Amended in Assembly April 9, 2013

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 begin delete and accessibility. end delete begin insert , accessibility, and utilization. end insert

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

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

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

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

(6)  begin insert (A) end insert begin insert   end insert A Medi-Cal managed care dashboard that is publicly
available and provides up-to-date information regarding begin delete the end delete begin insert all of
the following: end insert

begin insert (i) end insert begin insert   end insert begin insert The end insert quality of, and access to, primary, begin delete speciality end delete begin insert specialty end insert ,
dental, mental health, behavioral health care services, and long-term
care support and services. begin delete The end delete

begin insert

(ii) The utilization of primary, specialty, mental health, and
behavioral health care services, inpatient acute care, emergency
services, and long-term care support and services.

end insert

begin insert (B) end insert begin insert   end insert begin insert The end insert 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, begin insert utilization levels, end insert 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 and collect data, 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
funding is provided in the annual budget act or federal, private, or
other non-General Fund moneys are available for this purpose.