Report 2011-104 Recommendations and Responses in 2014-041

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 2013-041 Response Not Implemented as of Most Recent Response
Department of Health Care Services 2 4 2 1 1

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

A&I, MRB is on track with its overall implementation plan which includes classroom training, field mentoring, ongoing Subject Matter Expert (SME) consultation for audit staff who perform medical audits of contracting health plans. As of May 2014, seven audit teams completed the classroom training; and by December 2014, those teams will have performed an audit under guidance from experienced managers and SMEs. Internal quality review of completed reports is conducted by senior management to assure report reliability and consistency.

Bi-monthly, Joint Audit meetings with DHCS, Medi-Cal Managed Care Division (MMCD), A&I, MRB and the DMHC, Plan Surveys Division serve to coordinate audit/survey schedules, obtain MMCD Corrective Action Plan (CAP) status reports, and policy & legislative updates.

Joint DHCS and DMHC on-site engagements are coordinated in accordance with Welfare & Institution Section 14457; the current DMHC focus is on health plan implementation of SPD; and starting in 2015, the CalMediConnect implementation.

Whenever possible, coordination of on-site schedules is achieved between DHCS & DMHC. However, two scheduled audits were postponed due to the financial circumstances of the health plans (one Local Initiative (LI) and one County Organized Health System (COHS)).

From September 2013 through to July 2014, an additional eight health plans (four LIs, three commercial plans, and one COHS) were audited

Upon completion of the CAPs, the issued Audit Reports, completed CAPs and corresponding MMCD Close out Letters are posted to the MMCD website's Monitoring page.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: Fall 2015
  • Response Date: October 2014

Current Status of Recommendations

All Recommendations in 2014-041