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 with 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 geographic region,begin insert primary language,end insert
race, ethnicity,begin delete and primary language,end deletebegin insert and, to the extent data is available, by sexual orientation and gender identity,end insert and to implement strategies to reduce identified disparities between members from different regions,begin insert with different primary languages, andend insert of differentbegin delete races andend deletebegin insert races,end insert ethnicities,begin insert sexual orientations,end insert andbegin delete with different primary languages.end deletebegin insert
gender identities.end insert 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 geographic region,begin insert primary
10language,end insert race,begin delete and ethnicityend deletebegin insert ethnicity,end insertbegin insert
and, to the extent data is
11available, by sexual orientation and gender identityend insert in order to
12identify disparities in medical treatment between Medi-Cal
13managed care members from differentbegin delete regionsend deletebegin insert regions, with
14different primary languages, end insert and of differentbegin delete races and ethnicitiesend delete
15begin insert races, ethnicities, sexual orientations, and gender identities,end insert and
16to implement strategies to reduce those disparities.
17(2) The department shall require the plans described in paragraph
18(1) to analyze their HEDIS measures, or their EAS performance
19
measure equivalent, by primary language in order to identify
20disparities in medical treatment between Medi-Cal managed care
21members with different primary languages and to implement
22strategies to reduce those disparities.
23(3)
end delete
24begin insert(end insertbegin insert2)end insert The results of the analyses prepared in accordance with this
25subdivision shall be reported to the department annually. The
26department shall make such analyses available to the public through
27the department’s Internet Web site.
P3 1(b) The department shall
require the plans described in paragraph
2(1) of subdivision (a) to link all individual level data collected as
3a part of analyzing their HEDIS measures, or their EAS
4performance measure equivalent, to patient identifiers in a manner
5that allows for an analysis of disparities in medical treatment by
6
geographic region,begin insert primary language,end insert race, ethnicity,begin delete and primary begin insert and, to the extent data is available, by sexual orientation
7language,end delete
8and gender identity,end insert and to provide that information to the
9department annually. The department shall make this data available,
10in a format that complies with the Health Insurance Portability and
11Accountability Act of 1996, for research purposes through a data
12use or business associate agreement.
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