CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2275Introduced by Assembly Member ArambulaFebruary 13, 2018 An act to add Section 14310 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2275, as introduced, Arambula. Medi-Cal managed care: quality assessment and performance improvement.Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified, low-income persons. 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 various types of managed care health plans, including through a county organized health system and geographic managed care.This bill would require the department to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, through which the plans would be required to meet annual improvements in quality measures and reduction of health disparities, as specified. The bill would require the department to require the plans to track and trend quality measures by specified demographic categories. The bill would require the department to establish quality improvement performance targets, commencing July 1, 2019, and to develop a financial incentive program to reward high-performing plans and progress towards meeting annual targets, as specified.The bill would also require the department to establish a public stakeholder process in the planning, development, and ongoing oversight of the program and in the planning of the financial incentive program. The bill would require the department to annually and publicly report the program results on its Internet Web site.The bill would require the program to require plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality. The bill would require the department to provide translations of the CAHPS survey in all Medi-Cal threshold languages, and require plans to administer the surveys in each county. The bill would require the department to publicly report on the survey results, including specified information.The bill would require the department to utilize the program results to develop a Quality Rating System for Medi-Cal managed care plans, subject to federal approval.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 14310 is added to the Welfare and Institutions Code, to read:14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:(A) Geographic region.(B) Primary language.(C) Race.(D) Ethnicity.(E) Gender.(F) Sexual orientation and gender identity.(G) Disability.(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2275Introduced by Assembly Member ArambulaFebruary 13, 2018 An act to add Section 14310 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 2275, as introduced, Arambula. Medi-Cal managed care: quality assessment and performance improvement.Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified, low-income persons. 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 various types of managed care health plans, including through a county organized health system and geographic managed care.This bill would require the department to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, through which the plans would be required to meet annual improvements in quality measures and reduction of health disparities, as specified. The bill would require the department to require the plans to track and trend quality measures by specified demographic categories. The bill would require the department to establish quality improvement performance targets, commencing July 1, 2019, and to develop a financial incentive program to reward high-performing plans and progress towards meeting annual targets, as specified.The bill would also require the department to establish a public stakeholder process in the planning, development, and ongoing oversight of the program and in the planning of the financial incentive program. The bill would require the department to annually and publicly report the program results on its Internet Web site.The bill would require the program to require plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality. The bill would require the department to provide translations of the CAHPS survey in all Medi-Cal threshold languages, and require plans to administer the surveys in each county. The bill would require the department to publicly report on the survey results, including specified information.The bill would require the department to utilize the program results to develop a Quality Rating System for Medi-Cal managed care plans, subject to federal approval.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
Assembly Bill No. 2275
Introduced by Assembly Member ArambulaFebruary 13, 2018
Introduced by Assembly Member Arambula
February 13, 2018
An act to add Section 14310 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2275, as introduced, Arambula. Medi-Cal managed care: quality assessment and performance improvement.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified, low-income persons. 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 various types of managed care health plans, including through a county organized health system and geographic managed care.This bill would require the department to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, through which the plans would be required to meet annual improvements in quality measures and reduction of health disparities, as specified. The bill would require the department to require the plans to track and trend quality measures by specified demographic categories. The bill would require the department to establish quality improvement performance targets, commencing July 1, 2019, and to develop a financial incentive program to reward high-performing plans and progress towards meeting annual targets, as specified.The bill would also require the department to establish a public stakeholder process in the planning, development, and ongoing oversight of the program and in the planning of the financial incentive program. The bill would require the department to annually and publicly report the program results on its Internet Web site.The bill would require the program to require plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality. The bill would require the department to provide translations of the CAHPS survey in all Medi-Cal threshold languages, and require plans to administer the surveys in each county. The bill would require the department to publicly report on the survey results, including specified information.The bill would require the department to utilize the program results to develop a Quality Rating System for Medi-Cal managed care plans, subject to federal approval.
Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified, low-income persons. 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 various types of managed care health plans, including through a county organized health system and geographic managed care.
This bill would require the department to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, through which the plans would be required to meet annual improvements in quality measures and reduction of health disparities, as specified. The bill would require the department to require the plans to track and trend quality measures by specified demographic categories. The bill would require the department to establish quality improvement performance targets, commencing July 1, 2019, and to develop a financial incentive program to reward high-performing plans and progress towards meeting annual targets, as specified.
The bill would also require the department to establish a public stakeholder process in the planning, development, and ongoing oversight of the program and in the planning of the financial incentive program. The bill would require the department to annually and publicly report the program results on its Internet Web site.
The bill would require the program to require plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality. The bill would require the department to provide translations of the CAHPS survey in all Medi-Cal threshold languages, and require plans to administer the surveys in each county. The bill would require the department to publicly report on the survey results, including specified information.
The bill would require the department to utilize the program results to develop a Quality Rating System for Medi-Cal managed care plans, subject to federal approval.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 14310 is added to the Welfare and Institutions Code, to read:14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:(A) Geographic region.(B) Primary language.(C) Race.(D) Ethnicity.(E) Gender.(F) Sexual orientation and gender identity.(G) Disability.(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 14310 is added to the Welfare and Institutions Code, to read:14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:(A) Geographic region.(B) Primary language.(C) Race.(D) Ethnicity.(E) Gender.(F) Sexual orientation and gender identity.(G) Disability.(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.
SECTION 1. Section 14310 is added to the Welfare and Institutions Code, to read:
### SECTION 1.
14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:(A) Geographic region.(B) Primary language.(C) Race.(D) Ethnicity.(E) Gender.(F) Sexual orientation and gender identity.(G) Disability.(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.
14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:(A) Geographic region.(B) Primary language.(C) Race.(D) Ethnicity.(E) Gender.(F) Sexual orientation and gender identity.(G) Disability.(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.
