Lawmakers Advance Bill Filling Gap In End-Of-Life Care

Oregon has long been at the forefront of palliative care for people with a terminal illness.

But it lacks a program to provide patients with round-the-clock services to keep them comfortable at home and avoid running up hospital costs.

Senate Bill 179 would fix that. The bill, written by the Oregon Hospice & Palliative Care Association with state Sen. Sara Gelser, would create a palliative care program for Medicaid patients in the Oregon Health Plan.

The bill passed its first hurdle on Monday, with approval by the Senate Health Care Committee. It was referred to the Joint Committee on Ways and Means.

“If it passes, that would be fantastic,” said Dr. Tim Siegel, a palliative care physician at Oregon Health & Science University, during testimony on the bill in the Senate health care committee.

He said patients statewide could benefit. Patients nowadays often live longer with serious illnesses because of medical advances, he said. They need support towards the end of their life.

Palliative care is aimed at patients with a serious illness, such as heart failure, cancer or Alzheimer’s disease. Services can include pain medication, mental health counseling or help with dietary needs. Like hospice care, palliative care aims to improve the quality of life for terminal patients. But hospice care usually limits services to those with a six-month prognosis. Palliative care is designed to keep people comfortable for a year or two, sometimes even helping them through medical treatments.

The bill sets a two-year limit on services by an interdisciplinary team that would visit patients in their home or a skilled nursing facility.

The team members would have to be trained or certified in palliative care, and they would have to provide 24/7 phone support. If patients needed help in the middle of the night, they could call a nurse.

“That’s how you keep people out of the hospital,” said Barbara Hansen, chief executive officer of the Oregon Hospice & Palliative Care Association.

A companion bill, Senate Bill 177, which has passed the Senate, would allow hospice programs to be able to provide palliative care services.

Senate Bill 179, which defines a palliative care program, is modeled after one in California that went into effect in January 2018, making the state one of the first nationwide to require all Medicaid managed programs to provide palliative care to patients.

“Oregon residents should have the same opportunity,” Hansen said.

Right now, Oregon Health Plan patients with a terminal illness who don’t qualify for hospice have to coordinate their own pain management and mental health care. That can mean juggling appointments and trips to various doctors and specialists. Hansen said it can be difficult for patients with a terminal illness to cope.

The palliative care team would work with the patient and their family to create a plan and then coordinate the care.  

Services would span help with advanced planning and could include help with filling out a POLST -- Physician Orders for Life-Sustaining Treatment -- form. These documents, which were developed by a team at Oregon Health & Science University, are medical directives that emergency responders must follow in a medical emergency. They detail exactly how much care the patient wants at the end of life, including cardiopulmonary resuscitation or CPR, use of mechanical ventilation and the placement of a feeding tube.

State officials said the bill would have no impact on state or local revenues.

The program would be funded in part by federal dollars under the state’s Medicaid program. That means Oregon would need the go-ahead from the Centers for Medicare & Medicaid Services, said Saerom England, a spokesperson for the Oregon Health Authority. Without that approval, the state would have to fund the program itself.


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