Report 2023-115 Recommendation 2 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 #2 To: Health Care Services, Department of

To better ensure appropriate and effective monitoring of timely access to behavioral health care for children, by November 2024 DHCS should make changes to its survey methodologies to do the following, and then implement those changes for the subsequent reporting period: Disclose the proportion of providers excluded from its survey results for each plan, the reasons for excluding those providers, and how such exclusions may affect the survey's conclusions about access to care.

6-Month Agency Response

After further discussion with the EQRO contractor, it was determined it is not necessary to update their Statement of Work to effectuate the change of disclosing the proportion of providers excluded from the survey, the reasons for exclusion, and the impact on the survey results. The change will be reflected in the 2024 Medi-Cal Managed Care (MCMC) External Quality Review Technical Report, which will be published by April 30, 2025.

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

60-Day Agency Response

The Department of Health Care Services (DHCS) updated the External Quality Review Organization (EQRO) Timely Access scope of work for the 2024 reporting year to reflect the addition of the two-day urgent appointment. The change will be reflected in the 2024 EQRO Technical Report, which will be published by April 30, 2025.

As part of the methodology adjustment, DHCS will explore implementing monitoring for both new and existing patients. The adjustment will significantly impact the EQRO's scope of work pertaining to the timely access survey. DHCS will need to secure additional funding for the EQRO to change the survey approach, updating all call scripts and methodology, and work to test the updated methodology. Assuming funding is secured, and scope can be expanded DHCS will implement the change no later than the 2025 EQRO Technical Report, which is published by April 30, 2026.

DHCS also updated the EQRO scope of work for the 2024 reporting year to disclose the proportion of providers excluded from the survey, the reasons for exclusion, and impact on the survey results. The results will be part of the 2024 EQRO Technical Report, which will be published by April 30, 2025.

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

All Recommendations in 2023-115

Agency responses received are posted verbatim.