| 1 | | - | Enrolled September 18, 2023 Passed IN Senate September 12, 2023 Passed IN Assembly September 13, 2023 Amended IN Senate July 13, 2023 Amended IN Assembly March 29, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1202Introduced by Assembly Member Lackey(Coauthors: Assembly Members Boerner, Dixon, Schiavo, and Wallis)February 16, 2023 An act to add and repeal Section 14197.01 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1202, Lackey. Medi-Cal: health care services data: children and pregnant or postpartum persons.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes, until January 1, 2026, certain time or distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. Existing law sets forth various limits on the number of miles or minutes from the enrollees place of residence, depending on the type of service or specialty and, in some cases, on the county.This bill would require the department, no later than January 1, 2025, to prepare and submit a report to the Legislature that includes certain information, including an analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the plans compliance with the above-described time or distance and appointment time standards.Under the bill, the report would also include data, disaggregated as specified, on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries receiving certain health care services during the 202122, 202223, and 202324 fiscal years. The report would also include additional information regarding the departments efforts to improve access to pediatric preventive care, as specified. The bill would require that the report be made publicly available through its posting on the departments internet website.The bill would repeal these reporting provisions on January 1, 2029.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 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 1 | + | Amended IN Senate July 13, 2023 Amended IN Assembly March 29, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1202Introduced by Assembly Member Lackey(Coauthors: Assembly Members Boerner, Dixon, Schiavo, and Wallis)February 16, 2023 An act to add and repeal Section 14197.01 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1202, as amended, Lackey. Medi-Cal: time or distance standards: childrens health care services. health care services data: children and pregnant or postpartum persons.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes, until January 1, 2026, certain time or distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. Existing law sets forth various limits on the number of miles or minutes from the enrollees place of residence, depending on the type of service or specialty and, in some cases, on the county.Existing law authorizes a Medi-Cal managed care plan to use clinically appropriate video synchronous interaction as a means of demonstrating compliance with those standards. Existing law authorizes the department, upon request of a Medi-Cal managed care plan, to authorize alternative access standards for those standards under certain conditions, with the request being approved or denied on ZIP Code and provider type basis, as specified.This bill would, no later than January 1, 2025, require each Medi-Cal managed care plan to conduct, and report to the department the results of, an analysis to identify the number and, as appropriate, the geographic distribution of Medi-Cal providers needed to ensure the Medi-Cal managed care plans compliance with the above-described time or distance and appointment time standards for pediatric primary care, across all service areas of the plan. The bill would, no later than January 1, 2026, require the department to prepare and submit a report to the Legislature that includes certain information, including a summary of the results reported by Medi-Cal managed care plans, specific steps for Medi-Cal managed care plan accountability, evidence of progress and compliance, and level of accuracy of provider directories, as specified.The bill would, no later than July 1, 2024, require the department to submit a report to the Legislature, and to make it publicly available, with certain information for the 2019, 2020, 2021, and 2022 calendar years, including (1) the number of children 0 to 5 years of age, inclusive, and the number of children 6 to 18 years of age, inclusive, who are Medi-Cal beneficiaries receiving any of specified early childhood preventive or developmental services, and (2) the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of specified services. The bill would require that the report also include, for those populations, information about any disparities across racial or ethnic groups, primary languages spoken at home, service areas or counties, or age groups.The bill would repeal the analysis and reporting provisions on January 1, 2030.This bill would require the department, no later than January 1, 2025, to prepare and submit a report to the Legislature that includes certain information, including an analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the plans compliance with the above-described time or distance and appointment time standards.Under the bill, the report would also include data, disaggregated as specified, on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries receiving certain health care services during the 202122, 202223, and 202324 fiscal years. The report would also include additional information regarding the departments efforts to improve access to pediatric preventive care, as specified. The bill would require that the report be made publicly available through its posting on the departments internet website.The bill would repeal these reporting provisions on January 1, 2029.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 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed.SECTION 1.Section 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01.(a)No later than January 1, 2025, each Medi-Cal managed care plan shall conduct, and report to the department the results of, an analysis to identify the number and, as appropriate, the geographic distribution of Medi-Cal providers needed to ensure the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197 for pediatric primary care, across all service areas of the plan.(b)(1)No later than January 1, 2026, the department shall prepare and submit a report to the Legislature that includes all of the following:(A)A summary of the results reported by Medi-Cal managed care plans, as described in subdivision (a).