Report 2013-125 Recommendation 6 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 #6 To: Health Care Services, Department of

To ensure that the influx of beneficiaries resulting from recent changes to federal and state law is able to access Medi-Cal's dental services, Health Care Services should take these steps: continuously monitor beneficiary utilization, the number of beneficiaries having difficulty accessing appointments with providers, and the number of providers enrolling in and leaving the program.

Agency Response*

DHCS has fully implemented this recommendation. DHCS continues to regularly monitor the volume of beneficiaries having difficulty accessing appointments and the number of providers enrolling and disenrolling from the program to identify any trends affecting network adequacy.

  • Response Type†: 1-Year
  • Completion Date: July 2015
  • Response Date: December 2015

California State Auditor's Assessment of Status: Fully Implemented

Health Care Services provided examples of periodic reports that measured beneficiary utilization, the number of beneficiaries having difficulty accessing appointments with providers, and the number of providers leaving the program and reasons for leaving.


Agency Response*

DHCS shall use the beneficiary measures established to monitor utilization. DHCS has submitted a Delta Operational Instruction Letter to the contractor directing them to capture the number of beneficiaries having difficulty in accessing dental appointments. DHCS has been tracking provider enrollment and disenrollment information to help in analyzing access to care and network adequacy since September 2013. Data collected to date does not indicate a shift in enrollment/disenrollment.

  • Response Type†: 6-Month
  • Completion Date: July 2015
  • Response Date: July 2015

California State Auditor's Assessment of Status: Partially Implemented

Although Health Care Services provided policy documents pertaining to measuring beneficiary utilization and identifying and tracking weekly the numbers of beneficiaries having difficulty accessing appointments with providers, it did not provide documents showing that these policies were implemented. For instance, the instruction letter Health Care Services mentions directs Delta Dental, the fiscal intermediary, to track and report weekly several measures pertaining to access concerns, including urgent appointments not scheduled within 72 hours, non-urgent appointments not scheduled within 36 business days, and preventive appointments not scheduled within 40 business days out. Delta Dental is also to track appointments more than 25 miles from the beneficiary's address and whether the beneficiary's age is 20 and under or 21 and over. These documents indicate that DHCS will be able to monitor difficulties in beneficiary access to Medi-Cal dental care. However, Health Care Services did not provide documents showing the results of its monitoring of beneficiary utilization or copies of Delta Dental's weekly reports.

  • Auditee did not substantiate its claim of full implementation

Agency Response*

DHCS is currently in the process of gathering and assessing existing provider and beneficiary data and assessing health care industry methodologies to establish measures that best represent beneficiary utilization and provider participation and capacity in the Medi-Cal Dental Program. Once the DHCS has established standardized measures by which it will assess beneficiary utilization and provider participation and capacity by region and statewide, the DHCS will continuously monitor beneficiary utilization. DHCS is developing a draft instruction letter to its contractor that establishes a new category to capture the number of beneficiaries reporting difficulty in accessing dental appointments. Effective September 2013, DHCS started to monitor provider enrollment and disenrollment information to help in our assessment of access to care. The DHCS expects to meet the established implementation date of July 1, 2015.

  • Response Type†: 60-Day
  • Estimated Completion Date: July 2015
  • Response Date: February 2015

California State Auditor's Assessment of Status: Pending


All Recommendations in 2013-125

†Response Type refers to the interval in which the auditee is providing the State Auditor with their status in implementing recommendations made in an audit report. Auditees must submit a response regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year or subsequent to one year.

*Agency responses received after June 2013 are posted verbatim.


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