Medi-Cal: performance measures.

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 managed care plans. Existing federal law generally requires that a state that contracts with certain managed care plans ensure that an external quality review is performed by an External Quality Review Organization (EQRO) . This bill would require, when the department enters into a new contract with an EQRO for the EQRO to perform work associated with Medi-Cal managed care programs, that the department include in the terms of the new contract a requirement that, upon approval of the contract, the EQRO stratify all patient-specific Healthcare Effectiveness Data and Information Set measures, or their External Accountability Set performance measure equivalent, by certain characteristics, including geographic area and primary language. The bill would require the department to publicly report this analysis on the department's Internet Web site. The bill would provide that its provisions only be implemented to the extent that funding is available.