BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 411 (Pan) - Medi-Cal: performance measures.
Amended: July 2, 2013 Policy Vote: 8-1
Urgency: No Mandate: No
Hearing Date: August 30, 2013
Consultant: Brendan McCarthy
SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Bill Summary: AB 411 would require Medi-Cal managed care plans
to link performance measure data to patient identifiers. The
bill would require the Department of Health Care Services to use
that data to analyze potential disparities in the provision of
services by race, ethnicity, geography, primary language, and
other demographic characteristics. The bill would require
Medi-Cal managed care plans to develop plans to address any
disparities found.
Fiscal Impact (as proposed to be amended):
Likely costs in the hundreds of thousands per year for data
analysis and reporting by the Department of Health Care
Services or an external contractor, based on similar data
analysis costs incurred by the Managed Risk Medical
Insurance Board for the Healthy Families Program (50%
General Fund, 50% federal funds).
Minor potential costs to Medi-Cal managed care plans to
collect and report data to the Department or an external
contractor. To the extent that additional costs for the
Medi-Cal managed care plans are built into future managed
care rates, state Medi-Cal costs could increase slightly.
Background: The state's Medi-Cal program provides health care
services to seniors, the disabled, and certain low income
children and their parents. About 5.2 million Medi-Cal
beneficiaries (about 70% of the total Medi-Cal population)
receive their health care through Medi-Cal managed care. In
addition, the state is in the process of shifting certain
populations (seniors and persons with disabilities, rural
Medi-Cal beneficiaries, and individuals eligible for both
Medi-Cal and Medicare) from fee-for-service to managed care. In
AB 411 (Pan)
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total, these initiatives are likely to shift about two million
Medi-Cal beneficiaries to managed care.
Under federal law, state Medicaid programs (Medi-Cal in
California) are required to collect data and measure the
performance of managed care plans. The Department of Health Care
Services currently requires Medi-Cal managed care plans to
collect and report certain performance measures. In addition,
the Department has been working with an outside consultant
(through funding provided by the California Health Care
Foundation) to develop a "dashboard" to allow the public to more
easily compare quality measures across managed care plans.
Proposed Law: AB 411 would require Medi-Cal managed care plans
to link performance measure data to patient identifiers.
The bill would require the Department of Health Care Services to
use that data to analyze potential disparities in the provision
of services by race, ethnicity, geography, primary language, and
other demographic characteristics.
The bill would require Medi-Cal managed care plans to develop
plans to address any disparities found.
Related Legislation: AB 209 (Pan) would require the Department
of Health Care Services to develop a plan to monitor and
evaluate the quality, accessibility, and utilization of services
provided through Medi-Cal managed care. That bill is on the
Senate Floor.
Proposed author's amendments: would delay implementation of the
bill until the Department enters into a new contract with an
External Quality Review Organization, revise some of the data
analysis and reporting requirements, and delete the requirement
that managed care plans develop and implement quality
improvement plans.