Report 2014-130 Recommendation 10 Responses

Report 2014-130: California Department of Health Care Services: It Should Improve Its Administration and Oversight of School‑Based Medi-Cal Programs (Release Date: August 2015)

Recommendation #10 To: Health Care Services, Department of

To streamline the organizational structure of its administrative activities program and to improve the program's cost-effectiveness, Heath Care Services should implement a single statewide quarterly random moment time survey and develop and implement a plan to take over responsibility for conducting quarterly time surveys and performing related activities as soon as reasonably possible.

Annual Follow-Up Agency Response From October 2021

An analysis was conducted of the RMTS data from Regions 8 and 9 both separately (pre-merger) and after becoming a consortium (post-merger). Generally speaking, the numbers appear very similar pre- and post-merger for all codes except for code 1, which had a decrease of 10 percent, and code 16, which had a commensurate increase of 10 percent. Additionally, DHCS notes, although all four quarters have closed for 2019-20, only actual data is available for two of the four quarters because during the public health emergency Quarters 2 and 3 were used to create an average for Quarter 4.

We will complete again when actual data is available for three quarters in a year, which should be available in two years, when the data from all of 21/22 is available.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From November 2020

Once the FY 2019-20 sample is complete for all four quarters, DHCS will review the results of the Region 8 and Region 9 merger to determine the overall impact on the RMTS results, and then compare the results to the results from prior FYs. The data will provide additional documentation to help DHCS determine the feasibility of implementing a single statewide time survey.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From October 2019

Although DHCS continues to review the feasibility of implementing a statewide RMTS process, in January 2018, San Diego LGA discontinued their participation in the SMAA program and the administration of their LEAs was assumed by the Orange County Region 9 LEC. This reduced the total number of RMTS Sample Universes in the state to eight. Beginning in FY 2019-20, Kern County Region 8 LEC and Orange County Region 9 LEC will merge into a single administrative unit for the purposes of conducting a single RMTS Sample Universe. This will reduce the total number of RMTS Sample Universes in the state to seven. This will streamline the organizational structure and improve cost effectiveness of the overall RMTS process by approximately 20 percent. Once the FY 2019-20 sample is complete for all four quarters, DHCS will review the results of the Region 8 and Region 9 merger to determine the overall impact on the RMTS results, and then compare those results to the results from prior fiscal years. This will provide additional documentation to help DHCS determine the feasibility of implementing a single statewide time survey.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From August 2019

Although DHCS continues to review the feasibility of implementing a statewide RMTS process, in January 2018, San Diego LGA discontinued their participation in the SMAA program and the administration of their LEAs was assumed by the Orange County Region 9 LEC. This reduced the total number of RMTS Sample Universes in the state to eight. Beginning in Fiscal Year (FY) 2019-20, Kern County Region 8 LEC and Orange County Region 9 LEC will merge into a single administrative unit for the purposes of conducting a single RMTS Sample Universe. This will reduce the total number of RMTS Sample Universes in the state to seven. This will streamline the organizational structure and improve cost effectiveness of the overall RMTS process by approximately 20%. Once the FY 2019-20 sample is complete for all four quarters, DHCS will review the results of the Region 8 and Region 9 merger to determine the overall impact on the RMTS results, and then compare those results to the results from prior fiscal years. This will provide additional documentation to help DHCS determine the feasibility of implementing a single statewide time survey.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From November 2018

DHCS continues to assert that implementing a single, statewide RMTS is premature at this time. RMTS has been in place for 2.5 years and DHCS currently has the first two quarters (six months) of RMTS invoices processed and believe it is not a sufficient and complete data set to determine if moving to a statewide platform would be warranted.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

Annual Follow-Up Agency Response From September 2017

DHCS continues to assert that implementing a single, statewide RMTS is premature at this time. RMTS has been in place for 2.5 years and DHCS currently has the first two quarters (six months) of RMTS invoices processed and believe it is not a sufficient and complete data set to determine if moving to a statewide platform would be warranted.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

1-Year Agency Response

DHCS reached out to other states and considered the advantages and disadvantages of implementing a statewide process which would include assuming responsibility for the time surveys. While the state may continue to research this and other options in efforts to continue improving the SMAA program, DHCS continues to believe that assuming the responsibility for conducting a statewide process is premature at this time since our current process has only been in place for 1.5 years and has shown that it successfully captures the activities of the participants.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

We continue to believe that if Health Care Services completed its research, it would agree that implementing a single statewide quarterly time survey would result in significant savings for claiming units and would simplify the oversight of the administrative activities program. As we mention on page 42 of our audit report, by conducting nine separate time surveys each quarter rather than a single statewide quarterly time survey, participants in the administrative activities program expend nine times the effort and incur corresponding additional costs to complete, code, and assure the quality of the time survey responses.

6-Month Agency Response

DHCS is reaching out to other states to better understand how the state could transition the administration of the SMAA program from a regional, county-based approach to a comprehensive statewide approach. DHCS is reviewing scope of service, cost effectiveness, and the number and type of resources needed to implement an effective statewide program.

DHCS will complete their review by December 2016.

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

We believe that when Health Care Services completes its analysis, it will agree that implementing a single statewide quarterly time survey will result in significant savings for claiming units and will simplify the oversight of the administrative activities program.

60-Day Agency Response

At this time, DHCS will not implement this recommendation. However, DHCS has begun to review the implications and cost effectiveness of taking over the responsibility of conducting quarterly time surveys, and related activities. DHCS has Begun reaching out to other states that utilize a single statewide time survey to determine the scope of services involved in this methodology and identify a set of best practices for possible implementation in California. This research is in the very early stages and does not yet support any conclusions.

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

We believe that when Health Care Services completes its analysis, it will agree that implementing a single statewide quarterly time survey will result in significant savings for claiming units and will simplify the oversight of the administrative activities program.

All Recommendations in 2014-130

Agency responses received are posted verbatim.