CA
California Senate Bill SB612

California 2019-2020 Regular Session

California Senate Bill SB612 Compare Versions

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11 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Senate Bill No. 612Introduced by Senator PanFebruary 22, 2019 An act to add Section 1348.7 to the Health and Safety Code, and to add Section 10125.5 to the Insurance Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTSB 612, as introduced, Pan. Health care: data reporting.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) in the California Health and Human Services Agency to regulate health planning and research development.This bill would require a health care service plan, health insurer, and medical group to report specified information to OSHPD on or before January 1, 2021, and on or before January 1 annually thereafter, on its participation in collaboratives and activities, including a program in which an enrollee or insured receives comprehensive transitional care or the supportive and therapeutic needs of an enrollee or insured are addressed in a holistic fashion. The bill would require OSHPD to compile and publish, on or before April 1, 2021, and on or before April 1 annually thereafter, the aggregate information received, organized by health care service plan, health insurer, and medical group, on its internet website. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1348.7 is added to the Health and Safety Code, to read:1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating enrollees.(2) The demographic profile of participating enrollees.(3) The number and type of participating providers.(4) The length of participation of enrollees.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.(4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.SEC. 2. Section 10125.5 is added to the Insurance Code, to read:10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating insureds.(2) The demographic profile of participating insureds.(3) The number and type of participating providers.(4) The length of participation of insureds.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
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33 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Senate Bill No. 612Introduced by Senator PanFebruary 22, 2019 An act to add Section 1348.7 to the Health and Safety Code, and to add Section 10125.5 to the Insurance Code, relating to health care. LEGISLATIVE COUNSEL'S DIGESTSB 612, as introduced, Pan. Health care: data reporting.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) in the California Health and Human Services Agency to regulate health planning and research development.This bill would require a health care service plan, health insurer, and medical group to report specified information to OSHPD on or before January 1, 2021, and on or before January 1 annually thereafter, on its participation in collaboratives and activities, including a program in which an enrollee or insured receives comprehensive transitional care or the supportive and therapeutic needs of an enrollee or insured are addressed in a holistic fashion. The bill would require OSHPD to compile and publish, on or before April 1, 2021, and on or before April 1 annually thereafter, the aggregate information received, organized by health care service plan, health insurer, and medical group, on its internet website. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
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55
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99 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
1010
1111 Senate Bill No. 612
1212
1313 Introduced by Senator PanFebruary 22, 2019
1414
1515 Introduced by Senator Pan
1616 February 22, 2019
1717
1818 An act to add Section 1348.7 to the Health and Safety Code, and to add Section 10125.5 to the Insurance Code, relating to health care.
1919
2020 LEGISLATIVE COUNSEL'S DIGEST
2121
2222 ## LEGISLATIVE COUNSEL'S DIGEST
2323
2424 SB 612, as introduced, Pan. Health care: data reporting.
2525
2626 Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) in the California Health and Human Services Agency to regulate health planning and research development.This bill would require a health care service plan, health insurer, and medical group to report specified information to OSHPD on or before January 1, 2021, and on or before January 1 annually thereafter, on its participation in collaboratives and activities, including a program in which an enrollee or insured receives comprehensive transitional care or the supportive and therapeutic needs of an enrollee or insured are addressed in a holistic fashion. The bill would require OSHPD to compile and publish, on or before April 1, 2021, and on or before April 1 annually thereafter, the aggregate information received, organized by health care service plan, health insurer, and medical group, on its internet website. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
2727
2828 Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) in the California Health and Human Services Agency to regulate health planning and research development.
2929
3030 This bill would require a health care service plan, health insurer, and medical group to report specified information to OSHPD on or before January 1, 2021, and on or before January 1 annually thereafter, on its participation in collaboratives and activities, including a program in which an enrollee or insured receives comprehensive transitional care or the supportive and therapeutic needs of an enrollee or insured are addressed in a holistic fashion. The bill would require OSHPD to compile and publish, on or before April 1, 2021, and on or before April 1 annually thereafter, the aggregate information received, organized by health care service plan, health insurer, and medical group, on its internet website. Because a willful violation of the bills requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.
3131
3232 The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
3333
3434 This bill would provide that no reimbursement is required by this act for a specified reason.
3535
3636 ## Digest Key
3737
3838 ## Bill Text
3939
4040 The people of the State of California do enact as follows:SECTION 1. Section 1348.7 is added to the Health and Safety Code, to read:1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating enrollees.(2) The demographic profile of participating enrollees.(3) The number and type of participating providers.(4) The length of participation of enrollees.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.(4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.SEC. 2. Section 10125.5 is added to the Insurance Code, to read:10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating insureds.(2) The demographic profile of participating insureds.(3) The number and type of participating providers.(4) The length of participation of insureds.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
4141
4242 The people of the State of California do enact as follows:
4343
4444 ## The people of the State of California do enact as follows:
4545
4646 SECTION 1. Section 1348.7 is added to the Health and Safety Code, to read:1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating enrollees.(2) The demographic profile of participating enrollees.(3) The number and type of participating providers.(4) The length of participation of enrollees.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.(4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.
4747
4848 SECTION 1. Section 1348.7 is added to the Health and Safety Code, to read:
4949
5050 ### SECTION 1.
5151
5252 1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating enrollees.(2) The demographic profile of participating enrollees.(3) The number and type of participating providers.(4) The length of participation of enrollees.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.(4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.
5353
5454 1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating enrollees.(2) The demographic profile of participating enrollees.(3) The number and type of participating providers.(4) The length of participation of enrollees.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.(4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.
5555
