Report 2023-115 Recommendation 7 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 #7 To: Health Care Services, Department of

To assess opportunities to help ensure unbiased timely access survey data, by November 2024, DHCS should determine the feasibility, costs, and likely benefits of adopting a "secret shopper" approach to its timely access surveys. If the department determines that adopting such an approach is reasonably feasible and beneficial, it should implement this methodology by the next reporting year.

1-Year Agency Response

CMS published the Managed Care Final Rule (MCFR) in May 2024, which included a requirement for the timely access survey to be conducted via a secret shopper method beginning January 1, 2029. DHCS is working on securing funding for the secret shopper survey. DHCS has begun coordinating with EQRO to deploy a secret shopper survey by January 1, 2029, to meet compliance with MCFR requirements. DHCS will work with EQRO to develop the secret shopper survey methodology and call scripts in 2028.

Prior to the full implementation of the Access Final Rule Secret Shopper requirement for timely access for all delivery systems on January 1, 2029, DHCS is continuing to actively engage with the EQRO contractor to develop the methodology to adopt the secret shopper approach to the timely access surveys for the Drug Medi-Cal Organized Delivery System (DMC-ODS) and Specialty Mental Health Services (SMHS) providers. DHCS plans to launch a small-scale pilot for the delivery systems in reporting year 2025.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DHCS is continuing to evaluate the feasibility and costs of adopting a "secret shopper" approach to the timely access surveys for the Medi-Cal managed care plans (MCPs) with the EQRO. DHCS engaged its EQRO contractor to conduct an analysis of the secret shopper approach.

DHCS received the report and is reviewing it to develop recommended next steps. If the approach is determined feasible, DHCS will implement the adjusted methodology by the reporting year 2026 for the MCMC delivery system.

DHCS still plans to pilot the secret shopper process in the reporting year 2025 for Drug Medi-Cal Organized Delivery System and Specialty Mental Health Services providers and is working to incorporate this work into the EQRO contract.

DHCS will begin kick-off meetings regarding project development with DHCS' EQRO in approximately July 2024.

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

60-Day Agency Response

DHCS is continuing to evaluate the feasibility of adopting a "secret shopper" approach to the timely access surveys for the Medi-Cal managed care plans (MCPs).

As part of the feasibility analysis, DHCS will need to consider the operational steps needed when adjusting the methodology, which includes securing additional funding for the EQRO to change the survey approach, working with the EQRO to test the new methodology, and providing guidance to implement the new process with MCPs.

If the approach is determined feasible, DHCS will implement the adjusted methodology by the reporting year 2026 for the Medi-Cal Managed Care delivery system.

DHCS intends to pilot the secret shopper process in the reporting year 2025 for Drug Medi-Cal Organized Delivery System (DMC-ODS) and Specialty Mental Health Services (SMHS) providers.

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

All Recommendations in 2023-115

Agency responses received are posted verbatim.