(B)Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i)Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii)Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(C)Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(D)Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(E)Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(2)No later than July 1, 2024, the department shall submit a report to the Legislature, and shall make the report publicly available by posting it on the departments internet website, with all of the following data:(A)For the 2019, 2020, and 2021, and 2022 calendar years, as one cohort, the number of children zero to five years of age, inclusive, and, as a separate cohort, the number of children 6 to 18 years of age, inclusive, who are Medi-Cal beneficiaries receiving any of the following early childhood preventive or developmental services, disaggregated by age-related cohort and by service type:(i)Immunizations.(ii)Blood lead screenings.(iii)Physical examinations.(iv)Developmental screenings.(v)Nutrition screenings.(vi)Mental health screenings.(vii)Dental screenings.(viii)Vision screenings.(ix)Hearing screenings.(x)Autism spectrum disorder screenings.(xi)Developmental surveillance.(xii)Behavioral, social, or emotional screenings.(B)For each of the two cohorts of children described in subparagraph (A), information about any disparities across the following:(i)Racial or ethnic groups.(ii)Primary languages spoken at home.(iii)Service areas or counties of the state.(iv)Age groups within the cohort.(C)For the 2019, 2020, and 2021, and 2022 calendar years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i)Maternal depression screenings.(ii)Tobacco, alcohol, or drug use assessments.(iii)Depression or suicide risk screenings.(D)For the pregnant persons, and for the postpartum persons, described in subparagraph (C), information about any disparities across the following:(i)Racial or ethnic groups.(ii)Primary languages spoken at home.(iii)Service areas or counties of the state.(iv)Age groups.(3)The reports described in paragraphs (1) and (2) shall be submitted in accordance with Section 9795 of the Government Code.(c)Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2030, and as of that date is repealed. |
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| 3 | | - | Enrolled September 18, 2023 Passed IN Senate September 12, 2023 Passed IN Assembly September 13, 2023 Amended IN Senate July 13, 2023 Amended IN Assembly March 29, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1202Introduced by Assembly Member Lackey(Coauthors: Assembly Members Boerner, Dixon, Schiavo, and Wallis)February 16, 2023 An act to add and repeal Section 14197.01 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1202, Lackey. Medi-Cal: health care services data: children and pregnant or postpartum persons.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes, until January 1, 2026, certain time or distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. Existing law sets forth various limits on the number of miles or minutes from the enrollees place of residence, depending on the type of service or specialty and, in some cases, on the county.This bill would require the department, no later than January 1, 2025, to prepare and submit a report to the Legislature that includes certain information, including an analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the plans compliance with the above-described time or distance and appointment time standards.Under the bill, the report would also include data, disaggregated as specified, on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries receiving certain health care services during the 202122, 202223, and 202324 fiscal years. The report would also include additional information regarding the departments efforts to improve access to pediatric preventive care, as specified. The bill would require that the report be made publicly available through its posting on the departments internet website.The bill would repeal these reporting provisions on January 1, 2029.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO |
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| 3 | + | Amended IN Senate July 13, 2023 Amended IN Assembly March 29, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1202Introduced by Assembly Member Lackey(Coauthors: Assembly Members Boerner, Dixon, Schiavo, and Wallis)February 16, 2023 An act to add and repeal Section 14197.01 of the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1202, as amended, Lackey. Medi-Cal: time or distance standards: childrens health care services. health care services data: children and pregnant or postpartum persons.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes, until January 1, 2026, certain time or distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. Existing law sets forth various limits on the number of miles or minutes from the enrollees place of residence, depending on the type of service or specialty and, in some cases, on the county.Existing law authorizes a Medi-Cal managed care plan to use clinically appropriate video synchronous interaction as a means of demonstrating compliance with those standards. Existing law authorizes the department, upon request of a Medi-Cal managed care plan, to authorize alternative access standards for those standards under certain conditions, with the request being approved or denied on ZIP Code and provider type basis, as specified.This bill would, no later than January 1, 2025, require each Medi-Cal managed care plan to conduct, and report to the department the results of, an analysis to identify the number and, as appropriate, the geographic distribution of Medi-Cal providers needed to ensure the Medi-Cal managed care plans compliance with the above-described time or distance and appointment time standards for pediatric primary care, across all service areas of the plan. The bill would, no later than January 1, 2026, require the department to prepare and submit a report to the Legislature that includes certain information, including a summary of the results reported by Medi-Cal managed care plans, specific steps for Medi-Cal managed care plan accountability, evidence of progress and compliance, and level of accuracy of provider directories, as specified.The bill would, no later than July 1, 2024, require the department to submit a report to the Legislature, and to make it publicly available, with certain information for the 2019, 2020, 2021, and 2022 calendar years, including (1) the number of children 0 to 5 years of age, inclusive, and the number of children 6 to 18 years of age, inclusive, who are Medi-Cal beneficiaries receiving any of specified early childhood preventive or developmental services, and (2) the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of specified services. The bill would require that the report also include, for those populations, information about any disparities across racial or ethnic groups, primary languages spoken at home, service areas or counties, or age groups.The bill would repeal the analysis and reporting provisions on January 1, 2030.This bill would require the department, no later than January 1, 2025, to prepare and submit a report to the Legislature that includes certain information, including an analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the plans compliance with the above-described time or distance and appointment time standards.Under the bill, the report would also include data, disaggregated as specified, on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries receiving certain health care services during the 202122, 202223, and 202324 fiscal years. The report would also include additional information regarding the departments efforts to improve access to pediatric preventive care, as specified. The bill would require that the report be made publicly available through its posting on the departments internet website.The bill would repeal these reporting provisions on January 1, 2029.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO |
