2019-105 Audit Scope and Objectives

Departments of Health Care Services and Public Health&mdsah;Management of Blood Lead Tests and Services

The audit by the California State Auditor will provide independently developed and verified information related to the oversight of blood lead tests and associated services by the Department of Health Care Services (Health Care Services) and the California Department of Public Health (Public Health). 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 whether Health Care Services, Public Health, and a selection of applicable contracted agencies compiled with relevant laws and regulations governing blood lead level testing and follow-up services for children. If any of the agencies did not meet statutory or regulatory requirements, identify the reasons.
  3. For at least the previous three years, determine how many children enrolled in Medi-Cal for at least three months received blood lead tests at age 12 months and age 24 months, respectively. Additionally, determine how many children did not receive the two required blood lead tests by age 24 months and did receive them before age 72 months. To the extent possible, determine how many of these children with elevated blood lead levels received the appropriate follow-up services as required by laws and regulations, identify which agencies provided the services, and assess whether the services provided were appropriate or duplicative. Furthermore, to the extent possible, identify how many children who should have received tests did not, and how many who should have received appropriate services did not.
  4. Determine how Health Care Services and Public Health collect and share data and reporting related to blood lead level testing and follow-up services for children in Medi-Cal, and assess whether the information is shared efficiently and effectively between the two entities. Assess how the entities use the collected data and whether other opportunities exist to make use of the collected data to better serve children with elevated blood lead levels and to improve statutory or regulatory compliance.
  5. Determine whether Health Care Services and Public Health maintain complete data for blood lead level test results and follow-up services for children. Assess how Public Health and Health Care Services ensure that they receive accurate and complete data from entities they work with to administer blood lead level tests and follow-up services, such as contracted local agencies and managed care plans. Additionally, determine how this data is managed and utilized to ensure entities comply with laws and regulations in providing tests and services.
  6. Assess the extent to which the programs to manage blood lead testing and lead exposure prevention administered by Health Care Services and Public Health are achieving their respective missions. If the programs are not meeting their missions, identify the major reasons why not.
  7. Determine the extent to which Health Care Services and Public Health could achieve programmatic efficiencies, cost-savings, and more effective service provision through greater coordination of blood lead level testing and follow-up services as required by laws and regulations.
  8. Determine what efforts Health Care Services and Public Health have taken to increase the number of children who receive blood lead level testing and follow-up services to comply with applicable laws and regulations.
  9. Identify and display the geographic distribution, identify any possible factors that may help explain concentration of children with elevated blood lead levels. Additionally, identify the geographic distribution of areas with children who should have been tested and have not been.
  10. Review and assess any other issues that are significant to the audit.