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 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.


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