Report 2023-115 Recommendation 16 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 #16 To: Health Care Services, Department of

To ensure that Medi-Cal managed care plans make efforts to obtain additional providers to meet network adequacy standards, by May 2024, DHCS should revise its agreements with plans that do not meet time and distance standards to require them to demonstrate efforts to recruit new providers to underserved areas.

Annual Follow-Up Agency Response From December 2025

DHCS has incorporated new MCP contract language to implement provider recruitment requirements as part of the MCP's 2025 contract amendment. Please refer to pages 354 and 376 of Section 5.2.5(B)(6) and Section 5.2.13(A)(4) of the Managed Care Contract.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

DHCS is revising the contracts with MCPs to contractually require MCPs who do not comply with specified network adequacy requirements to demonstrate efforts in recruiting new providers in underserved areas. DHCS has developed and added MCP contract language to effectuate the provider recruitment requirements. The contract language will be included in the MCP Contract amendment, effective January 1, 2025.

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

We will review the updated contracts for the relevant requirements when DHCS provides them.

6-Month Agency Response

DHCS acknowledges an increase in the behavioral health care workforce, including physicians who practice in California and are enrolled in Medi-Cal would be beneficial. DHCS contractually requires MCPs to ensure and monitor an appropriate provider network within service areas in compliance with network adequacy standards, and if necessary, attempt to contract with providers in adjoining counties outside the service area. To strengthen further, no sooner than the contract year 2025, DHCS will contractually require MCPs who do not comply with specified network adequacy requirements to demonstrate efforts in recruiting new providers in underserved areas. DHCS has begun MCP contract language development efforts to effectuate the provider recruitment requirements.

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

60-Day Agency Response

DHCS acknowledges an increase in the behavioral health care workforce, including physicians who practice in California and are enrolled in Medi-Cal would be beneficial. DHCS contractually requires MCPs to ensure and monitor an appropriate provider network within service areas in compliance with network adequacy standards, and if necessary, attempt to contract with providers in adjoining counties outside the service area. To strengthen further, no sooner than the contract year 2025, DHCS will contractually require MCPs that do not comply with specified network adequacy requirements to demonstrate efforts in recruiting new providers in underserved areas. The same contract requirements and considerations apply to specialty behavioral health plans. DHCS has begun MCP contract language development efforts to effectuate the provider recruitment requirements.

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

All Recommendations in 2023-115

Agency responses received are posted verbatim.