The Waiver

What is the waiver?

The waiver is a MediCal CCS demonstration project that will enable children with life-limiting illnesses to receive curative treatment as well as home-based palliative care services similar to those that are provided by hospice agencies. The program will be open to children who meet medical diagnosis criteria and have MediCal coverage. It is anticipated that Alameda, Santa Cruz, Monterey, Santa Clara and San Diego Counties will be able to begin enrolling children in January of 2009.

Why palliative care?
Palliative care aims to enhance quality of life and minimize suffering through interdisciplinary services and interventions. Ideally, this care is provided by the same care team from the time of diagnosis onward. Patients who receive palliative care often experience increased continuity of care, less crises, and a decrease in both hospital admissions and length of hospital stays.

Why the waiver?
Currently, home-based palliative care is only accessible by most pediatric patients through the hospice benefit. The requirements of the current hospice benefit present significant obstacles that prevent many families and children from receiving palliative care. The waiver will be an opportunity for provision of in-home palliative services to children who are still receiving curative or disease-modifying therapies from a traditional pediatric healthcare provider.

How do I refer a patient?
Any physician can refer a patient for the waiver. The referral will be given to a CCS Nurse Liaison (CCSNL) who will help to determine if the child is eligible to receive waiver services. The CCSNL will then refer appropriate patients to the Care Coordinator who will be based at the community-based hospice or home-health agency.

What services might the patient receive?
The patient will be assigned to a Care Coordinator who will do an in-home palliative care assessment. The coordinator will assess the patient’s and family’s goals of care. With input from the child’s health care team the care coordinator will create a family centered action plan which will be shared with both CCS and the child’s entire health care team. The waiver WILL NOT change any of the services that the patient is receiving at the time of referral and will provide additional services which may include respite care, expressive therapies (art, music), family training and bereavement services.

CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES PEDIATRIC PALLIATIVE CARE WAIVER
Services available to CCS clients (and families) who are enrolled in the waiver

*Waiver Services*	*Medi-Cal & CCS Services*
Care Coordination Respite Care Expressive therapies Child Life Art Music Family centered training on Palliative care principles Care needs Medical regimens Equipment use Bereavement Counseling for Families	Inpatient hospital care Physician services, X-rays and laboratory Pharmaceuticals Medical supplies Durable medical equipment Home health agency services Intermittent nursing Shift nursing Rehabilitation services Physical and occupational therapy Speech pathology Audiology Special Care Center Services Pain management and symptom control Child and family counseling

CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES PEDIATRIC PALLIATIVE CARE SERVICES
Services available to CCS clients who are NOT enrolled in the waiver*

Medi-Cal & CCS Services

Inpatient hospital care
Physician services, X-rays and laboratory
Pharmaceuticals
Medical supplies
Durable medical equipment
Home health agency services
- Intermittent nursing
- Shift nursing
Rehabilitation services
- Physical and occupational therapy
- Speech pathology
- Audiology
Special Care Center Services
Pain management and symptom control
Child and family counseling

*Please refer to CCS Numbered Letter 04-0207 that can be found at www.dhcs.ca.gov/services/ccs

This article was posted on Sunday, September 28th, 2008 and is filed under California Benefit.