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 link individual level data collected as a part of analyzing their Healthcare Effectiveness Data and Information Set (HEDIS) measures, or theirbegin delete EASend deletebegin insert External Accountability Set (EAS)end insert
performance measure equivalent, to patient identifiers in a manner that allows for an analysis of disparities in medical treatment by certain characteristics and to submit that data to the department annually. The department would be required to make that individual level data available for research purposes, as specified. 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 qualitybegin delete improvement,end deletebegin insert improvement plan,end insert 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 14029.92 is added to the Welfare and
2Institutions Code, to read:
(a) 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 link
7all individual level data collected as a part of analyzing their
8
Healthcare Effectiveness Data and Information Set (HEDIS)
9measures, or theirbegin delete EASend deletebegin insert External Accountability Set (EAS)end insert
10 performance measure equivalent, to patient identifiers in a manner
11that allows for an analysis of disparities in medical treatment by
12 geographic region, primary language, race, ethnicity, gender, and,
13to the extent data is available, by sexual orientation and gender
14identity, and to provide that information to the department annually.
15The department shall make this data available, in a format that
16complies with the Health Insurance Portability and Accountability
17Act of 1996, for research purposes through a data use or business
18associate agreement.
19(b) The department shall stratify, in the aggregate, all HEDIS
20begin delete measuresend deletebegin insert measures, or their EAS performance measure equivalent,end insert
21 from the plans described in subdivision (a) by geographic region,
22primary language, race, ethnicity, gender, and, to the extent data
P3 1is available, by sexual orientation and gender identity, in order to
2identify disparities in the quality of care provided to Medi-Cal
3managed care enrollees based on those factors. The department
4shall develop a report with this data and publish the report on the
5department’s Internet Web site.
6(c) (1) The department shall, based upon the data described in
7subdivision (b), identify
disparities in care provided to all Medi-Cal
8managed care enrollees based upon the factors described in
9subdivision (b), and notifybegin delete thoseend deletebegin insert theend insert plansbegin insert described in subdivision
10(a)end insert of any disparities identified.
11(2) If the department identifies any disparities, a plan described
12in subdivision (a) shall reviewbegin delete theirend deletebegin insert itsend insert administrative data,
13including, but not limited to, encounter and claims data, to assess
14whether the
disparities identifiedbegin insert by the departmentend insert exist among
15the Medi-Cal managed care enrollees enrolled in its plan.
16(3) If, upon review of its administrative data, a plan described
17in subdivision (a) identifies the same disparities identified by the
18department among the Medi-Cal managed care enrollees enrolled
19in its plan, the plan shall develop and implement a quality
20improvement plan to address those disparities. The quality
21improvement plan may be used to meet existing contractual
22requirements to develop and implement a quality improvement
23plan. A quality improvement plan developed and implemented
24pursuant to this paragraph shall be provided to the department and
25the department shall publish that plan on the department’s Internet
26Web
site.
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