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| 32 | | - | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes, until January 1, 2026, certain time or distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. Existing law sets forth various limits on the number of miles or minutes from the enrollees place of residence, depending on the type of service or specialty and, in some cases, on the county.This bill would require the department, no later than January 1, 2025, to prepare and submit a report to the Legislature that includes certain information, including an analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the plans compliance with the above-described time or distance and appointment time standards.Under the bill, the report would also include data, disaggregated as specified, on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries receiving certain health care services during the 202122, 202223, and 202324 fiscal years. The report would also include additional information regarding the departments efforts to improve access to pediatric preventive care, as specified. The bill would require that the report be made publicly available through its posting on the departments internet website.The bill would repeal these reporting provisions on January 1, 2029. |
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| 29 | + | Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services through various health care delivery systems, including managed care pursuant to Medi-Cal managed care plan contracts. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.Existing law establishes, until January 1, 2026, certain time or distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified. Existing law sets forth various limits on the number of miles or minutes from the enrollees place of residence, depending on the type of service or specialty and, in some cases, on the county.Existing law authorizes a Medi-Cal managed care plan to use clinically appropriate video synchronous interaction as a means of demonstrating compliance with those standards. Existing law authorizes the department, upon request of a Medi-Cal managed care plan, to authorize alternative access standards for those standards under certain conditions, with the request being approved or denied on ZIP Code and provider type basis, as specified.This bill would, no later than January 1, 2025, require each Medi-Cal managed care plan to conduct, and report to the department the results of, an analysis to identify the number and, as appropriate, the geographic distribution of Medi-Cal providers needed to ensure the Medi-Cal managed care plans compliance with the above-described time or distance and appointment time standards for pediatric primary care, across all service areas of the plan. The bill would, no later than January 1, 2026, require the department to prepare and submit a report to the Legislature that includes certain information, including a summary of the results reported by Medi-Cal managed care plans, specific steps for Medi-Cal managed care plan accountability, evidence of progress and compliance, and level of accuracy of provider directories, as specified.The bill would, no later than July 1, 2024, require the department to submit a report to the Legislature, and to make it publicly available, with certain information for the 2019, 2020, 2021, and 2022 calendar years, including (1) the number of children 0 to 5 years of age, inclusive, and the number of children 6 to 18 years of age, inclusive, who are Medi-Cal beneficiaries receiving any of specified early childhood preventive or developmental services, and (2) the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of specified services. The bill would require that the report also include, for those populations, information about any disparities across racial or ethnic groups, primary languages spoken at home, service areas or counties, or age groups.The bill would repeal the analysis and reporting provisions on January 1, 2030.This bill would require the department, no later than January 1, 2025, to prepare and submit a report to the Legislature that includes certain information, including an analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the plans compliance with the above-described time or distance and appointment time standards.Under the bill, the report would also include data, disaggregated as specified, on the number of children and pregnant or postpartum persons who are Medi-Cal beneficiaries receiving certain health care services during the 202122, 202223, and 202324 fiscal years. The report would also include additional information regarding the departments efforts to improve access to pediatric preventive care, as specified. The bill would require that the report be made publicly available through its posting on the departments internet website.The bill would repeal these reporting provisions on January 1, 2029. |
