Report 2011-104 Recommendations and Responses in 2013-041

Report 2011-104: Medi-Cal Managed Care Program: The Departments of Managed Health Care and Health Care Services Could Improve Their Oversight of Local Initiatives Participating in the Medi-Cal Two-Plan Model

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of 2012-041 Response Not Implemented as of Most Recent Response
Department of Health Care Services 1 4 2 n/a 1

Recommendation To: Health Care Services, Department of

To make its financial solvency reviews more efficient and reduce the risk of errors, Health Care Services should coordinate with Managed Health Care when analyzing local initiatives' consolidated financial reports.

Response

On November 13, 2013, the Capitated Rates Development Division (CRDD) revised current policies and procedures pertaining to the monthly and quarterly financial analyses. CRDD will utilize the financial information available on the website of the Department of Managed Health Care (DMHC) as the primary source of information when completing CRDD's monthly and quarterly financial analyses. These changes will effectively eliminate the recreation of financial ratios by CRDD which has already been computed and provided through the DMHC financial website.

  • California State Auditor's Assessment of Status: Fully Implemented
  • Completion Date: November 2013
  • Response Date: November 2013

Recommendation To: Health Care Services, Department of

Health Care Services should ensure that it performs annual medical audits of local initiatives as required by law.

Response

The Medical Review Branch (MRB) is ramping up to full implementation of the annual medical audits. There are currently four of seven audit teams trained and functioning. We anticipate all seven teams functional by 2014 and have the capacity to conduct the annual audits for all Medi-Cal managed care plans. The Department of Managed Health Care (DMHC) reviews all managed care plans every three years. The MRB teams work with the DMHC teams in joint efforts on the Medi-Cal managed care plans.

In 2013, of the 10 operational Local Initiatives, 3 (Contra Costa Health Plan, CalViva, and Kern Family Health Plan) were audited. By the end of 2013 MRB, MRB will have audited 4 of the 10 operational Local Initiatives. An audit of the Tulare County LI which is operated by Anthem Blue Cross will start mid-November.

In 2012, 1 GMC Plan, Community Health Group, and 1 COHS, Gold Coast Health Plan were audited.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: 2014
  • Response Date: September 2013

Current Status of Recommendations

All Recommendations in 2013-041