Medi-Cal: vision services: performance measures.

Source-provided summary

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 by, and funded pursuant to, federal Medicaid program provisions. Under existing law, certain vision care benefits are covered under the Medi-Cal program, relating to, among other things, optometric and optician services and eyeglasses, as specified. This bill would require the department, by no later than January 1, 2028, to establish a list of performance measures to ensure that the vision services under the Medi-Cal program meet quality and access criteria. The bill would require that the performance measures be designed to evaluate utilization, access, and availability of Medi-Cal vision services. The bill would require certain information within the performance measures, relating to providers and examinations, among other factors. The bill would require the department, when evaluating performance measures, to consider certain criteria, including trended data and other state performance and quality measures. The bill would require the department to report on each performance measure only to the extent that the department has existing data sources from which to calculate the applicable measure, as specified. The bill would specify a timeline for the posting of performance measures and data on the department's internet website. The bill would also require the department to establish benchmarks for each performance measure and to annually prepare a summary report on complaints and grievances, as specified.