End of Life Option Act Information for Healthcare Professionals

 

Key Information About The End Of Life Option Act For Healthcare Professionals

Message to Providers: The Coalition for Compassionate Care of California (CCCC) has prepared responses to the most commonly asked questions concerning provider participation in the California End of Life Option Act. These responses highlight important actions required of participating providers. This information is offered strictly as guidance on provisions in the legislation and is not specific methodology for provider participation.

Forms available from the California Department of Public Health (CDPH) are required under the law, and familiarity with these forms may assist both healthcare providers and patients to comply with the process. CCCC recommends healthcare professionals review all forms, especially the “Attending Physician Follow-up Form,” to ensure all required information is collected and documented.

Nothing on this web page is intended to be, and should not be interpreted as, specific medical or legal advice regarding this complex piece of legislation and related medical issues. This information may serve as a guideline for providers who are seeking general information about participation in the End of Life Option Act.

Note: Key terms defined in the legislation are listed in bold.

What Are The Responsibilities Of The Consulting Physician?

The consulting physician must:

  • Confirm in writing the diagnosis and prognosis of the patient and determine that the individual has capacity to make medical decisions and is making an informed decision
  • Refer for mental health evaluation if indicated
  • Determine that the individual has complied with requirements of the End of Life Option Act
  • Fulfill the documentation requirements for consulting physicians
  • Complete the Consulting Physician Compliance Form and submit it to the attending physician

 

Who Can Serve As A Consulting Physician?

A consulting physician must be independent from the attending physician. (Note: The law does not define “independent.”)

A consulting physician must:

  • Be qualified by specialty or experience to make a diagnosis and prognosis regarding the patient’s terminal disease
  • Not be a witness to a patient’s written request
  • Not be related to a patient by blood, marriage, registered domestic partnership, or adoption, or be entitled to a portion of the patient’s estate upon death

 

What Is Involved In The Mental Health Assessment?

If the attending or consulting physician determines the patient may have a mental disorder, the physician must refer the patient for an assessment by a mental health specialist for the purpose of determining if the patient has capacity to make medical decisions and is not suffering from impaired judgement due to a mental disorder.

The Mental Health Assessment is required only if the attending or consulting physician determines the patient has indication of a mental disorder which may impact capacity to make medical decisions.

A prescription for an aid-in-dying drug cannot be given unless and until a mental health specialist determines the patient:

  • Has capacity to make medical decisions, and
  • Is not suffering from impaired judgment due to a mental disorder

 

Who Is Considered A Mental Health Specialist?

A mental health specialist is a psychiatrist or licensed psychologist.

 

Who Can Serve As A Mental Health Specialist?

A mental health specialist must be independent from the attending physician. (Note: The law does not define “independent.”)

The mental health specialist must:

  • Not be a witness to a patient’s written request
  • Not be related to a patient by blood, marriage, registered domestic partnership, or adoption, or be entitled to a portion of the patient’s estate upon death

 

Which Physicians Can Prescribe An Aid-In-Dying Drug?

Only a physician who meets the statutory definition of attending physician may prescribe an aid-in-dying drug.

Under the law, an attending physician is the physician who has primary responsibility for:

  • The health care of the requesting patient AND
  • Treatment of the requesting patient’s terminal disease

 

Do Medicare’s CPT Codes For Advance Care Planning Cover Discussions Related To Aid-In-Dying?

For billing purposes, check with the related payer for the patients. California’s Medi-Cal program has agreed to provide coverage and reimbursement for physicians providing End-of-Life Option Act services (see APL 16-006). The Medi-Cal advance care planning codes may be appropriate–check with your billing services.

Because federal law does not support aid-in-dying, it is possible End of Life Option Act services are not reimbursable under the Medicare CPT codes for advance care planning. For Medicare Advantage enrollees it is advised to check with the patient’s health plan.

 

What Forms Are Used And Where Do I Get The Forms?

Forms and instructions on submitting the forms are available through the California Department of Public Health (CDPH). All forms except the Patient’s Final Attestation must be submitted to CDPH. (The Patient’s Final Attestation should be returned to the attending physician to be included in the patient’s medical record.)

The End of Life Option Act requires various forms.

Provider Forms:

  • Attending Physician’s Checklist & Compliance Form
  • Consulting Physician’s Compliance Form
  • Attending Physician’s Follow-up Form

Patient Forms:

  • Patient’s Request for Aid-in-Dying Drug
  • Interpreter’s Declaration

Visit the CDPH website to download the provider forms.

 

How Do I Submit The Forms?

Within 30 calendar days of writing a prescription for an aid-in-dying drug, the attending physician must submit the following completed, signed, and dated forms to the California Department of Public Health (CDPH):

  • A copy of the qualifying individual’s written request
  • Attending Physician’s Checklist and Compliance form
  • Consulting Physician’s Compliance form

Within 30 calendar days of a qualified individuals’ ingestion of the aid-in-dying drug obtained under the terms of the Act, or death from any other cause, whichever comes first, the attending physician shall submit the Attending Physician Follow-Up Form.

The forms can be sent to the California Department of Public Health.

 

How Will Cause Of Death Be Reported?

This “All County Letter” from the California Department of Public Health provides information regarding accurate reporting on the cause of death on the California Certificate of Death when a person uses an aid-in-dying drug to end his or her life, as authorized by the End of Life Option Act.

Download the letter as a PDF

 

What Are The Best Practices Regarding POLST Forms For Patients Who Choose To Participate In The End Of Life Option Act?

All patients approaching the end of life should discuss their preferences for end-of-life care, complete an advance directive, select a surrogate, and be offered a POLST form to protect those wishes.

For patients choosing  the End of Life Option Act—to request, receive and ingest an aid-in-dying drug—a POLST form should be completed to reflect choices consistent with their wish to actively end their life. For those patients we recommend selecting:

A: Do Not Attempt Resuscitation

B: Comfort-Focused Treatment

C: No Artificial Nutrition

 

Where Can I Find Education And Training On The End Of Life Option Act?

The Coalition for Compassionate Care of California does not take a position on the End of Life Option Act, but we are experts in helping healthcare professionals learn how to have quality conversations with patients about serious illness, choices in end-of-life care, life-sustaining treatments, advance directives and POLST.

For Healthcare Professionals:

California End of Life Option Act (Coalition for Compassionate Care of California) $79
This webinar provides an insightful overview of the End of Life Option Act, patient eligibility requirements, ethical considerations, and a look at the demographics on how this option is used in areas of the country where similar legislation is in place.

The webinar also covers approaches to communicating with patients about treatment choices in the setting of life-limiting illness.

For Health Systems, Medical Practices And Others:

The CCCC Client Services can bring a customized training to your organization. Learn more here.

 

I'm Looking For Publications And Articles On The End Of Life Option Act...

A number of organizations have published information related to the End of Life Option Act.

Reports/Statistics

California Department of Public Health: California End of Life Option Act 2017 Data Report (PDF)

Overview/Guidance

The following may be relevant to CCCC members: