California § 1399.872 - Upon the department

§ 1399.872. Upon the department

(a) Upon the department’s establishment or updating of standard measures and annual benchmarks pursuant to Section 1399.871, a health care service plan shall annually submit to the department, at the time and in a manner specified by the department, a report containing health equity and quality data and information. A health care service plan shall implement the policies, procedures, and systems necessary for compliance with this article and shall, in a manner specified by the department, disclose substantiating documentation to the department demonstrating how the health care service plan shall achieve that compliance. (b) The department shall review a health care service plan’s equity and quality report submitted pursuant to this section for compliance with the health equity and quality standard measures and annual benchmarks established pursuant to Section 1399.871. The department may also review and use other credible sources of information and data, including, but not limited to, relevant data provided by other state agencies, to determine a health care service plan’s compliance with the equity and quality standard measures and annual benchmarks. (c) The department shall determine a health care service plan’s compliance with the health equity and quality standard measures and annual benchmarks and issue a report of its findings to the health care service plan, which shall also be made publicly available on the department’s internet website. (d) If a health care service plan does not demonstrate compliance with this article, the department may take the following actions, which may be progressive, as appropriate: (1) Require the health care service plan to implement corrective action to achieve and demonstrate compliance with the health equity and quality standard measures and annual benchmarks. (2) Monitor a health care service plan’s corrective action plan and improvement efforts. (3) Investigate and require supplemental reporting by the health care service plan. (4) Assess an administrative penalty in an amount that is initially commensurate with the failure to meet the requirements of this article, and assess additional penalties, in escalating amounts for repeated or continuing failure to meet the requirements. The director may assess administrative penalties under this paragraph if a health care service plan engages in any of the following conduct: (A) Fails to report complete and accurate data required by this article. (B) Neglects to file a required corrective action plan with the department. (C) Fails to file an acceptable required corrective action plan with the department. (D) Fails to implement or monitor a required corrective action plan. (E) Fails to provide information required by this article to the department. (F) Falsifies information required by this section. (G) Fails to meet the health equity and quality standard measures and annual benchmarks established pursuant to Section 1399.871. (5) Take other disciplinary or other enforcement action, as determined necessary and appropriate by the director. (6) If the department assesses an administrative penalty or takes other disciplinary action, the department shall inform the California Health Benefit Exchange, the Office of Statewide Health Planning and Development, CalPERS, and the State Department of Health Care Services, each of which shall consider appropriate action. (e) (1) For the measurement years 2023 and 2024, the department’s enforcement activities pursuant to subdivision (d) shall address deficiencies in procedural data collection, reporting, corrective action plan implementation, or monitoring requirements pursuant to this article. (2) Commencing with measurement year 2025, and for each following measurement year, the department’s enforcement activities shall address deficiencies in meeting the requirements under paragraph (1), compliance with the standard measures and annual benchmarks, and all other requirements pursuant to this article. (3) For the purpose of this subdivision, “measurement year” means the time period within which a health care service plan shall collect the required information for the report required by this section. (f) Commencing in 2025, and annually thereafter, the department shall publish on its internet website a Health Equity and Quality Compliance Report. (g) The department shall coordinate with the State Department of Health Care Services to support the review of, and any compliance action taken with respect to, Medi-Cal managed care plans consistent with this article, to maintain consistency with the applicable federal and state Medicaid requirements governing those plans.