BILL NUMBER: SB 1004 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 22, 2014
AMENDED IN ASSEMBLY AUGUST 18, 2014
AMENDED IN SENATE MAY 5, 2014
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. One of
the methods by which Medi-Cal services are provided is pursuant to
contracts with various types of managed health care plans.
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 develop a
palliative care benefit under the Medi-Cal program.
establish standards and provide technical assista nce 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. The bill would require that authorized providers
include licensed hospice agencies and home health agencies licensed
to provide hospice care, subject to criteria developed by
the department for provider participation. care that
are contracted with Medi-Cal managed care plans to provide palliative
care services. This bill would require the department, to the
extent practicable, to structure the delivery of the
palliative care benefit in a manner that is projected to be
ensure that the delivery of palliative care services under
these provisions is provided in a manner that is cost neutral
to the General Fund on an ongoing basis. 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. This bill would authorize the department
to implement these provisions through all plan letters or similar
instructions.
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 develop a palliative care benefit under the Medi-Cal
program. establish standards and provide technical
assistance for Medi-Cal managed care plans to ensure delivery of
palliative care services.
(c) Services covered under the palliative care benefit
Covered services shall include, but are not
limited to, those types of services that are available through the
Medi-Cal hospice benefit. The benefit These
services shall also include the
following services, following, regardless of
whether those these 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 determine establish guidance on
the medical conditions and prognoses that render a beneficiary
eligible for the benefit. palliative care
services.
(e) Providers authorized to provide services shall include
licensed hospice agencies and home health agencies licensed to
provide hospice care, subject to criteria developed by the
department for provider participation. care that are
contracted with Medi-Cal managed care plans to provide palliative
care services.
(f) The department shall, to the extent practicable,
structure the delivery of the palliative care benefit in a manner
that is projected to be ensure that the delivery of
palliative care services under this section is provided in a manner
that is cost neutral to the General Fund on an ongoing basis.
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.
(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
provider bulletins all plan letters 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
a provider bulletin all plan letters or other
similar instruction at least five days
instructions 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 benefit
services 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.