CHA News Article

CMS Approves DHCS’ Proposed Medi-Cal Managed Care Access Assessment Design

On Sept. 19, the Department of Health Care Services (DHCS) received Centers for Medicare & Medicaid Services’ approval of its proposed Access Assessment Design. California’s section 1115(a) demonstration waiver (titled “California’s Medi-Cal 2020 Demonstration”) requires that DHCS, working with its external quality review organization, conduct a one-time assessment evaluating primary, core specialty and facility access to care for managed care members.

The evaluation will be based on current health plan network adequacy requirements, as set forth in the state’s Knox-Keene Health Care Service Plan Act of 1975 and Medicaid managed care contracts. It will consider the state’s fair hearing and independent medical review decisions as well as grievances and appeals/complaints data, and will report on the number of providers accepting new beneficiaries. The report will also describe the state’s current compliance with the access and network adequacy standards outlined in the Medicaid managed care final rule.

As a part of the assessment process, DHCS established an advisory committee to provide input on the assessment’s structure and design. The committee includes representatives from consumer advocacy organizations, providers, provider associations, health plans, health plan associations and legislative staff. CHA’s Amber Kemp, vice president, health care coverage, represents CHA members on the advisory committee.

DHCS’ External Quality Review Organization contractor, Health Services Advisory Group, will begin to conduct the assessment and produce an initial draft report. Stakeholders will have an opportunity to provide comments on the draft report, once released. CHA will keep members apprised of DHCS’ progress and the opportunity to comment on the draft report via CHA News.

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