Report 2018-122 Recommendation 10 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 #10 To: Health Care Services, Department of

To ensure that all counties are aware of the managed care model options available to them and of the steps necessary to implement those models, DHCS should provide by December 2019 information to all counties that clearly defines each managed care model and the steps and legal requirements needed to establish each model.

Annual Follow-Up Agency Response From October 2021

To further support the recommendation to ensure that all counties are aware of the managed care model options available to them and of the steps necessary to implement those models, DHCS held a webinar on February 8th, 2021 entitled Medi-Cal Managed Care Models: Technical Assistance for Counties. The purpose of the webinar was to provide guidance on the opportunity for counties to transition to a Managed Care Model that includes a local plan model, County Organized Health System (COHS) or Local Initiative, by January 2024. The webinar explained what options were available, information on County, State and Federal Authorization and a timeline. The webinar also described in detail the Letter of Intent Instructions that required various pieces of documentation to be submitted to DHCS for review and consideration of a possible Plan Model change in the county.

DHCS released the Letter of Intent Instructions to the County Health Executives Association of California and posted to the DHCS website to communicate the opportunity. In addition, DHCS provided technical assistance to Counties and Managed Care Plans by meeting with them when requested to address questions and provide guidance as needed.

In May 2021, DHCS released a Stakeholder Announcement informing them of the counties that submitted Letter of Intent documentation by the required deadline of April 30th, 2021.

In September 2021 DHCS launched the Managed Care Plan County Plan Model Change webpage on the DHCS website dedicated to County Plan Model change information.

The DHCS Model Fact Sheet remains as is, however, DHCS has described in its Letter of Intent Instructions and in the Conditional Approvals provided to Counties interested in changing the Plan Model that operate in their county, that Readiness Requirements can be located in the Managed Care Plan Boilerplate contract at MCP Boilerplate Contract.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Annual Follow-Up Agency Response From November 2020

In addition to the information on the DHCS website explaining the steps and legal requirements to establish each plan model type, DHCS has also held initial meetings with various county stakeholders as well as MCPs to discuss the process and timeline for counties to change the MCP model type operating in the county. DHCS is also planning a webinar for counties to attend and hear further details on steps counties must take to change the MCP model type in the county. DHCS will provide technical assistance as needed including necessary timelines and milestones counties must meet in relation to the final request for procurement.

The link on the DHCS website to where the document can be found is

https://www.dhcs.ca.gov/services/Documents/MMCD/MMCDModelFactSheet.pdf.

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

The document that DHCS refers to was referenced in its previous responses. However, the information in the fact sheet is presented at a very high level and does not describe specific details that would direct counties on how to establish each model. DHCS subsequently informed us of additional available information, known as readiness requirements, that describes the requirements for health plans to contract under the various managed care model options. Accordingly, DHCS could add references to the readiness requirements in its fact sheet to provide additional context to the counties on how to implement the models. We will review DHCS' efforts during its next annual follow-up response to determine whether it has fully implemented this recommendation.

1-Year Agency Response

DHCS has created and posted to the DHCS website a document outlining the necessary information that explains the steps and legal requirements to establish each plan model type. DHCS has shared the link to the document with the County Health Executives Association of California and California State Association of Counties to distribute to its members. The document was also mailed out to the Managed Care Advisory Group and other groups as identified by DHCS. The link on the website to where the document can be found is

https://www.dhcs.ca.gov/services/Documents/MMCD/MMCDModelFactSheet.pdf.

California State Auditor's Assessment of 1-Year Status: Partially Implemented

DHCS describes the same document that it referenced in its six-month response. Although that fact sheet defines the managed care models and presents required steps and legal references, the information it provides is at a very high level and does not describe specific details that would direct counties on how to establish each model. DHCS subsequently informed us of additional available information, known as readiness requirements, that describes the requirements for health plans to contract under the various managed care model options. Accordingly, DHCS could add references to the readiness requirements in its fact sheet to provide additional context to the counties on how to implement the models. We look forward to hearing from DHCS on its efforts to issue more specific guidance for that purpose.

6-Month Agency Response

DHCS has created and posted to the DHCS website a document outlining the necessary information that explains the steps and legal requirements to establish each plan model type. DHCS has shared the link to the document with the County Health Executives Association of California and California State Association of Counties to distribute to its members. The document was also mailed out to the Managed Care Advisory Group and other groups as identified by DHCS. The link on the website to where the document can be found is https://www.dhcs.ca.gov/services/Documents/MMCD/MMCDModelFactSheet.pdf.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

Although DHCS' fact sheet defines the managed care models and presents required steps and legal references, the information it provides is at a very high level and does not describe specific details that would direct counties on how to establish each model. We look forward to hearing more from DHCS on its efforts to issue more specific guidance for that purpose.

60-Day Agency Response

DHCS is working internally to create the necessary information for posting to the DHCS website that explains the steps and legal requirements to establish each plan model type. In addition, DHCS has recently updated the DHCS website and has made improvements that allows the public easy access to information regarding information about health plans. Two improvements to the website include easily accessible links entitled "Medi-Cal Managed Care", as well as a direct link entitled "Finding your County Office". DHCS also continues to be committed to meet with counties when requested to discuss issues about managed care and answer questions regarding the models. Finally, DHCS will issue an information update letter to the County Health Executives Association of California and/or the CA State Association of Counties notifying them of changes to the DHCS website which may be of assistance to counties.

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

We look forward to reviewing DHCS' six-month response to evaluate the information DHCS is creating that will address the steps and requirements for establishing each plan model type.

All Recommendations in 2018-122

Agency responses received are posted verbatim.