In the months near the end of life, what most people want is a last chance to be themselves, in their homes, with the people they love.
Palliative care is patient- and family-centered care that anticipates, prevents, and treats suffering during end of life. And beginning Jan. 1, 2018, palliative care becomes a covered benefit for all eligible Medi-Cal beneficiaries.
The benefit gives individuals, during the period before hospice care is necessary, an alternative to spending time in hospitals and emergency rooms.
Partnership HealthPlan of California, or PHC, the Medi-Cal managed care plan for 14 Northern California counties, is pleased that its community-based palliative care pilot program, which launched in September 2015, is becoming a full-fledged benefit.
“Our pilot efforts have shown that palliative care really works,” said Elizabeth Gibboney, CEO of PHC. “Members have been able to spend their final months as they wish, at home, with the medical support they need and the family support they want. We are glad to help our members access this invaluable care.”
In PHC’s Partners in Palliative Care pilot every $1 spent to administer the pilot, $3 were saved in hospital costs. From enrollment to death, 55 percent those participating in the pilot avoided hospitalization, compared to 21 percent of matched comparison beneficiaries.
ResolutionCare and Collabria Care, which participated in PHC’s pilot program, are now among those contracted with PHC to provide palliative care services to eligible members, and more contracted providers are being added. The care they give includes assessment, pain management, care coordination, access to caregiver support, and case management.
“Our living and dying are not medical. While it’s a natural truth that we all die, the last chapter of life is better centered in our homes and with our families,” said Dr. Michael Fratkin, president and founder of ResolutionCare, based in Humboldt County. “We are proud to be a participant in the creation of palliative care capacity and access for all Partnership members, and Medi-Cal recipients across the state.”
“Palliative care increases the quality of life of all recipients, and this new benefit will increase access to this special care for thousands of patients,” said Linda Gibson, President & CEO, Collabria Care, based in Napa County. “Collabria Care looks forward to continuing their work with Partnership HealthPlan and offering community-based palliative care services to all eligible patients in our region.”
Collabria shared a palliative care success story involving a PHC member who took part in the pilot program.
The Napa County woman, in her mid-50s, had end-stage liver disease. She was given information about her diagnosis and agreed to explore counseling. She was taught skills to be in control of her own health management.
She began working with a volunteer to write her life story, and after seven months graduated from the palliative care program due to improved prognosis. She has had no ER visits or hospitalizations, has remained alcohol-free, and is enjoying her family.
Consistent with new state guidelines, PHC will offer palliative care to members with an expected survival of one year or less who have one of four diagnoses: advanced cancer, liver disease, congestive heart failure, or chronic obstructive pulmonary disease.
Some additional factors are considered in eligibility, but essentially the care is to be provided to PHC members who need more help at the end of life but who are not yet ready for hospice care.
Members must be willing to have home-based care, participate in advanced care planning discussion, and avoid hospital care and ER visits.
PHC members or their family who want to learn more about the palliative care benefit can call the PHC Member Services team at 800-863-4155 or TTY 800-735-2929 or 711.
The following palliative care organizations are currently contracted with PHC and accepting patients. More are being added, so please contact PHC for an updated list:
– ResolutionCare – Del Norte, Humboldt, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Trinity; – Collabria Care – Napa, Solano and Sonoma; – Yolo Hospice – Yolo; – Hospice Services of Lake County – Lake; – Medical Home Care Professionals – Shasta; – Continuum Hospice – Solano.
OAKLAND, Calif. – On Thursday, the U.S. District Court for the Northern District of California granted a preliminary injunction in State of California v. Wright, to block the Trump Administration regulations that would allow employers to exclude contraceptive coverage mandated by the Affordable Care Act from their employees' health insurance policies.
The action by a California court follows the nationwide injunction issued in Pennsylvania earlier this month.
Both the Pennsylvania and California rulings were based on the failure of the federal government to comply with the Administrative Procedures Act in promulgating its Interim Final Rule; the Pennsylvania court also based its ruling on the additional grounds of the likelihood of the Commonwealth of Pennsylvania prevailing on its substantive challenge to the Interim Final Rule. The Pennsylvania court found that the regulations "contradict the text of the statute that they purport to interpret."
“The law couldn’t be more clear: a woman, not her boss and certainly not a politician, should decide what’s best for her own healthcare,” said California Attorney General Xavier Becerra. “The Affordable Care Act guarantees that women are not burdened with high costs for seeking basic healthcare, including birth control. This court ruling serves as yet another reminder to the Trump Administration: the rule of law applies to everyone, no matter who you are or how high your rank. In concert with last week's injunction in Pennsylvania, today's ruling amounts to a one-two punch against the Trump Administration's unlawful overreach. Having said this, our work will not end until women are guaranteed the healthcare they deserve.”
California Insurance Commissioner Dave Jones submitted a declaration in this case, providing evidence demonstrating that women would be harmed if the Trump rule denying women access to contraceptives is permitted to remain in effect.
"Thanks to the Affordable Care Act, health insurance policies must cover contraceptives. Tens of millions of women across the nation benefit from the ACA provision that requires health insurance coverage of contraceptives without any copays or deductibles. Courts in Pennsylvania and now California have put in place injunctions to block regulations that would otherwise permit employers to interfere with women's right to access to contraceptives,” said Jones.