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| 48 | | - | The people of the State of California do enact as follows:SECTION 1. Section 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 61 | + | The people of the State of California do enact as follows:SECTION 1. Section 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed.SECTION 1.Section 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01.(a)No later than January 1, 2025, each Medi-Cal managed care plan shall conduct, and report to the department the results of, an analysis to identify the number and, as appropriate, the geographic distribution of Medi-Cal providers needed to ensure the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197 for pediatric primary care, across all service areas of the plan.(b)(1)No later than January 1, 2026, the department shall prepare and submit a report to the Legislature that includes all of the following:(A)A summary of the results reported by Medi-Cal managed care plans, as described in subdivision (a).(B)Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i)Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii)Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(C)Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(D)Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(E)Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(2)No later than July 1, 2024, the department shall submit a report to the Legislature, and shall make the report publicly available by posting it on the departments internet website, with all of the following data:(A)For the 2019, 2020, and 2021, and 2022 calendar years, as one cohort, the number of children zero to five years of age, inclusive, and, as a separate cohort, the number of children 6 to 18 years of age, inclusive, who are Medi-Cal beneficiaries receiving any of the following early childhood preventive or developmental services, disaggregated by age-related cohort and by service type:(i)Immunizations.(ii)Blood lead screenings.(iii)Physical examinations.(iv)Developmental screenings.(v)Nutrition screenings.(vi)Mental health screenings.(vii)Dental screenings.(viii)Vision screenings.(ix)Hearing screenings.(x)Autism spectrum disorder screenings.(xi)Developmental surveillance.(xii)Behavioral, social, or emotional screenings.(B)For each of the two cohorts of children described in subparagraph (A), information about any disparities across the following:(i)Racial or ethnic groups.(ii)Primary languages spoken at home.(iii)Service areas or counties of the state.(iv)Age groups within the cohort.(C)For the 2019, 2020, and 2021, and 2022 calendar years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i)Maternal depression screenings.(ii)Tobacco, alcohol, or drug use assessments.(iii)Depression or suicide risk screenings.(D)For the pregnant persons, and for the postpartum persons, described in subparagraph (C), information about any disparities across the following:(i)Racial or ethnic groups.(ii)Primary languages spoken at home.(iii)Service areas or counties of the state.(iv)Age groups.(3)The reports described in paragraphs (1) and (2) shall be submitted in accordance with Section 9795 of the Government Code.(c)Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2030, and as of that date is repealed. |
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| 49 | 62 | | |
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| 50 | 63 | | The people of the State of California do enact as follows: |
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| 51 | 64 | | |
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| 52 | 65 | | ## The people of the State of California do enact as follows: |
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| 53 | 66 | | |
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| 54 | 67 | | SECTION 1. Section 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read:14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 55 | 68 | | |
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| 56 | 69 | | SECTION 1. Section 14197.01 is added to the Welfare and Institutions Code, immediately following Section 14197, to read: |
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| 57 | 70 | | |
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| 58 | 71 | | ### SECTION 1. |
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| 59 | 72 | | |
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| 60 | 73 | | 14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 61 | 74 | | |
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| 62 | 75 | | 14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 63 | 76 | | |
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| 64 | 77 | | 14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following:(1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101.(2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group:(A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group.(i) Six or more well-child visits in the first 15 months of life.(ii) Well-child visits in the third, fourth, fifth, and sixth years of life.(iii) Child and adolescent well-care visits.(iv) Immunizations.(v) Developmental screenings in the first three years of life.(vi) Weight assessment and nutrition and physical activity counseling.(vii) Lead screening.(viii) Screening for depression for children 12 to 17 years of age, inclusive.(ix) Annual dental visit.(x) Preventive dental services in the last year.(B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups:(i) 12 to 24 months of age, inclusive.(ii) 25 months to 6 years of age, inclusive.(iii) 7 to 11 years of age, inclusive.(iv) 12 to 19 years of age, inclusive.(C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type:(i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings.(ii) Tobacco, alcohol, or drug use assessments.(3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following:(A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following:(i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures.(ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care.(B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program.(C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained.(D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation.(b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website.(c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 65 | 78 | | |
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| 66 | 79 | | |
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| 67 | 80 | | |
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| 68 | 81 | | 14197.01. (a) No later than January 1, 2025, the department shall prepare and submit a report to the Legislature that includes all of the following: |
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| 69 | 82 | | |
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| 70 | 83 | | (1) An analysis of the adequacy of each Medi-Cal managed care plans network for pediatric primary care, including the number and geographic distribution of providers and the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197. In providing this analysis, the department is encouraged to use reports that are obtained to meet the CalAIM Terms and Conditions specified in paragraph (2) of subdivision (c) of Section 14184.101. |
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| 71 | 84 | | |
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| 72 | 85 | | (2) Data on the following populations and services, broken down by racial or ethnic groups, primary language spoken, county, and relevant age group: |
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| 73 | 86 | | |
