2018-111 Audit Scope and Objectives

California Department of Health Care Services—Children in Medi-Cal: Access to Care and Preventative Services

The audit by the California State Auditor will provide independently developed and verified information related to oversight by the Department of Health Care Services (Health Care Services) of timely access to care and use of preventive health care services for children in Medi-Cal. The audit's scope will include, but not be limited to, the following activities:

  1. Review and evaluate the laws, rules, and regulations significant to the audit objectives.
  2. Determine what efforts Health Care Services has made to do the following:
    1. Ensure that eligible children are receiving preventive health care services.
    2. Monitor and enforce standards for timely access, specifically for pediatric preventive care appointments.
  3. Determine whether Health Care Services is fully compliant with all federal Medicaid EPSDT policies and reporting requirements related to pediatric preventive care access and utilization.
  4. Evaluate Medi-Cal contract language and departmental guidance to ensure that they make clear the following:
    1. The requirements for timely access to care and delivery of preventive services for children.
    2. The oversight and monitoring activities performed by Health Care Services.
  5. Identify and evaluate incentives or quality improvement programs Health Care Services operates or has plans to implement to address deficiencies in pediatric preventive care access and utilization.
  6. Identify and evaluate Health Care Services' policies and procedures to ensure that children receive timely care in the language of both the child and the family.
  7. To the extent possible, identify and evaluate Health Care Services' policies and procedures for monitoring and mitigating disparities in preventive care access and utilization for children of differing racial and ethnic backgrounds.
  8. Review Health Care Services' plan to prepare for, implement, and monitor upcoming changes to Medi-Cal rules related to pediatric care.
  9. Review best practices for Health Care Services to consider to help ensure timely access to pediatric appointments and required children's preventive health services.
  10. Review and assess any other issues that are significant to the audit.

California State Auditor's Office
5/7/2018