To prevent the certification of ineligible providers, Health Care Services should immediately develop procedures on how to evaluate provider applicant license database searches.
DHCS has developed and will update, as appropriate, procedures on how to evaluate provider applicant license database searches. All PED staff that process applications are trained on state and federal program requirements and how to evaluate provider applicant license searches. Effective July 2013, trained staff were assigned to process DMC applications for recertification and effective January 2014, trained staff were assigned to process all new and backlogged certification applications. Any questions on licensing status are addressed through further research, a remediation request and onsite inspections to verify all standards of program participation are met by the DMC provider.
Health Care Services provided a copy of its Analyst Review Guide, in which analysts are instructed to verify information from the providers' applications. If Health Care Services' analysts review the databases specified in the guide, identify exceptions within those databases, and consult with their management appropriately, then these actions would adequately address the recommendation.
Although Health Care Services indicated that it has fully implemented this recommendation, it has not provided any information to indicate that it has taken any action on this recommendation.
Agency responses received are posted verbatim.