Cal. WIC § 14184.204 — California Code / Code wic / Division 9 / Part 3 / Chapter 7 / Article 5.51 / Section 14184.204
Section 14184.204
Status: in_force

(a) Commencing January 1, 2023, subject to subdivision (f) of Section 14184.102, the department shall implement the Population Health Management Program under the Medi-Cal managed care delivery system to improve health outcomes, care coordination, and efficiency through application of standardized health management requirements, in accordance with the CalAIM Terms and Conditions.

(b) The department shall require each Medi-Cal managed care plan, after consultation with counties and other affected stakeholders, to develop and maintain a beneficiary-centered population health management program, which is a model of care and plan of action designed to address member health needs at all points along the continuum of care, as described in the CalAIM Terms and Conditions.

(c) Each Medi-Cal managed care plan in the population health management program shall, at a minimum, do all of the following:

(1) Prioritize preventive and wellness services.

(2) Identify and assess beneficiary member risks and needs on an ongoing basis.

(3) Manage beneficiary member safety and outcomes during care transitions, across all applicable delivery systems and settings, through effective care coordination.

(4) Identify and mitigate social determinants of health and reduce health disparities or inequities.

(d) To support implementation of this section, the department shall develop and implement a Medi-Cal Population Health Management service that expands access to available medical, behavioral, and social service data and provides authorized entities access to necessary administrative and clinical data and information with respect to Medi-Cal beneficiaries across Medi-Cal delivery systems and other applicable public programs, as identified by the department. Data will be available at the individual member level and include the ability for bulk downloads for the purposes of population health analytics and clinical management by Medi-Cal managed care plans in support of the population health management activities described in subdivision (f).

(e) Population health management program components shall be developed in consultation with appropriate stakeholders, including, but not limited to, the State Department of Public Health, Medi-Cal managed care plans, Medi-Cal behavioral health delivery systems, county public health and social services, providers, community-based organizations, and consumer advocates.

(f) The Population Health Management Program shall include, but is not limited to, all of the following:

(1) Appropriate use of preventive services for children and adults, and other interventions, including chronic disease management, referrals for behavioral and oral health care services, housing, nutrition, and other health-related social needs.

(2) Risk assessment is comparable and consistent between Medi-Cal managed care plans.

(3) Any algorithm used to conduct member risk assessment is comparable, standardized, and mitigated for racial and other biases through consideration of disease burden relative to utilization and other patient risk factors beyond cost and historical utilization. The department shall report the underlying measures it uses in its algorithm.

(4) Any screening tool used to assess beneficiaries is age appropriate and comparable across Medi-Cal managed care plans.

(5) Each Medi-Cal managed care plan incorporates the findings of its Population Needs Assessment in its population health management program.

(6) Each Medi-Cal managed care plan describes how it will incorporate preventive and wellness services in partnership with Medi-Cal behavioral health delivery systems, county public health and social services, providers, community-based organizations, and consumer advocates.

(g) Beginning no later than January 1, 2024, the department shall annually post an analysis of the Population Health Management Program on its internet website.