BILL ANALYSIS �
AB 411
Page 1
ASSEMBLY THIRD READING
AB 411 (Pan)
As Amended April 18, 2013
Majority vote
HEALTH 14-0 APPROPRIATIONS 12-5
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|Ayes:|Pan, Ammiano, Atkins, |Ayes:|Gatto, Bocanegra, |
| |Bonilla, Bonta, Gomez, | |Bradford, |
| |Gordon, Maienschein, | |Ian Calderon, Campos, |
| |Nazarian, Nestande, | |Eggman, Gomez, Hall, |
| |V. Manuel P�rez, Wagner, | |Holden, Pan, Quirk, Weber |
| |Wieckowski, Wilk | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
| | |Nays:|Harkey, Bigelow, |
| | | |Donnelly, Linder, Wagner |
| | | | |
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SUMMARY : Provides that the Department of Health Care Services
(DHCS) 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, by geographic region, primary language,
race, ethnicity, and to the extent data is available, by sexual
orientation and gender identity to identify disparities in
medical treatment and to implement strategies to reduce
disparities. Requires MCPs to link individual level data to
patient identifiers in order to allow for an analysis of
disparities in medical treatment by geographic region, primary
language, race, ethnicity, and to the extent data is available,
by sexual orientation and gender identity and provide the
information annually to DHCS. Requires DHCS to make the data
available for research in a method that complies with the Health
Insurance Portability and Accountability Act of 1996.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, this bill would have minor costs to DHCS, which
currently designates performance measures on an annual basis and
requires MCPs to report on them.
COMMENTS : According to the author, as of February 2013,
approximately 5.2 million Californians are enrolled in Medi-Cal
AB 411
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MCPs in 30 counties, the majority of whom are from communities
of color. Additionally, 43% of Medi-Cal enrollees speak a
language other than English. 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
Medi-Cal MCPs. Of these children 47% are Latino and 9% Asian
American or Pacific Islander. Forty-six percent of these
children's households speak a language other than English. The
author points out that when HFP was administered by the Managed
Risk Medical Insurance Board (MRMIB), plans as in Medi-Cal, were
required to report HEDIS data. However, MRMIB did more than
report the results of the HEDIS measures. For instance MRMIB
monitored its plans to ensure that access to quality health care
was shared by all members. In order to accomplish this, MRMIB
performed 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. The author
explains that this allowed MRMIB to conduct qualitative and
comparative analysis, to identify disparities and to develop
strategies for improvement or to reduce disparities.
The author states that the purpose of this bill is to ensure
that the qualitative aspects of the way MRMIB measured and
reported plan data is not lost in the transition to Medi-Cal.
The federal Centers for Medicare and Medicaid Services requires
states through their contracts with MCPs to measure and report
on performance to assess the quality and appropriateness of care
and services provided to members. In response, DHCS implemented
a monitoring system that is intended to provide an objective,
comparative review of health plan quality-of-care outcomes and
performance measures called the EAS. DHCS designates EAS
performance measures on an annual basis and requires plans to
report on them. DHCS uses the HEDIS as the primary tool.
HEDIS is a national, standardized set of measures developed by
the National Committee for Quality Assurance. DHCS selects
which HEDIS measures to use after consultation with the plans
and with input from an External Quality Review Organization
(EQRO). All current measures are applicable across populations.
For example, well child visits, immunizations, comprehensive
diabetes care and annual monitoring of patients on persistent
medications are just a few of the currently required HEDIS
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measures that are applied equally to all Medi-Cal MCP enrollees.
DHCS in collaboration with MCPs and the EQRO, developed a
methodology by which to stratify several measures (comprehensive
diabetes care, children and adolescent access to Primary Care
Providers, annual monitoring for persistent medications,
ambulatory care utilization, and all cause readmissions) into
seniors and persons with disabilities (SPD) groups and non-SPD
groups.
An independent study conducted by Dr. Andrew Bindman, Professor
of Medicine, University of California, San Francisco, "Health
Plan Auto-Assignment Incentives in Medi-Cal and Health Care
Disparities for Children," found there were average deviances
from a health plan's overall performance among racial and ethnic
subpopulations on each of the HEDIS measures they analyzed.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0000343