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Pediatric Palliative Care Waiver End Date and Transition Plan

December 21, 2018

The Pediatric Palliative Care (PPC) Waiver that was originally approved by the Centers for Medicare & Medicaid Services (CMS) in 2008 ends December 31, 2018.

To ensure the continuity of care for services provided on or after January 1, 2019, for children transitioning from the PPC Waiver to receiving palliative care through Medi-Cal’s fee-for-service system or a Medi-Cal Managed Care Plan (MCP), the Department of Health Care Services (DHCS) has been educating parents, providers and MCPs about the expansion of pediatric palliative care services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medi-Cal benefit. EPSDT services are existing Medi-Cal benefits that provide comprehensive, preventive, diagnostic and treatment services to eligible participants under the age of 21, as specified in Section 1905(r) of the Social Security Act. The goal of EPSDT services is to ensure that eligible participants under the age of 21 receive age-appropriate screening, preventive services and treatment services that are medically necessary to correct or improve any identified conditions. The following basic services originally covered under the PPC Waiver will not change under EPSDT services:

  • Advance care planning
  • Care coordination
  • Mental health and medical social services
  • Pain and symptom management
  • Palliative care assessment and consultation
  • Palliative care team consultation
  • Plan of care

Expressive therapies and in-home respite are widely used benefits under the PPC Waiver and will not be an included benefit post transition.

For additional information on EPSDT services, providers should visit the EPSDT page on the DHCS website.

For additional information on the PPC Waiver transition, providers should visit the Partners for Children page on the DHCS website.