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| 74 | 87 | | (A) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries receiving any of the early childhood preventive or developmental services listed in clauses (i) through (x), disaggregated by age-related cohort and by service type. Unless the age is otherwise specified, the data shall be broken down by children zero to five years of age, inclusive, as one group and by children 6 to 18 years of age, inclusive, as another group. |
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| 75 | 88 | | |
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| 76 | 89 | | (i) Six or more well-child visits in the first 15 months of life. |
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| 77 | 90 | | |
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| 78 | 91 | | (ii) Well-child visits in the third, fourth, fifth, and sixth years of life. |
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| 79 | 92 | | |
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| 80 | 93 | | (iii) Child and adolescent well-care visits. |
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| 81 | 94 | | |
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| 82 | 95 | | (iv) Immunizations. |
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| 83 | 96 | | |
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| 84 | 97 | | (v) Developmental screenings in the first three years of life. |
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| 85 | 98 | | |
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| 86 | 99 | | (vi) Weight assessment and nutrition and physical activity counseling. |
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| 87 | 100 | | |
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| 88 | 101 | | (vii) Lead screening. |
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| 89 | 102 | | |
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| 90 | 103 | | (viii) Screening for depression for children 12 to 17 years of age, inclusive. |
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| 91 | 104 | | |
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| 92 | 105 | | (ix) Annual dental visit. |
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| 93 | 106 | | |
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| 94 | 107 | | (x) Preventive dental services in the last year. |
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| 95 | 108 | | |
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| 96 | 109 | | (B) For the 202122, 202223, and 202324 fiscal years, the number of children who are Medi-Cal beneficiaries who accessed primary care practitioners during the fiscal year, broken down by the following age groups: |
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| 97 | 110 | | |
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| 98 | 111 | | (i) 12 to 24 months of age, inclusive. |
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| 99 | 112 | | |
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| 100 | 113 | | (ii) 25 months to 6 years of age, inclusive. |
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| 101 | 114 | | |
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| 102 | 115 | | (iii) 7 to 11 years of age, inclusive. |
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| 103 | 116 | | |
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| 104 | 117 | | (iv) 12 to 19 years of age, inclusive. |
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| 105 | 118 | | |
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| 106 | 119 | | (C) For the 202122, 202223, and 202324 fiscal years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type: |
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| 107 | 120 | | |
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| 108 | 121 | | (i) Depression or suicide risk screenings. Depression screenings may include maternal depression screenings. |
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| 109 | 122 | | |
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| 110 | 123 | | (ii) Tobacco, alcohol, or drug use assessments. |
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| 111 | 124 | | |
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| 112 | 125 | | (3) Additional information regarding the departments efforts to improve access to pediatric preventive care, including all of the following: |
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| 113 | 126 | | |
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| 114 | 127 | | (A) Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following: |
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| 115 | 128 | | |
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| 116 | 129 | | (i) Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures. |
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| 117 | 130 | | |
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| 118 | 131 | | (ii) Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care. |
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| 119 | 132 | | |
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| 120 | 133 | | (B) Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program. |
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| 121 | 134 | | |
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| 122 | 135 | | (C) Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained. |
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| 123 | 136 | | |
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| 124 | 137 | | (D) Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation. |
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| 125 | 138 | | |
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| 126 | 139 | | (b) The report described in subdivision (a) shall be submitted in accordance with Section 9795 of the Government Code and shall be made publicly available through its posting on the departments internet website. |
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| 127 | 140 | | |
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| 128 | 141 | | (c) Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2029, and as of that date is repealed. |
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| 142 | + | |
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| 143 | + | |
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| 144 | + | |
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| 145 | + | |
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| 146 | + | |
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| 147 | + | (a)No later than January 1, 2025, each Medi-Cal managed care plan shall conduct, and report to the department the results of, an analysis to identify the number and, as appropriate, the geographic distribution of Medi-Cal providers needed to ensure the Medi-Cal managed care plans compliance with the time or distance and appointment time standards described in Section 14197 for pediatric primary care, across all service areas of the plan. |
