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Date: July 11, 2019
To: Health Plan of San Joaquin (HPSJ) Providers
From: HPSJ Medical Management Department
Subject: Pediatric Palliative Care
Business: Medi-Cal

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
    dystrophy); or
  • 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.

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