Policy Update

Originally posted on May 22, 2021

May 17, 2021

In this issue…
  • COVID Impacts Legislative Process
  • POLST Registry Bill on 2-Year Track
  • CCCC Seeks Budget Support for POLST Eco-System and Registry
  • Bill to Extend Ability of Hospices to Provide Palliative Care Moves to Assembly
  • Bill to Amend End of Life Option Act Moves Forward
  • CCCC Submits Comments on CalAIM
  • Older Americans Act State Plan Takes Shape

COVID Impacts Legislative Process

COVID-19 is leaving its mark on all aspects of our society – including the legislative process.

This year marks the beginning of a regular two-year legislative cycle in California, and the impact of COVID is being felt in two key areas of the legislative process. First, a large number of health-related bills have been introduced this year, many of them related to the pandemic.

At the same time, the legislative process itself has been impacted by the need to respond to the pandemic and reduce disease spread. Committee hearings are currently being conducted virtually, and committee chairs are enforcing strict limits on the number of bills which will be heard in each committee.

With more health-related bills and fewer opportunities for public hearings, the Legislature must prioritize which bills move forward now and which will have to be carried over and heard in the second year of the legislative session.

POLST Registry Bill on 2-Year Track

CCCC is sponsoring Assembly Bill 1234 to bring advance care planning into the electronic age. Assemblymember Dr. Joaquin Arambula, an emergency room physician, is the author of AB 1234, which would:
  • Establish a statewide electronic registry for POLST (Physician Orders for Life-Sustaining Treatment) to ensure that information about patients’ treatment preference are immediately available during a medical emergency.
  • Authorize the use of electronic signatures on advance directives, POLST, and pre-hospital DNR orders.
  • Establish that electronically-completed POLST forms (ePOLST) and electronic communication of POLST information are legally valid.
  • Establish that a POLST form executed in another state is valid and enforceable in California, so that people who are visiting California from out of state can be assured their treatment wishes will be honored.
After undergoing author’s amendments in early April to enhance key provisions in the bill, AB 1234 was not heard in its first legislative committee in time to move forward this year. COVID-19 has resulted in a bottleneck of health-related bills being introduced. (See article above.)

CCCC fully expects AB 1234 to move forward in January 2022. In the meantime, Asm. Dr. Arambula is championing a budget request that would commit the funds needed for establishment of a statewide POLST registry and robust POLST eco-system.

Learn more:

CCCC Seeks Budget Support for POLST Eco-system and Registry

Asm Dr. Arambula, chair of the California Assembly Budget Subcommittee on Health, is championing a state budget allocation to support POLST in California. Specifically, he is advocating for:
  • A one-time appropriation of $10 million to establish a statewide electronic registry for POLST over three years, and
  • An annual appropriation of $750,000 to support CCCC’s efforts to maintain a robust POLST environment and to promote and maintain quality POLST usage and standards.
POLST relies on a robust environment that promotes and maintains quality, including continuous and ongoing education and training of healthcare professionals, consistent messaging, community education and outreach, and adherence to quality standards and assurance activities.

Letters of Support Needed

CCCC is asking for a show of support for the budget request from other POLST stakeholders and interest groups, and letters of support are being submitted by healthcare organizations, payers, provider groups, and others to the Legislature’s budget committee chairs. For information on how you can help, please contact Kelley Queale at [email protected] or call (916) 779-7504.

Bill to Extend Ability of Hospices to Provide Palliative Care Moves to Assembly

Senate Bill 353 (Roth) – which CCCC is co-sponsoring with the California Hospice and Palliative Care Association (CHAPCA) – has been passed by the Senate and is now awaiting its first hearing in the Assembly.

This bill relates to the Palliative Care Pilot Program (PCPP), which allows a hospice licensee to provide palliative care to non-hospice patients. The PCPP pilot was established by SB 294 (Statutes 2017), and will sunset on December 31 of this year unless extended.

SB 353 is necessary to extend the PCPP another five years and continue allowing hospice licensees to provide palliative services to non-hospice, palliative care patients and share data on the program with the State to evaluate its effectiveness.

Bill to Amend End of Life Option Act Moves Forward

California’s End of Life Option Act (EoLOA) allows a terminally-ill adult California resident, who meets specific requirements, to request a drug from their physician for the specific purpose of ending their life. The EoLOA will sunset January 1, 2026, unless extended.

Senator Susan Eggman, who authored the original EoLOA legislation, has introduced SB 380 to amend the law. SB 380 passed out of Senate Health Committee by a vote of 8-1, and Senate Judiciary by a vote of 9-1. The bill will be heard May 17 in Senate Appropriations.

