|Date:||July 11, 2019|
|To:||Health Plan of San Joaquin (HPSJ) Providers|
|From:||HPSJ Medical Management Department|
|Subject:||Pediatric Palliative Care|
Medi-Cal plans are required to provide palliative care services to their pediatric members
(APL 18-020). A member under 21 years of age can receive palliative care and hospice services concurrently with curative care.
What conditions are covered?
All life-threatening conditions are covered.
This can include, but is not limited to:
- Conditions for which curative treatment is possible, but may fail (e.g., advanced or progressive cancer or complex and severe congenital or acquired heart disease); or
- Conditions requiring intensive long-term treatment aimed at maintaining quality of
life (e.g., human immunodeficiency virus infection, cystic fibrosis, or muscular
- Progressive conditions for which treatment is exclusively palliative after diagnosis (e.g., progressive metabolic disorders or severe forms of osteogenesis imperfecta); or
- Conditions involving severe, non-progressive disability, or causing extreme vulnerability to health complications (e.g., extreme prematurity, severe neurologic sequelae of infectious disease or trauma, severe cerebral palsy with recurrent infection or difficult-to control symptoms)
Palliative Care services can include:
- Advanced Care Planning
- Care Coordination and Care Plans
- Pain and symptom monitoring
- Mental Health and Medical Social Services
How can I refer members for Palliative Care services?
- Fill out the attached referral form.
- Fax your submission to the number listed on the form.
For further information or to request a referral to Palliative Care, please contact Health Plan of San Joaquin Case Management staff at (209) 942-6320.