HQI Support for California’s Hospital Equity Reporting Requirements

California’s AB 1204 (Medical Equity Disclosure Act) requires hospitals and hospital systems to submit an annual Hospital Equity Report to the California Department of Health Care Access and Information (HCAI).

The report requires hospitals and hospital systems to:

Calculate core quality measures stratified by demographic factors such as race/ethnicity, age, sex, payor, and language
Identify the Top 10 Disparities within those measures
Develop an Equity Plan describing actions to address those disparities
Submit the report to HCAI
Meet applicable website-posting requirements

Reports cover the previous calendar year (January 1–December 31) and are due to HCAI September 30 each year.

For hospitals using file upload, the reporting format is a complex CSV-based data submission. The reporting requirements involve thousands of fields, multiple source datasets, measure calculations, stratification, rate ratios, privacy masking, and detailed formatting requirements. Our platform allows hospitals to leverage existing administrative data and established analytics to generate the majority of the required report fields automatically, significantly reducing the technical burden on hospital staff.

The Hospital Quality Institute (HQI) has developed tools within the Hospital Quality Improvement Platform (HQIP) to help hospitals generate HCAI-formatted AB 1204 Equity Reports designed to meet the applicable reporting specifications.

Hospitals and hospital systems remain responsible for submitting their final reports to HCAI through the HDC submission portal. Hospitals must also satisfy the applicable website-posting requirements.

Which Hospitals are Required to Report?

2026 Reporting Year — List of Required Hospitals (CY 2025 Data) – Updated July 2026

HQI’s AB 1204 Equity Reporting Solution

HQI’s solution leverages data already available in the HQIP analytics platform to produce a near-complete Hospital Equity Report.

For participating hospitals, HQIP:

Generates most report fields automatically as data permit (typically about 95% of the required report fields)
Calculates required core quality measures
Applies required stratifications to the extent data are available
Identifies the Top 10 Disparities
Generates an HCAI-formatted CSV report
Provides an interactive Equity Dashboard to help hospitals develop their Equity Plan

Hospitals primarily focus on completing the approximately 33–38 hospital-provided fields, depending on report type and available data, that are not automatically populated by HQIP, particularly the narrative Equity Plan and the descriptions of hospital performance across six priority areas.

Click “Field Coverage Matrix” below to open a detailed PDF reference table showing which AB 1204 measures, stratifications, and report fields are generated by HQIP for hospital and system Equity Reports.

AB 1204 Hospital Equity Report Field Coverage Matrix – Updated July 2026

Equity Dashboard & Disparity Analysis

The HQIP Equity Dashboard provides an interactive environment for exploring disparities and validating the Top 10 Disparities included in the report.

The dashboard allows hospitals to:

Review calculated disparities and rate ratios
Compare stratified outcomes across demographic groups
Analyze trends over time
Use disparity results and trends to inform the assessment of population impact

These analytics help hospital teams develop the Equity Plan portion of the AB 1204 report, which describes strategies for reducing disparities across priority areas such as patient safety, access to care, care coordination, and effective treatment.

The next AB 1204 reporting cycle is now underway with a September 30 submission deadline.

Data Requirements for HQI Report Generation

To generate the Equity Dashboard and Top 10 Disparities for the 2026 AB 1204 reports, HQI requires hospitals to provide complete CY2025 administrative encounter data in the same format submitted to HCAI.

As applicable to the facility and measures being calculated, this typically includes:

Inpatient discharge data
Emergency Department encounter data
Ambulatory surgery encounter data

These files must match the original submission format used for HCAI reporting.

Important Note on SIERA Data Downloads

HQIP relies on patient identifiers contained in the original administrative submission files to link encounters when calculating 30-day readmissions. Files subsequently downloaded from SIERA may not contain the identifiers needed to reproduce that linkage. Hospitals should therefore use the original files submitted to HCAI whenever possible.

Compatibility with CMQCC Maternal Data

Many California hospitals already participate in the California Maternal Quality Care Collaborative (CMQCC) and generate maternal quality reports through the CMQCC Maternal Data Center (MDC).

HQI collaborates with CMQCC to ensure that maternal measure files generated in the MDC can be uploaded directly into the HQIP equity reporting workflow.

Hospitals upload the MDC-generated maternal measure files (not raw maternity encounter extracts) into HQIP to incorporate maternity measures into the Equity Report and Top 10 Disparities.

This approach helps hospitals avoid duplicate data preparation and ensures that maternal equity metrics remain consistent with CMQCC reporting.

Hospitals with questions about CMQCC maternal data files should contact the CMQCC Maternal Data Center (MDC) Team:

datacenter@cmqcc.org

Questions or Participation

If your hospital would like assistance generating an AB 1204 Equity Report using HQIP, or if you have questions about data preparation or report generation, please contact the HQI Analytics Team:

hqianalytics@hqinstitute.org

Updates for 2026

Biweekly Hospital Workgroups

HQI launched a biweekly workgroup to support hospitals as they prepare for AB 1204 Health Equity Measures reporting. This peer-to-peer forum gives hospital staff regular space to troubleshoot data submission challenges, share approaches to common reporting questions, and learn from one another’s experience navigating the requirements.

CHA members can sign up here: https://calhospital.org/ab-1204-hospital-equity-reporting-work-group-office-hours/

2026 Regulatory Updates Are Final

HCAI’s amendments to the Hospital Equity Measures Reporting Program regulations were approved by the Office of Administrative Law and became effective July 27, 2026. The revised regulations incorporate the Hospital Equity Report: Measures Submission Guide Version 1.4 and Format and File Specifications Version 1.4. HCAI also maintains updated readmission methodology as part of its reporting resources.

For more information: HCAI Laws and Regulations Webpage

Participation and Contracts

Most hospitals that participated in HQI’s AB 1204 reporting support during the first reporting cycle signed rolling contracts, which continue into the 2026 reporting year.

If you are unsure whether your hospital’s agreement is still active, please contact us and we will confirm.

Platform Improvements for the 2026 Reporting Cycle

Based on lessons learned during the first reporting year and subsequent audits, several improvements have been made to the HQIP equity reporting workflow.

Automatic SDOH Data Masking

SDOH and structural measure values entered by hospitals in the User Input Fields are now also automatically evaluated for data masking consistent with the California Health and Human Services Data De-Identification Guidelines (DDG) when the final report is generated.

Additional validation checks are applied during report generation.