DHCS Responds to State Auditor’s Recommendations for Improvement

DHCS submitted responses to more than twenty recommendations made by the California State Auditor’s office following their review of the Department’s oversight and administration of the school-based MAA and LEA Medi-Cal Billing Option programs.

The original report, published on August 20, 2015, cited several areas for improvement (read our summary, here). In their response, DHCS indicates that they will attempt to address most of the recommendations.

Below is a summary of the most notable responses from the Department. A complete list of recommendations and responses is available on the State Auditor’s website.

Recommendations that DHCS Will Not Implement

  • Establish and implement a formal appeals process that allows claiming units to directly appeal Health Care Services’ decisions (Rec. 1 & 2).
    • DHCS rejects this recommendation, stating that a claiming unit must first appeal to their contracted regional agency (the LEC or LGA) before DHCS will determine state intervention.
  • Develop and issue a standard contract for claiming units to sign to participate in the program (Rec. 13).
    • DHCS rejects this recommendation, stating that DHCS has a standard contract with LECs and LGAs, but it has no authority over the contracts between claiming units and their LEC and LGA. DHCS states that only if the administrative structure were to change, eliminating the role of LECs and LGAs, would they implement a standard contract with claiming units for participation.
  • Develop and implement a plan to take over responsibility for conducting a single statewide quarterly time survey and performing related activities (Rec. 10).
    • DHCS states that they will not implement this recommendation at this time, but that they will review the cost-effectiveness of implementing a statewide RMTS.

Select Recommendations DHCS Will Implement

  • Complete the oversight reviews for at least three high-risk local educational consortia or local governmental agencies by December 31, 2015, and post the results to its website (Rec. 4).
    • DHCS scheduled reviews for LACOE LEC, Tulare LGA, and Stanislaus LEC in accordance with this recommendation and states that their reviews will be made available by the end of the year.
  • Ensure all local educational consortia and local governmental agencies comply with requirements that their contracts with claiming units prohibit the claiming unit from seeking federal reimbursement of Health Care Services’ participation fee (Rec. 8).
    • DHCS has committed to releasing a Policy and Procedure Letter regarding this issue.
  • Draft revisions to regulations, the manual, oversight strategies and plans, and policy and procedure letters, as well as updating program FAQs (Rec. 12 and 14)
  • Revise reimbursement rates to authorize claiming units to claim the 75 percent reimbursement rate for translation activities as federal law allows (Rec. 18).
    • DHCS states that they will not implement this recommendation at this time, but that they will investigate further.
    • Note: This response conflicts with the Departments response to Rec. 19 in which they state that they’re working to incorporate the higher reimbursement rate for translation services into the SMAA invoice.
  • Immediately develop and adopt regulations cited in the four subdivisions of Section 14132.47 of the California Welfare and Institutions Code to provide the public with the ability to participate fully in developing the rules governing the administrative activities program (Rec. 21).
    • DHCS states that they are currently working to draft regulations for the SMAA program, with an estimated releast date of June 2017.

Also available are the State Auditor’s assessment of each DHCS response, as well as the schedule for follow-up that the Department must submit on each issue (30-Day, 60-Day, etc.).