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. Existing federal law generally requires that a state that contracts with certain managed care plans ensure that an external quality review is performed by an External Quality Review Organization (EQRO).
This bill wouldbegin delete require, when the department enters into a new contract with an EQRO, 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 their External Accountability Set (EAS) performance measure equivalent, to patient identifiers in a manner that allows for an analysis of disparities in medical treatment by certain characteristics, including geographic region and primary language, 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 alsoend delete require, when the department enters into a new contract with an EQRObegin delete,end deletebegin insert for the EQRO to perform work associated with Medi-Cal managed care programs,end insert that the departmentbegin delete eitherend delete include in the terms of the new contract a requirement that, upon approval of the contract, the EQRO stratify all patient-specificbegin delete HEDISend deletebegin insert end insertbegin insertHealthcare Effectiveness Data and
Information Setend insert measures, or theirbegin delete EASend deletebegin insert
External Accountability Setend insert performance measure equivalent,begin delete in the aggregate,end delete by certain characteristics, including geographicbegin delete regionend deletebegin insert areaend insert and primarybegin delete language, or that the department, upon approval of the contract, stratify those same measures, in the aggregate, by those same characteristics.end deletebegin insert language.end insert The bill would require the department to publicly report this analysis on the department’s Internet Web site.begin insert The bill would provide
that its provisions only be implemented to the extent that funding is available.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:
Section 14029.92 is added to the Welfare and
2Institutions Code, to read:
(a) When the department enters into a new contract
4with an External Quality Review Organization (EQRO), the
5department shall require all Medi-Cal managed care plans,
6including county organized health systems and plans contracting
7with the department to provide services pursuant to two-plan and
8geographic managed care models, to link all individual level data
9collected as a part of analyzing their
Healthcare Effectiveness Data
10and Information Set (HEDIS) measures, or their External
11Accountability Set (EAS) performance measure equivalent, to
P3 1patient identifiers in a manner that allows for an analysis of
2disparities in medical treatment by geographic region, primary
3language, race, ethnicity, gender, and, to the extent data is
4available, by sexual orientation and gender identity, and to provide
5that information to the department annually. The department shall
6make this data available, in a format that complies with the Health
7Insurance Portability and Accountability Act of 1996, for research
8purposes through a data use or business associate agreement.
9(b) (1)
begin insert(a)end insertbegin insert end insertWhen the department enters into a new contract
11with anbegin delete EQRO, the department shall do either of the following:end delete
12begin delete(A)end deletebegin delete end deletebegin deleteInclude inend deletebegin insert
External Quality Review Organization (EQRO)
13for the EQRO to perform work associated with Medi-Cal managed
14care programs,end insert the terms of the new contractbegin insert shall containend insert
a
15requirement that, upon approval of the contract, the EQRO stratify
16all patient-specificbegin delete HEDISend deletebegin insert Healthcare Effectiveness Data and
17Information Setend insert measures, or theirbegin delete EASend deletebegin insert External Accountability
18Setend insert performance measure equivalent,begin delete in the aggregate,end delete by
19geographicbegin delete region,end deletebegin insert area,end insert primary language, race, ethnicity,
gender,
20and, to the extent data is available, by sexual orientation and gender
21begin delete identity.end delete
22(B) Stratify, upon approval of the contract, all patient-specific
23HEDIS measures, or their EAS performance measure equivalent,
24in the aggregate, by geographic region, primary language, race,
25ethnicity, gender, and, to the extent data is available, by sexual
26orientation and gender identity.
27begin delete(2)end deletebegin delete end deletebegin deleteThe stratification required pursuant to paragraph (1) shall begin insert
identity,end insert in order to identify disparities in the quality
28be completedend delete
29of care provided to Medi-Cal managed care enrollees based on
30begin delete the factors identified in paragraph (1).end deletebegin insert those factors.end insert
31(3)
end delete
32begin insert(end insertbegin insertb)end insert The department shall publicly report the analysis identified
33inbegin delete paragraph (1)end deletebegin insert
subdivision (a) end insert
on the department’s Internet Web
34site.
35(c) This section shall be implemented only to the extent that
36funding is available.
O
93