Palliative care

How can palliative care help?

Studies show palliative care can:

• Reduce physical discomfort
• Improve quality of life
• Make living with a serious illness easier
• Provide support for family and/or caregivers
• Offer support for both persons with serious illnesses and those who help care for them
   

Blue Shield's home-based palliative care program

What services are covered?

• Treatment decision and support
• Care plan development and shared decision making
• Home-based palliative care visits - in person and via video conferencing
• Medication management and reconciliation
• Psychosocial support for mental, emotional, social, and spiritual well-being
• 24/7 access to patient help and support
• Caregiver support

Where are these services delivered?

Throughout California wherever the person needs or wants them such as:

• At home
• Via phone or video

Who is eligible for palliative care?

Palliative care is a standard service available to all members with Blue Shield of California primary coverage, with the exception of FEP PPO, Medicare Supplement, Shared Advantage, and Cal MediConnect. 

Palliative care services are in addition to a member's other medical care at no additional charge.

Palliative care is considered a primary Blue Shield of California service. Any member can self-refer, and no prior authorization is required.
 

Referrals can also come from:

• Family members
• Case management (Blue Shield and others)
• Providers (such as Primary Care Providers and specialists)
• Hospital discharge planners

Advanced care planning conversations

Ariadne Labs developed the What Matters to Me Workbook (PDF, 264 KB) in collaboration with The Conversation Project. It is designed to help people with a serious illness get ready to talk to their health care team about what is most important to them.

Providers also have access to the Serious Illness Conversation Guide (PDF, 134 KB) to help them speak with patients about their goals and values.

Have a member you would like to refer to the palliative care program? Download the Eligibility Screening Tool (PDF, 271 KB), complete the form, and email it to the palliative care team at BSCPalliativeCare@blueshieldca.com.

Palliative Care training & forms

Referring Patients to Home-Based Palliative Care

This webinar describes how providers can refer qualified patients to Blue Shield’s Home-Based Palliative Care (HBPC) program. The session covers  HBPC patient eligibility requirements, the referral process, HBPC services provided as part of the program, and resources available to support referring providers. 
  Recorded webinar (48 min)
  Presentation (PDF, 2.8 MB)
  Webinar FAQ (PDF, 54 KB)

Home-Based Palliative Care Program Overview for Servicing Providers

This webinar describes Blue Shield’s home-based palliative care program from the perspective of a servicing provider. Topics included how to qualify and enroll patients, how to code and bill for hassle-free payment, and more.
  Recorded webinar (48 min)
  Presentation (PDF, 775 KB)

Use the tool below to qualify Blue Shield members for the Home-Based Palliative Care (HBPC) Program. Only members meeting the criteria outlined in this tool can be enrolled in the program.
  HBPC program patient eligibility screening tool (PDF, 105 KB)

This one-page job aid captures key steps that servicing providers should follow when assessing, enrolling, and caring for members in the HBPC program.
  HBPC program servicing provider checklist (PDF, 199 KB)

The support documents below are provided to help servicing providers meet program requirements.
  CMS 1500 claim form sample (PDF, 177 KB)
  CMS 1500 claim form sample – PMPM (PDF, 180 KB)
  HBPC program UB sample – Initial evaluation (PDF, 1.2 MB)
  HBPC program UB sample – PMPM (PDF, 1.2 MB)