Medi-Cal managed care: quality assessment and performance improvement.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care health plans, including through a county organized health system and geographic managed care. This bill would require the department to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans, through which the plans, commencing January 1, 2021, would be required to meet a minimum performance level (MPL) that improves quality of care and reduces health disparities for beneficiaries, as specified. The bill would require managed care plans that meet the performance targets to receive specified financial incentives. The bill would require the department, in consultation with stakeholders, to develop a plan for a value-based financial incentive program. The bill would make the implementation of the plan subject to an appropriation of funds by the Legislature to the extent that additional funding is required to implement that plan, as specified. The bill would require the department to establish the measures by which the MPL and performance targets would be assessed and would require the measures to be collected annually, commencing July 1, 2019. The bill would also require the department to establish a public stakeholder process in the planning, development, and ongoing oversight of the program and in the planning of the financial incentive program. The bill would require the department to annually and publicly report the program results on its Internet Web site. The bill would require the department to utilize the program results to develop a Quality Rating System for Medi-Cal managed care plans, subject to federal approval. The department would not be required to report data that would result in statistically unreliable information or the disclosure of personally identifiable information, or to establish requirements mandated by the bill based solely on data that is determined to be statistically unreliable.