BILL ANALYSIS Ó
AB 2670
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2670
(Roger Hernández) - As Introduced February 19, 2016
SUBJECT: Medi-Cal: managed care health plans: Consumer
Assessment of Health Care Providers and Systems (CAHPS) Health
Plan surveys.
SUMMARY: Requires the Department of Health Care Services (DHCS)
to administer, on an annual basis, the Consumer Assessment of
Health Care Providers and Systems (CAHPS) Health Plan surveys,
as developed by the federal Agency for Healthcare research and
Quality for all Medi-Cal managed care plan (MCP) populations.
Specifically, this bill:
1)Requires DHCS to annually administer the CAHPS survey to all
MCP models, including county organized health systems (COHS),
two-plan models, and geographic managed care plans.
2)Requires DHCS to translate the CAHPS survey in all Medi-Cal
threshold languages and requires DHCS to administer the CAHPS
survey in all Medi-Cal threshold languages in each county.
3)Requires DHCS to stratify the results in order to identify
disparities in the quality of care provided to Medi-Cal
managed care enrollees based on all of the following factors:
a) Geographic region;
b) Primary language;
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c) Race;
d) Ethnicity;
e) Gender; and,
f) To the extent data is available, sexual orientation and
gender identity.
4)Requires DHCS to annually prepare and make publicly available
a report on the results of the surveys on the DHCS Website.
Provides that the report will include all of the following:
a) Aggregated data on MCP results compared to national
Medicaid data;
b) Aggregated MCP results stratified by the factors set
forth as specified; and,
c) Plan results at the county level, including results for
all MCP models, as specified.
EXISTING LAW:
1)Regulates health plans through the Department of Managed
Health Care under the Knox-Keene Act and health insurance
policies through the California Department of Insurance under
the Insurance Code.
2)Establishes the Medi-Cal program, administered by DHCS, under
which qualified low-income persons receive health care
benefits and, in part, governed and funded by federal Medicaid
program provisions.
3)Provides that Medi-Cal services are provided pursuant to
contracts with various types of managed care health plans,
including through a COHS, two plan, and geographic managed
care plan model.
4)Requires DHCS to monitor, evaluate, and improve the quality of
care provided by MCPs.
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FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The author states that this bill gives
us the opportunity to assess California's most diverse
populations and different health care needs. Futhermore, the
author states that Medi-Cal's quality measures must be
consistent and reflect everyone's health care experience. One
in three Californians is now enrolled in Medi-Cal. The author
states that it is time for us to make sure everyone is
receiving quality coverage and care.
2)BACKGROUND. According to California Pan-Ethnic Health
Network, the sponsor of this bill, California's Medi-Cal
program has grown tremendously in enrollment since
implementation of the Patient Protection and Affordable Care
Act (ACA). Medi-Cal covers approximately 12 million
enrollees, up from 7 million in 2013. Approximately 78% of
enrollees belong to a community of color, and more than a
third of the beneficiaries' primary language is not English.
Many communities of color face disproportionate rates of
chronic disease. With these groups comprising a majority of
Medi-Cal enrollees, the long term success of the ACA rests on
how the health system will improve the care experience of
California's diverse population.
a) CAHPS Survey - DHCS is charged with monitoring,
evaluating, and improving the quality of care provided by
MCPs. The CAHPS survey is a federally developed consumer
assessment tool that polls patients on their actual
experience receiving care. The CAHPS survey assesses both
patient satisfaction and perceptions of access to care. In
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the context of managed care, CAHPS measures assess the
experiences of surveyed managed care plan members in the
prior six months. The members are asked about their
experiences with getting the care they felt they needed,
getting care as quickly as they felt they needed to receive
the care, and other perceptions about their experiences
with care through their health plan. Currently, DHCS
conducts the CAHPS survey once every three years, and only
in two languages, English and Spanish. DHCS publishes the
results on its website and uses results as part of its
Medi-Cal Managed Care Program Quality Strategy. In
addition to reporting the performance measurement data for
each health plan on its website, DHCS presents annual
quality awards to high-performing plans based on
performance as assessed by HEDIS (Healthcare Effectiveness
Data and Information Set - widely used set of performance
measures in the managed care industry, developed and
maintained by the National Committee for Quality Assurance)
and CAHPS measures. Achievement awards are presented by
DHCS at an annual quality conference to the plans with the
highest performance on HEDIS measures, the plans with the
highest performance on CAHPS measures, and the plan with
the most improved performance on HEDIS measures.
b) Standards for Determining Threshold Languages - DHCS is
responsible for promulgating the standards that MCPs must
apply to determine which language, at a minimum, they must
use to provide translated materials to their enrollees. As
required by state and federal law, DHCS must identify
non-English languages spoken by enrollees and potential
enrollees through the state based on a significant number
or percentage of persons who speak each language; provide
member informing materials in each prevalent non-English
language; and require each MCP to make its written
information available in the prevalent non-English
languages in its particular service area. DHCS then
implements requirements through its MCP contracts.
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c) Legislative Analyst Office Report - A Legislative
Analyst Office (LAO) Report (Report) on Improving Medi-Cal
Managed Care Plan Quality dated May 5, 2015, analyzed the
quality of MCPs and current DHCS efforts to improve MCPs
plan quality, and considered additional steps and
alternative approaches, such as pay-for-performance
programs (that provide financial incentives to plans for
meeting specified quality performance standards), the state
could take to monitor plans and stimulate quality
improvement in MCPs. The Report recommended that the
Legislature direct DHCS to expand the collection of the
CAHPS survey from once every three years to annually to
improve current manage care quality monitoring and
incentive programs implemented by DHCS. This bill is
consistent with the LAO's recommendation.
d) Other states - Michigan, Colorado, and Connecticut
require annual CAHPS reporting.
3)SUPPORT. The California Pan-Ethnic Health Network (CPEHN)
contends that DHCS only conducts the CAHPS survey once every
three years and the most recent CAHPS survey data are from
2013, prior to the Medi-Cal expansion in 2014. Additionally,
CPEHN notes that this bill will be able to assess whether DHCS
is meeting its obligation to ensure all Medi-Cal beneficiaries
have access to quality healthcare by translating the CAHPS
survey in all of the Medi-Cal threshold languages. Health
Access California states that some or even most MCPs
voluntarily conduct CAHPS surveys annually. Additionally,
Health Access states that conducting consumer satisfaction
surveys in Medi-Cal threshold languages is an important step
toward assuring that all Californians are able to express
satisfaction or dissatisfaction with the care and coverage
they receive. Consumers Union state that consumers benefit
when validated surveys, such as CAHPS, are used to illuminate
the quality of products available, to identify disparities,
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and to guide improvements. Since DHCS only conducts the CAHPS
survey once every three years, it does not fully reflect the
views and experiences of California's diverse enrollees.
REGISTERED SUPPORT / OPPOSITION:
Support
California Pan-Ethnic Health Network (sponsor)
Asian Law Alliance
Consumers Union
Having Our Say
Health Access California
Inland Empire Immigrant Youth Coalition
SEIU California
Western Center on Law and Poverty
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Opposition
None on file.
Analysis Prepared by:Kristene Mapile / HEALTH / (916) 319-2097