BILL ANALYSIS �
AB 411
Page 1
Date of Hearing: May 1, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 411 (Pan) - As Amended: April 18, 2013
Policy Committee: HealthVote:14-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill directs the Department of Health Care Services (DHCS)
to require all Medi-Cal managed care plans (MCPs) to analyze
Healthcare Effectiveness Data and Information Set (HEDIS)
measures, or their External Accountability Set (EAS) performance
measure equivalent, and to implement strategies to reduce
disparities. Specifically, this bill:
1)Requires HEDIS or EAS measures to be analyzed by geographic
region, primary language, race, ethnicity, and to the extent
data is available, by sexual orientation and gender identity.
2)Requires analysis results to be reported to DHCS annually and
made available to the public on the DHCS website.
FISCAL EFFECT
Minor costs to DHCS, which currently designates performance
measures on an annual basis and requires MCPs to report on them.
COMMENTS
1)Rationale . The author intends to ensure the qualitative
aspects of MCP data measurement and reporting by the Managed
Risk Medical Insurance Board (MRMIB) are not lost in the
transition to Medi-Cal. MCPs currently analyze and report
HEDIS measures on important dimensions of care and service.
By analyzing utilization, quality, and outcome data by race,
ethnicity, and primary language, MCPs and DHCS will achieve
multiple benefits: a) a better understanding of the specific
needs of these enrollees; b) ability to develop culturally and
linguistically appropriate interventions; and c) ability to
AB 411
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allocate resources more effectively while reducing historic
health disparities faced by communities of color.
2)HEDIS and EAS . The federal Centers for Medicare and Medicaid
Services (CMS) requires states to measure and report on
quality. DHCS implemented EAS, a system intended to provide
an objective, comparative review of health plan
quality-of-care outcomes and performance measures. DHCS uses
HEDIS measures as the primary tool for EAS. HEDIS was
developed by the National Committee for Quality Assurance and
includes numerous indicators, such as rates for childhood
immunization and breast cancer screening, to facilitate an
apples-to-apples comparison of health plans.
3)Background: Medi-Cal Transition and MRMIB Analyses . Because
of numerous changes in state and federal law over the last
several years, the Medi-Cal population is undergoing a
significant expansion. For example, DHCS is in the process of
transitioning over 850,000 children from the Healthy Families
Program (HFP) to Medi-Cal and most of them will be enrolled in
MCPs. Of these children, 47% are Latino and 9% are Asian
American or Pacific Islander. MRMIB's administration of HFP
included, in addition to a report on HEDIS results,
demographic statistical analysis of HEDIS data where all
eligible members were counted. MRMIB then considered
groupings of this data by health plan, region, income level,
language spoken in the home, ethnicity, and age. MRMIB's
approach facilitated quality monitoring to identify
disparities and to develop strategies for improvement or to
reduce disparities.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081