What Is SB 1004?

Implemented in January 2018, Senate Bill 1004 (SB 1004) is the California law that requires Medi-Cal managed care plans to provide access to palliative care for eligible members. Policy documents, requirements of Medi-Cal managed care plans, and additional information about the law are available through the California Department of Health Care Services (DHCS) SB 1004 web page.

CHCF created this Resource Center to help health plans and palliative care providers implement, sustain, and improve SB 1004 programs. Currently, this Resource Center addresses adult palliative care only. Materials are designed for representatives from Medi-Cal managed care plans, health systems, and medical groups with delegated fiscal and operational responsibility for implementing SB 1004, and organizations that offer palliative care clinical services.

What is palliative care?

Palliative care can help people with serious illness to live better with their disease. It is specialized medical care focusing on relieving the stress and suffering of serious illness, with the goal of improving quality of life for both the patient and the family. Palliative care is provided by a team of palliative care doctors, nurses, social workers, and others who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

Why SB 1004 palliative care?

People with serious illness face many challenges, like dealing with the stress of their diagnosis, managing pain or other symptoms related to their disease (or their treatment), making decisions about which medical interventions are right for them, helping their families cope, and planning for the future. For people with lower incomes who qualify for Medi-Cal, the stress and suffering of a serious illness is compounded by day-to-day challenges related to economic and social struggles, such as inability to pay bills, lack of stable housing, difficulty getting to medical appointments, and inadequate access to healthy foods.

Resources

1. SB 1004 Basics

• • Basic information about SB 1004 requirements, as well as survey data collected from health plans and provider organizations describing early experiences implementing the law

2. Patient Population

• • A review of eligibility criteria, characteristics of the eligible patient population, and strategies for identifying eligible patients

3. Services, Costs, Payment

• • A review of required services, staffing models, payment models, variables that impact cost of care delivery, and strategies for increasing efficiency

4. Engaging Patients and Providers

• • A review of strategies for engaging patients, strategies for engaging providers who might refer eligible patients, and options for optimizing referral processes

5. Optimizing for Success

• • A review of the factors that promote success in launching and sustaining palliative care programs

6. Quality and Impact

• • A review of data that health plans report to DHCS, approaches to quality assessment in palliative care, and tools and resources for plans and providers to support improvement efforts

7. Telehealth

• • Resources for those caring for people with serious illness to develop strategies and programs to care for patients from a distance through telehealth.

8. Webinars

• • An archive of the webinars from CHCF’s 2017–18 SB 1004 Technical Assistance Series, as well as recordings of CHCF webinars on topics related to palliative care in Medi-Cal (SB 1004)