Amended in Senate September 11, 2013

Amended in Senate September 6, 2013

Amended in Senate September 3, 2013

Amended in Senate July 2, 2013

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 14029.92 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. 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 would require, when the department enters into a new contract with an EQRO for the EQRO to perform work associated with Medi-Cal managed care programs, that the department include in the terms of the new contract a requirement that, upon approval of the contract, the EQRO stratify all patient-specific Healthcare Effectiveness Data and Information Set measures, or their External Accountability Set performance measure equivalent, by certain characteristics, including geographic area and primary language. The bill would require the department to publicly report this analysis on the department’s Internet Web site. The bill would provide that its provisions only be implemented to the extent that funding is available.

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

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

SECTION 1.  

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

14029.92.  

(a) When the department enters into a new contract
with an External Quality Review Organization (EQRO) for the
EQRO to perform work associated with Medi-Cal managed care
programs, the terms of the new contract shall contain a requirement
that, upon approval of the contract, the EQRO stratify all
patient-specific Healthcare Effectiveness Data and Information
Set measures, or their External Accountability Set performance
measure equivalent, by geographic area, primary language, race,
ethnicity, gender, and, to the extent begin insert reliable end insert 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.

(b) The department shall publicly report the analysis identified
in subdivision (a) on the department’s Internet Web site.

(c) This section shall be implemented only to the extent that
funding is available.