DHCS Transparency Bill Moves Forward

The Senate Committee on Health this week approved a bill that would set new standards of accountability and transparency at the Department of Health Care Services.

AB 209 by Assembly member Richard Pan (D-Sacramento) received unanimous committee approval Wednesday and now heads for a Senate floor vote, the step before it can be sent to the governor’s desk.

The bill wants to hold the department accountable for problems that arise with patients moving to Medi-Cal managed care plans with stronger, measurable benchmarks, Pan said.

“None of this has been reported in a way that’s useful to people outside the department or one of the plans,” Pan said. “It’s not really enough to just measure things. One needs to respond to that, identify where the problems are and develop an action plan to address those things that are identified.”

Pan said data collected must be made public, and it should be in a usable and understandable format for consumers, providers, researchers, advocates and legislators.

The legislation was prompted by problems and concerns that cropped up during transitions to Medi-Cal managed care plans that were facilitated by DHCS, Pan said — specifically, this year’s transition of roughly 860,000 Healthy Families children to Medi-Cal. Pan said he appreciated the way the Managed Risk Medical Insurance Board handled its end of the transition.

“MRMIB actually set the model,” Pan said. “They held public meetings on a regular basis. This bill really takes the lessons we’ve learned from Healthy Families and MRMIB in terms of transparency and accountability and brings it to the entire Medi-Cal managed care program.”

Health care advocates voiced similar concerns about the 2011-12 transition of about 240,000 seniors and persons with disabilities to Medi-Cal managed care. In that transition, from June 2011 to May 2012, thousands of seniors and people with disabilities experienced gaps in care and confusion during the transition, according to advocates.

The California HealthCare Foundation, which publishes California Healthline, issued a 2012 report that concluded “the managed care system … was not prepared” to address beneficiaries’ specific needs including mental illness and developmental disabilities.

AB 209 has a number of goals, Pan said:

  • Bring transparency and accountability to Medi-Cal managed care;
  • Incorporate public and clinical expertise into the program;
  • Regularly evaluate cost, access and quality of care provided under managed care plans;
  • Set publicly available benchmarks to track progress; and
  • Require DHCS officials to hold quarterly public meetings to report on performance standards and monitor quality and access to care.

AB 209 also creates an advisory committee to oversee improvements.

“Our healthcare system needs oversight, especially with the implementation of the Affordable Care Act,” said Sen. Ed Hernandez (D-West Covina), chair of Senate Health. “Very soon, we’re going to be mandating that everyone purchase health insurance, so if we’re going to do that, shouldn’t we make sure that it is absolutely the highest quality?”

Hernandez said the additional bureaucratic effort to evaluate Medi-Cal managed care programs is worth doing.

About 4.5 million Californians are covered by Medi-Cal managed care plans, according to DHCS officials.

“It is incumbent on the Legislature to make sure that there is continuity of care and access,” Hernandez said. “So yes, there could be some areas we’re not as efficient as we’d like to be, but at the same time we want to make sure there’s oversight.”

“All of us are incredibly aware of the major transitions and large undertakings of the Department of Health Care Services right now,” said Vanessa Cajina, legislative advocate for the Western Center on Law and Poverty. “We need quality, accountability and utility of data to ensure that we’re providing California’s lowest-income Medi-Cal beneficiaries with the quality healthcare that they deserve.”

Related Topics

Capitol Desk Medi-Cal