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: develop procedures for identifying periodically counties or other geographic areas in which the utilization rate for child beneficiaries and the participation rate for providers fail to meet applicable criteria.
DHCS has established procedures for periodically identifying counties or other geographic areas where child beneficiary utilization and provider participation fail to meet applicable criteria.
Health Care Services provided a document labeled "Policies and Procedures Guide for Beneficiary Utilization Measurements" (guide). This guide identifies the utilization criteria (41.17 percent), five utilization measures (e.g., annual dental visit, use of preventive services, and use of sealants), a quarterly reporting schedule (January, April, July, and October), monitoring parameters (e.g., counties that fall below the 41.17 percent benchmark and counties in which utilization has declined for two successive quarters), and how results will be used (e.g., the fiscal intermediary's outreach unit will use the results to "inform" current and future outreach activities described in the Beneficiary Outreach and Education Program Plan).
Health Care Services also provided a document labeled "Provider Participation Measurement Policies and Procedures." This document identifies information such as reporting standards, data sources, and a measurement methodology.
DHCS is currently in the process of gathering and assessing existing provider and beneficiary data and assessing health care industry methodologies to establish measures that best represent beneficiary utilization and provider participation and capacity in the Medi-Cal Dental Program. Once DHCS has established standardized measures by which it will assess beneficiary utilization and provider participation and capacity by region and statewide, DHCS will establish procedures to annually identify counties and other geographic areas where child beneficiary utilization and provider participation fail to meet the criteria established in recommendations A1 and A2. The DHCS will employ mitigation strategies for identified underperforming geographic areas. DHCS expects to meet the established implementation date of May 1, 2015.
†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.
*Agency responses received after June 2013 are posted verbatim.