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

California Assembly Bill 411 (Prior Session Legislation)

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

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

BILL NUMBER: AB 411	AMENDED
	BILL TEXT

	AMENDED IN SENATE  SEPTEMBER 3, 2013
	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.  Existing federal law generally requires
that a state that contracts with certain managed care plans ensure
that an external quality review is performed by an External Quality
Review Organization (EQRO). 
   This bill would  require   require, when the
department enters into a new contract     with an
EQRO,  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 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  
characteristics, including geographic region and primary language,
 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   also require, when the department
enters into a new contract with an EQRO, that the department either
include in the terms of the new contract a requirement that, upon
approval of the contract, the EQRO stratify all patient-specific
HEDIS measures, or their EAS performance measure equivalent, in the
aggregate,  by certain  characteristics and to develop a
report, which would be published   characteristics,
including geographic region and primary language, or that the
department, upon approval of the contract, stratify those same
measures, in the aggregate, by those same characteristics. The bill
would require the department to publicly report this analysis 
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 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   When the department
enters into a new contract   with an External Quality Review
Organization (EQRO), 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
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,
  (1)     When the department enters
into a new contract with an EQRO, the department shall do either of
the following: 
    (A)     Include in the terms of the new
contract a requirement that, upon approval of the contract, the EQRO
  stratify    all  patient-specific 
HEDIS measures, or their EAS performance measure equivalent, 
from the plans described in subdivision (a)   in the
aggregate,  by geographic region, primary language, race,
ethnicity, gender, and, to the extent data is available, by sexual
orientation and gender  identity, in   identity.
 
   (B) Stratify, upon approval of the contract, all patient-specific
HEDIS measures, or their EAS performance measure equivalent, in the
aggregate, by geographic region, primary language, race, ethnicity,
gender, and, to the extent data is available, by sexual orientation
and gender identity. 
    (2)     The stratification required
pursuant to paragraph (1) shall be completed in  order to
identify disparities in the quality of care provided to Medi-Cal
managed care enrollees based on  those factors. The 
 the factors identified in paragraph (1). 
    (3)     The  department shall 
develop a report with this data and publish the  
publicly  report  the analysis identified in paragraph (1)
 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 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 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.