Amended in Assembly March 19, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 209

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 amended, 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 begin insert funding is provided in the annual budget act or end insert 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 begin insert the end insert quality of, and access to,
all Medi-Cal benefits, including long-term services and supports,
care coordination, and disease management begin insert , and to perform
analysis by race, ethnicity, primary language, and gender, to the
extent permitted by federal law end insert .

(3) Minimum and benchmark performance standards and
contract requirements.

(4) Strategies to encourage and reward improvement begin insert and to
identify and reduce health disparities among populations end insert .

(5) Sanctions and corrective actions in cases of deficiencies.

(6) A begin delete health end delete begin insert Medi-Cal managed end insert care dashboard that is publicly
available and provides up-to-date information regarding begin insert the end insert quality
of, and access to, primary, speciality, dental, mental health, begin delete and end delete
behavioral health care services begin insert , and long end insert begin insert -term care support and
services end insert . 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 begin insert and collect data, end insert as appropriate.

(3) Reviewing managed care plan contract terms and making
recommendations related to improving quality and access.

(4) Reviewing ratesetting methodologies and payment policies.

(d) This section shall be implemented only to the extent that
begin insert funding is provided in the annual budget act or end insert federal, private,
or other non-General Fund moneys are available for this purpose.