BILL NUMBER: AB 411	AMENDED
	BILL TEXT

	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

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  reliable  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.