Multipayer Payment Reform Collaborative.

Existing law establishes the California Health and Human Services Agency, which consists of various departments and offices, including the Department of Managed Health Care, the State Department of Health Care Services, the State Department of Public Health, and the Office of Statewide Health Planning and Development. Under existing law, those entities administer programs and services related to health care and perform various duties, including providing for the licensure and regulation of health care service plans, administering various public health programs, and performing health policy and planning for the state. By June 1, 2022, or within 90 days of receiving funding after June 1, 2022, this bill would require the California Health and Human Services Agency to convene a Multipayer Payment Reform Collaborative composed of specified individuals and entities, including representatives of organizations representing consumers and the Secretary of California Health and Human Services, and would require the collaborative to propose to the agency Multipayer Payment Reform Pilots (pilots) for the purpose of establishing pilots for primarily fee-for-service primary care practices in areas hit hardest by the COVID-19 pandemic. The bill would require the agency, in collaboration with the collaborative, to work with state regulators, agencies, and departments to ensure that the pilots include as participating payers specified entities, such as health care service plans, would authorize the collaborative to include certain entities as participating payers, and would require the collaborative to propose to the agency matters related to the pilots, including criteria to be adopted by the pilots for primary care practice participation and uniform payment methods to be adopted across payers in the pilots. The bill would also require the agency, at least 3 months before the implementation of a pilot, to provide the Legislature, including the appropriate policy committees of the Assembly and the Senate, with a summary of the proposed pilot, including the structure, eligibility, geography, payment methods, quality and equity metrics, and evaluation criteria. By the 2nd and 4th year following the implementation of the pilots, the bill would require the agency to provide to the Legislature comprehensive evaluations of the pilots that include prescribed information, such as the number of enrollees in the pilots and the health characteristics of the enrollees. The bill would require participating payers in the pilots to provide the agency with information necessary to complete these evaluations. The bill would make related legislative findings and declarations.