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| 148 | + | |
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| 149 | + | |
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| 150 | + | |
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| 151 | + | (b)(1)No later than January 1, 2026, the department shall prepare and submit a report to the Legislature that includes all of the following: |
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| 152 | + | |
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| 153 | + | |
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| 154 | + | |
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| 155 | + | (A)A summary of the results reported by Medi-Cal managed care plans, as described in subdivision (a). |
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| 156 | + | |
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| 157 | + | |
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| 158 | + | |
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| 159 | + | (B)Specific steps that the department has taken to hold Medi-Cal managed care plans accountable for improving utilization of childrens preventive services, including, but not limited to, the following: |
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| 160 | + | |
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| 161 | + | |
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| 162 | + | |
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| 163 | + | (i)Monitoring the efficacy of Medi-Cal managed care plan activities through Healthcare Effectiveness Data and Information Set (HEDIS) measures. |
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| 164 | + | |
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| 165 | + | |
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| 166 | + | |
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| 167 | + | (ii)Medi-Cal managed care plan requirements related to the Population Health Management Program, as described in Section 14184.204, as specific to childrens preventive care. |
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| 168 | + | |
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| 169 | + | |
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| 170 | + | |
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| 171 | + | (C)Evidence of progress in reducing racial and ethnic disparities for well-child visits and immunizations for children served by the Medi-Cal program. |
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| 172 | + | |
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| 173 | + | |
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| 174 | + | |
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| 175 | + | (D)Evidence of Medi-Cal managed care plan compliance with contractual requirements to train providers on Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, and the number of providers trained. |
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| 176 | + | |
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| 177 | + | |
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| 178 | + | |
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| 179 | + | (E)Level of accuracy of Medi-Cal managed care plan provider directories, based on the most recent available results of provider directory validation. |
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| 180 | + | |
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| 181 | + | |
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| 182 | + | |
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| 183 | + | (2)No later than July 1, 2024, the department shall submit a report to the Legislature, and shall make the report publicly available by posting it on the departments internet website, with all of the following data: |
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| 184 | + | |
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| 185 | + | |
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| 186 | + | |
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| 187 | + | (A)For the 2019, 2020, and 2021, and 2022 calendar years, as one cohort, the number of children zero to five years of age, inclusive, and, as a separate cohort, the number of children 6 to 18 years of age, inclusive, who are Medi-Cal beneficiaries receiving any of the following early childhood preventive or developmental services, disaggregated by age-related cohort and by service type: |
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| 188 | + | |
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| 189 | + | |
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| 190 | + | |
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| 191 | + | (i)Immunizations. |
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| 192 | + | |
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| 193 | + | |
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| 194 | + | |
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| 195 | + | (ii)Blood lead screenings. |
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| 196 | + | |
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| 197 | + | |
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| 198 | + | |
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| 199 | + | (iii)Physical examinations. |
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| 200 | + | |
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| 201 | + | |
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| 202 | + | |
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| 203 | + | (iv)Developmental screenings. |
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| 204 | + | |
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| 205 | + | |
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| 206 | + | |
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| 207 | + | (v)Nutrition screenings. |
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| 208 | + | |
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| 209 | + | |
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| 210 | + | |
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| 211 | + | (vi)Mental health screenings. |
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| 212 | + | |
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| 213 | + | |
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| 214 | + | |
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| 215 | + | (vii)Dental screenings. |
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| 216 | + | |
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| 217 | + | |
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| 218 | + | |
