AB 411, as introduced, Pan. Medi-Cal: performance measures.
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 all Medi-Cal managed care plans to analyze their Healthcare Effectiveness Data and Information Set (HEDIS) measures, or their External Accountability Set (EAS) performance measure equivalent, by race, ethnicity, and primary language, and to implement strategies to reduce identified disparities between members of different races and ethnicities and with different primary languages. The bill would also require that these analyses be reported to the State Department of Health Care Services annually and be made available to the public via the department’s Internet Web site. This bill would further require all Medi-Cal managed care plans to link individual level data collected as a part of analyzing their HEDIS measures, or their EAS performance measure equivalent, to personal identifiers and to submit that data to the department annually. The department would be required to make the individual level data available for research purposes, as specified.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 14029.91 is added to the Welfare and
2Institutions Code, to read:
(a) (1) The department shall require all Medi-Cal
4managed care plans, including county organized health systems
5and plans contracting with the department to provide services
6pursuant to two-plan and geographic managed care models, to
7analyze their Healthcare Effectiveness Data and Information Set
8(HEDIS) measures, or their External Accountability Set (EAS)
9performance measure equivalent, by race and ethnicity in order to
10identify disparities in medical treatment between Medi-Cal
11managed care members of different races and ethnicities and to
12implement strategies to reduce those disparities.
13(2) The department shall require the plans described in paragraph
14(1) to analyze their HEDIS measures, or their EAS performance
15
measure equivalent, by primary language in order to identify
16disparities in medical treatment between Medi-Cal managed care
17members with different primary languages and to implement
18strategies to reduce those disparities.
19(3) The results of the analyses prepared in accordance with this
20subdivision shall be reported to the department annually. The
21department shall make such analyses available to the public through
22the department’s Internet Web site.
23(b) The department shall require the plans described in paragraph
24(1) of subdivision (a) to link all individual level data collected as
25a part of analyzing their HEDIS measures, or their EAS
26performance measure equivalent, to patient identifiers in a manner
27that allows for an analysis of disparities in medical treatment by
28race, ethnicity, and primary language, and to provide that
29information to the department annually. The department
shall make
30this data available, in a format that complies with the Health
P3 1Insurance Portability and Accountability Act of 1996, for research
2purposes through a data use or business associate agreement.
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