Report 2023-115 Recommendation 15 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 #15 To: Health Care Services, Department of

To ensure that Medi-Cal managed care plan members do not have to travel unreasonable times or distances to receive care, DHCS should develop a definition of what times and distances are reasonable for members to travel. In doing so, DHCS should consider both the total time or distance a member needs to travel, as well as how those times and distances compare to other plans' times and distances for the same provider type and ZIP code. Thereafter, when DHCS determines that plans' requests for alternative time and distance standards are not reasonable, it should not approve those alternative access standards, thereby requiring those plans to offer members out-of-network access until such time as the plans can provide reasonable travel times and distances to care.

60-Day Agency Response

DHCS has begun analysis and is working on a project plan and approach to determine reasonability. To the extent possible, the policy will be aligned across managed care delivery systems and can be adopted for specialty behavioral health as well.

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

All Recommendations in 2023-115

Agency responses received are posted verbatim.