Report 2021-046 Recommendation 2 Responses
Report 2021-046: Proposition 56 Tobacco Tax: The Department of Health Care Services Is Not Adequately Monitoring Provider Payments Funded by Tobacco Taxes (Release Date: November 2022)
Recommendation #2 To: Health Care Services, Department of
To ensure that managed care plans pay Proposition 56 supplemental payments to the appropriate providers, DHCS should require managed care plans to submit Medi-Cal beneficiary identification information with their quarterly reports by June 2023. Once DHCS obtains this information, it should reconcile those reports to medical encounter data and then recover any overpayments it identifies.
1-Year Agency Response
DHCS released technical guidance to Medi-Cal managed care plans (MCPs) 03/01/23 requiring submission of beneficiary level information in their Proposition 56 (Prop 56) expenditure reporting on a semi-annual basis (see Attachment 3 in Substantiation folder). All MCPs submitted the data leveraging the new dataset beginning on 05/15/23. Furthermore, all Prop 56 APLs have been updated to incorporate the adherence to the technical guidance requirement, the first APL was issued on 04/28/23 and the last was issued on 07/25/23 (see Attachments 4 through 9 in Substantiation folder).
DHCS will continue to identify and address material discrepancies and, where appropriate, to require MCPs to pay remittances under the terms of the applicable Prop 56 directed payment arrangements for future data submissions based on each program year after accounting for appropriate data reporting lag.
- Completion Date: July 2023
- Response Date: December 2023
California State Auditor's Assessment of 1-Year Status: Partially Implemented
DHCS issued an all-plan letter directing managed care plans to submit a client index number with their required reports for directed payment programs. However, DHCS did not provide evidence to substantiate that it has received that information, reconciled those reports to medical encounter data, and recovered any overpayments. Thus, this recommendation is partially implemented.
- Auditee did not substantiate its claim of full implementation
- Auditee did not address all aspects of the recommendation
6-Month Agency Response
Health Care Services did not submit a response to this recommendation.
- Estimated Completion Date: unknown
- Response Date: October 2023
California State Auditor's Assessment of 6-Month Status: No Action Taken
60-Day Agency Response
Health Care Services did not submit a response to this recommendation.
- Estimated Completion Date: unknown
- Response Date: March 2023
California State Auditor's Assessment of 60-Day Status: No Action Taken
All Recommendations in 2021-046
Agency responses received are posted verbatim.