BILL ANALYSIS �
AB 209
Page 1
Date of Hearing: May 1, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 209 (Pan) - As Amended: April 9, 2013
Policy Committee: HealthVote:17-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill enacts the Medi-Cal Managed Care Quality and
Transparency Act of 2013 and requires the Department of Health
Care Services (DHCS) to 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
(MCMC). Specifically, this bill:
1)Requires DHCS to include in the plan nationally recognized
quality and access measures, a process for stakeholder input,
minimum and benchmark performance standards, strategies to
reward improvement and identify and reduce health disparities,
sanctions for deficiencies, and a publicly available dashboard
with specified information.
2)Requires DHCS to hold quarterly public meetings and appoint a
stakeholder advisory committee with specified
responsibilities.
FISCAL EFFECT
Minor costs to DHCS. This bill contains language making its
implementation contingent on funding through the budget act or
federal, private, or other non-General Fund moneys.
COMMENTS
1)Rationale . This bill is intended to provide an opportunity
for public oversight and to bring transparency to the
performance of the MCMC programs administered by DHCS. The
author states this is accomplished by requiring an open
process to allow public review of program performance measures
AB 209
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related to access and quality of care. The author's
particular concern is that while there is a vast quantity of
data available, it is not reported and produced in a fashion
that promotes qualitative assessments of the managed care
programs.
Numerous organizations representing various consumer and
provider stakeholder groups support this bill. There is no
opposition.
2)Background . MCMC serves about 5.2 million enrollees in 30
counties, or about 69% of the total Medi-Cal population
through three different health delivery models. DHCS has
embarked on an ambitious array of initiatives that could
result in over two million new enrollees into managed care
plans in 2012 and 2013. These program changes include all age
groups and all geographic regions. For example, DHCS is
transitioning approximately 860,000 children from the Healthy
Families Program to the Medi-Cal program in four phases
throughout 2013. In November of 2010, California obtained
federal approval authorizing mandatory enrollment of over
600,000 low-income seniors and persons with disabilities
(SPDs). DHCS is also participating in a demonstration
project authorized by the 2010 federal Affordable Care Act to
improve coordination of services for persons who are dually
eligible for state Medicaid programs (Medi-Cal in California)
and Medicare. AB 1467 (Committee on Budget), Chapter 23,
Statutes of 2012, authorized the expansion of MCMC to 28
mostly rural counties.
3)Oversight: Medi-Cal Transitions and Program Expansions . On
October 25, 2012, the Assembly Committee on Health held an
oversight hearing to review the status of these managed care
initiatives, to set the framework for an evaluation of these
various initiatives and to assess the Brown Administration's
plans to evaluate and monitor these policy changes. The
Committee reviewed existing mechanisms used for monitoring and
assessing quality and access in MCMC. For instance many of
the plans meet the licensing and regulatory standards of the
Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene
Act) and are regulated by DMHC. However, regulatory and
licensing requirements such as the Knox-Keene Act have
limitations with regard to measuring access and generally do
not measure utilization levels and quality of care. They also
do not provide a way to compare plans with regard to access or
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quality of care. DHCS reports on a variety of other measures,
some are unique to a specific population or initiative and
others apply more universally.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081