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| 219 | + | (viii)Vision screenings. |
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| 220 | + | |
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| 221 | + | |
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| 222 | + | |
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| 223 | + | (ix)Hearing screenings. |
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| 224 | + | |
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| 225 | + | |
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| 226 | + | |
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| 227 | + | (x)Autism spectrum disorder screenings. |
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| 228 | + | |
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| 229 | + | |
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| 230 | + | |
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| 231 | + | (xi)Developmental surveillance. |
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| 232 | + | |
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| 233 | + | |
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| 234 | + | |
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| 235 | + | (xii)Behavioral, social, or emotional screenings. |
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| 236 | + | |
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| 237 | + | |
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| 238 | + | |
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| 239 | + | (B)For each of the two cohorts of children described in subparagraph (A), information about any disparities across the following: |
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| 240 | + | |
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| 241 | + | |
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| 242 | + | |
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| 243 | + | (i)Racial or ethnic groups. |
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| 244 | + | |
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| 245 | + | |
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| 246 | + | |
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| 247 | + | (ii)Primary languages spoken at home. |
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| 248 | + | |
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| 249 | + | |
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| 250 | + | |
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| 251 | + | (iii)Service areas or counties of the state. |
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| 252 | + | |
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| 253 | + | |
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| 254 | + | |
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| 255 | + | (iv)Age groups within the cohort. |
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| 256 | + | |
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| 257 | + | |
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| 258 | + | |
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| 259 | + | (C)For the 2019, 2020, and 2021, and 2022 calendar years, the number of pregnant persons, and the number of postpartum persons, who are Medi-Cal beneficiaries receiving any of the following services, disaggregated by pregnancy or postpartum status and by service type: |
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| 260 | + | |
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| 261 | + | |
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| 262 | + | |
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| 263 | + | (i)Maternal depression screenings. |
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| 264 | + | |
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| 265 | + | |
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| 266 | + | |
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| 267 | + | (ii)Tobacco, alcohol, or drug use assessments. |
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| 268 | + | |
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| 269 | + | |
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| 270 | + | |
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| 271 | + | (iii)Depression or suicide risk screenings. |
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| 272 | + | |
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| 273 | + | |
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| 274 | + | |
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| 275 | + | (D)For the pregnant persons, and for the postpartum persons, described in subparagraph (C), information about any disparities across the following: |
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| 276 | + | |
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| 277 | + | |
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| 278 | + | |
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| 279 | + | (i)Racial or ethnic groups. |
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| 280 | + | |
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| 281 | + | |
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| 282 | + | |
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| 283 | + | (ii)Primary languages spoken at home. |
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| 284 | + | |
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| 285 | + | |
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| 286 | + | |
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| 287 | + | (iii)Service areas or counties of the state. |
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| 288 | + | |
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| 289 | + | |
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| 290 | + | |
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| 291 | + | (iv)Age groups. |
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| 292 | + | |
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| 293 | + | |
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| 294 | + | |
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| 295 | + | (3)The reports described in paragraphs (1) and (2) shall be submitted in accordance with Section 9795 of the Government Code. |
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| 296 | + | |
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| 297 | + | |
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| 298 | + | |
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| 299 | + | (c)Pursuant to Section 10231.5 of the Government Code, this section shall remain in effect only until January 1, 2030, and as of that date is repealed. |
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