Report 2023-115 Recommendation 11 Responses

Report 2023-115: Department of Health Care Services and Department of Managed Health Care: Children Enrolled in Medi-Cal Face Challenges in Accessing Behavioral Health Care (Release Date: November 2023)

Recommendation #11 To: Health Care Services, Department of

To improve Medi-Cal members' access to behavioral health services from county mental health plans and Drug Medi-Cal programs, by November 2024, DHCS should demonstrate that it has followed up with county mental health plans and Drug Medi-Cal programs on CAPs that continue to be deficient in timely access or other network adequacy standards. In doing so, it should assess whether the plans took the actions described in their CAPs and, if so, why those actions did not result in sufficient improvement.

60-Day Agency Response

Prior to the audit, DHCS had identified steps to improve the Corrective Action Plan (CAP) process for county Mental Health Plans (MHPs) and DMC-ODS plans, collectively referred to as Behavioral Health Plans (BHPs). For the FY 2023-24 network adequacy certification period, BHPs began submitting Annual Network Adequacy Certification documentation on November 1, 2023. DHCS is currently processing the information. BHPs found out-of-compliance with network adequacy standards will be required to submit a CAP along with applicable supporting documentation. BHPs that remain out-of-compliance will be contacted and required to attend a technical assistance call(s) required to address the reasons why the BHP remains non-compliant. Additionally, for data-driven network adequacy standards, the BHP will be required to submit the applicable data to DHCS monthly to show compliance. DHCS will conduct the appropriate analysis and provide results to the BHP. For non-data-related deficiencies that remain non-compliant, DHCS will establish a monitoring timeline to provide periodic check-ins with the BHP to ensure the applicable required documentation needed to bring the BHP into compliance is submitted and reviewed. If BHPs fail to demonstrate sufficient progress or improvement via this process, DHCS will issue financial sanctions when deemed appropriate. Additionally, Drug Medi-Cal (DMC) counties submitted timely access data on November 1, 2023, in response to the implementation of the Mental Health Parity and Addiction Equity Act of 2008. DHCS published BHIN 22-070 on December 30, 2022, which requires DMC counties to meet timely access requirements as specified in 28 CCR 1300.67.2.2 (c)(5). FY 2023-24 is the inaugural year; thus, results will be advisory. Beginning FY 2024-25, DMC counties will be held to compliance, and any DMC county found out of compliance will follow the CAP process as described above.

California State Auditor's Assessment of 60-Day Status: Partially Implemented

DHCS provided the Information Notice it created outlining its expectations of BHPs on CAPs, and indicating it will follow up with BHPs on CAPs that continue to be deficient in timely access or other network adequacy standards. We will assess whether DHCS fully implements this recommendation by conducting that follow-up and making determinations of causes for continued deficiencies after it fully processes the information BHPs submitted in November 2023, and after it begins conducting the same analysis for DMCs beginning in fiscal year 2024-25.

All Recommendations in 2023-115

Agency responses received are posted verbatim.