Report 2018-603 Recommendation 5 Responses

Report 2018-603: Department of Health Care Services: It Paid Billions in Questionable Medi-Cal Premiums and Claims Because It Failed to Follow Up on Eligibility Discrepancies (Release Date: October 2018)

Recommendation #5 To: Health Care Services, Department of

To assist counties in addressing discrepancies, Health Care Services should find a cost-effective method to provide its exception reports in an electronic format readable by common database and spreadsheet software products that would allow users to sort and filter the data readily by December 31, 2018.

As per the CSA's recommendation to make the reports accessible to counties in an electronic format, the electronic version of the EER reports are now delivered to the respective counties' MoveIT folders where the counties can access the reports to query as needed. Changes were implemented in three phases.

Phase I - Implementation to deliver electronic version of the formatted EER's to the counties via secured file transfer (MoveIT) was completed on December 31, 2018. All California counties now receive the electronic version of the formatted EER report (as is version) via MoveIT server.

Phase II - Implementation of changes to ensure the electronic version of the EER data is available to all California counties in a readable format was completed on June 12, 2019. Counties can now search and query the downloaded EER data in the excel spreadsheet.

Phase III - Changes to generate the electronic version of Burman reports, IEVS reports, and SAVES reports was implemented by November 8, 2019.

California State Auditor's Assessment of Status: Fully Implemented

Health Care Services provided screenshots showing that it has made electronic copies of its Burman reports, Income and Eligibility Verification System (IEVS) reports, and Systematic Alien Verification and Eligibility System (SAVES) reports, and other Medi-Cal Eligibility Data System (MEDS) alert reports available to the counties. In addition, Health Care Services provided an example of an electronic report, along with instructions that counties can follow to make the data ready for sorting and filtering.

The Burman reports, Income and Eligibility Verification System (IEVS) reports, and Systematic Alien Verification and Eligibility System (SAVES) reports were brought to our attention after the previous implementation of EER reports that were completed on June 12, 2019.

Changes to generate the electronic version of Burman reports, IEVS reports, and SAVES reports were coded, tested, and ready to implement. Some components of the Burman reports are already implemented and the reports are delivered to respective counties. The remainder of these reports are pending Data Release approvals which are underway. Due to the time required to Quality Assurance check these additional twelve reports for the 58 counties, we expect to have them all implemented in the month of November 2019.

California State Auditor's Assessment of Status: Pending

Per Health Care Services' response, implementation of this recommendation is pending.

Implementation of changes to ensure that the electronic version of the EER data is available to all California counties in a readable format was completed on Wednesday, June 12, 2019. EER data files are securely uploaded to the respective county folders in the MoveIT secure file transfer server and the instructions to download the EER data into a spreadsheet was provided to all California counties. Counties will be able to search and query the downloaded EER data in the spreadsheet.

California State Auditor's Assessment of Status: Partially Implemented

Health Care Services provided evidence that it has provided counties with exception reports for its EER data in an electronic format. However, Health Care Services noted that it is still in the process of implementing the recommendation for its other exception reports, including the Burman reports, Income and Eligibility Verification System (IEVS) reports, and Systematic Alien Verification and Eligibility System (SAVES) reports.

Phase I - Implementation of changes to deliver electronic version of the formatted EER's to the counties via secured file transfer (via MoveIT) was completed on December 31, 2018. All California counties now receive the electronic version of the formatted EER report via MoveIT server.

Phase II - DHCS will ensure that the electronic version of the EER data is available to all California counties in a readable format. Counties will be able to search and query on this data via common software products. DHCS is coordinating this work effort with counties to ensure that the counties are able to utilize the EER data file by June 30, 2019 the target implementation date.

California State Auditor's Assessment of Status: Partially Implemented

Though DHCS fully agrees with the findings, the recommendation is not feasible to implement by

December 31, 2018.

DHCS has completed the preliminary research and documented the proposed implementation approach below.

DHCS will implement the recommendation with a target phased completion by June 30, 2019, as detailed below.

Phase I

DHCS will deliver the electronic version of the formatted EER's to the counties via secured file transfer to eTransfer server (MoveIT). This migration of counties to MoveIT addresses counties that are currently not receiving the electronic version of the EER.

Planned Implementation Date: December 31, 2018

Phase II

DHCS will deliver the electronic version of the EER data, via secured file transfer to MoveIT in a format which is consumable by spreadsheet software products. This will allow all counties to sort and filter the data readily.

Planned Implementation Date: June 30, 2019

California State Auditor's Assessment of Status: Pending

All Recommendations in 2018-603

Agency responses received are posted verbatim.