Posted on: April 18, 2017
Written by: Coalition for Compassionate Care of California
It’s been another busy legislative year for us so far, with bills of interest moving forward in both the Assembly and the Senate. An important part of our work at CCCC is to track and take action on legislation that impacts the space of palliative care, hospice, or advance care planning. To keep up with the latest, you can check in our legislative tracking page here.
We wanted to take an opportunity to give a little more context and detail into some of the legislation in committee right now, and what our policy team at CCCC is doing to represent stakeholders in our space.
The CCCC is co-sponsoring Senate Bill 294 with the California Hospice and Palliative Care Association (CHAPCA). This bill, authored by Senator Ed Hernandez, O.D., would authorize a licensed hospice to provide palliative care services and would authorize these services to be provided concurrently with curative treatment to a person who does not have a terminal prognosis or who has not elected to receive hospice services only by licensed and certified hospices.
We’re co-sponsoring SB 294 for a few reasons, the first being the need to improve palliative care through building a seamless continuum through a patient’s illness. By breaking down the silos that exist, palliative care becomes more effective, easier to access, and a better service all around. The other important issue we hope to address with SB 294 is a grey area in hospice regulation around whether hospice providers can provide palliative care, beyond initial consult. We hope that SB 294 will provide much-needed clarity for providers.
As of publication of this post, SB 294 has passed the Senate health committee and will move on next to be heard in Senate Appropriations.
SB 481, authored by Senator Richard Pan, would amend existing law to require that the physician, skilled nursing facility, or intermediate care facility, before implementing a medical intervention that requires informed consent for a resident that lacks capacity and has no decision-maker, promptly notify the resident, orally and in writing, that it has been determined that the resident lacks capacity. CCCC’s Board of Directors has taken a “Support” position on this bill.
AB 937 is authored by Assemblymember Susan Talamantes Eggman, and sponsored by the California Conference of Bar Associations. This bill seeks to address a lack of clarity in state law regarding conflicts between an individual’s known health care instruction and decisions made by a health care agent or surrogate when the individual lacks capacity. This is a complex area of law which crosses multiple sections of state code and “common law” practice. CCCC is therefore concerned that the changes currently sought by AB 937 will cause unintended adverse consequences for patients. As currently written, AB 937 could also be interpreted in ways that endanger the POLST program and make it difficult for patients to update their POLST orders. Working with the California Medical Association (CMA), CCCC is engaged in discussions with Assemblymember Eggman and her staff to find a compromise that provides clarity without locking patients and their decisionmakers into a rigid structure which fails to recognize the complexities of end-of-life decision-making.
CCCC is also actively engaged this year in state budget negotiations. Implementation of SB 1004, which was passed in 2014 to expand access to palliative care services for beneficiaries of Medi-Cal managed care plans, has been caught up in the budget negotiations.
As we reported in January, the Governor’s proposed 2017-2018 budget would push back the implementation date of SB 1004 to no SOONER than July 1, 2018. It does not appear that SB 1004 was singled out in the budget for delay –rather it was swept up in a blanket policy at DHCS to not implement anything new in this fiscal year.
CCCC has been working with the California Department of Health Care Services and other stakeholders on implementation of SB 1004 since it was passed in 2014. Currently, CCCC is spearheading a collaborative of interested groups to push for an earlier implementation date. We are working to educate staffers that SB 1004 is budget-neutral, and therefore could be implemented without the same delay as other programs. So far, legislative staff and the Assembly Budget Committee have been receptive and have asked good questions.
In May, the Governor will announce any revisions to the budget based on updated state revenue estimates and we hope that by then, we will have been able to convince the state that implementation of SB 1004 can be moved up into the current fiscal year.
CHPCC/CCCC is working with the Department of Health Care Services on the renewal of the Home & Community-based waiver, which supports Partners for Children, Medi-Cal’s home-based pediatric palliative care program. The current waiver expires December 26, 2017; the pending renewal would extend through December 27, 2022. Stakeholder meetings are scheduled for April 14th in Sacramento and late April (date TBD) in Los Angeles to solicit input from PFC/PPCW participants, family members, advocates, providers, and other interested stakeholders on the development of the PPCW and possible changes to the PFC program. Since it’s implementation in 2010, PFC has demonstrated success in reducing caregivers’ stress and worry related to their child’s care, in building caregivers’ confidence in their ability to provide care in the home, and in reducing children’s pain as observed by their caregivers. In addition, the program has also demonstrated notable reductions in hospital admissions and lengths of stay, as well as expenditures per enrollee, and improvements in families’ quality of life.