Report 2023-115 Recommendation 4 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 #4 To: Managed Health Care, Department of

To better ensure appropriate and effective monitoring of timely access to behavioral health care for children, by November 2024 Managed Health Care should make changes to its survey methodologies to do the following, and then implement those changes for the subsequent reporting period: Use its timely access surveys to monitor compliance with the 48 hour urgent appointment standard established in state law where applicable.

6-Month Agency Response

In March of 2024, the Department of Managed Health Care (DMHC) published the Measurement Year (MY) 2022 Timely Access Report, which included charts and appendices setting forth the mean and median average appointment wait time for each required product, in accordance with Section 1367.03, sub. (f)(3) and included the 48 hour and 96 hour urgent appointment standards.

The DMHC intends to integrate the 48 hour standard into the rate of compliance survey data in the survey methodology by requiring health plans to identify whether prior authorization is required for each applicable provider type included in the survey. The DMHC will seek stakeholder feedback on the proposed APA exempt regulatory changes in its MY 2025 survey methodology. If the approach is adopted, the change would be included in the updated methodology by May 1, 2025. Health plans will report data under the updated methodology in 2026.

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

60-Day Agency Response

The Department of Managed Health Care's (DMHC) Measurement Year (MY) 2022 Timely Access Report will include new charts and appendices setting forth the mean and median average appointment wait time for each required product, in accordance with Section 1367.03, sub. (f)(3). To implement this recommendation, both the new charts and appendices will include the 48 hour and 96 hour urgent appointment standards to allow the DMHC and members of the public to easily evaluate compliance with both urgent appointment wait time standards across the industry, by product, and by health plan.

The DMHC believes this recommendation will be fully implemented upon publication of the MY 2022 Timely Access Report in early 2024; however, the DMHC will continue to assess ways to incorporate this standard into rate of compliance calculations for specialist physicians and non-physician mental health providers. If the CSA does not agree that this recommendation is fully implemented, the DMHC will need additional staffing and statistical funding, as well as an extension to the APA exemption set forth in Section 1367.03, sub. (f)(3) to implement and refine changes to the survey methodology.

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

Although Managed Health Care's upcoming report states that the standards for urgent appointments can be 48 or 96 hours, depending on whether prior authorization is required, it still combines the data on available urgent appointments. This makes it unclear whether the data is for the next available appointment that falls under the 48-hour standard or not. Full implementation of the recommendation will require more clarity that the surveys are asking about and recording appointments specifically for appointment types that fall under the 48-hour standard.

All Recommendations in 2023-115

Agency responses received are posted verbatim.