AB 411, as amended, 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 withbegin delete various types ofend delete 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, bybegin insert geographic region,end insert
race, ethnicity, and primary language, and to implement strategies to reduce identified disparities between membersbegin insert from differentend insertbegin insert regions,end insert of different races andbegin delete ethnicitiesend deletebegin insert ethnicities,end insert 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, bybegin delete raceend deletebegin insert geographic region, race,end insert
10 and ethnicity in order to identify disparities in medical treatment
11between Medi-Cal managed care membersbegin insert
from different regions
12andend insert of different races and ethnicities and to implement strategies
13to reduce those disparities.
14(2) The department shall require the plans described in paragraph
15(1) to analyze their HEDIS measures, or their EAS performance
16
measure equivalent, by primary language in order to identify
17disparities in medical treatment between Medi-Cal managed care
18members with different primary languages and to implement
19strategies to reduce those disparities.
20(3) The results of the analyses prepared in accordance with this
21subdivision shall be reported to the department annually. The
22department shall make such analyses available to the public through
23the department’s Internet Web site.
24(b) The department shall require the plans described in paragraph
25(1) of subdivision (a) to link all individual level data collected as
26a part of analyzing their HEDIS measures, or their EAS
27performance measure equivalent, to patient identifiers in a manner
28that allows for an analysis of disparities in medical treatment by
29begin insert
geographic region, end insert race, ethnicity, and primary language, and to
30provide that information to the department annually. The
31department shall make this data available, in a format that complies
P3 1with the Health Insurance Portability and Accountability Act of
21996, for research purposes through a data use or business associate
3agreement.
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