Report 2023-115 Recommendation 12 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 #12 To: Health Care Services, Department of

To ensure that children in Medi-Cal have timely access to behavioral health services from county mental health plans and Drug Medi-Cal programs, by November 2024, DHCS should analyze county mental health plans' and Drug Medi-Cal programs' appointment data according to age group to determine if each county meets the compliance threshold for timely access for both adults and children. To the extent a plan does not meet timely access standards for either group, DHCS should require corrective action.

6-Month Agency Response

DHCS is currently working to issue initial assessment findings for FY 2023-24 and the timely access compliance results will be reported out by age group and service/modality type. DHCS anticipates final finding results to be released to the BHPs in June 2024.

DHCS will continue to monitor all future timeliness reporting by age group and service/modality type.

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

60-Day Agency Response

For the county MHPs and DMC-ODS programs, DHCS revised the Timely Access Data Tool (TADT) for FY 2023-24 Annual Network Adequacy Certification submission to collect Client Identification Numbers (CIN) for all new members requesting behavioral health services. The CINs provide access to a multitude of demographic information which will allow for more robust reporting. On August 31, 2023, DHCS published BHIN 23-041, and on November 1, 2023, BHPs began submitting FY 2023-24 Annual Network Adequacy Certification Submission documentation, which includes the TADT. Due to reporting requirements outlined in BHIN 22-070, DMC counties also submitted timely access data on the FY 2022-23 TADT template. Beginning FY 2024-25, DMC counties will submit timely access data on the current version of the TADT. DHCS will analyze BHPs' appointment data according to age group. For SMHS timely access reporting, the age groups are Children/Youth (0-20) and Adults (21+). For DMC-ODS and State Plan DMC counties, the age groups are Youth (0-17) and Adults (18+). In March 2024, BHPs will receive reports detailing the results of the timely access analysis. The reports will inform each BHP of its compliance with the 80 percent timely access requirement by age group. For BHPs out of compliance with timely access standards, DHCS will require a CAP from the BHP to demonstrate how the BHP will come into compliance with timely access standards.

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

DHCS provided the template for its reports that indicate it will analyze county mental health plans' and Drug Medi-Cal programs' appointment data according to age group to determine if each county meets the compliance threshold for timely access for both adults and children. We will review full implementation of this recommendation when DHCS publishes those reports and demonstrates that it will require corrective action for plans not meeting timely access standards for either children or adults.

All Recommendations in 2023-115

Agency responses received are posted verbatim.