14132.916.
(a) (1) By no later than January 1, 2028, the department shall establish a list of performance measures to ensure that the vision services under the Medi-Cal program meet quality and access criteria required by the department. The performance measures shall be designed to evaluate utilization, access, and availability of Medi-Cal vision services.
(2) The performance measures established by the department to monitor the vision services for children and adults shall include, but not be limited to, all of the following:
(A) Overall utilization of vision services, presented both in the aggregate and on a per-provider basis.
(B) For eyeglasses fabricated by the California Correctional Training and Rehabilitation Authority, the average time elapsed between eye examination and receipt of eyeglasses by the beneficiary.
(C) Total number of rendering providers on an annual basis, including the number of claims billed per provider, and the credentials of each of the providers. The rendering providers shall include all providers that provide vision services, including, but not limited to, optometrists, ophthalmologists, pediatricians, physician assistants, and nurse practitioners.
(D) Number of annual refractive error diagnoses.
(E) For each provider, all of the following:
(i) Number of annual eye examinations.
(ii) Number of annual vision screening tests of visual acuity and instrument-based ocular screening eye examinations.
(iii) Number of annual eyeglasses prescribed.
(iv) Number of annual eyeglasses dispensed.
(3) (A) The performance measures shall be reported as aggregate numbers and as percentages, if appropriate, using standards that are as equivalent to those used by managed care entities as feasible.
(B) The performance measures shall apply to both fee-for-service and managed care, including information from specialized managed care plans that provide vision services.
(C) The performance measures shall be reported with an equity framework that includes stratification by available geographic and demographic factors, including, but not limited to, race, ethnicity, primary language, age, and gender, to understand inequities and disparities in care.
(D) The performance measures shall include all rendering providers as set forth in subparagraph (C) of paragraph (2).
(4) The department shall report on each performance measure listed in paragraph (2) only to the extent that the department has existing data sources from which to calculate the applicable measure. This subdivision shall not require the department to develop a new data-collection mechanism or to collect additional data to report on a performance measure if the department does not have an existing data source from which to calculate the applicable measure.
(b) To ensure that the vision health needs of Medi-Cal beneficiaries are met, the department shall, when evaluating performance measures for retention of, addition to, or deletion from the list of performance measures, consider all of the following criteria:
(1) Annual and multiyear Medi-Cal vision services trended data.
(2) Other state and national vision program performance and quality measures.
(3) Other state and national performance ratings.
(c) By January 1, 2029, the list of performance measures established by the department and the corresponding performance data for calendar year 2026 shall be posted on the department’s internet website. Medi-Cal vision performance data shall be posted on the department’s internet website annually thereafter for each subsequent performance period.
(d) (1) Following the initial three reporting years beginning in calendar year 2026, as described in subdivision (c), the department shall evaluate performance data and trends and establish an initial set of benchmarks for each performance measure by no later than July 1, 2029, for use beginning in calendar year 2030. Every subsequent year, the department shall utilize performance measure data to inform the establishment of annual benchmarks for each performance measure to track and facilitate improvement in utilization, access, and availability of vision services in the Medi-Cal program.
(2) In establishing and updating the performance measures and benchmarks, the department shall consult health plan and vision plan representatives and other stakeholders, including representatives from counties, local optometric and ophthalmologic societies, nonprofit entities, legal aid entities, and other interested parties.
(e) (1) The department shall annually prepare a summary report of the nature and types of complaints and grievances regarding access to, and quality of, vision services, including the outcome. Commencing on January 1, 2029, for the 2026 calendar year, and annually thereafter, for each preceding calendar year, this report shall be posted on the department’s internet website.
(2) The department shall include in the report data on complaints and grievances from existing sources accessible by the department. This subdivision shall not require the department to develop a new data-collection mechanism or to collect additional data to prepare this report.