BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 209 (Pan) - Medi-Cal: managed care: quality, accessibility,
and utilization.
Amended: April 9, 2013 Policy Vote: Health 9-0
Urgency: No Mandate: No
Hearing Date: June 24, 2013
Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: AB 209 would require the Department of Health Care
Services to develop a plan to monitor and evaluate the quality,
accessibility, and utilization of services provided through
Medi-Cal managed care.
Fiscal Impact:
Likely ongoing costs between $40,000 and $75,000 per year
to support additional consultation with stakeholders
regarding the development of performance measures and to
support the advisory committee (50% General Fund and 50%
federal funds).
Background: The state's Medi-Cal program provides health care
services to seniors, the disabled, and certain low income
children and their parents. About 5.2 million Medi-Cal
beneficiaries (about 70% of the total Medi-Cal population)
receive their health care through Medi-Cal managed care. In
addition, the state is in the process of shifting certain
populations (seniors and persons with disabilities, rural
Medi-Cal beneficiaries, and individuals eligible for both
Medi-Cal and Medicare) from fee-for-service to managed care. In
total, these initiatives are likely to shift about two million
Medi-Cal beneficiaries to managed care.
Under federal law, state Medicaid programs (Medi-Cal in
California) are required to collect data and measure performance
of managed care plans. The Department of Health Care Services
currently requires Medi-Cal managed care plans to collect and
report certain performance measures. In addition, the Department
has been working with an outside consultant (through funding
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provided by the California Health Care Foundation) to develop a
"dashboard" to allow the public to more easily compare quality
measures across managed care plans.
Concerns have been raised that, although Medi-Cal managed care
plans currently collect and report some performance measures,
this data is not complete and is not collected or reported in a
manner that allows easy comparison between plans.
Proposed Law: AB 209 would require the Department of Health Care
Services to develop a plan to monitor and evaluate the quality,
accessibility, and utilization of services provided through
Medi-Cal managed care.
The bill would specify the elements that must be included in the
plan, for example nationally recognized quality and access
measures, minimum and benchmark performance standards, and
sanctions and corrective actions to reward improvement.
The bill would require the Department to consult with
stakeholders on ways to improve upon existing measures.
The bill would require the Department to appoint an advisory
committee of stakeholders (such as providers, managed care
plans, and advocates) to review performance measure data, make
recommendations to improve performance data, and make other
recommendations.
Related Legislation: AB 411 (Pan) would require all Medi-Cal
managed care plans to review certain performance measures by
geographic region, enrollee primary language, race, ethnicity,
sexual orientation, and gender identity. That bill is in the
Senate Health Committee.
Staff Comments: As noted above, many of the activities required
under the bill are already being undertaken by the Department.
Codifying specific requirements relating to performance measures
is not anticipated to significantly increase the Department's
administrative costs or costs to the Medi-Cal managed care
plans. However, the Department will likely need to provide some
staff support to the required stakeholder process and the
required advisory committee.
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