California Assembly Bill AB411 Amended / Bill

 BILL NUMBER: AB 411AMENDED 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.