Report 2023-115 Recommendation 5 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 #5 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: 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

In March of 2024, the DMHC published the MY 2022 Timely Access Report with industry level ineligible and non-responsive provider data and set forth how the exclusion of these providers from the survey results may affect the rates of compliance. The DMHC also published the MY 2022 Timely Access Data that includes the health plan-reported number and percentage of ineligible and non-responsive providers in the survey results data for each county for each health plan network. As indicated in the 60 day response, the DMHC will need additional funding and resources to create a health plan-level summary analysis of the data published on the DMHC's public web site.

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

The MY 2022 Timely Access report includes a summary table of all health plans' survey response rates and a breakdown on the different reasons a provider was marked as ineligible. DMHC also included reasons why the survey data may not represent the enrollee's experience in obtaining a timely appointment. Nonetheless, DMHC notes that it will need additional finding to create a health plan-level summary analysis of the data, and will not implement the recommendation.

60-Day Agency Response

The DMHC will need additional resources to fully implement the CSA's recommendations. This includes producing dashboards or data tables that will enhance the DMHC's ability to present health plan-level ineligible and non-response data in the future. Therefore, the DMHC will not fully implement CSA's recommendation.

However, to be responsive to the CSA's recommendations within DMHC's current resources, the DMHC's MY 2022 Timely Access Report will include both industry level ineligible and non-responsive provider data and set forth how the exclusion of these providers from the survey results may affect the rates of compliance. While the health plan-reported number and percentage of ineligible and non-responsive providers is included in the survey results data, annually published on DMHC's public website, the MY 2022 Timely Access Report does not include health plan-level analysis due to resource limitations, the large volume of data (over 1.7 million records of data) and limited time to publish the report.

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

The department has indicated that it will not implement this recommendation.

All Recommendations in 2023-115

Agency responses received are posted verbatim.