Report 2023-115 Recommendation 14 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 #14 To: Health Care Services, Department of

When determining the number of mental health providers a managed care plan has available to serve children in Medi-Cal, DHCS should consider whether providers serve multiple plans or multiple regions within a single plan. When providers do so, DHCS should account for that overlap, such as by reducing the expected contribution of a provider to a given plan when that provider serves multiple plans or regions within a plan.

6-Month Agency Response

DHCS has updated the non-specialty outpatient behavioral health provider-to-member ratios methodology as part of improvements to the ANC process. The updated methodology added a full-time equivalent (FTE) analysis within each MCPs network. DHCS will initiate a work effort in 2024 to assess the feasibility of adjusting the FTE analysis to account for providers who are contracted with more than one MCP. If feasible, DHCS intends to roll out as part of ANC 2026.

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

60-Day Agency Response

DHCS has initiated a work effort to update the non-specialty outpatient behavioral health provider-to-member ratios methodology as part of improvements to the annual network certification (ANC) process. The updated methodology will add a full-time equivalent (FTE) analysis within each MCPs network and will be included in the 2024 ANC. DHCS will initiate a work effort in 2024 to assess the feasibility of adjusting the FTE analysis to account for providers who are contracted with more than one MCP. If feasible, DHCS intends to roll out as part of ANC 2026.

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

All Recommendations in 2023-115

Agency responses received are posted verbatim.