Report 2014-130 Recommendation 2 Responses

Report 2014-130: California Department of Health Care Services: It Should Improve Its Administration and Oversight of School‑Based Medi-Cal Programs (Release Date: August 2015)

Recommendation #2 To: Health Care Services, Department of

To ensure that it provides claiming units with reasonable opportunities to address concerns with its decisions or actions, Health Care Services should, within three months, inform all stakeholders, including claiming units, of the existence of this appeals process.

Annual Follow-Up Agency Response From September 2017

There is no change to DHCS' previous response. DHCS issued PPL 14-006 on April 4, 2014, that outlines the current appeal process. The PPL was sent to all stakeholders and posted to the DHCS/SMAA website.

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


1-Year Agency Response

DHCS will not implement this recommendation as an appeal process already exists.

DHCS issued Policy and Procedure Letter (PPL) 14-006 on April 4, 2014 that outlines the appeal process and posted it on the SMAA website.

  • Response Date: September 2016

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

As we mention on pages 27 and 28 of our audit report, Health Care Services has offered claiming units, including local educational agencies, no formal opportunity to appeal its decisions to deny reimbursement claims.


6-Month Agency Response

DHCS does not contract with the LEAs directly and all disputes must first be addressed at the LEC/LGA level before the issue can be elevated to DHCS. Policy and Procedure Letter (PPL) 14-006 was issued on April 4, 2014 that outlines the appeal process (this is posted on the SMAA website).

  • Response Date: March 2016

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

As we mention on pages 27 and 28 of our audit report, Health Care Services has offered claiming units, including local educational agencies, no formal opportunity to appeal its decisions to deny reimbursement claims.


60-Day Agency Response

As stated in the previous response, DHCS does not contract with the LEAs directly and all disputes must first be addressed at the LEC/LGA level before the issue can be elevated to DHCS. Policy and Procedure Letter (PPL) 14-006 was issued on April 4, 2014 that outlines the appeal process (this is posted on the SMAA website).

  • Response Date: October 2015

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

As we mention on pages 27 and 28 of our audit report, Health Care Services has offered claiming units, including local educational agencies (LEAs), no formal opportunity to appeal its decisions to deny reimbursement claims. Furthermore, no claiming units have used Health Care Services' current process, whereby they can appeal decisions made by local educational consortia and local governmental agencies.


All Recommendations in 2014-130

Agency responses received are posted verbatim.


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