Report 2020-613 Recommendation 3 Responses
Report 2020-613: Department of Health Care Services: Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi‑Cal Eligibility Problems (Release Date: July 2021)
Recommendation #3 To: Health Care Services, Department of
To reduce inappropriate payments made to medical providers and ensure eligible individuals' access to care, Health Care Services should, by August 2021, expand its workgroup planning efforts to address all high-risk eligibility alerts included in the pilot program.
Through various discussions, DHCS does not believe that the PHE lift workgroup has the participants needed to address the issue. Therefore, high-risk MEDS alerts will be addressed through the MEDS pilot which will be expanded to include all counties in discussions related to MEDS alerts processing upon termination of the PHE.
Due to the anticipated extension of the PHE that may result in updated guidance from the Centers for Medicare and Medicaid Services additional time is needed to complete the process. This resulted in the extension of the estimated implementation date to 04/30/2022.
- Estimated Completion Date: 04/30/2022
California State Auditor's Assessment of Status: Pending
No change from draft report response. DHCS will ensure PHE lift workgroup planning efforts incorporate resolution of system discrepancies as a component of the activities counties will perform once the PHE is lifted.
- Estimated Completion Date: 10/31/2021
California State Auditor's Assessment of Status: Pending
All Recommendations in 2020-613
Agency responses received are posted verbatim.
