Report 2018-111 Recommendation 18 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 #18 To: Health Care Services, Department of

To improve its ability to ensure that children are receiving recommended preventive health services, DHCS should create by September 2019 an action plan to annually address the EQRO's recommendations relating to children's preventive services, including recommendations left unaddressed from the previous two years' reports.

Annual Follow-Up Agency Response From September 2022

There is no agency response for this update. Government Code section 8546.1(d) authorizes the California State Auditor to conduct follow-up audit work on statutorily mandated or legislatively required financial and performance audits. Our office followed up on this March 2019 audit to assess DHCS's status regarding implementation of the eight outstanding recommendations from this report. Below is our assessment of the status of this recommendation based on work we performed during the follow-up audit. All future updates for this recommendation will be posted under the follow-up audit (2022-502).

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

DHCS has not demonstrated that it implemented the EQRO's prior recommendations. DHCS plans to fully implement this recommendation by January 2023.

Annual Follow-Up Agency Response From October 2021

DHCS implemented this recommendation by updating internal operating procedures in the EQRO Contract Management Unit to ensure all of the EQRO recommendations for improvement are understood and information is shared with appropriate DHCS areas responsible for addressing those recommendations.

DHCS will also implement an internal process of regular status checks across all of the areas impacted by the EQRO's recommendations to ensure progress is being taken throughout the year. To that end, DHCS is in the process of drafting explicit responses to EQRO recommendations to address prior year's recommendations which will be published in the 20-21 EQRO Technical Report in April 2022. Please note that DHCS may not agree with some of the EQRO's recommendations, and there are some recommendations that have been implemented or explored as Pilot Studies during 2021, as will be reflected in the April 2022 release of the EQRO Technical Report.

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

DHCS' new documented process includes annually addressing the EQRO's recommendations, and we will review its 2020-21 technical report once DHCS publishes it. We will be looking to verify that DHCS' process leads to it addressing recommendations left unaddressed from prior EQRO reports, including the reports from the two years referenced in our recommendation.

Annual Follow-Up Agency Response From November 2020

DHCS will continue to require the EQRO to include in the annual Technical Report, an evaluation of each MCP's follow-up on actions in response to the prior years' recommendations. The most recent report, published in July 2020, includes the stated evaluation. See each MCP's "Recommendations" section within the Plan Specific Evaluation Reports, in Volume 2 of the Technical Report, found here: https://www.dhcs.ca.gov/Documents/CA2018-19-EQR-Technical-Report-Vol2.pdf

California State Auditor's Assessment of Annual Follow-Up Status: No Action Taken

DHCS' response does not indicate that it has created an action plan to address the recommendations from its most recent July 2020 report or any recommendations left unaddressed from previous years.

1-Year Agency Response

DHCS has instructed the EQRO to evaluate each MCPs actions in response to the prior two years' worth of EQRO recommendations in the annual technical reports. MCPs have been notified that they will be required to report to the EQRO their actions in response to the recommendations as described. The evaluations are being incorporated into the annual technical report which will be available in April 2020.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DHCS has instructed the EQRO to evaluate each MCPs actions in response to the prior two years' worth of EQRO recommendations in the annual technical reports. MCPs have been notified that they will be required to report to the EQRO their actions in response to the recommendations as described. Although the plan to incorporate an assessment of MCP's actions to recommendations has been created before September 2019, the report including the evaluations will not be available until April 2020.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DHCS is developing a process to evaluate recommendations relating to children's preventive services and determine those which MCPs should operationalize through an action plan. These findings will be incorporated into the EQRO's annual technical report which is submitted to CMS in April of each year. DHCS will need approximately eight months to address prior year findings.

California State Auditor's Assessment of 60-Day Status: Pending

We look forward to evaluating DHCS' progress in implementing this recommendation in its 6-month and 1-year responses.

All Recommendations in 2018-111

Agency responses received are posted verbatim.