Report 2021-046 Recommendation 3 Responses
Report 2021-046: Proposition 56 Tobacco Tax: The Department of Health Care Services Is Not Adequately Monitoring Provider Payments Funded by Tobacco Taxes (Release Date: November 2022)
Recommendation #3 To: Health Care Services, Department of
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.
1-Year Agency Response
DHCS has fully implemented this process. As stated in the prior update, DHCS has augmented its annual managed care program to specifically test for Prop 56 supplemental payments. See Attachment 2 in Substantiation folder for Exhibit 3-Audit Guide Cat 6. Specifically, subsection 6.3 within the exhibit. If there are findings of non-compliance in DHCS test work, specifically, MCP(s) unable to provide evidence of eligible medical services for reimbursement, DHCS would exercise its corrective action process and implement additional monitoring and oversight mechanisms.
- Completion Date: February 2023
- Response Date: December 2023
California State Auditor's Assessment of 1-Year Status: No Action Taken
Although DHCS has implemented a process for annually selecting a sample of Proposition 56 supplemental payments and requesting the underlying medical records to confirm that the services were provided, there is no evidence in the documentation DHCS provided that it investigated those instances we identified in which managed care plans were unable to provide support that the medical services were provided.
- Auditee did not substantiate its claim of full implementation
- Auditee did not address all aspects of the recommendation
6-Month Agency Response
Health Care Services did not submit a response to this recommendation.
- Estimated Completion Date: unknown
- Response Date: October 2023
California State Auditor's Assessment of 6-Month Status: No Action Taken
60-Day Agency Response
Health Care Services did not submit a response to this recommendation.
- Estimated Completion Date: unknown
- Response Date: March 2023
California State Auditor's Assessment of 60-Day Status: No Action Taken
All Recommendations in 2021-046
Agency responses received are posted verbatim.