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​Palliative Care and SB 1004

SB 1004 (Hernandez, Chapter 574, Statutes of 2014) requires the Department of Health Care Services (DHCS) to “establish standards and provide technical assistance for Medi-Cal managed care plans to ensure delivery of palliative care services.”
Effective January 1, 2018, DHCS will implement the Medi-Cal palliative care program through managed care and fee-for-service providers. DHCS has posted an All Plan Letter (APL) with guidance to Medi-Cal Managed Care Plans, and a Fee-for-Service (FFS) Provider Bulletin. Both documents are located in the Policy Update section of this page.

DHCS has contracted with the California State University Institute for Palliative Care to fund palliative care training for qualified Medi-Cal providers and their clinician staff. Although some of the courses originally offered may be available, the focus for the remainder of the DHCS funding is on the Institute’s new curriculum focused on primary care providers. The primary care curriculum is scheduled for release in early March 2018. Providers can apply for palliative care training, available for a limited time at no charge, through the California State University Institute for Palliative Care website.

A full-page image of the SB 1004 Care Model, including the descriptive text, is available for download.


SB 1004 policy is informed by related efforts under the Pediatric Palliative Care Waiver Program, Coordinated Care Initiative, the Medi-Cal 2020 Public Hospital Redesign & Incentives in Medi-Cal (PRIME) program, and the Section 2703 Health Homes Program. Two other Medi-Cal benefits are closely related to palliative care: advance care planning and hospice.
A number of Medi-Cal managed care health plans, hospitals and health systems, and other providers are already incorporating palliative care strategies such as advance care planning, pain and symptom management, and palliative care consultations into their overall models of care. DHCS encourages those strategies to improve patient satisfaction and outcomes for Medi-Cal beneficiaries at all stages of life and illness, and to help meet the goals of Let’s Get Healthy California and the DHCS Quality Strategy.
To be added to the stakeholder distribution list for palliative care/SB 1004 efforts, or to send comments or questions, please contact the following email address:

Policy Update

On October 25, 2017, DHCS issued an All Plan Letter (APL) to provide specific details to Medi-Cal managed care health plans regarding implementation of palliative care pursuant to SB 1004.
In November 2017, DHCS released the final version of the SB 1004 Policy Document to incorporate the aforementioned APL.

Stakeholder Engagement

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Stakeholder Input


Last modified on: 2/7/2018 10:57 AM