Report 2013-125 Recommendation 20 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 #20 To: Health Care Services, Department of

To make certain that it meets the requirements of the new state law and that its performance measures are accurate, Health Care Services should establish the provider-to-beneficiary ratio statewide and by county as performance measures designed to evaluate access and availability of dental services and include this measure in its October 2015 report to the Legislature.

Annual Follow-Up Agency Response From September 2017

As previously reported, DHCS does not agree with the recommendation to include a provider-to-beneficiary ratio in the October 2015 report to the Legislature, as this recommendation is not a part of the required reporting in W&I Code 14132.915

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


Annual Follow-Up Agency Response From November 2016

DHCS does not agree with the recommendation to include a provider-to-beneficiary ratio in the October 2015 report to the Legislature as this recommendation is not a part of the required reporting in Welfare and Institutions Code 14132.915. However, DHCS is committed to monitoring provider-to-beneficiary ratios as a part of its ongoing monitoring efforts to ensure that beneficiaries are able to access care. DHCS provided extensive technical assistance to the author's office on the provisions contained in the recently chaptered Assembly Bill (AB) 2207 (Chapter 613, Statutes of 2016). AB 2207 aims to expand on the provider reporting requirements for W&I 14138.915 by increasing the level of public reporting for provider activity on a per provider basis which is far more granular that the requirements sought through this report. DHCS has also established county-specific provider-to-beneficiary ratios as a benchmark for assessing provider network capacity which is sought to enhance the transparency of the provider network and serve as a supplemental resource to that of which is required in. W&I 14138.915.

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


1-Year Agency Response

DHCS does not agree with the recommendation to include a provider-to-beneficiary ratio in the October 2015 report to the Legislature as this recommendation is not a part of the required reporting in Welfare and Institutions Code 14132.915. However, DHCS is committed to monitoring provider-to-beneficiary ratios as a part of its ongoing monitoring efforts to ensure that beneficiaries are able to access care. DHCS has established county-specific provider-to-beneficiary ratios as a benchmark for assessing provider network capacity and will publicly report this measure by the end of 2015.

  • Response Date: December 2015

California State Auditor's Assessment of 1-Year Status: Will Not Implement

As we stated in our audit report, we believe Health Care Services should reconsider its decision to not implement our recommendation. Although Section 14132.915 of the Welfare and Institutions Code does not specifically mention provider-to-beneficiary ratio as a performance measure to report annually, it does require Health Care Services to establish a list of performance measures to ensure that the program meets quality and access criteria and that this list include, but not be limited to, certain specific performance measures. In addition, state law requires that these performance measures be designed to evaluate utilization, access, availability, and effectiveness of preventive care and treatment and that Health Care Services post these performance measures on its website site annually.

As we point out on page 55 of our report, we believe one critical measure of access and availability is each county's provider-to-beneficiary ratio for this program. Although Health Care Services included on its website performance measures related to service utilization and effectiveness of preventive care and treatment, it did not include measures related to access and availability. As a result, until Health Care Services establishes the provider-to-beneficiary ratio as a performance measure, it cannot accurately predict whether sufficient numbers of providers are available to meet the increasing needs of the program in each county.


6-Month Agency Response

DHCS does not agree with the recommendation to include a provider-to-beneficiary ratio in the October 2015 report to the Legislature as this recommendation is not a part of the required reporting in Welfare and Institutions Code 14132.915. However, DHCS is committed to monitoring provider-to-beneficiary ratios as a part of its ongoing monitoring efforts to ensure that beneficiaries are able to access care. DHCS has established county-specific provider-to-beneficiary ratios as a benchmark for assessing provider network capacity and will publicly report this measure by the end of 2015.

  • Response Date: July 2015

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

As we stated in our audit report, we believe Health Care Services should reconsider its decision to not implement our recommendation. Although Section 14132.915 of the Welfare and Institutions Code does not specifically mention provider-to-beneficiary ratio as a performance measure to report annually, it does require Health Care Services to establish a list of performance measures to ensure that the program meets quality and access criteria and that this list include, but not be limited to, certain specific performance measures. In addition, state law requires that these performance measures be designed to evaluate utilization, access, availability, and effectiveness of preventive care and treatment and that Health Care Services post these performance measures on its Web site annually.

As we point out on page 55 of our report, we believe one critical measure of access and availability is each county's provider-to-beneficiary ratio for this program. Although Health Care Services included on its Web site performance measures related to service utilization and effectiveness of preventive care and treatment, it did not include measures related to access and availability. As a result, until Health Care Services establishes the provider-to-beneficiary ratio as a performance measure, it cannot accurately predict whether sufficient numbers of providers are available to meet the increasing needs of the program in each county.


60-Day Agency Response

DHCS does not agree with the recommendation to include a provider-to-beneficiary ratio in the October 2015 report to the Legislature, as this recommendation is not a part of the required reporting in Welfare and Institutions Code 14132.915. However, DHCS is committed to establishing and monitoring provider to beneficiary ratios as a part of its ongoing monitoring efforts to ensure that beneficiaries are able to access care. DHCS will not implement this recommendation.

  • Response Date: February 2015

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

Health Care Services stated above and in our audit report that it will not implement this recommendation because the provider-to-beneficiary ratio measure is not part of the reporting required by the Welfare and Institutions Code. However, we believe a critical measure of access and availability is each county's provider-to-beneficiary ratio for the Medi-Cal Dental Program. If the Legislature similarly believes that this ratio is critical for measuring access and availability of dental services for Medi-Cal beneficiaries, it should consider requiring Health Care Services to include the provider-to-beneficiary ratio statewide and for each county as part of the annual reporting.


All Recommendations in 2013-125

Agency responses received are posted verbatim.


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