Report 2023-115 Recommendation 6 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 #6 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 timely appointment standards for both new and existing patients.

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. Thus, the DMHC is unable to implement this change at this time.

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

Managed Health Care's response indicates 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

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. 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 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 that it will not implement this recommendation.

All Recommendations in 2023-115

Agency responses received are posted verbatim.