Among key provisions, the bill would:
  • Reduce the required time between a patient’s oral requests from 15 days to 48 hours.
  • Eliminate the requirement that an individual who is prescribed and ingests aid-in-dying medication make a final attestation.
  • Require a physician, if they choose not to participate in the EoLOA, to inform an individual who makes a request for a prescription for aid-in-dying medication that they do not participate in the EoLOA, document the individual’s date of request and the physician’s notice to the individual of their non-participation in the medical record, and transfer the individual’s relevant medical records upon request.
  • Require that the date of all oral and written requests be documented in an individual’s medical record and would require that, upon a transfer of care, that record be provided to the qualified individual.
  • Require each healthcare facility to post on the facility’s public website the facility’s current policy governing medical aid-in-dying.
  • Restrict the ability of healthcare facilities to opt-out of the EoLOA.
  • Prohibit certain false, misleading, or deceptive practices relating to the EoLOA.
  • Delete the Act’s sunset date, thereby extending its operation indefinitely. Existing law authorizes a healthcare provider to prohibit its employees, independent contractors, or other persons or entities, including other healthcare providers, from participating in activities under the Act while on the premises or while acting within the course and scope of employment by, or in contract with, the prohibiting healthcare provider.
Existing law allows healthcare organizations, including hospitals and health systems, to opt-out of participating in the EoLOA. SB 380 would limit the ability of organizations and facilities to do so.

SB 380’s supporters say the bill is necessary to reduce current procedural barriers that delay qualifying individuals from obtaining aid in dying services in time. Some healthcare organizations oppose the bill because it limits protections for health facilities that choose not to participate.

CCCC has no position on SB 380. Rather, CCCC’s role is to serve as neutral source for information on the EoLOA.

CCCC Submits Comments on CalAIM

California Advancing & Innovating Medi-Cal (CalAIM) is a multi-year initiative to revamp Medi-Cal in ways that improve the quality of life and health outcomes of Medi-Cal beneficiaries by implementing broad delivery system, program, and payment reform. The major components of CalAIM build upon the successful outcomes of various pilots (including but not limited to the Whole Person Care Pilots (WPC), Health Homes Program (HHP), and the Coordinated Care Initiative) from the previous federal waivers and will result in a better quality of life for Medi-Cal members as well as long-term cost savings/avoidance.

CalAIM has three key goals:
  • Identify and manage member risk and need through whole person care approaches and addressing social determinants of health;
  • Move Medi-Cal to a more consistent and seamless system by reducing complexity and increasing flexibility; and
  • Improve quality outcomes, reduce health disparities, and drive delivery system transformation and innovation through value-based initiatives, modernization of systems, and payment reform.
Since 2018, the California Department of Health Care Services (DHCS) has been working closely with stakeholders on the CalAIM proposal, and recently hosted a 30-day public comment period to gather additional input as part of its preparation in applying to CMS for the CalAIM Section 1115 demonstration and Section 1915(b) waiver in summer 2021.

CCCC outlined our recommendations in a recent letter to DHCS. CCCC believes palliative care and advance care planning can help achieve the goals of CalAIM, and supports CalAIM proposals that will make it easier to provide palliative care to Medi-Cal beneficiaries, including the ability to address social determinants of health, increased system flexibility, and payment reform.

CalAIM implementation was originally scheduled to begin in January 2021, but was delayed due the impact of the COVID-19 public health emergency. As a result, DHCS is proposing a new CalAIM start date of January 1, 2022.

Learn more about the State’s CalAIM proposal here.

Older Americans Act State Plan Takes Shape

The California Department of Aging (CDA) is developing California’s Older Americans Act (OAA) State Plan for 2021-2025. The Older Americans Act is a federal law that mandates and funds certain programs serving older adults, such as the Area Agencies on Aging (AAAs). The State must submit an OAA State Plan to the federal Administration for Community Living every four years. The plan currently in development will go into effect October 1, 2021. A draft plan is posted on the CDA webpage for public review.

CCCC submitted comments to CDA on how Area Agencies on Aging and other organizations funded under the OAA can play an important role in educating seniors and their caregivers about the availability of palliative care and how to access it, and the importance of advance care planning and how to record your wishes.

CCCC is recommending that CDA:
  • Ensure that the appropriate AAA program staff understand and recognize the benefits and principles of culturally appropriate, person-centered care planning.
  • Empower seniors and caregivers residing in the community to consider their needs and wishes around care and to make their wishes known to family, friends, advocates, and healthcare providers.
  • Provide information to appropriate AAA program staff to increase their understanding of palliative care and engage them in identifying and referring appropriate consumers for palliative care services.
  • Share information and resources about palliative care and community-based palliative care resources on AAA websites.
Read more about CCCC’s recommendations here.

Once the State plan is approved by the federal Administration for Community Living, it will be posted on the CDA website. This should occur in July. The plan will take effect on October 1, 2021.