To ensure that the influx of beneficiaries resulting from recent changes to federal and state law is able to access Medi-Cal's dental services, Health Care Services should take these steps: continuously monitor beneficiary utilization, the number of beneficiaries having difficulty accessing appointments with providers, and the number of providers enrolling in and leaving the program.
DHCS has fully implemented this recommendation. DHCS continues to regularly monitor the volume of beneficiaries having difficulty accessing appointments and the number of providers enrolling and disenrolling from the program to identify any trends affecting network adequacy.
Health Care Services provided examples of periodic reports that measured beneficiary utilization, the number of beneficiaries having difficulty accessing appointments with providers, and the number of providers leaving the program and reasons for leaving.
DHCS shall use the beneficiary measures established to monitor utilization. DHCS has submitted a Delta Operational Instruction Letter to the contractor directing them to capture the number of beneficiaries having difficulty in accessing dental appointments. DHCS has been tracking provider enrollment and disenrollment information to help in analyzing access to care and network adequacy since September 2013. Data collected to date does not indicate a shift in enrollment/disenrollment.
Although Health Care Services provided policy documents pertaining to measuring beneficiary utilization and identifying and tracking weekly the numbers of beneficiaries having difficulty accessing appointments with providers, it did not provide documents showing that these policies were implemented. For instance, the instruction letter Health Care Services mentions directs Delta Dental, the fiscal intermediary, to track and report weekly several measures pertaining to access concerns, including urgent appointments not scheduled within 72 hours, non-urgent appointments not scheduled within 36 business days, and preventive appointments not scheduled within 40 business days out. Delta Dental is also to track appointments more than 25 miles from the beneficiary's address and whether the beneficiary's age is 20 and under or 21 and over. These documents indicate that DHCS will be able to monitor difficulties in beneficiary access to Medi-Cal dental care. However, Health Care Services did not provide documents showing the results of its monitoring of beneficiary utilization or copies of Delta Dental's weekly reports.
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 the DHCS has established standardized measures by which it will assess beneficiary utilization and provider participation and capacity by region and statewide, the DHCS will continuously monitor beneficiary utilization. DHCS is developing a draft instruction letter to its contractor that establishes a new category to capture the number of beneficiaries reporting difficulty in accessing dental appointments. Effective September 2013, DHCS started to monitor provider enrollment and disenrollment information to help in our assessment of access to care. The DHCS expects to meet the established implementation date of July 1, 2015.
Agency responses received are posted verbatim.