Bill Text: CA AB209 | 2013-2014 | Regular Session | Amended

California Assembly Bill 209 (Prior Session Legislation)

Bill Title: Medi-Cal: managed care: quality, accessibility, and utilization.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2014-08-27 - Read second time. Ordered to third reading. [AB209 Detail]

Download: California-2013-AB209-Amended.html

BILL NUMBER: AB 209	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 9, 2013
	AMENDED IN ASSEMBLY  MARCH 19, 2013

INTRODUCED BY   Assembly Member Pan

                        JANUARY 30, 2013

   An act to add Section 14029.9 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 209, as amended, Pan. Medi-Cal: managed care: quality 
and accessibility.   , accessibility, and utilization.

   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions. Under existing law, one of the methods
by which Medi-Cal services are provided is pursuant to contracts with
various types of managed care plans.
   This bill would require the department to develop and implement a
plan, as specified, to monitor, evaluate, and improve the quality
 and   ,  accessibility ,  
and utilization  of health care and dental services provided
through Medi-Cal managed care. The bill would require the department
to hold quarterly public meetings to report on, among other things,
performance measures and quality and access standards, and to invite
public comments. The bill would require the department to appoint an
advisory committee, with specified responsibilities, for the purpose
of making recommendations to the department and to the Legislature in
order to improve quality and access in the delivery of Medi-Cal
managed care services. The bill would be implemented to the extent
that funding is provided in the annual budget act or federal,
private, or other non-General Fund moneys are available.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  This act shall be known and may be cited as the
Medi-Cal Managed Care Health Care Quality and Transparency Act of
2013.
  SEC. 2.  Section 14029.9 is added to the Welfare and Institutions
Code, to read:
   14029.9.  (a) The department shall develop and implement a plan to
monitor, evaluate, and improve the quality  and 
 ,  accessibility  , and utilization  of health
care and dental services provided through Medi-Cal managed care. The
plan shall include all of the following:
   (1) Nationally recognized quality and access measures.
   (2) A process to solicit input from providers, health care quality
experts, consumers, and consumer representatives for recommendations
on supplementing existing measures and indicators in order to fully
evaluate the quality of,  and access to,  and
utilization of  all Medi-Cal benefits, including long-term
services and supports, care coordination, and disease management, and
to perform analysis by race, ethnicity, primary language, and
gender, to the extent permitted by federal law.
   (3) Minimum and benchmark performance standards and contract
requirements.
   (4) Strategies to encourage and reward improvement and to identify
and reduce health disparities among populations.
   (5) Sanctions and corrective actions in cases of deficiencies.
   (6)  (A)    A Medi-Cal managed care dashboard
that is publicly available and provides up-to-date information
regarding  the   all of the following: 
    (i)     The  quality of, and access
to, primary,  speciality   specialty  ,
dental, mental health, behavioral health care services, and long-term
care support and services.  The  
   (ii) The utilization of primary, specialty, mental health, and
behavioral health care services, inpatient acute care, emergency
services, and long-term care support and services. 
    (B)     The  data shall be reported,
at a minimum, by eligibility category, plan, county of residence,
age, gender, ethnicity, and primary language to the extent permitted
by federal law, including the federal Health Insurance Portability
and Accountability Act of 1996 (Public Law 104-191).
   (7) Coordination with the Department of Managed Health Care to
monitor, survey, and report on network adequacy and fiscal solvency.
   (b) At least quarterly, the department shall hold public meetings
to report on performance measures,  utilization levels, 
quality and access standards, network adequacy, fiscal solvency, and
evaluation standards with regard to all Medi-Cal managed care
services and to invite public comments. The department shall notify
the public of the meetings within a reasonable time prior to each
meeting.
   (c) The department shall appoint an advisory committee composed of
providers, plans, researchers, advocates, and enrollees for the
purpose of making recommendations to the department and the
Legislature in order to improve quality and access in the delivery of
Medi-Cal managed care services. The responsibilities of the advisory
committee shall include, but are not limited to, all of the
following:
   (1) Reviewing existing performance standards, quality data, and
measures.
   (2) Developing recommendations to modify, add, or eliminate
measures and collect data, as appropriate.
   (3) Reviewing managed care plan contract terms and making
recommendations related to improving quality and access.
   (4) Reviewing ratesetting methodologies and payment policies.
   (d) This section shall be implemented only to the extent that
funding is provided in the annual budget act or federal, private, or
other non-General Fund moneys are available for this purpose.