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SB-612 Health care: data reporting.(2019-2020)

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Date Published: 02/23/2019 04:00 AM
SB612:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 612


Introduced by Senator Pan

February 22, 2019


An act to add Section 1348.7 to the Health and Safety Code, and to add Section 10125.5 to the Insurance Code, relating to health care.


LEGISLATIVE COUNSEL'S DIGEST


SB 612, as introduced, Pan. Health care: data reporting.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) in the California Health and Human Services Agency to regulate health planning and research development.
This bill would require a health care service plan, health insurer, and medical group to report specified information to OSHPD on or before January 1, 2021, and on or before January 1 annually thereafter, on its participation in collaboratives and activities, including a program in which an enrollee or insured receives comprehensive transitional care or the supportive and therapeutic needs of an enrollee or insured are addressed in a holistic fashion. The bill would require OSHPD to compile and publish, on or before April 1, 2021, and on or before April 1 annually thereafter, the aggregate information received, organized by health care service plan, health insurer, and medical group, on its internet website. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1348.7 is added to the Health and Safety Code, to read:

1348.7.
 (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health care service plan, including a Medi-Cal managed care plan, or a medical group shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:
(1) A program in which an enrollee has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical home certified organizations.
(2) A program in which the supportive and therapeutic needs of an enrollee are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.
(3) A program in which an enrollee receives comprehensive transitional care, including appropriate follow up, when entering and leaving an acute care facility or long-term care setting.
(4) A program in which an enrollee receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.
(5) Services and supports that are geographically located as close as possible to where an enrollee resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.
(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.
(7) Activities that prioritize working with enrollees who have high-risk conditions and that involve those enrollees to access and manage appropriate preventative, health, remedial, and supportive care and services.
(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.
(9) Integration of behavioral or oral health services with medical services.
(10) Programs that include, but are not limited to:
(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.
(B) The CMS Partnership for Patients.
(C) The Public Hospital Redesign and Incentives in Medi-Cal program.
(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.
(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.
(F) The California Quality Collaborative.
(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.
(11) Other similar activities.
(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:
(1) A detailed description, including the number of participating enrollees.
(2) The demographic profile of participating enrollees.
(3) The number and type of participating providers.
(4) The length of participation of enrollees.
(5) The length of carrier participation.
(6) Performance measures and outcomes.
(c) For purposes of this section:
(1) “High-risk condition” includes, but is not limited to, one or more of the following:
(A) Asthma.
(B) Congestive heart failure.
(C) Diabetes.
(D) Heart disease.
(E) High blood pressure.
(F) Obesity.
(G) Serious psychological distress.
(H) Substance use disorder.
(2) “Incentive payments” includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:
(A) Preventative services management.
(B) Diagnosis coordination and treatment planning.
(C) Continued management of chronic conditions.
(3) “Medi-Cal managed care plan” means an individual, organization, or entity that enters into a contract with the State Department of Health Care Services to provide general health care services to enrolled Medi-Cal beneficiaries, including any of the following:
(A) Article 2.7 (commencing with Section 14087.3) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, excluding dental managed care programs developed pursuant to Section 14087.46 of the Welfare and Institutions Code.
(B) Article 2.8 (commencing with Section 14087.5) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
(C) Article 2.81 (commencing with Section 14087.96) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
(D) Article 2.82 (commencing with Section 14087.98) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
(E) Article 2.91 (commencing with Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code.
(F) Chapter 3 (commencing with Section 101675) of Part 4 of Division 101.
(4) “Medical group” means a professional medical corporation, other form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure pursuant to subdivision (l) of Section 1206, or another lawfully organized group of physicians that may or may not deliver, furnish, or otherwise arrange for or provide health care services.
(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health care service plan and medical group, on its internet website.

SEC. 2.

 Section 10125.5 is added to the Insurance Code, to read:

10125.5.
 (a) On or before January 1, 2021, and on or before January 1 annually thereafter, a health insurer shall report to the Office of Statewide Health Planning and Development its participation in any of the following collaboratives and activities:
(1) A program in which an insured has a consistent and stable relationship with a care team that is responsible for comprehensive care management and service delivery, including advanced models of primary care, National Committee for Quality Assurance patient-centered medical homes, or Joint Commission Primary Care Medical Home certified organizations.
(2) A program in which the supportive and therapeutic needs of an insured are addressed in a holistic fashion, using models, including medical homes, medical neighborhoods, accountable care organizations, or other models that support patient-centered primary care and behavioral health care, backed by a team of physician specialists, and individualized care plans to the extent feasible.
(3) A program in which an insured receives comprehensive transitional care, including appropriate followup, when entering and leaving an acute care facility or long-term care setting.
(4) A program in which an insured receives assistance in navigating the health care delivery system and in accessing community and social support services and statewide resources.
(5) Services and supports that are geographically located as close as possible to where an insured resides and are, if available, offered in nontraditional settings, including through telehealth, that are accessible to families, diverse communities, and underserved populations.
(6) Use of health information technology to link services and care providers across the continuum of care to the greatest extent practicable.
(7) Activities that prioritize working with insureds who have high-risk conditions and that involve those insureds to access and manage appropriate preventative, health, remedial, and supportive care and services.
(8) Providing incentive payments and resources to physicians and other providers for achieving clinical integration and collaboration necessary to reduce the total cost of care and improve population health.
(9) Integration of behavioral or oral health services with medical services.
(10) Programs that include, but are not limited to:
(A) The federal Centers for Medicare and Medicaid Services (CMS) Innovation Center Transforming Clinical Practice Initiative.
(B) The CMS Partnership for Patients.
(C) The Public Hospital Redesign and Incentives in Medi-Cal program.
(D) A payment reform program sponsored by the Integrated Healthcare Association or CMS Innovation Center.
(E) A CMS Innovation Center accountable care organization (ACO) program, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Next Generation ACO Model, and other models.
(F) The California Quality Collaborative.
(G) A diabetes prevention program recognized by the federal Centers for Disease Control and Prevention.
(11) Other similar activities.
(b) Data reported pursuant to subdivision (a) shall include at least all of the following for each collaborative or activity:
(1) A detailed description, including the number of participating insureds.
(2) The demographic profile of participating insureds.
(3) The number and type of participating providers.
(4) The length of participation of insureds.
(5) The length of carrier participation.
(6) Performance measures and outcomes.
(c) For purposes of this section:
(1) “High-risk condition” includes, but is not limited to, one or more of the following:
(A) Asthma.
(B) Congestive heart failure.
(C) Diabetes.
(D) Heart disease.
(E) High blood pressure.
(F) Obesity.
(G) Serious psychological distress.
(H) Substance use disorder.
(2) “Incentive payments” includes, but is not limited to, risk-sharing arrangements and incentive payments tied to quality measures, including patient-centered measures for providing any of the following:
(A) Preventative services management.
(B) Diagnosis coordination and treatment planning.
(C) Continued management of chronic conditions.
(d) On or before April 1, 2021, and on or before April 1 annually thereafter, the Office of Statewide Health Planning and Development shall compile and publish the aggregate information received pursuant to this section, organized by health insurer, on its internet website.

SEC. 3.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.