Report 2013-119 Recommendation 24 Responses
Report 2013-119: California Department of Health Care Services: Its Failure to Properly Administer the Drug Medi-Cal Treatment Program Created Opportunities for Fraud (Release Date: August 2014)
Recommendation #24 To: Health Care Services, Department of
To prevent the certification of ineligible providers, Health Care Services should immediately develop a schedule for recertifying all program providers every five years.
Annual Follow-Up Agency Response From November 2018
DHCS has implemented Provider Application and Validation for Enrollment (PAVE) version 3.0, to prevent the certification of ineligible providers. https://www.dhcs.ca.gov/provgovpart/Pages/PAVE.aspx. PAVE allows DMC providers to use the portal for enrollment needs and provides a schedule for recertifying program providers. Through PAVE, DHCS is able to identify providers when their continued enrollment is due in accordance with federal requirements.
- Completion Date: September 2018
California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented
Health Care Services provided screenshots of its Provider Application and Validation for Enrollment system, which notifies providers of upcoming recertifications that must take place every five years.
Annual Follow-Up Agency Response From August 2017
DMC providers will be able to use PAVE phase/version 3.0 for their enrollment needs. This has been moved up from the original plan to include DMC providers in phase/version 3.5. PAVE phase/version 3.0 is expected to go live on January 23, 2018. The PAVE portal will automatically issue continued enrollment notices for providers when their continued enrollment is due.
- Estimated Completion Date: 1/23/18
California State Auditor's Assessment of Annual Follow-Up Status: Pending
Date of implementation is set for January 23, 2018.
Annual Follow-Up Agency Response From October 2016
DHCS will conduct a revalidation of all DMC program providers at least once every five years. For the last two years, DHCS has been engaged in the development of a web-based automated enrollment system to manage the workload more efficiently. The web-based enrollment system Provider Application and Validation for Enrollment (PAVE) system will be rolled out in phases. DMC is in phase 3.5 and expected to go live in Fall of 2017.
- Estimated Completion Date: October 2017
California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented
1-Year Agency Response
DHCS will conduct a revalidation of all DMC program providers at least once every five years. For the last two years, DHCS has been engaged in the development of a web-based automated enrollment system to manage the workload more efficiently.
DHCS seeks to implement the automated enrollment system in summer 2015. This automated system will identify providers who are due for recertification.
- Estimated Completion Date: December 2015
- Response Date: August 2015
California State Auditor's Assessment of 1-Year Status: Pending
Date of implementation is set for December 2015.
6-Month Agency Response
DHCS will conduct a revalidation of all DMC program providers at least once every five years. For the last two years, DHCS has been engaged in the development of a web-based automated enrollment system to manage the workload more efficiently.
DHCS seeks to implement the automated enrollment system in Summer 2015. This automated system will identify providers who are due for recertification.
- Estimated Completion Date: Summer 2015
- Response Date: February 2015
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
DHCS seeks to implement the automated enrollment system in Spring 2015. This automated system will identify providers who are due for recertification.
- Estimated Completion Date: Spring 2015
- Response Date: October 2014
California State Auditor's Assessment of 60-Day Status: Pending
Based on its response, the department has not yet implemented this recommendation.
All Recommendations in 2013-119
Agency responses received are posted verbatim.