To prevent the certification of ineligible providers, Health Care Services should immediately develop policies and procedures for its program recertification process.
DHCS has developed new policies and procedures for the DMC recertification process, and will continue to update these policies and procedures as warranted. DHCS has developed a DMC enrollment and certification section whose sole purpose is to conduct continued certification and certification functions for all DMC provider applicants. PED staff work collaboratively with SUDS' staff and the A&I staff in implementing its policies and procedures.
Additionally, in January 2014, the department began the process of implementing emergency regulations regarding the enrollment of DMC providers with a targeted effective date of July 1, 2015. As part of the emergency regulation package, all DMC providers will be required to adhere to current CCR Title 22 requirements used to enroll and revalidate fee-for-service providers.
Health Care Services provided a copy of its procedures for recertifying program providers.
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.