Bill Text: CA AB411 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medi-Cal: performance measures.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2014-03-06 - Last day to consider Governor's veto pursuant to Joint Rule 58.5. [AB411 Detail]

Download: California-2013-AB411-Amended.html

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BILL NUMBER: AB 411	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 2, 2013
	AMENDED IN SENATE  JUNE 6, 2013
	AMENDED IN ASSEMBLY  APRIL 18, 2013
	AMENDED IN ASSEMBLY  APRIL 9, 2013

INTRODUCED BY   Assembly Member Pan

                        FEBRUARY 15, 2013

   An act to add Section 14029.92 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 411, as amended, Pan. Medi-Cal: performance measures.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Under existing law, one of the methods
by which Medi-Cal services are provided is pursuant to contracts with
managed care plans.
   This bill would require all Medi-Cal managed care plans to link
individual level data collected as a part of analyzing their
Healthcare Effectiveness Data and Information Set (HEDIS) measures,
or their  EAS   External Accountability Set
(EAS)  performance measure equivalent, to patient identifiers in
a manner that allows for an analysis of disparities in medical
treatment by certain characteristics and to submit that data to the
department annually. The department would be required to make that
individual level data available for research purposes, as specified.
The bill would further require the department to stratify, in the
aggregate, that data by certain characteristics and to develop a
report, which would be published on the department's Internet Web
site. The bill would also require the department to identify, based
upon that data, any disparities in care provided to all Medi-Cal
managed care enrollees on the basis of those characteristics, and
notify Medi-Cal managed care plans of any disparities identified. If
disparities in care are identified, the bill would require each
Medi-Cal managed care plan to analyze its internal data to determine
if that disparity in care is present among Medi-Cal managed care
enrolled in its plan, and require the Medi-Cal managed care plan to
develop and implement a quality  improvement,  
improvement plan,  as specified.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14029.92 is added to the Welfare and
Institutions Code, to read:
   14029.92.  (a) The department shall require all Medi-Cal managed
care plans, including county organized health systems and plans
contracting with the department to provide services pursuant to
two-plan and geographic managed care models, to link all individual
level data collected as a part of analyzing their Healthcare
Effectiveness Data and Information Set (HEDIS) measures, or their
 EAS   External Accountability Set (EAS) 
performance measure equivalent, to patient identifiers in a manner
that allows for an analysis of disparities in medical treatment by
geographic region, primary language, race, ethnicity, gender, and, to
the extent data is available, by sexual orientation and gender
identity, and to provide that information to the department annually.
The department shall make this data available, in a format that
complies with the Health Insurance Portability and Accountability Act
of 1996, for research purposes through a data use or business
associate agreement.
   (b) The department shall stratify, in the aggregate, all HEDIS
 measures   measures, or their EAS performance
measure equivalent,  from the plans described in subdivision (a)
by geographic region, primary language, race, ethnicity, gender,
and, to the extent data is available, by sexual orientation and
gender identity, in order to identify disparities in the quality of
care provided to Medi-Cal managed care enrollees based on those
factors. The department shall develop a report with this data and
publish the report on the department's Internet Web site.
   (c) (1) The department shall, based upon the data described in
subdivision (b), identify disparities in care provided to all
Medi-Cal managed care enrollees based upon the factors described in
subdivision (b), and notify  those   the 
plans  described in subdivision (a)  of any disparities
identified.
   (2) If the department identifies any disparities, a plan described
in subdivision (a) shall review  their  its
 administrative data, including, but not limited to, encounter
and claims data, to assess whether the disparities identified  by
the department  exist among the Medi-Cal managed care enrollees
enrolled in its plan.
   (3) If, upon review of its administrative data, a plan described
in subdivision (a) identifies the same disparities identified by the
department among the Medi-Cal managed care enrollees enrolled in its
plan, the plan shall develop and implement a quality improvement plan
to address those disparities. The quality improvement plan may be
used to meet existing contractual requirements to develop and
implement a quality improvement plan. A quality improvement plan
developed and implemented pursuant to this paragraph shall be
provided to the department and the department shall publish that plan
on the department's Internet Web site.