Report 2023-103 Recommendation 7 Responses

Report 2023-103: The Comprehensive Perinatal Services Program: The Lack of Usage Data Prevents the State From Knowing How Often Medi‑Cal Members Receive Perinatal Care (Release Date: February 2024)

Recommendation #7 To: Public Health, Department of

By December 2024, Public Health should develop and implement a system to sufficiently verify the survey responses provided by fee-for-service providers. For example, Public Health could conduct chart reviews annually on a selection of fee-for-service providers who have completed its survey to ensure the accuracy of responses. To the extent that such oversight could be provided through a partnership with Health Care Services, Public Health should seek such a collaboration.

1-Year Agency Response

Public Health completed its analysis of the 2024 CPSP Provider Annual survey of 206 providers with confirmed email addresses. The survey had a 92% response rate, 80% of respondents indicated they were actively billing fee-for-service and 84% of respondents indicated they were also billing managed care plans. The optional question on provider training needs revealed topics such as mental health and psychosocial services, maternal morbidity, community resources for referrals, training resources for Community Perinatal Health Workers, health education topics, billing, and opportunities for year-round training. Survey respondents were matched against Health Care Services' Medi-Cal utilization data and 75% of those providers showed active billing for CPSP services, closely aligning with the 80% survey finding.

Public Health has developed and is implementing a protocol review process to verify survey responses. Public Health's Maternal, Child and Adolescent Health Division (MCAH) utilizes a protocol checklist that includes the following components: Routine CPSP Procedures (e.g., orientation, case coordination, care plan, referrals, and supervision), assessments/reassessments (for Nutrition, Health Education, and Psychosocial), and Interventions based on Assessments (e.g., mental health) and Postpartum Education. Based on the information received, MCAH will review for clarity and/or gaps. This review will prompt scheduling a virtual meeting to address technical assistance and/or chart review follow-ups. Findings identified from chart reviews will be assessed to determine if a Corrective Action Plan is needed. Gaps identified in the protocol review will be required to be resubmitted. Public Health will continue to identify strategies that support CPSP Provider needs to meet CPSP standards.

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

6-Month Agency Response

Public Health implemented the first annual CPSP Provider Survey, which was designed for provider oversight purposes.

Public Health is working to maximize survey response rates by actively billing providers, including cross-referencing with administrative data received from Health Care Services.

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

60-Day Agency Response

Public Health will establish procedures for chart reviews to verify a sample of Public Health provider survey responses. Public Health will work with Health Care Services to align with their procedures. Public Health's procedures for chart review may involve identification of provider and beneficiary selection methods to inform an annual request to Health Care Services for perinatal service utilization reports. Public Health will develop and implement a system by December 2024.

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

All Recommendations in 2023-103

Agency responses received are posted verbatim.