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California Leading the Way in Palliative Care with SB 1004

By Melanie Marshall

Legislation taking effect in January expands palliative care services to some of California’s most vulnerable patients and keeps the state at the forefront of a national movement to transform care for the chronically and seriously ill.

The latest action includes the implementation of Senate Bill 1004 (Hernandez, 2014), which requires the California Department of Health Care Services (DHCS) to expand community-based palliative care services to Medi-Cal beneficiaries.

Under the law, California became the first state in the nation to make palliative care part of the services provided under a Medicaid managed care plan. Palliative care is a patient-centered, whole-person approach that helps people with serious or life-limiting illness live well, from diagnosis until death.

In October, Gov. Jerry Brown signed another palliative care bill, SB 294, which updates and clarifies state law to allow hospices to offer palliative care to patients still seeking curative treatment.

State leading the way

The new laws underscore the state’s role as a leader in addressing serious illness, said Judy Thomas, CEO for the Coalition for Compassionate Care of California, which advocates for palliative care and advance care planning in the state. The coalition co-sponsored SB 294 with the California Hospice and Palliative Care Association (CHAPCA).

Thomas said California – which passed the first living will law in the 1970s – is “continuing its tradition of being on the cutting edge of the palliative care field, including from a public policy standpoint.” SB 1004 is particularly key, she said, because “it is going to open up access to community-based palliative care for a lot more folks.”

As part of the implementation, DHCS announced in October it would fund $244,000 in professional education for Medi-Cal providers through the CSU Shiley Institute for Palliative Care, which offers a broad range of online palliative care courses for doctors, nurses, social workers, and other health care providers.

“The CSU Shiley Institute for Palliative Care is honored and delighted to be able to offer our education to safety net providers across the state who are serving our most vulnerable and medically complex citizens,” said Jennifer Ballentine, the Institute’s Executive Director. “Palliative care enhances quality of life, expands therapeutic solutions, and reduces costs — everybody wins.”

Ballentine, Thomas, and other advocates hope more states will follow California’s lead in expanding palliative care to Medicaid beneficiaries, and that more private insurers will begin embracing community-based palliative care as well.

New pilot for hospice providers

Exactly how the second bill, SB 294, will be implemented is still a bit unclear, Thomas said. The legislation essentially creates a pilot program to evaluate the effectiveness of hospices that provide palliative care.

Thomas said the original intent of the legislation was simply to clarify that hospice nurses providing such care could go into homes and treat patients. But state health officials expressed some concerns about the legislation and it became a pilot with reporting requirements.

The final language sets up reporting standards so that DHCS can collect data and learn more about how palliative care is delivered in a home setting. DHCS will need to develop specific reporting forms and processes. The legislation takes effect next year and sunsets in 2022, at which point it could be extended.

What comes next for palliative care?

Thomas said both laws come at a time when the field of serious-illness care is advancing, fueled in part by an aging population and a growing belief that patients should have the defining voice in their own healthcare decisions.

“(Palliative care) is moving from just ‘champions at the bedside’ who have been making this happen one by one, to creating something that’s actually part of the healthcare system and doesn’t just depend on your individual physician,” she said.

“Part of that is figuring out what it means outside the inpatient setting, how it gets delivered, how it is structured and how it will be paid for,” Thomas said.

To establish such a framework, the Coalition has joined other healthcare organizations and experts in developing the Community-Based Palliative Care Consensus Standards for California, recently released by the California Advanced Illness Collaborative (CAIC).

Beginning in January, the standards will be tested in a multi-payer/multi-provider pilot, funded by the California Health Care Foundation.

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