Report 2021-046 Recommendations

To provide more accurate information to the public, Education should report on its website the amount of Proposition 56 funds that it actually received beginning with the information it reports for fiscal year 2021-22.

When Education posts information to its website about the amounts of Proposition 56 funds it has received and spent, it should also post links to that information on its social media platforms to increase transparency.

To ensure that Education receives its proportional share of Proposition 56 funds, the Department of Finance (Finance) should determine the amount of fiscal year 2017-18 Proposition 56 funds that Education is owed and arrange for the transfer of those funds from CDPH to Education by June 2023.

To ensure that Education can spend the funds that it was allocated in prior fiscal years, Finance should transfer the unspent portion of these funds to an account that Education can access by June 2023. Further, it should inform Education the funds are available to be spent.

To ensure that managed care plans pay Proposition 56 supplemental payments to the appropriate providers, DHCS should require managed care plans to submit Medi-Cal beneficiary identification information with their quarterly reports by June 2023. Once DHCS obtains this information, it should reconcile those reports to medical encounter data and then recover any overpayments it identifies.

To ensure that managed care plans issue Proposition 56 supplemental payments only when providers have actually performed the services in question, DHCS should do the following:

-By June 2023, investigate those instances in which managed care plans were unable to provide evidence that the medical services we reviewed were provided. After determining why the managed care plans lacked this evidence, it should use its corrective action plan process to implement additional monitoring and oversight of those managed care plans.

To ensure that managed care plans issue Proposition 56 supplemental payments only when providers have actually performed the services in question, DHCS should do the following:

-By June 2023, begin annually selecting a sample of Proposition 56 supplemental payments of a sufficient size to ensure that it can project the results of its review to the population of services that receive supplemental payments, and requesting the underlying medical records to confirm that the services were provided.

To comply with state law, reduce the amount of time it takes to suspend providers from delivering Medi-Cal services, and better protect Medi-Cal beneficiaries from potentially ineligible providers, DHCS should, by June 2023, begin issuing temporary provider suspensions or temporary payment suspensions when permissible or required by state law while it engages in the process of issuing a mandatory provider suspension.

To prevent providers from billing for services performed by other providers that have been suspended, DHCS should, by June 2023, revise its policies and billing system to assess all service-rendering providers included in claim data and verify that they have not been suspended.

To ensure that it reports accurate information to the public, DHCS should institute a more robust management review process for posting Proposition 56 expenditure information on its website beginning with the information it reports for fiscal year 2021-22.

To provide more accurate information to the public, DHCS should report on its website the amount of Proposition 56 funds that it actually received beginning with the information it reports for fiscal year 2021-22.

When DHCS posts information to its website about the amounts of Proposition 56 funds it has received and spent, it should also post links to that information on its social media platforms to increase transparency.

To provide more accurate information to the public, Justice should report on its website the amount of Proposition 56 funds that it actually received beginning with the information it reports for fiscal year 2021-22.

To better protect Medi-Cal beneficiaries, the Legislature should consider amending state law to permit DHCS and the boards that license Medi-Cal providers to execute agreements that would allow those licensing boards to provide DHCS with timely information from the notifications sent to the licensing boards when Medi-Cal providers are arrested and the arrest involves a credible allegation of fraud or indicates the provider is under investigation for fraud or abuse.

To ensure that it reports accurate information to the public, CDPH should compile the expenditure information for each of its Proposition 56 programs using the same type of accounting report beginning with the information it reports for fiscal year 2021-22.

To provide more accurate information to the public, CDPH should report on its website the amount of Proposition 56 funds that it actually received beginning with the information it reports for fiscal year 2021-22.

To ensure that other tobacco product manufacturer-distributors pay the appropriate amount of OTP taxes, CDTFA should obtain sufficient documentation to verify the accuracy of those entities' wholesale costs. If these manufacturer-distributors refuse to provide necessary documentation, CDTFA should compel them to do so using the mechanisms existing in state law, such as administrative subpoenas, and it should consider referring them for criminal prosecution.

To provide more accurate information to the public, CDTFA should report on its website the amount of Proposition 56 funds that it actually received beginning with the information it reports for fiscal year 2021-22.

When CDTFA posts information to its website about the amounts of Proposition 56 funds it has received and spent, it should also post links to that information on its social media platforms to increase transparency.