for in this
section, any services, including home health services, for which
the individual would have been eligible in the absence of this
section.