Report 2018-122 Recommendation 3 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 #3 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 determine a specific minimum number of providers that health plans must attempt to contract with before requesting an alternative access standard.
1-Year Agency Response
DHCS issued All Plan Letter (APL) 20-003 in February 2020, which supersedes APL 19-002. The policy guidance addressed in the APL includes the requirement for Managed Care Providers (MCP) to detail the names, addresses, and driving time/distance to at least two of the nearest out of network providers when making an Alternative Access Standards (AAS) request.
- Completion Date: February 2020
- Response Date: August 2020
California State Auditor's Assessment of 1-Year Status: Fully Implemented
6-Month Agency Response
DHCS is finalizing stakeholder feedback on the APL 19-002, which will instruct MCP to provide information regarding attempts to outreach to a minimum of two out-of-network providers when submitting AAS requests. DHCS will publish the APL by February 2020.
- Estimated Completion Date: February 2020
- Response Date: January 2020
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
DHCS is currently revising All Plan Letter 19-002 which will instruct Managed Care Providers to provide information regarding attempts to outreach to a minimum of two out-of-network providers when submitting AAS requests.
- Estimated Completion Date: July 2020
- Response Date: October 2019
California State Auditor's Assessment of 60-Day Status: Pending
All Recommendations in 2018-122
Agency responses received are posted verbatim.