Report 2023-115 Recommendation 11 Responses

Report 2023-115: Department of Health Care Services and Department of Managed Health Care: Children Enrolled in Medi-Cal Face Challenges in Accessing Behavioral Health Care (Release Date: November 2023)

Recommendation #11 To: Health Care Services, Department of

To improve Medi-Cal members' access to behavioral health services from county mental health plans and Drug Medi-Cal programs, by November 2024, DHCS should demonstrate that it has followed up with county mental health plans and Drug Medi-Cal programs on CAPs that continue to be deficient in timely access or other network adequacy standards. In doing so, it should assess whether the plans took the actions described in their CAPs and, if so, why those actions did not result in sufficient improvement.

6-Month Agency Response

For 2023 and subsequent submission cycles, DHCS is on track to conduct ongoing follow-up with all Behavioral Health Plans (BHPs) that continue to be out of compliance after submitting a Corrective Action Plan (CAP) for timely access and/or network adequacy standards, in addition to issuing financial sanctions when BHPs do not come into compliance with CAPs.

DHCS is in the process of releasing initial assessment of findings packages for FY2023-24 Annual Network Adequacy Certification. Where relevant (i.e., for deficiencies appearing to be linked to incorrect or incomplete data submissions) BHPs will be given an opportunity to resubmit corrected data to address deficient findings with a Reassessment Submission. DHCS anticipates final finding results to be released to the BHPs in June 2024.

BHPs found to be out-of-compliance with network adequacy standards during initial assessment and having uncorrected/unresolved deficiencies remaining after reassessment submissions will be required to submit a CAP after the reassessment submission period along with applicable supporting documentation. The BHPs will be contacted and required to attend a technical assistance call(s) to address the reasons why the BHP remains non-compliant. CAP completion timelines for BHPs vary depending on the nature and severity of the identified non-compliance. DHCS requires regular periodic check-ins with the plan to ensure the plan is on track to accomplish the stated goals and milestones detailed within the CAP.

DHCS is finalizing internal sanctions protocol and will begin to impose sanctions for network deficiencies beginning FY 2024-25. At this time, DHCS will assess FY 2023-24 annual network certification results along with prior fiscal years' annual network certification results. If BHP network deficiencies identified in prior fiscal years remain unresolved, demonstrating a pattern of non-compliance, DHCS may impose sanctions.

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

60-Day Agency Response

Prior to the audit, DHCS had identified steps to improve the Corrective Action Plan (CAP) process for county Mental Health Plans (MHPs) and DMC-ODS plans, collectively referred to as Behavioral Health Plans (BHPs). For the FY 2023-24 network adequacy certification period, BHPs began submitting Annual Network Adequacy Certification documentation on November 1, 2023. DHCS is currently processing the information. BHPs found out-of-compliance with network adequacy standards will be required to submit a CAP along with applicable supporting documentation. BHPs that remain out-of-compliance will be contacted and required to attend a technical assistance call(s) required to address the reasons why the BHP remains non-compliant. Additionally, for data-driven network adequacy standards, the BHP will be required to submit the applicable data to DHCS monthly to show compliance. DHCS will conduct the appropriate analysis and provide results to the BHP. For non-data-related deficiencies that remain non-compliant, DHCS will establish a monitoring timeline to provide periodic check-ins with the BHP to ensure the applicable required documentation needed to bring the BHP into compliance is submitted and reviewed. If BHPs fail to demonstrate sufficient progress or improvement via this process, DHCS will issue financial sanctions when deemed appropriate. Additionally, Drug Medi-Cal (DMC) counties submitted timely access data on November 1, 2023, in response to the implementation of the Mental Health Parity and Addiction Equity Act of 2008. DHCS published BHIN 22-070 on December 30, 2022, which requires DMC counties to meet timely access requirements as specified in 28 CCR 1300.67.2.2 (c)(5). FY 2023-24 is the inaugural year; thus, results will be advisory. Beginning FY 2024-25, DMC counties will be held to compliance, and any DMC county found out of compliance will follow the CAP process as described above.

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

DHCS provided the Information Notice it created outlining its expectations of BHPs on CAPs, and indicating it will follow up with BHPs on CAPs that continue to be deficient in timely access or other network adequacy standards. We will assess whether DHCS fully implements this recommendation by conducting that follow-up and making determinations of causes for continued deficiencies after it fully processes the information BHPs submitted in November 2023, and after it begins conducting the same analysis for DMCs beginning in fiscal year 2024-25.

All Recommendations in 2023-115

Agency responses received are posted verbatim.