Jones said that before the ACA was in effect, he spoke to women who could not always afford to fill their prescriptions for contraceptives.
“President Trump's regulations would prevent some women from being able to make fundamental decisions about reproductive health care for themselves. Trump's rule, if allowed to stand, would deprive women of their rights and access to basic health care services, while increasing the number of unintended pregnancies and abortions. Women will suffer serious and irreparable harm if these rules are in place and we will continue to do everything in our power to prevent that from occurring,” Jones said.
California was joined in this lawsuit by the states of Delaware, Maryland, New York and the Commonwealth of Virginia.
Last Friday, Pennsylvania obtained a preliminary injunction in a similar case, Commonwealth of Pennsylvania, v. Trump, et al., U.S. Dist. Court, Eastern District of Pennsylvania, Case no. 17-4540.
SACRAMENTO – State Treasurer John Chiang announced the appointment of Ronald L. Washington to the position of executive director of the California Health Facilities Financing Authority, or CHFFA.
The authority provides critical financial assistance to public and nonprofit health care providers through loans, grants and tax exempt bonds.
Washington previously served as deputy executive director of CHFFA. He also has served as executive director of the California Educational Facilities Authority (CEFA), a post he assumed in August 2009.
At CEFA he provided policy, program, and technical direction for a lease revenue bond program and academic assistance grant program.
A former high school mathematics teacher, Washington earlier in his state government career spent nine years in the Public Finance Division of the California State Treasurer’s Office, where he held oversight responsibility for several bond programs and worked on more than $10 billion in new money and refunding transactions. He also was instrumental in developing the division’s variable rate bond program.
“With health care programs under attack by Congress it is more important than ever that we make the most of our state programs – and for that we need experienced leaders like Ronald Washington,” Chiang said as he announced Washington’s appointment.
“Providing the public with high-quality health care facilities and services has never been more urgently needed,” Washington said. “I look forward to meeting that challenge.”
Washington served in the U.S. Navy and holds a Bachelor of Arts degree in business economics from the University of California, Riverside. In addition, he has a Master of Arts degree in education from Claremont Graduate University.
Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma has announced that the agency has taken immediate steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires ravaging southern portions of the state.
On Dec.11, 2017, Acting Health and Human Services Secretary Eric D. Hargan declared a public health emergency (PHE) in the state of California retroactive to Dec. 4, 2017.
The PHE allows CMS to waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements if necessary to provide health services.
“While the lives and homes of southern Californians remain at risk from dangerous wildfires, CMS is taking the necessary steps to provide flexibilities that help meet the medical needs of the individuals and families affected,” said Administrator Verma. “Our work will continue as long as the people impacted work to recover, rebuild their lives, and access care for themselves and their families.”
The agency has taken the following steps to support the state of California and those residents impacted by wildfires.
Waivers for skilled nursing facilities and assistance for hospitals and other healthcare facilities
CMS issued a blanket skilled nursing facility waiver, described on the Web site below; and the Regional Office has provided numerous technical assistance responses to the state,
California Hospital Association and providers on specific types of CMS and other HHS program flexibilities that were available with and without waivers.
These program flexibilities and waivers work to provide continued access to care for beneficiaries.
Special enrollment opportunities and medicare flexibilities
CMS is providing beneficiaries affected by the California wildfires a Special Enrollment Period (SEP) that gives them an additional opportunity through March 31, 2018, to add, drop or change their Medicare health and prescription drug plan in the event they are eligible for an SEP and were unable to make an election during the fall open enrollment period or another election period for which they were eligible.
When a public health emergency is in effect, Medicare Advantage Organizations in affected areas are required to waive prior authorization and other gatekeeper requirements and to allow care to be provided by non-contracted providers and facilities. In addition, Part D plan sponsors are expected to lift certain limit for drug benefits.
Dialysis care
Dialysis patients who are unable to receive dialysis services at their usual facility and who need assistance to locate a facility where they can be dialyzed, should call the NW 18 (Southern California) Patient Hotline 800-637-4767 for assistance.
The following large dialysis organization hotline numbers are also available for patients: DaVita Emergency Dialysis Services: 800-400-8331, Fresenius Kidney Care Emergency Hotline: 800-626-1297, Dialysis Clinic Inc. (DCI) Emergency Command Center: 866-424-1990, and U.S. Renal Care Emergency Hotline: 866-671-USRC (8772).
Healthcare Provider Hotline
CMS established a toll-free hotline servicing Medicare’s Part B providers and suppliers in California.
The hotline is intended to assist non-certified Part B suppliers, physicians and non-physician practitioners helping with recovery efforts enroll in federal health programs and receive temporary Medicare billing privileges.
CMS is temporarily waiving the application fee, fingerprint-based criminal background checks, site visits, and in-state licensure requirements usually required for providers to access Medicare billing privileges. The toll-free hotline telephone number is 855-259-2396.
People with federal benefits and providers and suppliers of healthcare equipment and services that have been impacted by the California wildfires are encouraged to seek help by visiting CMS’ emergency Web page, www.cms.gov/emergency.