BILL ANALYSIS �
AB 411
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 411 (Pan)
As Amended September 11, 2013
Majority vote
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|ASSEMBLY: |54-19|(May 16, 2013) |SENATE: |27-10|(September 12, |
| | | | | |2013) |
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Original Committee Reference: HEALTH
SUMMARY : Requires that a new contract after January 1, 2014,
between the Department of Health Care Services (DHCS) and an
External Quality Review Organization (EQRO) include a
requirement that patient-specific Healthcare Effectiveness Data
and Information Set (HEDIS) measures, or their External
Accountability Set (EAS) performance measure equivalent, be
stratified by geographic region, primary language, race,
ethnicity, gender, and, to the extent reliable data are
available, by sexual orientation and gender identity, in order
to assist with the identification of health care disparities in
the care provided to Medi-Cal managed care enrollees based on
these factors. Requires the results of the analysis to be
publicly reported on the DHCS Web site. Conditions
implementation on the availability of federal, private, or State
General Funds (GFs).
The Senate amendments delete the Assembly-approved version and
require contracts with an EQRO to stratify specified performance
measures by geographic region, primary language, race,
ethnicity, gender, and, to the extent reliable data is
available, by sexual orientation and gender identity.
AS PASSED BY THE ASSEMBLY , this bill required DHCS to require
all Medi-Cal managed care plans (MCPs) to analyze, by geographic
region, primary language, race, ethnicity, and to the extent
data are available, by sexual orientation and gender identity to
identify disparities in medical treatment and to implement
strategies to reduce disparities. Required 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 are available, by sexual orientation and gender
identity and provide the information annually to DHCS. Required
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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 Senate Appropriations
Committee, likely costs in the hundreds of thousands per year
for data analysis and reporting by DHCS or an external
contractor, based on similar data analysis costs incurred by the
Managed Risk Medical Insurance Board (MRMIB) for the Healthy
Families Program (HFP) (50% GF, 50% federal funds). Minor
potential costs to Medi-Cal MCPs to collect and report data to
DHCS or an external contractor. To the extent that additional
costs for the Medi-Cal MCPs are built into future managed care
rates, state Medi-Cal costs could increase slightly.
COMMENTS : According to the author, as of February 2013,
approximately 5.2 million Californians are enrolled in Medi-Cal
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 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 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
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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 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 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
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