14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:(A) Geographic region.(B) Primary language.(C) Race.(D) Ethnicity.(E) Gender.(F) Sexual orientation and gender identity.(G) Disability.(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.
14310. (a) (1) The department shall establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, including county organized health systems implemented pursuant to Article 2.8 (commencing with Section 14087.5) of Chapter 7 and Article 2.82 (commencing with Section 14087.98) of Chapter 7, and entities contracting with the department to provide services pursuant to Article 2.7 (commencing with Section 14087.3) of Chapter 7 (two-plan models), Article 2.81 (commencing with Section 14087.96) of Chapter 7, and Article 2.91 (commencing with Section 14089) of Chapter 7 (geographic managed care).
(2) The quality assessment and performance improvement program shall require Medi-Cal managed care plans to meet annual improvements in quality measures and the reduction of health disparities determined by the department and achieve target performance improvements in these areas as determined by the department. The department shall require all of the following:
(A) Medi-Cal managed care plans shall track and trend quality measures by geographic area, primary language, race, ethnicity, gender, sexual orientation, gender identity, and disability status.
(B) Medi-Cal managed care plans that fall below the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics to meet the MPL. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).
(C) Medi-Cal managed care plans that meet or exceed the minimum performance level (MPL) established by the department shall make annual performance improvements in quality metrics as determined by the department. Annual performance improvements shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A).
(3) Commencing July 1, 2019, the department shall establish quality improvement performance targets for all Medi-Cal managed care plans based on national benchmarks, analysis of variation in California performance, best existing science of quality improvement, and effective engagement of stakeholders. Performance improvement targets shall reduce disparities in quality of care received by Medi-Cal beneficiaries as identified in subparagraph (A) of paragraph (2).
(b) The department shall develop a financial incentive program to reward high-performing managed care plans and progress towards meeting annual targets for quality improvement and health disparities reduction pursuant to subdivision (a). Annual targets include reaching 80 percent self-reported demographic data by July 1, 2019, adopting the latest federal standards for Electronic Health Records, and other targets to be established pursuant to subdivision (c).
(c) (1) The department shall establish a public stakeholder process in the planning, development, and ongoing oversight of the quality assessment and performance improvement program established in subdivision (a) and in the planning of the financial incentive program established in subdivision (b).
(2) The stakeholder process shall provide stakeholders meaningful input in the selection of quality assessment metrics, including patient-specific Healthcare Effectiveness Data and Information Set measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures or their External Accountability Set performance measure equivalent, and in the design of the financial incentive program.
(3) The stakeholders shall, at a minimum, include consumer advocates and representatives from the Medi-Cal managed care plans. The department shall consult with other state purchasers, including the California Health Benefit Exchange (Exchange) to discuss alignment of quality measures across payers where appropriate.
(4) The department shall convene the stakeholders no less than quarterly until such time that all stakeholders agree that quarterly meetings are no longer necessary. Materials for those meetings shall be posted on the departments Internet Web site 24 hours in advance of the meetings. Information about the meetings time and place shall be sent to all interested members of the public no later than one week prior to the meeting. Stakeholder meetings shall be open to the public either in person or over the phone.
(d) The department shall annually and publicly report the results of the quality assessment and performance improvement program on the departments Internet Web site. The report shall identify disparities in quality of care provided to Medi-Cal managed care enrollees and shall include all of the following:
(1) An analysis of all-patient specific Healthcare Effectiveness Data and Information Set (HEDIS), or External Accountability Set (EAS) performance measure equivalent, by geographic area, primary language, race, ethnicity, gender, sexual orientation, and disability status.
(2) An analysis of the performance of each county, Medi-Cal managed care plan, and the overall Medi-Cal managed care program by the factors identified in paragraph (1).
(e) The department shall require the quality improvement system in Medi-Cal managed care contracts to include a definition of health disparities that includes primary language, race, ethnicity, gender, sexual orientation, gender identity, income, and disability status.
(f) (1) The quality assessment and performance improvement program shall require the Medi-Cal managed care plans to annually complete and report to the department the results of the Consumer Assessment of Health Care Providers and Systems (CAHPS) Health Plan surveys, which are developed by the federal Agency for Healthcare Research and Quality, and shall include CAHPS supplemental questions pertaining to cultural competency and health literacy.
(2) The department shall provide translations of the CAHPS survey in all Medi-Cal threshold languages and shall require plans to administer the surveys in each county in all Medi-Cal threshold languages in that county.
(3) In order to identify disparities in the quality of care provided to Medi-Cal managed care enrollees based on the factors set forth in this subdivision, the department shall stratify the results of the surveys described in this subdivision by all of the following factors:
(A) Geographic region.
(B) Primary language.
(C) Race.
(D) Ethnicity.
(E) Gender.
(F) Sexual orientation and gender identity.
(G) Disability.
(4) The department shall annually prepare and make publicly available a report on the results of the surveys on the departments Internet Web site. The report shall include all of the following:
(A) Aggregated data on Medi-Cal managed care results compared to national Medicaid data and statewide data.
(B) Aggregated Medi-Cal managed care results stratified by the factors set forth in paragraph (3).
(C) Plan results at the county level, including results for all Medi-Cal managed care plan models.
(g) (1) The department shall utilize the results of the quality assessment and performance improvement program to develop a publicly reported Quality Rating System for Medi-Cal managed care plans subject to federal approval.
(2) In developing the Quality Rating System, the department shall consult with stakeholders, including Medi-Cal managed care plans and consumers, to provide feedback to the department on topics that include the selection of data domains, survey methodology, rate calculation methodology, public display so that it is accessible to all members, including members who are limited-English-proficient and persons with disabilities, dissemination, and rules regarding marketing of results.