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Quality Measurement and Reporting in California

California law outlines quality measurement and reporting requirements for health care providers as well as its Medicaid program, called Medi-Cal.  Each Medi-Cal plan must take steps to monitor and evaluate the quality of care given by providers as well as improve the quality of care.  Plans are required to implement a quality improvement plan, a system of accountability, objective and systematic monitoring and evaluation of the quality of clinical care and health care service delivery and a utilization management program.1  Additionally, the Department of Health Services must utilize the Management Information System in order to oversee and evaluate the quality of care given to Medicaid recipients and their access to services.2

Further quality measures in California include the reporting of  physician malpractice settlements or judgments to the Medical Board.  California requires reporting malpractice settlements or judgments when the amount is above $30,000 in certain circumstances.3  In addition, the Medical Board is authorized to release physician information related to provider quality to the public, upon request.  Information that can be released includes a physician’s disciplinary actions, the issuance of temporary restraining orders, and civil judgments.4

 

Footnotes

  • 1. 22 CA ADC §53860
  • 2. Welfare & Inst. Code §14459.7
  • 3. Bus. & Prof. Code §801.1
  • 4. Bus. & Prof. Code §803.1

 

Quality Measurement and Reporting in California

Subtopic Statute/Regulation Description
Quality assurance programs for hospitals or public programs California Medicaid Quality of Care Monitoring, Evaluation, and Improvement Plan Requirements – Cal. Code Regs. tit. 22 § 53860 Quality of Care California’s Medicaid plan is administered through a two plan mode, where one plan is a prepaid plan awarded by competitive...
Use and availability of Patient satisfaction surveys/Facility compliance surveys Charge Description Master Requirements – Cal. Health & Safety Code § 1339.51 All hospitals must make a written or electronic version of the charge master available either by posting an electronic version on the hospital’...
Grievance programs (Reporting requirements, Management of grievance reports) Establishment of the Centralized Consumer Response Unit and Consumer Complaints – Cal. Health & Safety Code §1419 The Department of Health must establish a centralized consumer response unit within the Licensing and Certification Division to respond to consumer...
Delivery system reforms to promote and measure health care quality (ACOs/health homes) (Cross reference Care Coordination) Health Care Waiver or Demonstration Project in California Medicaid – Cal. Welf & Inst. Code §14180 “Health care waiver or demonstration project; application; proposals; amendments”   The State Department of Health Services must...
Organized Health Care Delivery Models For Children Eligible For California Children Services (CCS) – Cal. Welf & Inst. Code §14182.2 “Organized health care delivery models for children eligible for California Children Services (CCS); establishment; report of expenditures;...
Reporting, Use and/or Confidentiality of quality data (Cross reference Privacy & Confidentiality) Management Information System/Decision Support System and Access to Information – Cal. Welf. & Inst. Code § 14459.7 "Management information system/decision support system; progress and status reports; expenditures and staffing; access to information"   The...
Quality assessment for health plans Medical Quality Audit System Standards – Cal. Health & Safety Code § 1380.1 In order to improve the quality of care provided and lower costs for consumers, the state of California has authorized the director of the Department...
External review for insurance and/or peer review purposes (Cross reference to Private Insurance Data and Medical Peer Review) Medical, Osteopathic, and Podiatry Boards and Disclosure of Information to Public – Cal. Bus. & Prof. Code § 803.1 Medical, osteopathic, and podiatry boards; disclosure of information to public The Medical Board of California can release the following information...
Reports to Applicable State Agencies Concerning Settlement, Arbitration Award, or Civil Award – Cal. Bus. & Prof. Code § 801.1 Legislative findings and declarations; reports to applicable state agencies concerning settlement, arbitration award, or civil award; failure to...
Requirements for Central File of Licensed Practitioners in California – Cal. Bus. & Prof. Code § 800 Central files; creation; contents; complaint forms; confidentiality The California Medical Board must keep a central file of all licensed...