Report 2013-125 Recommendation 19 Responses
Report 2013-125: California Department of Health Care Services: Weaknesses in Its Medi-Cal Dental Program Limit Children's Access to Dental Care (Release Date: December 2014)
Recommendation #19 To: Health Care Services, Department of
To ensure that it reports in the CMS-416 an accurate number of child beneficiaries who received specific types of dental services from the centers and clinics, Health Care Services should continue working on a solution to capture the details necessary to identify the specific dental services rendered.
Annual Follow-Up Agency Response From October 2019
DHCS has implemented solutions to identify the categories of dental services provided by SNCs using procedure code "03" along with International Classification of Diseases (ICD) 10 codes for each dental performance measure, and includes the SNC data in the CMS-416 submissions. As a result, DHCS has published dental performance measure reports since federal FY 2015-16 to include dental services rendered in SNCs. The reports are updated quarterly on the DHCS Website at the link shown below and each measure has notes defining the specific ICD 10 codes used in the measure.
See website at: https://www.dhcs.ca.gov/services/Pages/DentalReports.aspx
- Completion Date: January 2018
California State Auditor's Assessment of Annual Follow-Up Status: Resolved
- Auditee did not substantiate its claim of full implementation
- Auditee did not address all aspects of the recommendation
Annual Follow-Up Agency Response From November 2018
The ASO and Fiscal Intermediary (FI) contractors have fully assumed their respective operations, as of January 29, 2018. The FI is tasked with housing and adjudicating all claims data. The FI submits dental fee-for-service claims data to the DHCS Data Warehouse, Management Information System/Decision Support System (MIS/DSS) on a monthly basis. The dental encounters provided by Safety Net Clinics (SNCs) are also included in the DHCS Data Warehouse MIS/DSS. DHCS identifies the categories of dental services provided by SNCs using procedure code "03" along with International Classification of Diseases 10 codes to identify types of dental services for all dental performance measures. As a result, DHCS is able to isolate sets of data available for ad hoc reports as well as in published reports to include specific types of dental services from the SNCs with service dates since October 2015. The Dental Performance Measures are updated quarterly on the DHCS Website located at:
https://www.dhcs.ca.gov/services/Pages/DentalReports.aspx
and annually with more stratifications on the CHHS Open Data Portal located at:
https://data.chhs.ca.gov/dataset?organization=department-of-health-care-services&q=dental
Furthermore, DHCS has published a DTI Annual Report for PY One that included data on specific types of dental services rendered at SNCs. DHCS accurately reported the data on children its submission of the Centers for Medicare and Medicaid Services (CMS) 416 report of Federal FY 2017 in April 2018. DHCS is readily able to produce accurate reports on the number of children who received specific types of dental services; therefore, DHCS is now adequately monitoring its dental services.
- Completion Date: January 2018
California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented
- Auditee did not substantiate its claim of full implementation
- Auditee did not address all aspects of the recommendation
Annual Follow-Up Agency Response From September 2017
Due to the complexity of the system changes and timing required to implement the necessary modifications to the CD-MMIS/CA-MMIS systems to accommodate capturing the details services rendered, DHCS will revisit this request/solution after the new dental FI and ASO contractors have assumed their respective operations. Assumption of operations is scheduled for January 2018. Additionally, in 2016, approximately 208 safety net clinics chose to participate in the DTI; therefore, at minimum, DHCS is capturing the detailed preventive dental services rendered to Medi-Cal children at these sites
- Estimated Completion Date: 12/31/2018
California State Auditor's Assessment of Annual Follow-Up Status: Pending
Annual Follow-Up Agency Response From November 2016
DHCS acknowledges safety net clinics throughout the state do not currently submit claims for reimbursement through the CD-MMIS. Due to the complexity of the system changes and timing required to implement modifications to the CD-MMIS/CA-MMIS systems to accommodate capturing the detailed services rendered, DHCS will have to revisit this request/solution after the new dental FI and ASO contractors have assumed their respective operations in late 2017 or early 2018. As a significant step forward, in the interim, and as component of the DTI, DHCS began capturing detailed information of all preventive dental services provided to Medi-Cal child beneficiaries as a requirement to participate in the DTI to receive incentive payments. This commenced in 2016. Participation from the 480 safety net clinics who currently render dental services is voluntary.
- Estimated Completion Date: 2018
California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented
1-Year Agency Response
DHCS is continuing to work towards establishing a project that would allow the system to capture detailed information of all dental services provided to Medi-Cal beneficiaries in order to ensure more complete reporting in the CMS-416 report. Due to the complexity of the project, DHCS will no longer be able to implement this project by July 1, 2016. DHCS is currently evaluating whether this can be done within the existing contract or if will need to be adopted during the next fiscal intermediary and administrative services organization contracts given the system changes that will be needed to implement this project.
- Estimated Completion Date: July 2016
- Response Date: December 2015
California State Auditor's Assessment of 1-Year Status: Pending
6-Month Agency Response
The Department of Health Care Services (DHCS) is currently working towards establishing a project that would allow for the system to capture detailed information for all dental services provided to ensure more complete reporting in the CMS-416 report. DHCS will implement this project by July 1, 2016.
- Estimated Completion Date: July 2016
- Response Date: July 2015
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
DHCS is currently working towards establishing a project that would allow the system to capture detailed information for all dental services provided to ensure more complete reporting in the CMS-416 report. DHCS will implement this project by the July 1, 2016.
- Estimated Completion Date: July 2016
- Response Date: February 2015
California State Auditor's Assessment of 60-Day Status: Pending
All Recommendations in 2013-125
Agency responses received are posted verbatim.