Report 2018-111 Recommendation 10 Responses
Report 2018-111: Department of Health Care Services: Millions of Children in Medi-Cal Are Not Receiving Preventive Health Services (Release Date: March 2019)
Recommendation #10 To: Health Care Services, Department of
To ensure that health plans and providers are adequately delivering children's preventive services, DHCS should implement by September 2019 audit procedures through its annual medical audits that address the delivery of EPSDT services to all eligible children for all plans annually.
1-Year Agency Response
Please see attached workpapers for the 2019 audits of Kaiser, San Mateo, and Community Health Group. The areas in the workpapers that relate to the delivery of EPSDT services are highlighted in yellow.
- Completion Date: July 2019
- Response Date: March 2020
California State Auditor's Assessment of 1-Year Status: Fully Implemented
DHCS demonstrated implementation of the new audit procedures in its recently completed audit workpapers.
6-Month Agency Response
Updated audit procedures have been included in our audit guide and communicated to staff. Implementation will begin immediately for managed care audits.
- Completion Date: July 2019
- Response Date: September 2019
California State Auditor's Assessment of 6-Month Status: Partially Implemented
DHCS' updated audit procedures address the delivery of EPSDT services, but it has not yet demonstrated that it has implemented these procedures through conducting annual medical audits using these new procedures. We look forward to reviewing DHCS' one-year response to learn about the results of its annual medical audits showing implementation of these new procedures.
- Auditee did not substantiate its claim of full implementation
60-Day Agency Response
DHCS is collaborating internally on various methods to monitor plan processes to detect underutilization of children's preventive services and their merits and drawbacks, feasibility given existing criteria, and their anticipated effectiveness. DHCS will develop and incorporate the optimal method into draft audit procedures, pilot test the procedures during a live audit, and refine as needed before finalizing implementation for all audits.
- Estimated Completion Date: September 2019
- Response Date: May 2019
California State Auditor's Assessment of 60-Day Status: Pending
We look forward to reviewing the updated audit procedures with DHCS' 6-month response.
All Recommendations in 2018-111
Agency responses received are posted verbatim.