CHA News Article

DHCS Submits Access Assessment Design to CMS

DHCS has submitted an access assessment design required by California’s section 1115(a) demonstration waiver, titled “California’s Medi-Cal 2020 Demonstration,” for approval by the Centers for Medicare & Medicaid Services (CMS). The waiver requires that DHCS, working with its external quality review organization (EQRO), conduct a one-time assessment evaluating primary, core specialty and facility access to care for managed care beneficiaries based on the current health plan network adequacy requirements of the state’s Knox-Keene Health Care Service Plan Act of 1975 and Medicaid managed care contracts.

After the design is approved, the assessment 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. It will also describe the state’s 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 into the 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, which met on March 28 to review the assessment framework and finalize the design proposal. With committee feedback, the EQRO produced a draft design and submitted it to CMS for review. Once the design is approved, the EQRO will begin to conduct the assessment and produce an initial draft report. More information about the design and upcoming advisory committee meetings is available on the DHCS website at access assessment web page.