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

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 6, 2013
	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, 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, 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 also 
require, when the department enters into a new contract with an EQRO
 ,   for the EQRO   to perform work
associated with Medi-Cal managed care programs,  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   
 Healthcare Effectiveness Data and   Information Set
 measures, or their  EAS   External
Accountability Set  performance measure equivalent,  in
the aggregate,  by certain characteristics, including
geographic  region   area  and primary
 language, or that the department, upon approval of the
contract, stratify those same measures, in the aggregate, by those
same characteristics.   language.  The bill would
require the department to publicly report this analysis on the
department's Internet Web site.  The bill would provide 
 that its provisions only be implemented to the extent that
funding is available. 
   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) 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) (1) 
    14029.92.    (a)    When the
department enters into a new contract with an  EQRO, the
department shall do either of the following: 
    (A)     Include in
  External Quality Review Organization (EQRO) for the
EQRO to perform work associated with Medi-Cal managed care programs,
 the terms of the new contract  shall contain  a
requirement that, upon approval of the contract, the EQRO stratify
all patient-specific  HEDIS   Healthcare
Effectiveness Data and Information Set  measures, or their
 EAS   External Accountability Set
performance measure equivalent,  in the aggregate, 
by geographic  region,   area,  primary
language, race, ethnicity, gender, and, to the extent data is
available, by sexual orientation and gender  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
  identity,  in order to identify disparities in
the quality of care provided to Medi-Cal managed care enrollees based
on  the factors identified in paragraph (1).  
those factors.  
   (3) 
    (   b)  The department shall publicly report
the analysis identified in  paragraph (1)  
subdivision (a)  on the department's Internet Web site. 
   (c) This section shall be implemented only to the extent that
funding is available.