Report 2023-115 Recommendation 18 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 #18 To: Managed Health Care, Department of

To identify and address timely access issues that affect children, by November 2024, Managed Health Care should update its survey methodology to assess compliance with timely access standards specifically for behavioral health care providers serving children.

Annual Follow-Up Agency Response From November 2025

The timely access methodology does not require health plans to survey a statistically reliable sample of providers who treat children and adolescents separately from providers who treat adults. Using timely access data and the age of the populations served from another data source, the DMHC attempted to evaluate timely access data for non-physician mental health (NPMH) providers treating children and adolescents. Due to the limited sample size and health plan reporting variations, the DMHC's statistical contractor was unable to produce a reliable statistical assessment.

Given the upcoming expiration of the current APA exemption and CSA's prior response, the DMHC added the age of population served field into the Non Physician Mental Health (NPMH) timely access report forms to improve health plan reporting, allow for future assessment of statistical reliability, and to promote transparency. Health plans will begin reporting the age served in the timely access data to the DMHC in 2027.

To further revise the timely access methodology to ensure a statistically significant sample of NPMH providers who treat children and adolescents, the DMHC would need new statutory authority and additional resources.

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

1-Year Agency Response

To address the CSA's recommendation, the DMHC updated its Annual Network Review Report Forms to include fields that identify the age of the populations served by each provider. The DMHC will receive this information in May of 2025 and will use this information to assess whether it can use the existing timely access methodology to evaluate timely access to behavioral health services for children.

To implement an approach beyond what is noted above and to fully implement the CSA's recommendation, the DMHC would need legislation enacted to extend the current administrative procedure act (APA) waiver, additional staffing, statistical funding to develop and test changes to the methodology, and annually evaluate and report the results in the Timely Access Report.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

Managed Health care provided evidence that it will collect information about the age of populations providers serve, however, Managed Health Care's response continues to indicate that it will not implement this recommendation because it would need an extension of its APA exemption. As we state in our comments to DMHC's response in our report on page 69, it is unclear how this relates to our recommendation that Managed Health Care simply make changes to its survey methodology by November 2024 and then implement those changes for the subsequent reporting period. Managed Health Care's current exemption from the APA does not expire until December 2025. To the extent that Managed Health Care is unable to ensure the feasibility of the changes and to confirm the changes result in reliable, valid, and comparable data over the next year, then it may choose to request that the Legislature extend the exemption.

6-Month Agency Response

As previously indicated in the 60 day response, to implement this recommendation the DMHC would need additional staffing and statistical funding to develop and test changes to the methodology, and annually evaluate and report the results in the Timely Access Report. In addition, the DMHC would need an extension of the APA exemption to implement and refine these changes in future regulatory amendments to the survey methodology.

California State Auditor's Assessment of 6-Month Status: Will Not Implement

Managed Health Care's response continues to indicate that it will not implement this recommendation because it would need an extension of its APA exemption. However, as we state in our comments to DMHC's response in our report on page 69, it is unclear how this relates to our recommendation that Managed Health Care simply make changes to its survey methodology by November 2024 and then implement those changes for the subsequent reporting period. Managed Health Care's current exemption from the APA does not expire until December 2025. To the extent that Managed Health Care is unable to ensure the feasibility of the changes and to confirm the changes result in reliable, valid, and comparable data over the next year, then it may choose to request that the Legislature extend the exemption.

60-Day Agency Response

To be responsive to the CSA's recommendations, the DMHC will need additional staffing and statistical funding to develop and test changes to the methodology, and annually evaluate and report the results in the Timely Access Report. As indicated in response to recommendation 3, the DMHC's methodology is codified into regulation. Any change to the methodology requires regulatory amendment. The DMHC's current exemption from the Administrative Procedures Act (APA) only allows the DMHC to make changes until December 31, 2025. Typically, development and testing of significant changes to the statistical methodology require several years to complete. After the initial implementation, the DMHC and its statistical vendor evaluate the data reported under the updated methodology and make additional refinements to ensure that the resulting data is valid and reliable. Where significant changes are made, such as those recommended by the CSA, refinements may be required over several reporting cycles. As of this date, any changes would be included in the next methodology for measurement year 2025, and the resulting data would be reported to the DMHC on May 1, 2026. Given, given the expiration of the APA exemption in H&S section 1367.03, sub. (f)(3) on December 31, 2025, the DMHC will need an extension of the APA exemption to implement and refine these changes in future regulatory amendments to the survey methodology.

California State Auditor's Assessment of 60-Day Status: Will Not Implement

Managed Health Care's response indicates it will not implement this recommendation.

All Recommendations in 2023-115

Agency responses received are posted verbatim.