Report 2010-103R All Recommendation Responses

Report 2010-103R: Department of Public Health: It Faces Significant Fiscal Challenges and Lacks Transparency in Its Administration of the Every Woman Counts Program (Release Date: July 2010)

Recommendation #1 To: Health Care Services, Department of

To the extent that Public Health continues to fund its various contracts, it should establish clearer expectations with its contractors concerning how much money is to be spent directly on the different aspects of the EWC program and should monitor spending to confirm that these expectations are being met.

Annual Follow-Up Agency Response From October 2016

Will not implement

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement


Annual Follow-Up Agency Response From October 2015

Will not implement

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement


Annual Follow-Up Agency Response From October 2014

Will Not Implement

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement


Annual Follow-Up Agency Response From November 2013

EWC believes its current practice is adequate for monitoring contract activities and spending. See Exhibit A - Scope of Work, Santa Barbara County Public Health Department; Contract #12-89329 (Attachment 1). Contractors are required to submit a biannual Progress Report detailing their progress in meeting Scope of Work objectives. See Regional Contractor Progress Report Checklist, Santa Barbara County Public Health Department; Contract #12-89329 (Attachment 2). All invoices are required to include full supporting documentation for expenses charged. Additional monitoring is not required to confirm that contract expectations are being met.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement


Annual Follow-Up Agency Response From October 2012

EWC believes its current practice is adequate for monitoring contract activities and spending. Contractor activities are tied to the salaries of staff performing the duties plus associated operating costs. For contract regional coordinators, "provider network duties" and "provider site reviews" are performed by nurse clinical coordinators. Tailored health education is performed by health educators. These classifications are funded in the personnel line-item and can be seen in budget and invoice detail. Clinical coordinators are assigned specific numbers of site reviews to conduct each fiscal year in accordance with the funded FTE (30 site visits per 1 FTE). Similarly, health educators are assigned specific numbers of women to reach through tailored health education each fiscal year. Progress for each deliverable is reported biannually. Contractors provide documentation for all activities and expenses invoiced during annual site reviews. EWC staff continuously track, monitor and verify that all SOW deliverables have been completed each FY and that invoices can be adjusted if the contractors fail to perform part or all of a specific deliverable.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement


Recommendation #2 To: Health Care Services, Department of

To ensure better public transparency and accountability for how the EWC program is administered, Public Health should comply with state law to develop regulations, based on input from the public and interested parties, that will direct how Public Health administers the EWC program. At a minimum, such regulations should define the eligibility criteria for women seeking access to EWC screening services.

Annual Follow-Up Agency Response From October 2016

At this time, DHCS, EWC program continues to cooperate with DHCS Office of Legal Services to appropriately review procedural requirements for developing EWC Regulation Package DHCS 12-006E. Program refers to their Breast and Cervical Cancer Advisory Council on specific substantive rules essential to ensuring public health, safety, and the general welfare of California's women. Corresponding with the Administrative Procedure Act (APA), EWC continues to integrate the APA Emergency Regulation provisions. Program has completed major steps towards adding the required documentation to the regulation package. However, EWC has not completed the regulation package yet due to major revision of the entire package we prepared last year. We have revised each proposed regulation section, including the provider enrollment forms, clinical guidance sections, and eligibility requirements to conform to the CDC and National Breast and Cervical Cancer Screening provisions and current Affordable Care Act policies.

  • Estimated Completion Date: June 2017

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From October 2015

No update

  • Estimated Completion Date: 2016

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From October 2014

At this time, the Department of Health Care Services (DHCS), EWC program continues to cooperate with DHCS Office of Regulations and Office of Legal Services to appropriately review procedural requirements, for developing EWC Regulation Package DHCS-12-006E. Program refers to their Breast and Cervical Cancer Advisory Council on specific substantive rules essential to ensuring public health, safety, and the general welfare of California's women. Corresponding with the Administrative Procedure Act, EWC continues to integrate the APA Emergency Regulation provisions. Program has completed major steps that comprises of the required documentation to ensure promulgating regulations. A target date to implement EWC Emergency Regulations is scheduled for December 2014.

  • Estimated Completion Date: December 2014

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From November 2013

At this time, DHCS/EWC program continues to cooperate with DHCS Office of Regulations and Office of Legal Services to appropriately review procedural requirements, for developing regulation package DHCS-12-006E. See DHCS 2013-Rule Making Calendar (Attachment 1). A target date to implement EWC Emergency Regulations is scheduled for September 2014. See attached EWC Regulations Timeline (Attachment 2). EWC consults with the Breast and Cervical Cancer Advisory Council (BCCAC) on specific substantive rules essential to ensuring public health, safety, and the general welfare of California's women. See the December 5, 2012, EWC Regulations Review Webinar PowerPoint Presentation (Attachment 3) and December 2012 Draft Regulations Text (Attachment 4) that was presented to BCCAC members and EWC stakeholders. Corresponding with the Administrative Procedure Act, EWC continues to integrate step-by-step Emergency Regulation provisions. Program has completed major steps that comprise researching, evaluating program authority and standards, and other required documentation to ensure promulgating regulations. EWC respectfully submits the July 2013 Draft Regulations Text (Attachment 5) and Draft Initial Statement of Reasons (Attachment 6) as evidence of progress towards promulgation of program regulations.

  • Estimated Completion Date: September 2014

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Annual Follow-Up Agency Response From October 2012

At this time, the Department of Health Care Services (DHCS), EWC program is intently collaborating with the DHCS Office of Regulations and Office of Legal Services to develop regulation package DHCS-12-006E (Please note: Effective July 1, 2012 EWC formally transitioned to DHCS). EWC is determining what specific substantive rules are necessary to ensure public health, safety and general welfare of California's women. Program is following a specific DHCS step-by-step Emergency Regulation process. In addition, EWC is researching and evaluating program authority, standards, and other reference documentation necessary for promulgating regulations. A target date to implement EWC Emergency Regulations is scheduled for June of 2013. Currently, draft regulation articles are not available for public comment, and a date has not yet been determined.

  • Estimated Completion Date: June 2013

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented


Recommendation #3 To: Public Health, Department of

To ensure that Public Health maximizes its use of available funding for breast cancer screening services, it should evaluate each of the EWC programís existing contracts to determine whether the funds spent on nonclinical activities are a better use of taxpayer money than paying for a womanís breast or cervical cancer screening.

Recommendation #4 To: Public Health, Department of

To ensure that Public Health can maintain fiscal control over the EWC program, we recommend that it develop budgets for the EWC program that clearly communicate to the Legislature the level of service that it can provide based on available resources. One way Public Health could do this would be to estimate the number of women that can be screened at different levels of funding.

Recommendation #5 To: Public Health, Department of

To ensure that Public Health can maintain fiscal control over the EWC program, we recommend that it seek legislation or other guidance from the Legislature to define actions the program may take to ensure that spending stays within amounts appropriated for a fiscal year.

Recommendation #6 To: Public Health, Department of

To ensure better public transparency and accountability for how the EWC program is administered, Public Health should provide the Legislature and the public with a time frame indicating when Public Health will issue its annual report on the effectiveness of the EWC program. Further, Public Health should inform the Legislature and the public of the steps it is taking to continue to comply with the annual reporting requirement in the future.

All Recommendations in 2010-103R

Agency responses received after June 2013 are posted verbatim.


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