Amended in Senate June 6, 2013

Amended in Assembly April 18, 2013

Amended in Assembly April 9, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 411

Introduced by Assembly Member Pan

February 15, 2013

An act to add Section begin delete 14029.91 end delete begin insert 14029.92 end insert to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

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 begin delete 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, primary language, race, ethnicity, and, to the extent data is available, by sexual orientation and gender identity, and to implement strategies to reduce identified disparities between members from different regions, with different primary languages, and of different races, ethnicities, sexual orientations, and gender identities. 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 end delete require all Medi-Cal managed care plans to link individual level data collected as a part of analyzing their begin delete HEDIS end delete begin insert Healthcare Effectiveness Data and Information Set (HEDIS) end insert measures, or their EAS performance measure equivalent, to begin delete personal end delete begin insert patient end insert identifiers begin insert in a manner that allows for an analysis of disparities in medical treatment by certain characteristics end insert and to submit that data to the department annually. The department would be required to make begin delete the end delete begin insert that end insert individual level data available for research purposes, as specified. begin insert The bill would further require the department to stratify, in the aggregate, that data by certain characteristics and to develop a report, which would be published on the department’s Internet Web site. The bill would also require the department to identify, based upon that data, any disparities in care provided to all Medi-Cal managed care enrollees on the basis of those characteristics, and notify Medi-Cal managed care plans of any disparities identified. If disparities in care are identified, the bill would require each Medi-Cal managed care plan to analyze its internal data to determine if that disparity in care is present among Medi-Cal managed care enrolled in its plan, and require the Medi-Cal managed care plan to develop and implement a quality improvement, as specified. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin delete

SECTION 1.  

Section 14029.91 is added to the Welfare and
Institutions Code, to read:

14029.91.  

(a) (1) The department shall require all Medi-Cal
managed care plans, including county organized health systems
and plans contracting with the department to provide services
pursuant to two-plan and geographic managed care models, to
analyze their Healthcare Effectiveness Data and Information Set
(HEDIS) measures, or their External Accountability Set (EAS)
performance measure equivalent, by geographic region, primary
language, race, ethnicity, and, to the extent data is available, by
sexual orientation and gender identity in order to identify disparities
in medical treatment between Medi-Cal managed care members
from different regions, with different primary languages, and of
different races, ethnicities, sexual orientations, and gender
identities, and to implement strategies to reduce those disparities.

(2) The results of the analyses prepared in accordance with this
subdivision shall be reported to the department annually. The
department shall make such analyses available to the public through
the department’s Internet Web site.

(b)

end delete

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 14029.92 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 14029.92. end insert   

end insert

begin insert (a) end insert  The department shall require begin delete the plans described
in paragraph (1) of subdivision (a) end delete begin insert all Medi-Cal managed care
plans, including county organized health systems and plans
contracting with the department to provide services pursuant to
two-plan and geographic managed care models, end insert to link all
individual level data collected as a part of analyzing their begin delete HEDIS end delete
begin insert Healthcare Effectiveness Data and Information Set (HEDIS) end insert
measures, or their EAS performance measure equivalent, to patient
identifiers in a manner that allows for an analysis of disparities in
medical treatment by geographic region, primary language, race,
ethnicity, begin insert gender, end insert and, to the extent data is available, by sexual
orientation and gender identity, and to provide that information to
the department annually. The department shall make this data
available, in a format that complies with the Health Insurance
Portability and Accountability Act of 1996, for research purposes
through a data use or business associate agreement.

begin insert

(b) The department shall stratify, in the aggregate, all HEDIS
measures from the plans described in subdivision (a) by geographic
region, primary language, race, ethnicity, gender, and, to the extent
data is available, by sexual orientation and gender identity, in
order to identify disparities in the quality of care provided to
Medi-Cal managed care enrollees based on those factors. The
department shall develop a report with this data and publish the
report on the department’s Internet Web site.

end insert begin insert

(c) (1) The department shall, based upon the data described in
subdivision (b), identify disparities in care provided to all Medi-Cal
managed care enrollees based upon the factors described in
subdivision (b), and notify those plans of any disparities identified.

end insert begin insert

(2) If the department identifies any disparities, a plan described
in subdivision (a) shall review their administrative data, including,
but not limited to, encounter and claims data, to assess whether
the disparities identified exist among the Medi-Cal managed care
enrollees enrolled in its plan.

end insert begin insert

(3) If, upon review of its administrative data, a plan described
in subdivision (a) identifies the same disparities identified by the
department among the Medi-Cal managed care enrollees enrolled
in its plan, the plan shall develop and implement a quality
improvement plan to address those disparities. The quality
improvement plan may be used to meet existing contractual
requirements to develop and implement a quality improvement
plan. A quality improvement plan developed and implemented
pursuant to this paragraph shall be provided to the department
and the department shall publish that plan on the department’s
Internet Web site.

end insert