Report 2013-125 Recommendation 2 Responses

Report 2013-125: California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care (Release Date: December 2014)

Recommendation #2 To: Health Care Services, Department of

To ensure that child beneficiaries throughout California can reasonably access dental services under Medi-Cal and to increase child beneficiary utilization and provider participation, Health Care Services should take the following steps for the fee-for-service delivery system by May 2015: establish criteria for assessing provider participation in the program.

6-Month Agency Response

DHCS has established criteria for assessing provider participation in the Medi-Cal Dental Program. DHCS developed a standardized measure and county-specific benchmarks that will be used to assess provider participation and evaluate network capacity in the Medi-Cal dental fee-for-service delivery system. DHCS utilized existing provider and beneficiary data and, as a collaborative effort, incorporated input from the dental stakeholder community to develop the measures. DHCS will begin reporting on final measures in 2015. DHCS will also take proactive steps to evaluate additional data resources for assessing provider participation and capacity by region and statewide as appropriate. On July 20, 2015, DHCS released the results of the first dental provider network capacity survey conducted in the last quarter of 2014.

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

Health Care Services provided a document labeled "Medi-Cal Dental Program Provider Participation Measurement." This document states that Health Care Services will use "county-specific licensed dentist-to-general population ratio" as the benchmark to compare Medi-Cal provider participation ratios. It also states that the numerator of the ratio will be the number of rendering providers and "safety net clinics" who serviced 25, 50, 75, and 100 or more unduplicated beneficiaries in a 12-month period; the denominator will be the number of "Medi-Cal eligibles" in the county.

Health Care Services also provided a document labeled "Dental Provider Network Capacity Survey Summary" (summary) dated June 2015. This summary described the results of Health Care Services' survey of providers around the State and included information such as whether providers increased the number of Medi-Cal patients seen in a week and whether they were willing to accept new Medi-Cal patients.

60-Day Agency Response

DHCS is currently in the process of gathering and assessing existing provider data and assessing health care industry methodologies to establish measures that best represent provider participation and capacity in the Medi-Cal Dental Program. Once DHCS establishes a standardized measure by which it will assess provider participation and capacity by region and statewide, DHCS will develop benchmarks. The established benchmarks will be used to evaluate network adequacy and identify geographic areas where the fee-for-service provider network can be strengthened to inform future outreach efforts and develop mitigation strategies as appropriate. DHCS will consult and engage with stakeholders during the development of the measure for provider participation and benchmarks thereof. DHCS intends to report this measure publically, consistent with DHCS' reporting policies. DHCS expects to meet the established implementation date of May 1, 2015.

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

All Recommendations in 2013-125

Agency responses received are posted verbatim.