Bill Text: CA AB847 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medi-Cal: pediatric palliative care services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2023-10-13 - Chaptered by Secretary of State - Chapter 814, Statutes of 2023. [AB847 Detail]

Download: California-2023-AB847-Amended.html

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Amended  IN  Assembly  March 23, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 847

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Introduced by Assembly Member Luz Rivas

February 14, 2023

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An act to add Section 14132.76 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

AB 847, as amended, Luz Rivas. Medi-Cal: pediatric palliative care services.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law requires the department to develop a pediatric palliative care benefit as a pilot program to Medi-Cal beneficiaries under 21 years of age, to be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. Existing law requires that program to include, among other things, hospice services to individuals whose conditions may result in death, regardless of the estimated length of the individual’s remaining period of life.

Pursuant to the above-described provisions, the department established the Pediatric Palliative Care (PPC) Waiver in 2009, upon receiving federal approval in December 2008. After the waiver ended on December 31, 2018, the department implemented a plan in 2019 to transition some pediatric palliative care services to the Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) benefit, which is available to Medi-Cal beneficiaries under 21 years of age, as specified.

Existing federal law makes individuals less than 21 years of age eligible for both hospice care and treatment for their underlying illness for which a physician has made a terminal diagnosis.

This bill would extend eligibility for pediatric palliative care services and concurrent treatment for an underlying illness for those individuals who have been determined eligible for those services prior to 21 years of age, after 21 years of age. To the extent that these provisions would alter the eligibility of individuals for these services, the bill would create a state-mandated local program. The bill would require a managed care plan to be liable for payment of these services received in a county different from the individual’s county of residence if they are not available in that county. The bill would implement these provisions only to the extent that necessary federal approvals are obtained and federal financial participation is not otherwise jeopardized.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

This bill would state the intent of the Legislature to enact legislation that would enhance the scope of pediatric palliative care services that have been transitioned from the PPC Waiver, to the EPSDT benefit, under the Medi-Cal program.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NOYES  

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Bill Text

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

SECTION 1.

 Section 14132.76 is added to the Welfare and Institutions Code, to read:

14132.76.

 (a) An individual who is determined to be eligible to receive palliative care and hospice services as an Early and Periodic Screening, Diagnostic and Treatment benefit prior to 21 years of age, shall remain eligible for those services after 21 years of age, if they are otherwise eligible.

(b) An individual who is determined to be eligible to receive palliative care and hospice services concurrently as curative treatment for their terminal illness prior to 21 years of age, shall remain eligible for those services after 21 years of age, if they are otherwise eligible.

(c) If pediatric palliative and hospice care is unavailable in the individual’s county of residence, a managed care plan shall be liable for payment of those services received in another county.

(d) This section shall be implemented only to the extent that any necessary federal waivers are obtained and federal financial participation is not otherwise jeopardized.

SEC. 2.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.

SECTION 1.

It is the intent of the Legislature to enact legislation that would enhance the scope of pediatric palliative care services that have been transitioned from the Pediatric Palliative Care (PPC) Waiver, to the Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) benefit, under the Medi-Cal program.