Carve-Outs
End of Life Services (EOLs)
During an unrelated visit with an MCP physician, a member may provide an oral request for EOL services. If the physician is also enrolled with the Department of Health Care Services (DHCS) as a Medi-Cal FFS provider, that physician may elect to become the member’s attending physician as he or she proceeds through the steps in obtaining EOL services.
EOL services following the initial visit are no longer the responsibility of the MCP and must be completed by a Medi-Cal FFS attending physician, or a Medi-Cal FFS consulting physician.
Alternatively, if the MCP physician is not a Medi-Cal FFS provider, the physician may document the oral request in his or her medical records as part of the visit; however, the MCP physician should advise the member that following the initial visit he or she must select a Medi-Cal FFS physician in order for all of the remaining requirements to be satisfied.
MCP physician should advise the member that following the initial visit he or she must select a Medi-Cal FFS physician for all of the remaining requirements to be satisfied.
PALLIATIVE CARE (Carve-Out)
Palliative care consists of patient-and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. The provision of palliative care does not result in the elimination or reduction of any covered benefits or services under the MCP contracts and does not affect a members eligibility to receive any services, including home health services, for which the member would have been eligible in the absence of receiving palliative care. Unlike hospice, palliative care does not require the member to have a life expectancy of six months or less, and palliative care may be provided concurrently with curative care. A member 21 years of age or older may not be concurrently enrolled in hospice care and palliative care. A member under 21 years of age may be eligible for palliative care and hospice services concurrently with curative care.