Report 2018-122 Recommendation 5 Responses

Report 2018-122: Department of Health Care Services: It Has Not Ensured That Medi-Cal Beneficiaries in Some Rural Counties Have Reasonable Access to Care (Release Date: August 2019)

Recommendation #5 To: Health Care Services, Department of

To obtain assurance that health plans throughout the State exhaust all of their reasonable options to meet the access requirements before requesting alternative access standards, DHCS should immediately establish a process for periodically verifying the health plans' efforts, such as contacting a sample of the listed providers and determining whether the plans attempted to contract with them.

60-Day Agency Response

DHCS implemented a validation process that requires MCPs with approved AAS to submit various documentation that demonstrates efforts made to contract with closer out-of-network provider(s). In addition, APL 19-002 is also being revised to instruct MCPs to provide information regarding attempts to outreach to a minimum of two out-of-network providers when submitting AAS requests.

  • Completion Date: August 2019
  • Response Date: October 2019

California State Auditor's Assessment of 60-Day Status: Fully Implemented

All Recommendations in 2018-122

Agency responses received are posted verbatim.