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AB-1122 Health data: County of Ventura: super user pilot project.(2019-2020)

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Date Published: 07/11/2019 09:00 PM
AB1122:v95#DOCUMENT

Amended  IN  Senate  July 11, 2019
Amended  IN  Assembly  May 16, 2019
Amended  IN  Assembly  April 29, 2019
Amended  IN  Assembly  March 21, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1122


Introduced by Assembly Member Irwin

February 21, 2019


An act to add and repeal Chapter 1.5 (commencing with Section 128825) of Part 5 of Division 107 of the Health and Safety Code, relating to health data.


LEGISLATIVE COUNSEL'S DIGEST


AB 1122, as amended, Irwin. Health data: County of Ventura: super user pilot project.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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.
Existing law requires a health facility that maintains and operates an emergency department to provide emergency services and care to any person requesting the services or care for any condition in which the person is in danger of loss of life, or serious injury or illness, as specified. Existing law makes a violation of that provision a crime.
Existing law, the Health Data and Advisory Council Consolidation Act, requires certain health facilities to make and file with the Office of Statewide Health Planning and Development specified reports containing various financial and patient data and an Emergency Care Data Record for each patient encounter in a hospital emergency department.
This bill would authorize the County of Ventura to conduct a 3-year super user pilot project, to predict which Medi-Cal beneficiaries are likely to become “super users,” who are persons whose complex, unaddressed health issues result in frequent encounters with health care providers, in particular, emergency departments. departments, and to develop and implement interventions for likely “super users.” The bill would require certain county and state entities to provide the county with specified data, upon request, for purposes of the pilot project, including to obtain a historical perspective of its super users. The bill would require the data provisions to be implemented in accordance with applicable state and federal confidentiality laws. The bill would terminate the pilot project on December 31, 2022, and would require the county to report the results of the pilot project, including specified information, to relevant fiscal and policy committees of the Legislature by July 1, 2023.
This bill would make these provisions inoperative on July 1, 2023, and would repeal them as of January 1, 2024.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Medi-Cal spending represents a growing proportion of California’s overall state funding.
(b) Medi-Cal beneficiaries deserve high-quality health care so that they can lead healthy lives.
(c) Overuse of the emergency room by some Medi-Cal beneficiaries is expensive and leads to less-than-ideal health care for these patients, who are referred to as “super users.” The federal Centers for Medicare and Medicaid Services identify these patients as Medicaid beneficiaries with complex, unaddressed health issues and a history of frequent encounters with health care providers, emergency departments in particular.
(d) Research in other states has shown that certain information can predict, with a high degree of accuracy, which patients have the highest probability of becoming super users. If super users could receive appropriate, good-quality health care outside of emergency departments, they would be in better health and the state would spend less money on their care.
(e) Medi-Cal claims data, incarceration data, and human services data can help to identify potential Medi-Cal super users who may benefit from health care treatment that is initially more intensive, so they can avoid multiple returns to local emergency departments to seek care.

SEC. 2.

 Chapter 1.5 (commencing with Section 128825) is added to Part 5 of Division 107 of the Health and Safety Code, to read:
CHAPTER  1.5. Super User Pilot Project

128825.
 (a) The County of Ventura is authorized to conduct a three-year super user pilot project, to predict which Medi-Cal beneficiaries are likely to become “super users,” who are persons whose complex, unaddressed health issues result in frequent encounters with health care providers, in particular, emergency departments. departments, and to develop and implement interventions for likely “super users.”
(b) (1) Entities of the county or state shall provide to the County of Ventura, upon request, specified data relating to the county for the 2010 calendar year, and each subsequent calendar year, for purposes of the pilot project, as follows:
(A) The State Department of Health Care Services, the county organized health system in the County of Ventura, and the county mental health plan in the County of Ventura providing specialty mental health services, shall provide Medi-Cal claims data.
(B) The Labor and Workforce Development Agency shall provide employment and unemployment data.
(C) The Department of Corrections and Rehabilitation shall provide county resident incarceration and release data.
(D) The State Department of Social Services County of Ventura Human Services Agency shall provide CalWORKs and CalFresh user data.
(2) The entities shall provide the data described in paragraph (1) on machine-readable media and only to the extent existing data is are available.
(c) (1) The county shall keep confidential all personally identifiable information included in the data provided pursuant to subdivision (b) for purposes of the pilot project.
(2) The county shall anonymize the data provided pursuant to subdivision (b) for purposes of the pilot project, in order to do all of the following:
(A) Obtain a historical perspective of super users in the county.
(B) Develop a prospective model to predict which Medi-Cal beneficiaries will be super users.
(C) Furnish the findings of the prospective model developed pursuant to subparagraph (B) to the county organized health system and the county mental health plan in the County of Ventura.
(3) If the county contracts with a third-party entity for purposes of implementing the pilot project, the county shall ensure both of the following:
(A) The third-party entity meets all applicable state and federal confidentiality laws.
(B) At least one county staff member is designated to manage and oversee the pilot project, including any work conducted by the third-party entity.
(d) This section shall be implemented in accordance with applicable state and federal confidentiality laws.
(e) This section neither limits nor impairs either of the following:
(1) The authority of the County of Ventura to request or obtain the data described in subdivision (b) based on the county’s authority under existing law.
(2) The authority of, or requirement for, an entity described in subdivision (b) to furnish or release the data described in subdivision (b) pursuant to existing law.

128826.
 (a) The pilot project shall terminate on December 31, 2022. By July 1, 2023, the county shall report the results of the pilot project to relevant fiscal and policy committees of the Legislature.
(b) The report shall include, but not be limited to, all of the following:
(1) The county’s standards or parameters established for the definition of “super users” under subdivision (a) of Section 128825, and how the term is used for the prospective model.
(2) The number of individuals whose information is used for purposes of the prospective model.
(3) The average per-person health care cost and emergency department and hospital utilization for Medi-Cal beneficiaries predicted by the prospective model to be “super users,” as compared to the average per-person health care cost and emergency department and hospital utilization for the population not predicted to be “super users.”
(4) The predictive accuracy of the prospective model in identifying Medi-Cal beneficiaries as “super users.”
(5) Interventions by the county organized health system and the county mental health plan in the County of Ventura to address the utilization of super users.
(6) Findings and recommendations on how to manage data for the “super user” prospective model, county staffing needs, and information technology (IT) integration best practices.

128827.
 This chapter shall become inoperative on July 1, 2023, and, as of January 1, 2024, is repealed.

SEC. 3.

 The Legislature finds and declares that Section 2 of this act, which adds Section 128825 to the Health and Safety Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
The need to protect individuals from the public disclosure of their personally identifiable information outweighs the interest in public disclosure of that information.