Access Assessment

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The Centers for Medicare and Medicaid Services (CMS) approved California's Section 1115(a) Medicaid Waiver Renewal, titled California Medi-Cal 2020 Demonstration (Medi-Cal 2020) on December 30, 2015. The Special Terms and Conditions (STCs) set forth by CMS and DHCS established the conditions and limitations on the waiver and expenditure authorities. In accordance with the Medi-Cal 2020 STCs, California was required to conduct a one-time assessment (Access Assessment) of Medi-Cal Managed Care (MCMC) beneficiaries' access based on current Medi-Cal managed care health plan (MCP) network adequacy requirements.

This Access Assessment evaluated MCMC beneficiaries' access to primary, core specialty, and facility services, as well as compliance with MCP network adequacy and timely access requirements and standards. Following the State's approval to move forward with the Access Assessment on July 25, 2016, DHCS coordinated with Health Services Advisory Group, Inc. (HSAG), the State's external quality review organization (EQRO), to design and conduct the required Access Assessment. The final report has been prepared for the period of March 1, 2017 - December 30, 2017.

CA 2017-2018 Access Assessment Final Report

Stakeholder Engagement

The state established an Advisory Committee to provide input into the structure of the Access Assessment. The Advisory Committee include representatives from consumer advocacy organizations, providers, provider associations, health plans, health plan associations, and legislative staff. The Committee provided input into the assessment structure including network adequacy requirements and metrics, as well as feedback on the initial draft and final report.

Final Advisory Committee Meeting

On Thursday, June 20, 2019, HSAG hosted an Access Assessment Advisory Committee Meeting to review the access assessment results and provide guidance to the committee for submitting its feedback to HSAG.