BILL NUMBER: AB 209	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Pan

                        JANUARY 30, 2013

   An act to add Section 14029.9 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 209, as introduced, Pan. Medi-Cal: managed care: quality and
accessibility.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Under existing law, one of the methods
by which Medi-Cal services are provided is pursuant to contracts with
various types of managed care plans.
   This bill would require the department to develop and implement a
plan, as specified, to monitor, evaluate, and improve the quality and
accessibility of health care and dental services provided through
Medi-Cal managed care. The bill would require the department to hold
quarterly public meetings to report on, among other things,
performance measures and quality and access standards, and to invite
public comments. The bill would require the department to appoint an
advisory committee, with specified responsibilities, for the purpose
of making recommendations to the department and to the Legislature in
order to improve quality and access in the delivery of Medi-Cal
managed care services. The bill would be implemented to the extent
that federal, private, or other non-General Fund moneys are
available.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  This act shall be known and may be cited as the
Medi-Cal Managed Care Health Care Quality and Transparency Act of
2013.
  SEC. 2.  Section 14029.9 is added to the Welfare and Institutions
Code, to read:
   14029.9.  (a) The department shall develop and implement a plan to
monitor, evaluate, and improve the quality and accessibility of
health care and dental services provided through Medi-Cal managed
care. The plan shall include all of the following:
   (1) Nationally recognized quality and access measures.
   (2) A process to solicit input from providers, health care quality
experts, consumers, and consumer representatives for recommendations
on supplementing existing measures and indicators in order to fully
evaluate quality of, and access to, all Medi-Cal benefits, including
long-term services and supports, care coordination, and disease
management.
   (3) Minimum and benchmark performance standards and contract
requirements.
   (4) Strategies to encourage and reward improvement.
   (5) Sanctions and corrective actions in cases of deficiencies.
   (6) A health care dashboard that is publicly available and
provides up-to-date information regarding quality of, and access to,
primary, speciality, dental, mental health, and behavioral health
care services. The data shall be reported, at a minimum, by
eligibility category, plan, county of residence, age, gender,
ethnicity, and primary language to the extent permitted by federal
law, including the federal Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191).
   (7) Coordination with the Department of Managed Health Care to
monitor, survey, and report on network adequacy and fiscal solvency.
   (b) At least quarterly, the department shall hold public meetings
to report on performance measures, quality and access standards,
network adequacy, fiscal solvency, and evaluation standards with
regard to all Medi-Cal managed care services and to invite public
comments. The department shall notify the public of the meetings
within a reasonable time prior to each meeting.
   (c) The department shall appoint an advisory committee composed of
providers, plans, researchers, advocates, and enrollees for the
purpose of making recommendations to the department and the
Legislature in order to improve quality and access in the delivery of
Medi-Cal managed care services. The responsibilities of the advisory
committee shall include, but are not limited to, all of the
following:
   (1) Reviewing existing performance standards, quality data, and
measures.
   (2) Developing recommendations to modify, add, or eliminate
measures as appropriate.
   (3) Reviewing managed care plan contract terms and making
recommendations related to improving quality and access.
   (4) Reviewing rate setting methodologies and payment policies.
   (d) This section shall be implemented only to the extent that
federal, private, or other non-General Fund moneys are available for
this purpose.