5656 1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating enrollees.(2) The demographic profile of participating enrollees.(3) The number and type of participating providers.(4) The length of participation of enrollees.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.(4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.
5757
5858
5959
6060 1348.7. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:
6161
6262 (1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.
6363
6464 (2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.
6565
6666 (3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.
6767
6868 (4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.
6969
7070 (5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.
7171
7272 (6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.
7373
7474 (7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.
7575
7676 (8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.
7777
7878 (9) Integration of behavioral or oral health services with medical services.
7979
8080 (10) Programs that include, but are not limited to:
8181
8282 (A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.
8383
8484 (B) The CMS Partnership for Patients.
8585
8686 (C) The Public Hospital Redesign and Incentives in Medi-Cal program.
8787
8888 (D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.
8989
9090 (E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.
9191
9292 (F) The California Quality Collaborative.
9393
9494 (G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.
9595
9696 (11) Other similar activities.
9797
9898 (b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:
9999
100100 (1) A detailed description, including the number of participating enrollees.
101101
102102 (2) The demographic profile of participating enrollees.
103103
104104 (3) The number and type of participating providers.
105105
106106 (4) The length of participation of enrollees.
107107
108108 (5) The length of carrier participation.
109109
110110 (6) Performance measures and outcomes.
111111
112112 (c) For purposes of this section:
113113
114114 (1) High-risk condition includes, but is not limited to, one or more of the following:
115115
116116 (A) Asthma.
117117
118118 (B) Congestive heart failure.
119119
120120 (C) Diabetes.
121121
122122 (D) Heart disease.
123123
124124 (E) High blood pressure.
125125
126126 (F) Obesity.
127127
128128 (G) Serious psychological distress.
129129
130130 (H) Substance use disorder.
131131
132132 (2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:
133133
134134 (A) Preventative services management.
135135
136136 (B) Diagnosis coordination and treatment planning.
137137
138138 (C) Continued management of chronic conditions.
139139
140140 (3) Medi-Cal managed care plan means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:
141141
142142 (A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.
143143
144144 (B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
145145
146146 (C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
147147
148148 (D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
149149
150150 (E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
151151
152152 (F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.
153153
154154 (4) Medical group means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.
155155
156156 (d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.
157157
158158 SEC. 2. Section 10125.5 is added to the Insurance Code, to read:10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating insureds.(2) The demographic profile of participating insureds.(3) The number and type of participating providers.(4) The length of participation of insureds.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.
159159
160160 SEC. 2. Section 10125.5 is added to the Insurance Code, to read:
161161
162162 ### SEC. 2.
163163
164164 10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating insureds.(2) The demographic profile of participating insureds.(3) The number and type of participating providers.(4) The length of participation of insureds.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.
165165
166166 10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating insureds.(2) The demographic profile of participating insureds.(3) The number and type of participating providers.(4) The length of participation of insureds.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.
167167
168168 10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.(9) Integration of behavioral or oral health services with medical services.(10) Programs that include, but are not limited to:(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.(B) The CMS Partnership for Patients.(C) The Public Hospital Redesign and Incentives in Medi-Cal program.(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.(F) The California Quality Collaborative.(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.(11) Other similar activities.(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:(1) A detailed description, including the number of participating insureds.(2) The demographic profile of participating insureds.(3) The number and type of participating providers.(4) The length of participation of insureds.(5) The length of carrier participation.(6) Performance measures and outcomes.(c) For purposes of this section:(1) High-risk condition includes, but is not limited to, one or more of the following:(A) Asthma.(B) Congestive heart failure.(C) Diabetes.(D) Heart disease.(E) High blood pressure.(F) Obesity.(G) Serious psychological distress.(H) Substance use disorder.(2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:(A) Preventative services management.(B) Diagnosis coordination and treatment planning.(C) Continued management of chronic conditions.(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.
169169
170170
171171
172172 10125.5. (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:
173173
174174 (1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.
175175
176176 (2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.
177177
178178 (3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.
179179
180180 (4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.
181181
182182 (5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.
183183
184184 (6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.
185185
186186 (7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.
187187
188188 (8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.
189189
190190 (9) Integration of behavioral or oral health services with medical services.
191191
192192 (10) Programs that include, but are not limited to:
193193
194194 (A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.
195195
196196 (B) The CMS Partnership for Patients.
197197
198198 (C) The Public Hospital Redesign and Incentives in Medi-Cal program.
199199
200200 (D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.
201201
202202 (E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.
203203
204204 (F) The California Quality Collaborative.
205205
206206 (G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.
207207
208208 (11) Other similar activities.
209209
210210 (b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:
211211
212212 (1) A detailed description, including the number of participating insureds.
213213
214214 (2) The demographic profile of participating insureds.
215215
216216 (3) The number and type of participating providers.
217217
218218 (4) The length of participation of insureds.
219219
220220 (5) The length of carrier participation.
221221
222222 (6) Performance measures and outcomes.
223223
224224 (c) For purposes of this section:
225225
226226 (1) High-risk condition includes, but is not limited to, one or more of the following:
227227
228228 (A) Asthma.
229229
230230 (B) Congestive heart failure.
231231
232232 (C) Diabetes.
233233
234234 (D) Heart disease.
235235
236236 (E) High blood pressure.
237237
238238 (F) Obesity.
239239
240240 (G) Serious psychological distress.
241241
242242 (H) Substance use disorder.
243243
244244 (2) Incentive payments includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:
245245
246246 (A) Preventative services management.
247247
248248 (B) Diagnosis coordination and treatment planning.
249249
250250 (C) Continued management of chronic conditions.
251251
252252 (d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.
253253
254254 SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
255255
256256 SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
257257
258258 SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
259259
260260 ### SEC. 3.