Report 2013-119 Recommendation 33 Responses

Report 2013-119: California Department of Health Care Services: Its Failure to Properly Administer the Drug Medi-Cal Treatment Program Created Opportunities for Fraud (Release Date: August 2014)

Recommendation #33 To: Health Care Services, Department of

To improve the coordination between its divisions, branches, and units and ensure that it addresses allegations of fraud in a timely manner, Health Care Services should fully implement the investigations division's recommendations shown in Appendix B. If it chooses not to implement a recommendation, it should document sufficiently the reasons for its decision.

Annual Follow-Up Agency Response From August 2017

SUDPPFD has established the following policy related to Narcotic Treatment Program (NTP) performance reports: All NTP providers that provide DMC services will be required to submit an annual report to the county with which they contract that includes the following information: all NTP services provided, DMC services claimed, and reimbursement amounts by funding line and beneficiary aid code. This year-end cost settlement information will be identified as the NTP provider performance report. The county will collect this cost data and enter it onto the web-based county cost report. The result will be to establish the actual cost for the county settlement. NTP providers that receive funding other than DMC for NTP services, or that contract with the county to provide services other than NTP, must accurately reflect all cost and revenue data for all services on their performance report (in addition to the unit of service and reimbursement information specified above).

Completion Date: July 2017

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

Health Care Services provided evidence that it resolved the remaining recommendation from its "Limited Scope Review of the Drug Medi-Cal Treatment Program."

Annual Follow-Up Agency Response From October 2016

Of the 32 recommendations issued by the Audits & Investigations Division, DHCS has implemented an additional three recommendations (1, 4, and 6). Emergency regulations giving Provider Enrollment Division authority to certify DMC providers and increasing Medical Director responsibilities including medical oversight was approved by Office of Administrative Law on August 17, 2015 and made permanent on February 11, 2016. Recommendation 20 to explore the use of statistical extrapolation was completed but it was determined to be not be feasible to implement

Substance Use Disorders Program, Policy and Fiscal Division (SUDPPFD) is responsible for one remaining recommendation: #25 Partially implemented. Estimated completion date July 2017

Estimated Completion Date: July 2017

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

1-Year Agency Response

Of the 32 recommendations issued by the Audits & Investigations Division, DHCS has fully implemented 25 (recommendations 3, 5, 7 - 20, 22, 23, and 26 - 32), and continues to work toward implementing the remaining recommendations. DHCS continues to aim for full implementation by June 2016.

Estimated Completion Date: June 2016
Response Date: August 2015

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

Date of implementation was set for June 2016.

6-Month Agency Response

Update for Appendix B's partially implemented recommendations and implementation dates are as follows:

A. On June 25, 2014, Health Care Services used its emergency regulatory authority to amend Title 22 of the California Code of Regulations to clarify the responsibilities of program providers and other provider personnel. Health Care Services is in the process of aligning program certification standards with the enrollment requirements for the Medi-Cal fee-for-service providers and is in the process of drafting regulatory changes to accomplish this alignment. Health Care Services anticipates implementing the new requirements by mid-year 2015.Estimated completion date is July 2015.

B. Health Care Services stated that its enrollment division assumed responsibility of all program certifications as of January 1, 2014. Health Care Services also stated that the enrollment division will complete its alignment of the program certification process with the Medi-Cal fee-for-service provider enrollment process by mid-year 2015. Estimated completion date is July 2015.

C. Health Care Services stated that currently all program providers are in the PRIMe system. The licensing and certification portion of PRIMe was released on June 12, 2014. PRIMe is not capable of accepting applications for the DUI programs. In addition, data from the non-eligible provider list(s) from the enrollment division is not in PRIMe; this information is stored in a different database— Short Doyle Medi-Cal ADP Remediation Technology 6i. Estimated completion date is June 2016.

Estimated Completion Date: June 2016
Response Date: February 2015

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

60-Day Agency Response

Estimated Completion Date: June 2016
Response Date: October 2014

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

Based on its response, the department has not yet fully implemented this recommendation.

All Recommendations in 2013-119

Agency responses received are posted verbatim.