In a request for information (RFI) released April 25, the California Department of Health Care Services (DHCS) calls for information on “assessing and improving access to care in Medi-Cal.” DHCS has submitted to the Centers for Medicare and Medicaid Services (CMS), it said in the RFI, a “State Work Plan for Access Improvement and Timeline for Medi-Cal Managed Care Plan Access Report for Multiple Lines of Business, which outlines DHCS’ plan to assess and improve access to care in Medi-Cal.” Among the takeaways:
- As set out in the work plan and in a California Advancing and Innovating Medi-Cal (CalAIM) special waiver, DHCS “must arrange for an initial independent assessment of access to care in the four managed care delivery systems.” These are: Medi-Cal Managed Care (MCMC), Dental Managed Care (Dental MC), Specialty Mental Health Services (SMHS), and Drug Medi-Cal Organized Delivery System (DMC-ODS). The access report for MCMC must examine access “across multiple lines of business, including MCMC, Medicare Advantage and the private market.” In the state work plan, DHCS “outlines actions in progress or planned to improve access across all DHCS managed care delivery systems.” To measure how these efforts are doing, DHCS has to submit to CMS an “Access Improvement Results Report (STC A2), detailing areas with marked improvement and areas without marked improvement.” DHCS intends to “work with an entity to draft this report,” it said in the RFI; and for areas without improvement, the report must offer recommendations to achieve improvement.
- In the RFI, DHCS said it seeks “information from experienced vendors on conducting independent assessments of access to care and access improvement work” in Medi-Cal’s four managed care delivery systems. To both assess and improve access, the department “intends to work with a single entity to assess and develop recommendations to align access standards and monitoring across managed care delivery systems and leverage the necessary expertise for the assessments.” It needs three reports to do the “assessment of access to care and access improvement work.” First, an “Independent Access and Interim Improvement Report,” to deliver an “independent assessment of access to care” across MCMC, Dental MC, SMHS, and DMC-ODS. Second, a “Medi-Cal MCP Access Report Across Multiple Lines of Business,” to report on “access assessment of Managed Care Plan (MCP) access across multiple lines of business,” including MCMC, Medicare Advantage and the private market. And third, a “Final Access Improvement Results Report,” spelling out areas with improvement and making recommendations for improvement elsewhere.
- The scope of work centers on six items. First, there’s data aggregation and trending for the four managed care delivery systems: convening a data team, aggregating current DHCS access data, and trending the data “including the number of providers accepting new patients,” and examining “differences by geography.” Second is access measure development and training, including analyzing preliminary data elements, working with DHCS to vet proposed measures and finalizing measure specifications by Sept. 30. Third is creating an internal access monitoring road map to standardize those processes across all delivery systems by Oct. 31. Fourth is gathering external data sources for the Medi-Cal MCP Access Report, confirming data source feasibility and the data procurement process by Oct. 31; and executing data-sharing agreements with other departments. Fifth is creating a dashboard and review tools and processes to “standardize and facilitate access monitoring and compliance” across delivery systems by June 30, 2024. Sixth is access reports – doing all “data de-identification steps required by DHCS” and delivering a fully formatted, Americans with Disabilities Act-compliant version of each final report, to be posted on DHCS’ website.
- Respondent requirements include a description of company processes for delivering the services sought, including whether the company has the ability to provide the requested services and whether it has provided similar services previously. Also required is a description of the “team’s experience in health-care access assessment, improvement and service delivery in Medi-Cal managed care delivery systems; data collection, aggregation and analysis; and use of quality improvement techniques to improve outcomes.” Respondents should also provide recommendations and suggestions for each of the main categories in the statement of work; a list of positions that would be necessary to carry out the statement of work; and an estimate of direct and indirect costs. DHCS may use the information it receives to “initiate future discussions with vendors”; however, the RFI is not a solicitation and responses can’t be used to form a “binding contract.” Questions on the RFI are due by 4 p.m. Wednesday, and responses will come May 10. Responses to the RFI are due by 4 p.m. May 25.
