Report 2013-125 Recommendation 8 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 #8 To: Health Care Services, Department of

To ensure that Medi-Cal's child beneficiaries have reasonable access to dental services, Health Care Services should immediately resume performing its annual reimbursement rate reviews, as state law requires.

6-Month Agency Response

DHCS gathered pertinent data that informed the annual reimbursement rate assessment as required by State law. DHCS recognizes that the findings of the rate review and implementation of any such changes will be subject to approval within the Administration, the Legislature, and with the federal Centers for Medicare and Medicaid Services for purposes of receiving federal reimbursement while ensuring the proper and efficient administration of the program. The annual reimbursement rate assessment was submitted to the legislature on July 2, 2015 and DHCS will continue conducting such assessments annually thereafter.

California State Auditor's Assessment of 6-Month Status: Fully Implemented

Health Care Services issued a rate review for Medi-Cal Dental Services dated July 1, 2015. In this review, Health Care Services stated that given recent legal actions (which it describes), a reimbursement rate and its relationship to beneficiary access is not a strict or linear one, and that a multitude of factors must be considered and addressed when ensuring appropriate access to covered services. Although Health Care Services does not specifically mention whether California's reimbursement rates are sufficient to ensure the reasonable access of Medi-Cal beneficiaries to dental services, the review includes such information as comparisons of California's reimbursement rates to other states' Medicaid reimbursement rates and to the commercial rates in other regions around the US, and descriptions of Health Care Services' efforts to improve beneficiary utilization (e.g., developing and implementing beneficiary and provider outreach plans, contracting with additional providers, and enrolling para-professionals).

60-Day Agency Response

DHCS is currently gathering pertinent data that will be used to perform the annual reimbursement rate assessment as required by State law. DHCS also recognizes that the findings of the rate review and implementation of any such changes will be subject to approval within the Administration, the Legislature, and with the federal Centers for Medicare and Medicaid Services for purposes of receiving federal reimbursement while ensuring the proper and efficient administration of the program. DHCS anticipates fulfilling the established implementation date of July 1, 2015.

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

All Recommendations in 2013-125

Agency responses received are posted verbatim.